iReview-US 4.4.13.P6

Aquarius iReview User Guide
Version 4.4.13.P6
Norths
Symbols used in the label:
Symbol Meaning
Consult Instructions for Use.
The CE 0197 mark applies to iNtuition and AquariusAPS Software.

The CE mark is affixed onto the iNtuition and AquariusAPS software.
Manufacturer
The name and address of the manufacturer are listed next to this symbol.
Date of Manufacture
The year of manufacture is listed next to this symbol.
Authorized Representative in the European Community

The name and address of TeraRecon’s authorized representative in the
European Community are listed next to this symbol.
Customer Support
Contact TeraRecon
TeraRecon, Inc. — Headquarters
4309 Emperor Boulevard, Suite 310
Durham, NC 27703
Phone: 650.372.1100
Fax: 650.372.1101
For International Inquiries: +1.650.372.1100
Customer Support
For training, service, and technical issues or questions, please contact:
Technical Support: 877.996.0100.

Email: support@terarecon.com
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Customer Support
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Notices Aquarius iReview User Guide
Notices
Copyright
TeraRecon, Inc., reserves all rights in this document, which is copyrighted, Copyright 2011-2020 by TeraRecon, Inc.,
(“TeraRecon”).1 Reproduction of this document in any form is strictly prohibited, unless specific written consent from TeraRecon
has been obtained. Contents is subject to change without notice. This document may be used only if the reader releases
TeraRecon from all claims relating to or arising from any errors it may contain. Use by the reader herewith constitutes such an
understanding. This provision may be modified only on an individual basis, in a separate written agreement executed between
TeraRecon and the owner or licensee of a specific instance of the product to which this documentation relates.
Apart from any warranty that may be stated in a specific written agreement between a party and TeraRecon, TeraRecon makes no
warranty of any kind, whether expressed or implied, relating to the contents of this document, or any software provided by
TeraRecon, including, but not limited to iNtuition™ Enterprise Medical Viewer(iEMV), iNtuition™ Review, Aquarius Workstation®,
Aquarius Workstation® iNtuition™ Edition, AquariusGATE, AquariusNET®, AquariusBLUE, AquariusAPS, AquariusNET® Thin Client
software and Aquarius iNtuition™ Client software. TeraRecon will not be liable in any event for incidental or consequential
damages in connection with, or arising out of, the provision, performance, or use of this documentation or any software product
to which it may relate, or any software or hardware product supplied by TeraRecon for use with any such software product or this
documentation itself.
This document contains important, helpful, usage, and precautionary information. Please review carefully all precautionary
statements and advisories, whether on-screen or contained herein, as these are essential to the effective and authorized use of
the products and applications discussed. Sample Screens in this document may differ from your installation, depending on
installed versions, available functionality, and configuration. Refer to the version number to ensure you are accessing the correct
information.
Note: Any beta features extended are not to be used clinically, and can only be authorized,
obtained or accessed through an appropriate beta agreement.
1. TeraRecon, Aquarius Workstation, AquariusNET, VolumePro, iNtuition, iNteract+, Viewer First, Morphable Viewer,
Overlay PACS are either registered trademarks or trademarks of TeraRecon, Inc. in the United States and/or other
countries. Copyright© 2011-2020 TeraRecon, Inc. All rights reserved.
AQ-iREV-USER-US-4.4.13.P6 iii
Aquarius iReview User Guide Notices
General Description
iNtuition (also referred to as Aquarius iNtuition and AQi) is a medical device comprised of two stand-alone software
components: a server software backend (iNtuition Server) which performs complex image post processing, and
client viewer software (iNtuition Client Viewers) that provides a user interface, enabling the user to view medical
image data and associated derived metadata.
The Aquarius iNtuition Client (“AQi”) is one of the iNtuition client viewers with 2D/3D/4D (3D with dimension of
time) image processing and advanced visualization capabilities to assist physician review of medical images. The
base functionality of Aquarius iNtuition includes, but is not limited to, various tools for visualization and analysis,
customizable workflow templates to deliver structured workflow, and support for the physician to write and store
the report.
A fully-configured iNtuition system is capable of a comprehensive suite of image processing and visualization
functions, including full-color Volume Rendering, Calcium Scoring, Time-Dependent Analysis (TDA), Time Volume
Analysis (TVA), Segmentation Analysis and Tracking (SAT), Vessel Analysis, Flythrough, Multi-phase review, CT/CTA
Subtraction, Lobular Decomposition (LD), iGENTLE, Maxillo-Facial, Volumetric Histogram, Findings Workflow, Fusion
CT/MR/PET/SPECT, MultiKV. Results from the AquarisAPS Server module may be displayed in the viewer. Each of
these features may vary by client viewer and offered as an independent upgrade option to the basic configuration.
Important! Based on published literature and TeraRecon’s analysis, any derived value results,
while using AQi, have approximately 3% of uncertainties, depending upon the noises in
the data, image acquisition and reconstruction techniques, and human interventions.
Indications for Use

To receive, store, transmit, post-process, display and allow manipulation of reports and medical images from
acquisition devices, including optical or other non-DICOM format images, DICOM images with modality type XA, US,
CR, DR, SPECT, NM and MG, and images from volumetric medical scanning devices such as EBT, CT, PET or MRI. To
provide access to images derived data and derived images via client-server software, web browser and mobile
technology.
Visualization in 2D, 3D and 4D are supported for single or multiple datasets, or combinations thereof. Tools are
provided to define and edit paths through structures such as centerlines that may be used to analyze cross-sections
of structures, or to provide Flythrough visualizations rendered along such a centerline. Segmentation of regions of
interest and quantitative analysis tools are provided, for images of vasculature, pathology and morphology,
including distance, angle, volume, histogram, ratios thereof, and tracking of quantities over time. A database is
provided to track and compare results using published comparison techniques such as RECIST and WHO. Calcium
scoring for quantification of atherosclerotic plaque is supported.
Support is provided for digital image processing to derive metadata or new images from input image sets, for
internal use or for forwarding to other devices using the DICOM protocol. Image processing tools are provided to
extract metadata to derive parametric images from combinations of multiple input images, such as temporal phases,
or images co-located in space but acquired with different imaging parameters, such as different MR pulse
sequences, or different CT image parameters (for example, dual energy).
iNtuition is designed for use by healthcare professionals and is intended to assist the physician in diagnosis.
Important! The physician is responsible for making all final patient management decisions.
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Interpretation of mammographic images or digitized film screen images is supported only when the software is used
without compression and with an FDA-approved monitor that offers at least 5Mpixel resolution and meets other
technical specifications reviewed and accepted by the FDA.
iNtuitionMOBILE provides wireless and portable access to medical images. This device is not intended to replace full
workstations and should be used only when there is no access to a workstation.
Important! Aquarius iNtuition is not intended for diagnostic when used via a web browser or
mobile device.
iNtuition-TDA, TVA, and Parametric Mapping Indications for Use

iNtuition-TDA, TVA, and Parametric Mapping are software modules which supports assessment of time-dependent
behavior of image intensity, density, dimensions or volume of regions of interest over time, for volumetric or planar
dynamic image types such as CT or MR. Parametric mapping tools encode in color various parameters derived from
the temporal or spatial characteristics of the planar or volumetric data.
Support is provided for digital image processing to derive metadata or new images from input image sets, for
internal use or for forwarding to other devices using the DICOM protocol. Image processing tools are provided to
extract metadata to derive parametric images from combinations of multiple input images.
iNtuition-TDA, TVA and Parametric Mapping are iNtuition-based software features with dedicated workflows and
basic tools and thus support post-processing, displaying and manipulation of reports and medical images from
acquisition devices and visualization in 2D, 3D and 4D for single or multiple datasets, or combinations thereof.
iNtuition-TDA, TVA, Parametric Mapping are designed for use by healthcare professionals and are intended to assist
the physician in diagnosis, who is responsible for making all final patient management decisions.
iNtuition-T1 Mapping and T2/T2* Mapping Indication for Use

iNtuition T1 Mapping and T2/T2* Mapping are software modules that support the derivation and quantification of
T1, T2, and T2* values from MR DICOM image pixel intensities and header information. The quantification of these
parameters can be used to characterize tissues. Support is provided to overlay the T1, T2, and T2* values using color
maps on related MR images.
Support is provided for using different color maps to overlay different ranges of T1, T2 or T2* values and restrict the
overlay to region of interest on the images. The MR images can be of simple planar scan like a single slice or
volumetric or 4D scans of a body part. iNtuition T1 Mapping and T2/T2* Mapping are iNtuition software features
that can be used in multiple workflows or be used as basic tools for cardiac functionality. Additionally, the overlaid
images can be captured and forwarded to other systems using standards such as DICOM or http protocol.
Quantitative analysis is derived and available as text and graphical display.
iNtuition T1 Mapping and T2/T2* Mapping qualitative results and visualization can be used in a clinical setting on
MR images of an individual patient and can be used to support the clinical decision making for the diagnosis of the
patient. iNtuition T1 Mapping and T2/T2* Mapping are designed for use by healthcare professionals and are
intended to assist the physician in diagnosis, who is responsible for making all final patient management decisions.
iNtuition-T1 Mapping and T2/T2* Mapping Accuracy Statement

Based on published literature and our analysis, the derived t1/t2/t2* values have approximately 3% of uncertainties,
depending on noises in the data.
AQ-iREV-USER-US-4.4.13.P6 v
iNtuition-T1 Mapping and T2/T2* Mapping Supported Data
T1 Mapping T2/T2* Mapping
Modality MRI MRI
Series Type Look-Locker or Modified Look-Locker T2 or T2* with or without offset
Number of series One or Two, multiple slices One, multiple slices

supported
Structural Heart Indications for Use - Available only in the USA

iNtuition Structural Heart is an optional image post-processing module using iNtuition standard features.
TeraRecon iNtuition Structural Heart module is a software solution that is intended to assist Cardiologists, Radiologists
and Clinical Specialists with the visualization and measurements of structures of the heart and vessels.
iNtuition Structural Heart modules support the visualization and quantification of cardiac, coronary and related
structures for anatomic and pre- or post-operative evaluations through guided clinical workflows. TeraRecon
Structural Heart enables assessment and measurement of different structures of the heart, for example, aorta, aortic
valves, mitral valve, pulmonic valve, atria, and atrial appendages, and ventricles. It provides analysis of the feasibility
of a transapical, transfemoral ,or subclavian approach to structures for replacement or repair procedures via 3D
measurements.
TeraRecon iNtuition Structural Heart module enables the user to:
• Visualize and measure (diameters, lengths, areas, volumes, angles) structures of the heart and vessels for pre-
operative planning and sizing for cardiovascular interventions and surgery, and for post-operative evaluation.
• Quantify calcium (volume, density) present in coronary arteries
TeraRecon iNtuition CPR Workflows tool works with TeraRecon iNtuition Structural Heart and enables the user to:
• Visualize and assess stenosis, calcifications, aneurisms and vascular structures
Structural Heart Accuracy Statement

Based on published literature and TeraRecon’s analysis, the derived values for the structural heart values have
approximately 3% of uncertainties, depending upon the noises in the data, image acquisition and reconstruction
techniques, and human interventions.
Structural Heart Supported Data

Data Required for the iNtuition-Structural Heart Module
The iNtuition-Structural Heart Module consists of images of the heart function. The module works on heart images
taken during the systolic phase of heart functioning. It guides you through determining annulus measurements
required for valve replacement surgery. It also displays in 4D possible fittings of the replacement device.
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Safety Notifications
The Aquarius iReview is part of a Class II medical device regulated by the Food and Drug Administration.
Warning! Not intended for diagnostic use when used via a mobile device.
CAUTION! U.S. Federal Law restricts use of this device to trained physicians, or other suitably
qualified and trained personnel on the order of a physician.
If you require training, please contact TeraRecon or a suitably qualified trainer. Please always keep this
documentation readily available near the Aquarius iReview application, and please keep it updated with all
corrections/addenda that may be released by TeraRecon.
Patient information is restricted, private, and extremely confidential, and subject to stringent legal regulations. You
should control access to Aquarius iReview, and any patient data contained in AQi should be protected accordingly.
Devices integrated to this product must comply with their own applicable safety standards.
Precautions Relating to General Use

Please review the Aquarius iReview User Guide for all warning messages, notices, and precautions prior to using the
software.
Rx Only
Caution: Federal law (USA) restricts this device to sale only by or on the order of a physician.
Aquarius iReview software may allow images to be generated in which parts of the original scan data are obscured,
removed (including but not limited to, through use of lossy compression), hidden, or modified. Similarly, output
images and reports can be produced, saved, and annotated, with elements of the original acquisition omitted,
obscured, modified, or hidden. Careful and responsible use of the equipment and its output images requires that
the user be aware of, and effectively communicate these important facts to, untrained or uninformed observers or
recipients of the processed information.
Please ensure that all processing has completed (including completion of any final stage after an intermediate stage
of processing) before formulating a final interpretative decision.
In certain situations, you may experience a delay in certain display processing. Please ensure that all processing has
completed (including, for example, completion of any final stage after an intermediate stage of processing) before
seeking to validate, or validating, a final interpretative decision.
Precautions Relating to Display Hardware

Aquarius iReview image display is limited in acuity and color or Grayscale depth to that of the display device used.
Display hardware characteristics can vary widely. Interpretation of mammographic images or digitized film screen
images is supported only when the software is used without compression and with an FDA-approved monitor
that offers at least 5Mpixel resolution and meets other technical specifications reviewed and accepted by the
FDA.
If a monitor is not calibrated, image quality may vary. Monitors must be calibrated by the monitor vendor's
calibration method. Image quality is subject to the quality of the monitor. An image displayed on a color monitor can
appear different from the same image displayed on a Grayscale monitor.
AQ-iREV-USER-US-4.4.13.P6 vii
A monitor may contain small defects on the surface, such as dust or scratches on the surface of the CRT, defects of
LCD cell, and so on. A customer should understand this problem and not confuse the defects with a software
problem.
The surrounding lighting conditions are critically important for optimal image viewing in Aquarius iReview. Lighting
conditions can reduce the contrast of images being viewed and may hinder your ability to distinguish subtle changes
in the image.
The judgment of the medical imaging professional is essential to reaching the appropriate conclusion from the
results presented by Aquarius iReview.
Precautions Relating to Interpretation

Calculations relating to distances, measurements and other physical properties performed by Aquarius iReview are
dependent in accuracy of the input DICOM images. It is the responsibility of the operator to ensure that the source
DICOM images are correctly formatted and to heed any warnings that the software may display during operation
relating to potential problems with the information supplied in those DICOM images.
In certain instances, there may be problems or inconsistencies in the image information, Aquarius iReview is unable
to detect this, and erroneous image display will be unavoidable unless the user properly ensures the correctness of
all input data in advance. Potential problems relating to errors in the DICOM information include incorrect
dimensional readouts, incorrect orientation markings, and incorrect pixel value calibration. Three-dimensional
imaging inherently offers a wide variety of different imaging views of any given dataset; it is an important
responsibility of the operator to ensure that a proper visualization is achieved, and that a complete review of the
data has been performed before reaching any diagnostic or interpretive conclusion relating to the dataset in
question. Limitations present in the original input data (such as those relating to spatial and/or temporal resolution,
pixel size, and slice thickness) remain valid even when Aquarius iReview processes the data, and these provisos
should be considered when using the equipment for image review.
The image processing and display techniques offered by Aquarius iReview are only intended as an adjunct to, and
not a substitute for, conventional diagnostic review of medical imaging data.
CAUTION! iNtuition software should be used only by physicians and trained clinical users. All
results should be validated by qualified physicians trained in the subject matter prior
to diagnosis.
Aquarius iReview provides tools and protocols to quantify metrics and distances relating to structures in the CT, MR
or other scans or images which are based upon the dimensions of the anatomy scanned or imaged at the time the
images were originally acquired from the patient and based on the measurement calibrations provided by the
acquiring device. The suitability for any particular purpose, especially monitoring the progression of disease, or the
sizing or planning of a device to be implanted in a patient, is dependent upon many factors, including, but not
limited to, the accuracy of the original acquisition, the extent to which the images acquired still represent the
patient's anatomy, and the way in which the actual device deployment may modify the anatomy into which it is
introduced.
TeraRecon does not represent that the Aquarius products are suitable for such purposes. All such activities should
always be cross-correlated with other techniques to ensure a complete understanding of the patient and
contemplated procedure is obtained by the validating physician(s) in charge.
Precautions Relating to Magnetic Resonance Imaging Machines

Components of Aquarius iReview, including this document and its packaging or binding, may contain metallic or
ferromagnetic components. Please ensure that no such component is introduced into the influence of magnetic
viii AQ-iREV-USER-US-4.4.13.P6
fields from devices such as Magnetic Resonance Imaging Scanners, since injury or damage to equipment or property
could occur.
Precautions Relating to Risk of Loss of Data

Neither Aquarius iNtuition nor AquariusNET Thin Client are intended to be used as a primary archive for medical
imaging data. A secure copy of any data should be maintained in a location separate from this software, for example,
in the scanner, in a PACS archive, or on archive media. Please do not rely on Aquarius iNtuition and/or AquariusNET
Thin Client as your primary archive.
In addition, do not rely on Aquarius iNtuition and/or AquariusNET. Thin Client to convey data from its acquisition
point to your primary archive, because in this configuration, a failure in Aquarius iNtuition and/or AquariusNET Thin
Client could compromise your primary archive. Your primary archive should be maintained in a manner independent
of, and not relying on, Aquarius iNtuition and/or AquariusNET.
Precautions Relating to Computer Software and Hardware

Note that the installation and use of any additional software or hardware component without the specific direction
and approval of TeraRecon may impair the safety and effectiveness of the product. No additional software or
hardware component should be added to Aquarius iNtuition and/or AquariusNET, nor should the configuration be
changed in any way, except under the express direction of TeraRecon personnel. Do not use the software if it is
damaged, compromised, or if you in any way suspect that its safety may have been compromised; in such case,
contact your customer service representative immediately.
Important! All results should be validated by qualified physicians trained in the subject matter.
Microsoft Windows Operating System Updates

Aquarius iReview software relies on the integrity of the Microsoft Windows operating system to perform as
documented by Microsoft. If a Microsoft Knowledge Base article is released that exposes a bug or defect adversely
affecting specific hardware platforms documented for use with Aquarius iNtuition or AquariusNET Thin Client
software, it is the customer's responsibility to remedy those defects using the steps outlined by Microsoft in its
Knowledge Base Articles.
Aquarius iReview is not accessible without a network, including LAN and WAN. The availability of a network is the
customer's responsibility. This includes accessibility to other devices on the network including but not limited to
authentication servers and storage locations.
Precautions Related to Image Output Option

Aquarius iReview allows for output of selected images and series to various computer standard file types. This
technique does not maintain full image fidelity and may affect image quality. JPG, PNG, BMP and AVI files are not
intended for diagnostic purposes.
Captured images for output may contain patient information and use and distribution must be controlled to ensure
that secure access to PHI is maintained pursuant to all applicable U.S. and International Laws, including but not
limited to, the Health Insurance Portability and Accountability Act ("HIPAA") and the Health Information Technology
for Economic and Clinical Health Act (“HITECH Act”).
Patent Information
U.S. patents apply to this product. For details, see http://www.terarecon.com/patents.
AQ-iREV-USER-US-4.4.13.P6 ix
Welcome
Welcome to the Aquarius iReview User Guide. This manual is intended for users performing and analyzing different
studies using the Aquarius iReview application. Please read all chapters to gain a complete understanding of the
Aquarius iReview application. Use the table of contents to navigate to the desired information.
Pay special attention to all NOTES, IMPORTANT, TIP, WARNING, and CAUTION notifications, whether presented on-
screen, or contained in this manual, including all precautionary statements and advisories in the Notice section, as
these are essential to the effective and authorized use of the Aquarius iReview application.
Conventions used in this Manual

This manual uses the following conventions:
• The text that appears on buttons, menu items, dialog boxes and other elements of the application are printed in
a bold font. For example, Click the Save button.
• Screen names are capitalized. For example, Patient List, Viewer.
• The chapters are arranged based on the functions in the application.
• A NOTE contains supplementary and important information about a topic. Please do not ignore NOTES,
IMPORTANT, TIP, WARNING, and CAUTION notifications. Read each one carefully.
Additional Typographical Conventions

After an action, button, or command is spelled-out in the first instance, they are abbreviated:
• RMB – Right mouse button; also referred to as “right-click”
• LMB – Left mouse button; also referred to as “left-click”
• MMB – Middle mouse button
Page Numbering Conventions

Page numbers are formatted for ease of use at the bottom of each page in a position based on left and right pages.
They contain the Chapter number and page number in this format:
This style indicates Chapter 3, page 1.
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Contents Aquarius iReview User Guide
Contents
Customer Support ........................................................................................................................ i
Notices .................................................................................................................................................i
General Description ..............................................................................................................................ii
Indications for Use ...............................................................................................................................ii
Safety Notifications ..............................................................................................................................v
Welcome ..............................................................................................................................................viii
Chapter 1 Introduction ................................................................................................................ 1-1

Features ..........................................................................................................................................1-1
Logging In .................................................................................................................................1-2
Chapter 2 System Configuration .................................................................................................. 2-1

System Configuration...............................................................................................................2-2
General.....................................................................................................................................2-2
Institution Information.............................................................................................................2-3
Display/Memory.......................................................................................................................2-3
Network....................................................................................................................................2-5
Settings.....................................................................................................................................2-5
Logging .....................................................................................................................................2-6
Analytics ...................................................................................................................................2-6
Modality ...................................................................................................................................2-7
User Management ..........................................................................................................................2-9
Application Rights ....................................................................................................................2-10
Data Access Rights ...................................................................................................................2-11
Filter Access Rights...................................................................................................................2-11
User Group Rights Configured on the AquariusNET Server............................................................2-12
Multi-Monitor Support ...................................................................................................................2-13
Multi Monitor Setup Tab..........................................................................................................2-13
Modality Display Configuration................................................................................................2-15
Pixel size calibration .................................................................................................................2-16
Test pattern..............................................................................................................................2-17
Working With Rules ........................................................................................................................2-18
Definition..................................................................................................................................2-18
Creating a Rule .........................................................................................................................2-18
Basic Rules................................................................................................................................2-20
Advanced Rules ........................................................................................................................2-22
Patient List Configuration ...............................................................................................................2-23
Basic Configuration ..................................................................................................................2-24
Basic Functionality ...................................................................................................................2-27
Appearance ..............................................................................................................................2-27
Filters........................................................................................................................................2-29
Folders......................................................................................................................................2-31
Workflows ................................................................................................................................2-33
Stack filter ................................................................................................................................2-34
Keywords..................................................................................................................................2-35
AQ-iREV-USER-US-4.4.13.P6 ix
Aquarius iReview User Guide Contents
DICOM Tag Options..................................................................................................................2-39

Import ......................................................................................................................................2-40
Viewer Configuration......................................................................................................................2-42
Appearance ..............................................................................................................................2-43
Default Settings........................................................................................................................2-47
Annotations..............................................................................................................................2-48
Measurements .........................................................................................................................2-57
Synchronization........................................................................................................................2-57
Color templates........................................................................................................................2-59
Capture Format ........................................................................................................................2-59
Capture Options .......................................................................................................................2-61
Output ......................................................................................................................................2-62
Save To Folder ..........................................................................................................................2-64
Timeline....................................................................................................................................2-65
SR..............................................................................................................................................2-68
Mouse ......................................................................................................................................2-69
PET............................................................................................................................................2-73
View Options ............................................................................................................................2-74
Video ........................................................................................................................................2-76
Navigation ................................................................................................................................2-76
GSPS and KIN............................................................................................................................2-77
Window/Level Presets .............................................................................................................2-78
Display Protocols ............................................................................................................................2-78
Stack Definitions.......................................................................................................................2-79
Display Protocols......................................................................................................................2-82
Loading a Study ........................................................................................................................2-100
Integration ......................................................................................................................................2-102
Configuring AQi Integration .....................................................................................................2-102
Third-Party Application Launch................................................................................................2-106
Chapter 3 The Patient List ........................................................................................................... 3-1

The Study List..................................................................................................................................3-2
The Filter Bar ............................................................................................................................3-2
The Patient Information Row...................................................................................................3-4
Viewing Local and Remote Data in the Study List ....................................................................3-9
Resizing Components of the Patient List Screen......................................................................3-21
The Series List and Thumbnail List..................................................................................................3-22
Features of the Series and Thumbnail Lists..............................................................................3-22
Right-click Options in the Series List ........................................................................................3-25
Right-click Menu in the Thumbnail List ....................................................................................3-27
Study Management Tools...............................................................................................................3-28
Basic Management...................................................................................................................3-28
Workflow Loading Icons...........................................................................................................3-28
Patient History ................................................................................................................................3-31
The Datasource Panel .....................................................................................................................3-32
Elements of the Panel ..............................................................................................................3-32
The Task Log ...................................................................................................................................3-33
Filtering the Task Log ...............................................................................................................3-34
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Contents Aquarius iReview User Guide
Chapter 4 The Viewer .................................................................................................................. 4-1

Elements of the Viewer ..................................................................................................................4-1
Descriptions of Viewer Elements .............................................................................................4-1
Viewports .................................................................................................................................4-2
Toolbar .....................................................................................................................................4-2
Thumbnail Bar (Stacks).............................................................................................................4-2
Clickable Annotations...............................................................................................................4-3
Right-click menu.......................................................................................................................4-4
Patient History List ...................................................................................................................4-4
2D and 3D View Mode .............................................................................................................4-5
Host Collaboration ..................................................................................................................4-6
Log Out ...................................................................................................................................4-6
Icons in the Top-Right of the Viewer........................................................................................4-6
Navigating This Chapter..................................................................................................................4-7
User Interface Flexibility ..........................................................................................................4-7
User Interface Tools .................................................................................................................4-7
Thumbnail Size and Scroll Direction.........................................................................................4-20
Presenting and Viewing Data ...................................................................................................4-21
Measurement Descriptions......................................................................................................4-52
Output ............................................................................................................................................4-81
Image Capture..........................................................................................................................4-81
Structured Reports (SR)...........................................................................................................4-82
Other Tools .....................................................................................................................................4-83
Importing Files .........................................................................................................................4-83
Collaboration............................................................................................................................4-85
iReview Inactivity Timeout .......................................................................................................4-85
Starting Collaboration from iReview ........................................................................................4-85
Show DICOM Header ...............................................................................................................4-88
Launch Application...................................................................................................................4-89
Chapter 5 Output ........................................................................................................................ 5-1

Output Panel Functions ..................................................................................................................5-1
Integration With AquariusNET Thin Client ...............................................................................5-9
Exiting the Output Panel ..........................................................................................................5-9
Appendix A Default Keyboard Shortcuts ..................................................................................... A-1

Default Keyboard Shortcuts............................................................................................................A-1
Index
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Aquarius iReview User Guide Contents
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Chapter 1 Aquarius iReview User Guide
Chapter 1 Introduction
iNtuitionReview (iReview) is an AquariusNET viewer designed for the review of various DICOM modalities
including MR, CT, PT, MG, DR and XA. iReview has advanced layout configurations, which allow you to
view multi-modality series within a study or studies obtained at multiple times, according to your
preference for efficient image viewing.
Features
Display Protocols
iReview features the Display protocol, which focuses on arranging the different series of a study on the
screen. In iReview, you can present the multiple series that are a standard part of a certain type of study
the same way for every study of that type. For example, you can configure the different views of an MG
study, or the series of a Cardiac MR study to be displayed in the same way for every study.
Keywords
iReview keywords allow you to tag and label studies for many purposes. This is very flexible and allows
you to create any kind of keyword category, and then assign the keyword to the study. This can be used to
filter and search for studies.
Filters
Filters are used to display subsets of the database. In the case of a very large database, this would make
finding a desired study much easier. For example, if a department deals only with Cardiac MR studies,
they can create a filter so that only Cardiac MR studies are displayed in the Patient List.
Folders
iReview folders allow you to group studies together manually. The folders you create appear in the
sidebar on the left side of the Patient List screen. You can then drag and drop a study from the Patient List
to the folder for later review. Possible uses for this feature include creating teaching folders, assigning
studies to other users or preparing radiology demonstrations, where a list of cases is presented to
colleagues.
Stacks (Series)
In iReview, a stack refers to a series. A stack might comprise an entire series, or there might be multiple
stacks that are created from the content of a single series.
Rules
Much of the organization needed for the display layouts is done using rules. A rule is configured to match
studies in the Patient List, or loaded into the Viewer, based on the value of specified DICOM tags. Other
functions can then refer to the rule and specify what should be done with a study that satisfies the rule’s
conditions.
AQ-iREV-USER-US-4.4.13.P6 1-1
Aquarius iReview User Guide Introduction
Other Features
Aquarius iReview provides these features:
• High-performance full-resolution display
• 4D display support
• Ability to integrate the iNtuition Client and Thin Client, and launch them from iReview
• True size display and print
• Support for High brightness, High resolution medical displays
• Display of MG CAD markers
Logging In
Double-click on the desktop shortcut to launch iReview. The login screen displays.
1. Enter your username and password in the User name and Password boxes. Check the Remember
password box to remember the password on this computer.
2. Choose the server from the Server name drop down menu.
3. Click Login to connect to the server.

If you want to login as a different user, check the Allow user switching box and then click the Switch user
button. The following screen is displayed:
1-2 AQ-iREV-USER-US-4.4.13.P6
Click the user name to log in to that user account.

If you want to delete a user, click the Forget me button that is next to the user name to be deleted. That
user name is then removed from the list.
To cancel Switch User, click the Back button. The main login screen is redisplayed.
The Exit button cancels the login entirely. To log in, you will need to restart iReview.
Login Options
• Group name - Enter the name of the group your account belongs to.
• Save Group Name - Store the Group Name entered in the Group Name text box so that when you
login in the future, the group name is filled in.
• Use Windows Login - Use your Windows domain account to connect to the AquariusNET Server.
The iReview client is launched:
Top Bar Tools

The top bar of the iReview screen has several tools.
Left Top Bar Tools

The left end of the bar contains these:
Logoff Start Collaboration
• Logoff icon
Click this icon to log off iReview.
Hover over the icon to display information about the current login:
• Start Collaboration icon
This launches iEMV for collaboration. For details about collaboration, see "Collaboration" on page 4-
85.
Right Top Bar Tools

The right end of the top bar has the following tools:
System Configuration
Input/Output Log About Page
• Input/Output log - This opens a log of activity such as downloads, imports, anonymization and push-
ing data.
• Viewer icon - This shows the Viewer in the main window. If nothing has been loaded, the Viewer
screen is blank.
• System Configuration - Configuration settings for all aspects of iReview.
• About Page
• Contains information about the AqNet Server and iReview versions, a link to the iReview
user manual, and the Unique Device Identifier (UDI):
Unique Device
Identifier
Open user manual
• Click the ? (Help) icon in the lower-left corner of the About Page to open the iReview user
manual (see previous figure).
• Click Copy to clipboard to save the information shown on this screen to the clipboard.
The information can later be pasted into another file, such as a text file:
Chapter 2 System Configuration

Topics in this chapter:
User Management .............................................................................................................................2-9

Multi-Monitor Support ......................................................................................................................2-13
Working With Rules ...........................................................................................................................2-18
Patient List Configuration...................................................................................................................2-23
Viewer Configuration .........................................................................................................................2-42
Display Protocols................................................................................................................................2-78
Integration..........................................................................................................................................2-102
The system configuration allows you to control the function or appearance of the Viewer, Patient List,
networks, logs and the management of users and user groups. This is also where Display Protocols,
Layouts, Stacks, Folders, Keywords, Filters and Workflows are defined and configured.
To open the System Configuration screen, click the icon in the top-right corner of the iReview screen:
The System Configuration screen is displayed:
This chapter describes each of these configuration pages. To find the section you need, click the link for
the page listed below.
Aquarius iReview User Guide System Configuration
System Configuration
Topics in this section:
General...............................................................................................................................................2-2
Institution Information.......................................................................................................................2-3
Display/Memory ................................................................................................................................2-3
Network .............................................................................................................................................2-5
Settings...............................................................................................................................................2-5
Logging ...............................................................................................................................................2-6
Analytics.............................................................................................................................................2-6
Modality .............................................................................................................................................2-7
General
Select the appropriate language, date and time formats from the drop-down menus.
The Global Auto Logoff time is the number of minutes of inactivity before iReview automatically posts a
warning message before auto log off. This setting applies to all users connected to the same AquariusNET
Server.
The Local auto log off time is the same as the global logoff time, except that it applies only to your client,
and does not affect other users. If this field has a value greater than zero (0), it supersedes the global
logoff time. A value of zero (0) means that the local auto logoff is not used. The global logoff time is used
instead.
Institution Information
If desired, enter information about your institution.
Display/Memory
These settings determine how images will be rendered on the screen.
• Display mode
• GDI: Select this mode when using an older graphics system.
• Direct3D: Select this when using a system that has a modern video card.
• OpenGL: Select this if the video card in your system requires OpenGL for 10-bit displays.
• Allow GPU interpolation
Enable if the interpolation of 8-bit grayscale and 24-bit color images is performed by the CPU.
• Sync with vertical refresh
Sync the display in iReview with the screen refresh done by the monitor.
• Interpolate 16 bit before WindowLevel
When a 16-bit image is displayed, interpolation is performed before WindowLevel. This option is
enabled by default and should remain enabled. However, if your PC is an older machine or has a slow
CPU, disabling this option can reduce the amount of processing time.
• Image Streaming cache options
Click the down-arrow in the menu to show the options.

• Dynamic size: iReview will allocate memory for image caching
as needed and as available.
• No cache: iReview will not cache images.
• Fixed value in megabytes: iReview will allocate the exact
amount of memory specified for image caching.
• Fixed value in percent: iReview will allocate the specified percentage of available
memory for caching.
• Cache Current Study
This must be enabled for caching to work.
Network
Enter a packet size for network transfers. Then click Test network performance to see how well the
network performs with that setting.
Settings
Select the default user for logins.
Logging
Select a verbosity level for logging.
Analytics
Use this screen to display statistics about information available in the database.
The example shows the number of studies in the entire database, by modality. The pie chart illustrates the
percentage of the database taken by each modality.
You can restrict the information to be included in these statistics by selecting values or value ranges from
the menus in the left panel of the screen. For example, you might want to know how many studies involve
patients under a certain age. In that case you would select a range of birth dates in the Date of birth
menu. Or you might want to see how many studies were referred by a certain physician.
Modality
This screen allows you to do two things:
• Select all the modalities that are used at your institution, leaving out those that are not relevant
• Create custom modalities, including multi modalities
Selecting Modalities
You can prevent irrelevant data from being listed in the Patient List, or in any list, grouping, or dialog box,
by selecting only those modalities that you need to view with iReview. Click the checkbox next to each
modality you want to view, and make sure those that are not part of your workflow are unchecked.
Creating Custom Modalities

To create a single custom modality, click the Add a custom or multi-modality icon on the right side of the
Modality screen. A dialog opens where you can combine modalities to create a new multi-modality, or
create a single but new modality.
To create a new modality, type the name in the input box at the bottom of the window:
Click OK to save the modality.
Note: Make sure that all other modalities are unchecked while creating a single modality.
Otherwise, the new modality will be combined with any that are currently checked.
The custom modality is then shown in the list of Custom and Multi-Modalities:
To create a multi-modality, check two or more modalities that you would like to combine, and then click
Add a custom or multi-modality. The combined modality is then shown in the list.
Figure 2-1: Creating a Multi-Modality

Left - Select Two or More Modalities; Right - Multi-Modality Listed
User Management
All users and user groups configured on the AquariusNET Web Admin page are shown here. From this
screen, you can change the application rights, data access rights and DICOM node rights for any user or
user group.
Note: If no user or group permissions have been configured, the following warning is posted.
Unless you are sure that you intend to assign full access and control to everyone, it is
advised that you click No in this dialog.
If you attempt to access data, an iReview function or a DICOM node that you do not have access to, the
following dialog is posted:
If you have the username and password of another user who does have that access, you can log in as that
user in the dialog and be given access to that function.
Application Rights
The Application Rights tab allows you to select which iReview functions will be available to different user
groups. You can allow some functions to a group as a whole but deny them to a specific user in that group,
as well as the other way around (you can deny functions to a group as a whole, but allow specific users in
that group to have access to them).
Data Access Rights
The Data Access Rights tab allows you to select from which data list each user or user group is allowed to
view, add studies to or remove studies. Data lists include All images (everything in the Patient List), plus
all folders.
Filter Access Rights
Filter access rights determine which user groups are allowed to access specific filters, as well as what type
of access is granted (view, edit, or delete). Rights can also be assigned to individual users.
Filter Creation and Assignment
• If you have administrative privileges

• You can create any filter and assign it to a group or to multiple groups. Members of the
group or groups can then access the filter.
• You can create several filters and assign them to a specific user or to multiple users. Only
those users can access these filters.
• You can specify which type of access each group or user is allowed to have.
• If you are a regular user

• You can create filters and assign them to the group you are part of. You may not assign a
filter to another group.
• You can create your own filter and make it available to yourself, or to the group you are a
member of.
• You can share a filter with another user, whether or not you are in the same group.
• Access rights for a filter can be changed after it is created.
Any changes made to your filter access rights will take effect the next time you log in. If you are logged in
when a change is made to your filter access rights, they will not change. You will need to log out and log
back in to see the change.
User Group Rights Configured on the AquariusNET Server

User group rights configured on the AqNET Server, using the AqNET Web Admin, take priority over
settings configured in iReview. This means that any rights that have been restricted through the AqNET
Web Admin will automatically be unavailable in iReview, regardless of the iReview settings. If an iReview
feature is not working, or is not available through the user interface, it is possible that the user group right
has been disabled through the Web Admin. Contact your system administrator to verify whether this user
group right is disabled.
The following features are affected:
Table 1: Effected Features
iReview Feature Corresponding Web Admin User Group Rights Setting
Password is not saved in the Login screen. Disable Saving Password
Anonymize Study and Download Study do Disable Anonymize Data

not appear in the right-click menu on the
Study List.
Create study URL link does not appear in Disable Web Link Generation from Client
the right-click menu on the Study List.
Error message Cannot connect to server Restrict Rights to File Upload Only
(permission error) is posted when user or
attempts to login. Allow Web Viewer only
Cannot do Q/R retrieve. Disable Asynchronous Retrieve From Patient List
iReview Feature Corresponding Web Admin User Group Rights Setting
Import icon does not appear in the Data Disable Data Import From Client to AquariusNET
Management panel.
When user attempts to drag-and-drop a

file to the Patient List, nothing happens.
Send icon does not appear in the Output Disable Exporting Captured Images to DICOM Server
Panel.
Capture commands do not appear in the Disable Output (Capture, Filming, Batch etc)
right-click menu on Viewer image.
Publish study does not appear in the right- Disable Publishing Series for Web Viewer
click menu on the Study List.
Multi-Monitor Support
The Multi monitor Setup screen contains the following tabs. To find the section you need, click the desired
link below:
Multi Monitor Setup Tab....................................................................................................................2-13

Modality Display Configuration..........................................................................................................2-15
Pixel size calibration ...........................................................................................................................2-16
Test pattern ........................................................................................................................................2-17
Multi Monitor Setup Tab
Figure 2-2: Dual Monitor Configuration
The number of boxes on this screen reflects the number of monitors connected to your system. Clicking a
box toggles it between selected and deselected status.
Select the number of monitors you want to configure for display. You do not have to choose the maximum
number available on your system.
For example, two monitors are selected, as is shown in Figure 2-2 on page 2-13.
When two monitors are selected, the Viewer will be displayed on both monitors. However, on one of the
monitors, the Viewer is hidden beneath the Patient List, initially. To display the Viewer on that monitor,
click the Viewer icon in the upper-right corner of the Patient List.
Docked vs Floating
The Patient List can be either Docked or Floating, in relation to the Viewer. Docked means that the Patient
List shares a window with the Viewer on one of the monitors. You can dock the Patient List to the viewer
in either monitor.
The screens of the Viewer cannot be resized or moved to another monitor. When the Patient List is
docked, it cannot be resized either, because it is attached to the Viewer. When the Patient List is floating,
it is independent of the Viewer, and therefore can be resized and moved, if desired.
The following table shows what is displayed on the monitors in each of the configurations available in a
dual-monitor system:
Table 2: Configurations available in a Dual-monitor System
Patient List Configuration Monitor 1 Monitor 2
Docked at monitor 1 Patient List Viewer
Docked at monitor 2 Viewer Patient list
Floating Patient List Viewer
Modality Display Configuration
If your multi-monitor configuration contains both color and grayscale displays, this screen allows you to
specify preferences for the type of display that should be chosen for each modality.
Note: If you have configured iReview to show only selected modalities, only those modalities will
be listed on this tab. See "Modality" on page 2-7 for more information.
For each of the modalities listed on this screen, select a setting for a display monitor. The options are:
• Show on color display
• Show on grayscale display if available
• Show on color display if study contains color images
Pixel size calibration
Click on the Calibrate button to start the calibration. The calibration results will be used by the Viewer.
You can use the small or large option to do the scales.
Use a ruler to measure the size of the lines. Then enter the measurements into the input box next to each
line.
Note: The measurement input must be in millimeters.
The pixel size is shown automatically:
After the calibration is complete, click OK. The calibrated pixel information is displayed once you have
navigated back to the previous screen:
Test pattern
This tab is used to test the monitor’s resolution.
Working With Rules

Definition ...........................................................................................................................................2-18
Creating a Rule ...................................................................................................................................2-18
Basic Rules..........................................................................................................................................2-20
Advanced Rules ..................................................................................................................................2-22
Definition
Several configuration settings in the remaining pages depend on the ability to determine whether the
selected study or series is appropriate for certain actions. iReview uses rules to make that decision. A rule
consists of a set of DICOM tags that are used as a basis for comparison with corresponding tags in the
selected study or series. If the study under examination matches the attributes in the way the match has
been configured in the rule, then the study is said to satisfy or “pass” the rule.
For example, suppose you want to display all MR studies in the Patient List with yellow highlighting. You
would need to give iReview a way to determine whether a given study is an MR study. To do this, you can
construct a rule that checks the DICOM modality tag of each study to test whether it equals MR. When a
study passes the rule, then the highlighting is applied. (See "Text Color and Highlighting" on page 2-28 for
instructions on changing the background color of studies in the Patient List.)
Creating a Rule
There are two tabs in the Edit Rule dialog, Basic and Advanced. Depending on your needs, choose the
appropriate tab to create the rule:
Specific Attributes
All rules have the same essential structure. However, the specific attributes being compared in a rule can
vary, so Edit Rule dialogs might have different content, depending on the context. The instructions that
follow show how to configure a rule generally, and the figures that accompany them are typical examples.
The following figure is an example of the Edit Rule dialogs that are used in iReview.
This dialog is used to configure several options: The Patient List stack filter, the display groupings of multi-
phase data in the Series List, the annotations in the Viewer, and the display options based on modality:
Note: The Modality or Modalities in study menu, shown in the figure above, includes all
modalities that have been selected for display, including custom and multi-modalities. For
information on customizing modalities, see "Modality" on page 2-7.
Additional DICOM Tags

In addition to configuring the tags specified in the dialog, you can also select any DICOM tag to test for its
value.
1. In the bottom row of tag matches, click the down-arrow in the menu on the left (circled in the
previous figure). A menu is opened with only one item, Select DICOM Tag. Select this item.
A dialog is opened, where you can enter the desired tag, if known:
2. If you do not know the tag’s group or element number, click the “...” button to open the Browse for
DICOM Tag dialog, which contains a complete list of DICOM tags and their ID numbers.
If needed, you can search for the tag by entering the tag name, in full or partially, in the search input
box at the top of the Browse for DICOM Tag dialog.
3. Select the desired tag and click OK.

This dialog is used when creating workflows used to open an iNtuition Client Workflow:
Basic Rules
Note: To read about Advanced rules, see "Advanced Rules" on page 2-22.
The Basic tab contains a list of DICOM tags commonly shown in some of the Patient List columns (for
example, the Description column). Use this tab if the rule requires only a few simple matches.
1. For each DICOM tag that must be matched, select a comparator (for example: equals, not equal,
starts with, contains). Click the down-arrow in the input box of the tag to be matched and select the
comparator:
2. Type in the DICOM value or values required for the match.
Note: To find studies that match any of the words in a single condition, type each word on the
same line, separated by a space. To find studies that match an exact phrase or sequence of
words, enclose the entire group of words in single quotes.
Figure 2-3: Top - Matches either “Breast” or “MR”; Bottom - Matches only “Breast MR”
In Figure 2-3, the rule in the top image will match studies containing either “Breast” or “MR”, or both,
in the Study description DICOM tag. The rule in the bottom image will match only studies containing
the exact phrase “Breast MR” in the Study description field.
Note: Searches are not case-sensitive.
3. If a study is required to match all of the fields for which you have entered values, select Match all of
the following (shown in the following image). If a match in only one field is required, select Match
any of the following.
Note: Do not confuse these match options with the quoted and unquoted search strings
discussed in Step 2. The search strings are used to find matches in a single field. The
“Match all of the following” and “Match any of the following” options discussed in the
current step allow you to specify whether a study should match any field or all fields.
4. Click OK when done.
Advanced Rules
The Advanced tab uses the concept of rule groups. Within a single group, all conditions must match in
order for the group itself to satisfy the rule. This is called an AND rule. However, only one group needs a
successful match in order for the study to pass. This is an OR rule.
Add condition within group
Delete Group
Add Group
Figure 2-4: Advanced Rules
The first group has been created by default.
1. Create the first condition. Follow the same instructions as you would to create a basic rule (see "Basic
Rules" on page 2-20).
You can add as many conditions as needed to a single group, but remember that all of the conditions
within a group must have a successful match, or the comparison will fail.
2. To add another group, click the green plus sign on the left-hand side:
3. Click OK when the rule is completed.
Patient List Configuration

In this section:
Appearance ........................................................................................................................................2-27
Filters..................................................................................................................................................2-29
Folders................................................................................................................................................2-31
Workflows ..........................................................................................................................................2-33
Stack filter ..........................................................................................................................................2-34
Keywords............................................................................................................................................2-35
DICOM Tag Options ............................................................................................................................2-39
Basic Configuration
• Keep search filter when changing folders or filters
You can use either the default filters, which search all data in the database, or use the filters you have
created and added to the folder or filter. When this setting is disabled, you can use either the default
filters or the user-defined filters, but not both at the same time. When it is enabled, you can use both
kinds of filters combined.
• Keep selection when changing sort order
Keep the current Study List selection when resorting the list. When this setting is disabled, a resort of
the Study List causes the selection to be lost.
• Column used for search when typing in study list

Choose a default column to use as a basis for searches. This column will be used automatically when
you are typing a search term on the keyboard, without previously selecting a search column with the
mouse.
• Sort STAT studies to the top of the list
Always display studies having a STAT status at the top of the Study List, regardless of the sort order.
• Show warning when loading a study that is already open

If you try to load a study that is currently in use by another user, a warning dialogue is displayed:
• Show finish reading dialog
If you try to load a study that has already been read, a reading dialog is displayed, showing what has
been done on the current case (shown in Figure 2-5 on page 2-25).
Figure 2-5: Finish Reading Dialog
• Allow unrestricted query
An unrestricted query means a search with no filters. In that case, the full database is displayed in the
Patient List. This setting is not recommended if your database is very large, as the search could take a
long time. If this setting is disabled and there are no filters set up to limit the results, you will see the
following message when you log in:
If this setting is enabled, studies are displayed according to the filters that are currently configured,
including no filters. The search time depends on the narrowness of the search and the size of the
database.
• Study list auto update interval
Set the amount of time, in seconds, between each automatic refresh of the Patient List. A value of
zero (0) disables automatic refresh.
• Default QR Date Range
Set the default date/time range for Query/Retrieve from the currently selected remote node. This is
originally set to Last 7 days, but you can select another range from the menu. The date/time range for
searching that node will default to whichever is chosen here.
• Study list auto update interval (in seconds)
A value of 0 means no auto update.
Basic Functionality
• Copy link to clipboard
When enabled, a copy of the URL is saved to the clipboard of your PC when you generate a link.
• Copy link to new email
When enabled, the URL is automatically inserted into the body of the generated email message.
• Link expiration
Amount of time the link is stored on the AquariusNET server.
• Authentication mode
The recipient of your link must either have an account on the AqNET server or enter a password for
each link.
Appearance
Configure the font and size of text in the Study List, Series List or Data source list. You can also configure
the color of the text and highlighting of data, depending on rules you have created.
To select a text font and size for the Series List, Study List or Data source list, check the box next to the
desired list and then use the adjacent drop-down menus to make the selections.
The “Data source list” refers to the filters and folders shown in the upper-left corner of the Patient List
screen:
Note: You must restart iReview for these changes to take effect.
Text Color and Highlighting

You can use text color or highlighting to differentiate between different types of studies, such as studies
having different modalities, or to make some studies stand out, such as high-priority studies. These effects
are applied to studies according to rules that must be configured first.
To add a rule, click the Add rule icon. An Edit Rule dialog is opened. For instructions on how to use this
dialog to create a rule, see "Working With Rules" on page 2-18.
Once the rule has been created and saved, you will see that rule listed in the Rule name list on the
Appearance screen (see the following image). You can now configure the actions that iReview will take on
studies that satisfy the rule.
Select colors for the text and background to be shown in the Patient List for those studies that satisfy the
rule. When you redisplay the Patient List, you will be able to see studies displayed in certain colors,
according to the rules you have configured.
Filters
In the Patientlist Configuration screen, select the Filter tab.
To add a new filter, click the Add filter icon (circled in the previous image). The following dialog is opened:
1. Enter a name for the filter at the top of the screen. If you do not enter a name, one will be generated
automatically, but that name might not be as meaningful.
2. Check the box for each modality you want to include in the filter. (If all modalities are allowed, check
All modalities.)
Note: The Modalities in study section, shown in the previous figure, might not necessarily list all
modalities that are supported in iReview. The list in this dialog includes all modalities that
have been selected for display, including custom and multi-modalities. For information on
customizing modalities, see "Modality" on page 2-7.
3. Select a Study date and time range from the pulldown menu.
4. Check any number of Read status values that apply.
5. For the Referring Physician’s Name, Institution Name, and Study description inputs, do the
following:
a. Select a comparator from the pulldown menu (see the following image).
b. Enter search names in the input field. Each name to be searched must be separated by a
semicolon.
Select comparator
6. Select the desired date range from the Series added date pulldown menu.
7. Exit the screen by clicking on the red “X” in the top right corner.
To see the work lists and filters just added, exit iReview and then relaunch. The new folders and filters will
be shown in the Folder and Filter panel, in the upper-left corner of the viewer (see Figure 2-6 on page 2-
31).
New Filter
Figure 2-6: New Filter Added
Folders
Folders allow you to group studies together manually.
To set up folders and filters, use the Patient List Configuration screen of the System Configuration.
1. Click the Folder tab:
2. Click Create private folder to create a folder for private use, or Create public folder to share work
with other users.
3. The following dialog is opened:
4. Enter the name of the folder.
5. Click OK.
Workflows
The Workflows tab allows you to specify Aquarius iNtuition Client workflows to be made visible in the
Patient List screen when certain studies are selected. You can also specify which module will be opened
automatically in the AquariusNET Thin Client, when certain studies are opened.
Note: To configure Workflows using this feature, you must pre-configure integration of The
iNtuition Client for launching from iReview. To open Thin Client modules, integration for
launching from iReview must also be pre-configured. See "Integration" on page 2-102 for
information.
In the Patientlist Configuration screen, select the Workflows tab (circled in Figure 2-7).
If any Workflow rules have been configured previously, a list is shown in the left panel of the screen. You
can edit these rules to change the conditions for opening the iNtuition Client in any of the Workflows.
1. Click the Add Rule icon, circled in Figure 2-7. An Edit Rule dialog is opened. For instructions on how to
use this dialog to create a rule, see "Working With Rules" on page 2-18.
iNtuition Workflows
Thin Client Module
Previously
configured rules
Figure 2-7: Manage Workflows Screen
After you have configured the rule, the name of the rule is displayed in the Rule list of the Workflows
tab. When that rule is selected, the associated Workflows are displayed in the right-hand panel.
2. Check the checkbox for each Workflow you want to make available when a selected study satisfies
this rule.
Associated
Workflows
Selected
Rule
When you select a study that satisfies a rule, the selected workflows for that rule are displayed next
to the Study Management icons:
Stack filter
The Stack Filter allows you to group stacks into logical groups, making it easier to find the correct stack for
examination. For example, a cardiac MR study can have many stacks. Using a stack filter, you can
configure logical groups, such as Perfusion or Late Enhancement, and then configure rules to define which
stacks belong in which groups.
When you load a study into the Viewer that satisfies all the rules in a stack filter, the stacks are organized
into the configured groups. They are displayed with icons that allow you to switch easily between the
groups.
Keywords
Keywords are used to mark studies with clinical or other identifying information so that the studies can
easily be found in searches. Keywords are grouped together in categories so that they are easier to
organize.
To add keywords, do the following:
1. Click on the Keywords tab. The keywords screen is displayed:
2. Create a new keyword Category. Click on the Add category icon (circled in the previous image). A
dialog is opened for you to name and configure settings for the category:
a. Enter a name in the Name field.
b. Select a category type from the drop-down menu.
• List with fixed terms - The names of keywords belonging to this category cannot be
changed during searches or updates. They must be selected from a drop-down menu.
• List and manual edit - Keyword names are selected from a drop-down menu, but they
can be changed during searches or updates, by typing or erasing characters.
• Free text edit - Keyword names are entered at the time of the search or update.
c. Allow multiple values - Check this box if you want to be able to search for studies using
more than one keyword in the same search.
d. Show in context menu - Check this box if you want the category to be shown in the right-
click menu in the Study List.
e. Click OK when done. The category is now added to the Keywords screen.
You can now add keywords to this category.
3. Highlight the category to which you want to add keywords, and then click the Add keyword icon. A
dialog is opened for you to enter keywords.
4. Click OK to save the keyword. You can then repeat this process, adding as many keywords as you
need.
5. When finished, click OK to save the keywords.

You can also import keywords by clicking the Import icon.
Using Keywords to Mark Studies
To mark a study, right-click on it and select Edit Keywords.
A dialog is opened, allowing you to select a keyword from the appropriate category:
The bottom section of the dialog contains a list of all keyword categories that have been configured. Next
to each category name, there is a menu or input box, where you can select or enter a keyword (circled in
the previous image).
Click the down-arrow of the menu next to the desired category to display the keyword choices. In the
following example, the two categories listed are “Findings” and “Anatomical location.” The Findings
category contains four keywords. They can be seen in the drop-down menu:
Select a keyword and click OK.
The study is now marked in the Findings category with the keyword “Stenosis.”
Multiphase
Apply selected options to the display of multiphase studies and series in the Patient List, using rules to
select the appropriate data.
Add Rules
Click the Add Rule icon, circled in the figure above. An Edit Rule dialog is opened. For instructions on how
to use this dialog to create a rule, see "Working With Rules" on page 2-18.
DICOM Tag Options

The Options list, in the lower-right panel of the Multiphase tab, consists of DICOM tags that are used to
group multiphase studies or series together, or to perform other tasks on matching data, such as to check
for certain conditions in the sub-series, or to sort data according to certain criteria. To enable an option,
click the checkbox beside it.
You can add DICOM tags to be used for grouping studies or series together. To do so, follow these steps:
1. Click Add DICOM Tag, above the Options list. A dialog is opened, where you can enter the desired tag,
if known.
2. If you do not know the tag’s group or element number, click the “...” button to open the Browse for
DICOM Tag dialog, which contains a complete list of DICOM tags and their ID numbers.
If needed, you can search for the tag by entering the tag name, in full or partially, in the search input
box at the top of the Browse for DICOM Tag dialog.
3. Select the desired tag and click OK.
The tag is then added to the Options list. When that tag is enabled, studies that match the rule are
grouped together by the value of that DICOM tag.
Import
Settings for importing files into the iReview Patient List.
Table 3: Settings for Importing Files
Setting Values (default bolded) Description

Automatically open import dialog Enabled/Disabled
when a CD/DVD is inserted
Automatically open import dialog Enabled/Disabled

when a camera is connected
Maximum number of files to scan to Default 20

determine if import is DICOM
Remember the last selected folder Enabled/Disabled
Default import type of drag-and- Import DICOM Import all as DICOM files
drop in the patient list
Import Non-DICOM Import all as non-DICOM
Auto Detect Attempt to determine whether

imported file is DICOM or non-
DICOM
Non-DICOM import type for drag- Create new Patient and new Study Add file to Patient List as a new
and-drop in the patient list patient study
Add to selected Patient, Create Add file to currently selected

new Study Patient as a new study
Add to selected Study Add file to currently selected study

as a new series
Show dialog Allow user to select import type

for each import
Non-DICOM import type for drag- Add to selected Patient, Create Add file to currently selected
and-drop in the viewer new Study Patient as a new study
Add to selected Study Add file to currently selected study

as a new series
Show dialog Allow user to select import type

for each import
Federated Query
This tab allows you to decide which remote nodes will be accessible, by default, to each user group.
To configure, select a user group in the left panel. Then check the box for each node to be accessible to
that group.
Please note that this is only a default configuration. Individual users will still be able to enable any of the
remote nodes in the list.
Viewer Configuration
To find the section you need, turn to the page listed below. If you are viewing this manual online, click the
desired title:
Appearance ........................................................................................................................................2-27
Measurements ...................................................................................................................................2-57
Color templates..................................................................................................................................2-59
Capture Options .................................................................................................................................2-61
Save To Folder ....................................................................................................................................2-64
Mouse ................................................................................................................................................2-69
View Options......................................................................................................................................2-74
Video ..................................................................................................................................................2-76
GSPS and KIN......................................................................................................................................2-77
Window/Level Presets .......................................................................................................................2-78
Timeline .............................................................................................................................................2-65
Annotations........................................................................................................................................2-48
Synchronization..................................................................................................................................2-57
Capture Format ..................................................................................................................................2-59
Output................................................................................................................................................2-62
SR .......................................................................................................................................................2-68
PET .....................................................................................................................................................2-73
Default Settings ..................................................................................................................................2-47
Navigation ..........................................................................................................................................2-76
Appearance
Figure 2-8: Viewer Appearance Configuration Screen
Table 4: Appearance Settings
Setting Description
Color Select the default color for text on the screen.
Font Select the default text font.
Font Scale Set the relative font size.
Setting Description
Profile Configure the keyboard shortcuts. See Appendix A: "Default Keyboard

Shortcuts" for details.
Show series navigator Open a dialog of the series list when a study is loaded.
Show Scene Icons in Viewer Display icons for all scenes in the Series List, placed to the right of the series
icons.
Toolbar location Place the toolbar above or below the main image display window. Requires
re-login to take effect.
Iconbar location Place the iconbar above or below the main image display window. Requires
re-login to take effect.
Cache Color Select a color for the cache progress scrollbar (see "Vertical Progress Bars
for Caching" on page 4-3).
Triangulation Cursor Color Select a color for the triangulation cursor from the menu.
Triangulation Cursor Size Select a size for the triangulation cursor (Normal, Large, or Extra Large) from
the menu.
Keyboard Shortcut Profiles

Initially, there are two default keyboard profiles:
• Default AquariusNET Thin Client Keyboard Shortcuts - Selecting this item loads the keyboard short-
cuts used in the AquariusNET Thin Client product. This file cannot be modified directly. However, you
can make a copy of the default Thin Client shortcuts and rename the copy. The new file is editable.
• Default Aquarius iNtuition Keyboard Shortcuts - Selecting this item loads the keyboard shortcuts used
in the Aquarius iNtuition Client product. This file cannot be modified directly. However, you can make
a copy of the default Thin Client shortcuts and rename the copy. The new file is editable.
The Thin Client keyboard shortcuts are the default selection in this menu. To use another set of shortcuts,
click the down-arrow in the Profile menu and select the desired profile.
Reconfiguring a Shortcut Profile

To reconfigure keyboard shortcuts, first select which profile to open, and click the Configure button
(circled in Figure 2-8 on page 2-43).
There are the tworead-only default profiles mentioned above. If you open one of these, the dialog shown
at right is opened. This allows you to make a copy of the read-only profile. You can change the name of
the new profile before saving it. Click OK to save the new profile.
Figure 2-9: Editable Keyboard Shortcut Profile
You can edit this profile directly by adding, deleting or changing key assignments to any command in the
profile. If at some time later, you want to use the previous assignments, you will need to change them
back to what they were. However, you can copy the current profile to a new file and then configure the
new file. That will preserve your original profile as well as adding the new one.
Assigning Keys to Commands

To assign a key to a command, do the following:
1. Find the command in the profile list and select it. If another key has already been assigned to that
command, you can either remove it, by clicking Remove key, retain both key assignments, or choose
another key to assign to the command.
Note: A single command can have an unlimited number of keys assigned to it, but each key can
be assigned to only one command.
2. Enter the desired shortcut key in the Shortcut key field.
3. Click Assign key. If the key has already been assigned to another command, a dialog is posted to
inform you. You can either reassign the key to the new command, or cancel the reassignment to
preserve the previous setting.
Figure 2-10: Assigning a Shortcut Key
4. When finished, click OK to save your changes.

In the example shown in Figure 2-10, the ‘A’ key was assigned to Annotation Toggle. This means that when
an image is loaded, you can turn annotations on and off by typing the ‘A’ key.
Adding Commands to the Profile

Commands have special names that are known to the iReview software. In order to add a command, you
need to know its specific name.
1. Open the keyboard shortcut profile you want to add a new command to.
Note: You can add new commands to editable profiles only.
2. Right-click anywhere in the list of commands in the profile to open a menu.
3. Select Add Command. A dialog is opened.
4. Enter the name of the new command in the Name box of the dialog and click OK.
5. Assign a key to the command and click OK to exit the profile.
Default Settings
Table 5: Video Settings
Setting Description (default value bolded)
Auto-cine multiframe runs Enabled/Disabled - If a study contains a series with multiframe stacks,
enabling this setting will cause the series to begin playing automatically
when it is dropped into the viewer. Multiframe series are identified by a
video symbol in the top-right corner of the thumbnail (see Figure 2-11 on
page 2-48).
Annotation Display Mode • Show - Show the annotations set in the Standard tab.
• Hide - No annotations are displayed.
• Extended - Display the annotations set in the Extended tab.
• Minimum - Display the annotations set in the Minimum
tab.
• Current - Display the currently defined annotations for the
data’s modality.
For information about the annotation tabs, see "Copy Page" on page 2-
54.
Synchronize Study/Series • On - Synchronize using the default synchronization.
• Off - Do not synchronize
• Current - Synchronize using the currently defined
synchronization.
Setting Description (default value bolded)
Mouse zoom mode • Zoom from center - The image expands or shrinks around
its center during zoom.
• Zoom from cursor - The image expands or shrinks around
the initial cursor position at the start of zoom.
Default Display Protocol Match • First in List - (Default) If more than one display protocol is
available for the study, the first one found is used.
• Current Study - The first display protocol available that does
not have a prior study in it is used. If there are no display
protocols available (or all the available ones reference
priors), then the study loads in a 1x1 stack layout.
• Auto Detect - If the study is unread, iReview checks through
all the display protocols in the list. If one is found that
references priors and has a stack match in the patient
history, that one is used. Otherwise the first display
protocol that does not reference priors is used. If no
matches are found, then a default 1x1 stack layout is used.
Automatically display a single • Enabled/Disabled - When enabled, load a single series into
series study in a 1x1 stack layout a 1x1 stack layout.
Figure 2-11: Multiframe Series
Annotations
iiReview can be configured to display different annotations for different modality types.
Figure 2-12: Annotation Configuration
The annotation configuration is defined on three tabs: Standard, Extended and Minimum (see Figure 2-
12). The Standard tab defines the default configuration, and should contain information that you consider
to be relevant for the modality. Configure the Standard annotations first. More will be said about the
Extended and Minimum annotations later.
To add a new annotations protocol, click on the Add icon (circled in Figure 2-12). The Edit Rule dialog is
opened. Rule configuration is described in detail in "Working With Rules" on page 2-18.
After you have completed configuration of the new rule, the rule is shown in the protocol list. Click on it to
show a blank screen on the right. This is where the new annotation layout will be configured.
The screen is divided into four quadrants where annotations can be placed. When you hover the mouse
over the screen, the quadrant in which the cursor is located is highlighted with a yellow square:
You can place annotation items anywhere on the screen. For example, the Patient Name is often shown
on the first line of the upper-left quadrant. To add an item of annotation, right-click in the desired
quadrant and select Add new item, which at this time is the only option.
The Add tag dialog is opened:
1. Select the font size for the annotation text.
Click the Font size menu and choose a fixed size, from very small (10) to very large (30), or select
custom to enter any size that is not already included in the fixed sizes. Enter the custom size in the
input box to the right of the menu.
Enter custom
size here
2. Select the text color, either the default color or a color selected from a palette. To select from a
palette, choose More from the menu.
Figure 2-13: Left - Select Color Menu; Right - Color Palette
3. Select a tag whose value will be displayed. You can do this in one of the following ways:
• Choose an item from the Frequently Used Tags menu.
• Specify a DICOM tag.
If you know the Group and Element tag numbers, you can enter them in the
corresponding boxes. If not, you can browse for the tag you want by clicking the icon on
the right. The browse dialog allows you to search for the tag name, or to narrow the
search by providing the group number.
• Specify a private DICOM tag by entering the Group, Private creator name and Element.
This is similar to specifying a standard DICOM tag, except that the private creator name is
also required.
• Specify a private DICOM tag through a query.
Figure 2-14: Annotation Added
Once there is at least one annotation added, you can right-click on it to open a longer menu, which allows
more flexibility in where to place more annotations:
• Add item before/after
Place the new item before or after the selected item, on the same line.
• Add new line before/after
Place the new item above or below the selected item, on a separate line.
• Add separator before/after
Insert a blank line above or below the new item.

You can also define the positions of the rulers and orientation indicators, by choosing from the drop-down
menus just below the display screen:
Configuring the Extended and Minimum Annotations

Once the Standard annotations have been configured, the Extended and Minimum annotations are
initially configured the same way. You can then change those configurations manually. In order to see
what is on either of these tabs, check the Enabled box in the upper-left corner of the window:
The Extended annotations should contain everything that is in the Standard annotations, plus any extra
information that you might want to include.
The Minimum annotations might hide some information that is in the Standard, for example, the Patient
Name or Patient ID.
It is not necessary to configure the Extended or Minimum annotations. If you do not, those screens will
simply contain duplicates of the Standard annotations.
When you are finished, click OK to save the configurations.
Copy Page
To copy a single page from one modality in the list to another, do the following:
1. Click the modality that you want to copy.
2. Right-click on that page and select Copy Page.
3. Click on the modality where you will paste the copied annotation page. The annotation screen is
shown on the right.
Note: If the annotation page where you are pasting is new and has not yet been configured, the
screen will be blank, as shown in Figure 2-15.
4. Right-click on the screen and select Paste.
Figure 2-15: Pasting a Copied Page in a New Screen
Note: If annotations have already been configured on that page, they will be overwritten by the
Paste operation.
Copying and Pasting All Pages

To copy all three pages at once from one modality to another, do the following:
1. Right-click on the source modality and select Copy.
2. Right-click on the target modality and select Paste.

In summary, copying a page from one modality and pasting it to another copies only that page. Copying
the modality and pasting it to another modality copies all three pages.
Default Annotations
There are pre-configured annotations available by default for some modalities. These annotation
templates can be edited in the same way you would edit a user-configured template.
PET
The annotations for a PET study are configured:
To show these annotations in the Viewer configuration screen, select PT from the list of modalities in the
panel on the left:
If the PT modality is not listed in the left panel, you can create a template by adding a new rule:
1. Click the Add icon. The Edit Rule dialog is opened.
2. Type in a name for the rule.
3. Select PET from the Modality drop-down menu. You can configure additional conditions in the
section below, but that is not necessary for creating the annotations template.
4. Click OK.
Measurements
Figure 2-16Measurement Options
Value Description
Text Color Select the default color for the text of the measurement result.
Font Select the default text font.
Font Scale Set the relative font size.
Highlight on mouse hover Select measurement when the mouse is hovered over it.
Export Folder Select a folder on the local hard drive for exported measurements.
XML Export Format Choose the XML format used by AQi, or group measurement data hierarchi-
cally under patient/study/series/image information.
Enable Continuous Measure- After selecting and performing a measurement, the mouse remains in that
ments measurement mode until either another mouse mode is selected, or con-
tinuous measurements is disabled.
Synchronization
This menu allows you to configure different synchronization rules for different modalities. In addition, you
can configure different rules for different studies within the same modality.
Note: The column on the left (example shown in Figure 2-17) shows all modalities that have been
selected for display, including custom and multi-modalities. If you do not see the modality
you need, or for information on customizing modalities, see "Modality" on page 2-7.
Figure 2-17: Synchronization Configuration Screen
The following table describes each option:

Table 6: Synchronization Options
Value Description
Synchronize relative to recommended win- Synchronize the window/level of each window relative to that
dow/level. window’s recommended window/level. Each window is changed
by the same amount, but their actual values might be different,
depending on the recommended W/L for each.
Synchronize absolute values Synchronize the window/level of each window to the same val-
ues.
Synchronize FOV Based on the pixel spacing, the synchronization keeps all images
magnified proportionately.
Synchronize zoom factor Synchronize the zoom factor using absolute values. This might
result in different FOVs for each image, depending on the pixel
spacing of each.
Synchronize all images relative to registered Synchronize all stacks, based on the registered position.
position
Synchronize same plane relative to regis- Synchronize all stacks having the same orientation, based on the
tered position registered position.
Synchronize all images by absolute position Synchronize the slice position of all stacks, based on the absolute
patient position (within the same study).
Synchronize same plane by absolute position Synchronize the slice position of all stacks having the same orien-
tation, based on the absolute patient position (within the same
study).
Synchronize same plane Synchronize stacks having the same orientation.
Synchronize all images Synchronize all stacks.
Value Description
Synchronize same view position Use only when stacks having the same view position need to be
synchronized. View position is mostly used for mammography
studies.
Synchronized This is the same as “Synchronize all images”.
Color templates
You can add, delete and edit color templates in this menu. For a full description of this feature, see "Color"
on page 4-14.
Capture Format
This menu allows you to configure different capture rules for different modalities.
Note: The modality tabs shown in the previous figure are displayed according to which
modalities, including custom and multi-modalities, have been selected for use at your
institution. For example, if only CT, MR, US and PT are selected, the tabs would appear as
follows:
For information on customizing modalities, see "Modality" on page 2-7.

You can change the image size and format that will be used during captures. The All tab defines the
default settings for all modalities. To configure different settings for a specific modality, enable Overwrite
common settings by checking the box beside it.
This allows you to select a different setting in the menus below.
Custom Capture Size

This option allows you to enter a custom capture size.
When this menu item is selected, a dialog is opened where you can enter the desired width and height
(see image at right).
1. Enter the dimensions and click OK.
2. Capture images as needed.
3. In the Output Panel, move an image having the custom dimensions to the Clipboard.
4. Paste the image in another application, such as Microsoft Word or a graphics program.
The previous capture was set to 400 pixels x 600 pixels. For comparison, we will change the custom
dimension to a noticeably different size and shape, capture the image and copy it to the Clipboard,
and then paste it into the same application to show the contrast (see Figure 2-18).
Figure 2-18: Left - Set custom capture size; Right: Capture saved to Clipboard
Capture Options
Configure the clipboard mode for capture-to-clipboard.
The Clipboard operation captures an image or image portion from the Viewer window (viewport) to the
Windows clipboard. The image can then be pasted into another application. See "Custom Capture Size"
on page 2-60 for details.
Capture-to-Clipboard
There is no icon or menu selection to access this operation. It must be performed using a keyboard
shortcut. The default keyboard shortcut is CTRL+C.
If CTRL+C does not perform a capture to the clipboard, it is possible that CTRL+C has been reconfigured or
deleted from the keyboard shortcuts. If you are not sure which keyboard shortcut to use, you can open
the keyboard shortcut configuration that is currently in use, and search for the CaptureToClipboard
function. If no shortcut is assigned to the CaptureToClipboard function, you can assign one. See Appendix
A: "Default Keyboard Shortcuts" for instructions.
The two capture-to-clipboard modes are:
• Copy the entire viewbox to the clipboard
Copy-to-clipboard copies the entire image in the viewport to the clipboard.
• Copy a selection to the clipboard
Copy-to-clipboard changes the mouse mode so that you can draw a rectangle around a section of the
image to select it. When the mouse button is released, the selected area is copied to the clipboard.
Mouse cursor
Output
Output settings for captured images.
Options
Table 7: Output Options
Setting Description
When loading new study while • Keep images in Output Panel - Always loads new study
Output Panel is not empty without clearing the Output Panel
• Delete images from Output Panel - Always clears Output
Panel when loading a new study
• Ask every time - Posts a dialog to ask whether you want to
keep images from the previous study in the Output Panel
Starting series number Starting number for the series created by this output.
Setting Description
Create new study • User’s preference - A checkbox is provided so that you can
choose whether or not to create a new study each time you
send captures to DICOM.
• Always create new study - All captures sent to DICOM will be
stored as a new study.
• Never create new study - Captures are never stored as a new
study.
Note: iReview must be restarted for changes to this setting to take
effect.
Clear accession number when Remove old accession number before saving.
creating a new study
Clear Study ID when creating a Remove old Study ID before saving.

new study
Reset additional destinations When Clear output after send is enabled, these additional destinations are
after send cleared. You must then make a new selection next time. This prevents you
from accidentally sending output to the same destination used by the previ-
ous user.
Require additional store desti- In DICOM Store, captures are always stored on the AqNET server. In addition,
nation you might always want to store the captures on another server. Enabling this
setting will cause an error message to be posted if no additional destination is
selected.
Clear output after send Automatically clears all images from the Output Panel after they have been
sent to the appropriate destination(s).
DICOM Node type configuration This panel allows you to define the status of additional nodes where images
may be sent during DICOM send (see Figure 2-19 on page 2-64).
Figure 2-19: DICOM Node Type Configuration
Save To Folder
With this screen, you can configure settings for saving images to a folder on your PC. The settings are:
• The pathname of the folder where images are to be saved.
• The image output format.
• The compression level (JPG format only). A higher number means a larger file and better quality. A
lower number means greater compression but not as good quality.
Note: There is no default for the Path name. If one is not configured, a Windows browse dialog is
posted each time an image is saved.
Timeline
Configure the way that the patient history is displayed in the viewer. There are three styles: Timeline, List
view with filter bar, and List view with buttons.
Style
Configure the way the timeline is displayed.
• Timeline View
This style is the default. The patient history is displayed horizontally:
• Listview with Buttons
You can assign up to 4 modality icons to appear next to the patient history list. The icons are used to
filter the list by modality.
• Listview with Filter Bar
The filter bar is used to filter the list by modality, study date and time, and the contents of the study
description column. When this view style is configured, menus are displayed above the list columns
for modality and study date and time. A text box is placed above the study description column, where
you can enter text to filter on.
Note: There are no headers displayed to identify the column. They can be identified by the
contents of each column. Also note, iReview must be restarted for any configuration
changes to take effect.
Cache Progress bar GUI Settings

These settings allow you to configure the progress bar at the top of the series thumbnail:
• Back Color - This color represents the percentage of the series that is not yet cached.
• Fore Color - This color represents the percentage that is cached.
• Number of Bars - Number of partitions of the progress bar.
Figure 2-20: Left - Two Bars; Right - Four Bars
Position in Timeline
• KIN Location
• SR Location
These selections are used to configure where to place the stack thumbnails for KIN and SR objects in
the timeline.
SR
DICOM Structured Report (SR) viewer.
Table 8: SR Settings
Setting Description
Enable SR Viewer When disabled, the SR icon is not shown in the Viewer and this feature
cannot be accessed.
Show SR Viewer automatically after If the study has only SR series, automatically open the SR viewer when
open study the study is loaded.
Show Observation Context items
Auto-Open SR viewer for Studies that contain only SR objects
• If the Enable SR Viewer setting is checked, and a study consists only of SR Series (Basic Text SR,
Enhanced Text SR, or Comprehensive SR), then the SR viewer is opened automatically, even if the
Show SR Viewer Automatically After Open Study setting is not enabled.
• If the Show SR viewer setting in iReview is enabled and the study has only SR series, the SR report dia-
log is automatically displayed at load time.
• If a study contains a non-SR series, the SR report dialog will not be auto-opened at load time.
• The auto-open feature is not available unless the Show SR Viewer setting is enabled.
• The following table shows each possible situation and the result from each:
Table 9: Possible Situations and Results
Show SR viewer Contains Only SR

setting SR series series Result
Enabled Yes Yes SR reports dialog is auto-opened when study is loaded.
Show SR viewer Contains Only SR

Result
setting SR series series
Enabled Yes No SR reports dialog is not auto-opened.
Disabled - - Auto-open SR is disabled.
Mouse
Click the Mouse tab to display the configuration screen. Make sure that the All tab, within the Mouse tab,
is also selected (see the following figure). The All tab contains the Common settings for the mouse
functions. These settings are common to all modalities, unless different settings are configured for a
specific modality.
Mouse Button Settings

The mouse button settings are located in the top section of the Mouse tab. Any mouse button or
combination of buttons can be changed to perform any of the other functions. For example, if you would
prefer to use the left mouse button to zoom, you can configure that in this screen. Each mouse button has
a menu next to it (see figure below).
Figure 2-21: Mouse Configuration Menu
The default functions for each mouse button are as follows:

Table 10: Default Functions for Mouse Buttons
Button Default Function

Left mouse button Slice
Right mouse button Pan
Middle mouse button - drag Zoom
Middle mouse button - click Cine
Mouse wheel Slice
Left + right WindowLevel
Left + Middle None
Middle + Right None
Distance Measurements
In addition to the functions listed in the table, you can also configure a mouse button to begin a distance
measurement. When a series is loaded into a viewport, the configured mouse button is automatically in
Distance measurement mode.
Note: You cannot set the right mouse button to perform distance measurements. The right
mouse button is reserved for opening the context menu (right-click to open menu).
Configuration by Modality
The mouse buttons can be configured for each modality. If none of the modality settings have been
configured, the settings from the All tab are used. To enable settings for a modality, click the tab for that
modality.
When a modality tab is first opened, the configuration fields are disabled. You cannot enter preferences
for the modality until the tab is enabled. To do so, check the box labeled Overwrite common settings (see
figure above). Once you have enabled the modality tab, the menus and input boxes are displayed in black
text instead of gray. You can then configure the mouse functions for the selected modality.
The settings that can be configured are the same as the common settings in the All tab, which are
described below.
If a series is loaded and its modality does not have any special configuration, the settings in the All tab are
used.
Note: The modalities shown in Mouse tab depend on which modalities have been enabled in the
Modality tab of the System Configuration screen. For information, see "Modality" on page
2-7.
Speed Control Settings for Slice Mode

The speed control settings are located in the middle section of the Mouse tab.
The following settings control scroll speed and behavior using the mouse wheel.
Table 11: Scrolling Speed Control Settings
Setting Effect
Non-skipping slice On: As you advance through a volume, no slices are skipped.
mode
Off: Slices are skipped when scrolling quickly.
Adaptive: When scrolling quickly, some slices are skipped. When scrolling slowly, no
slices are skipped. You can define a threshold for the number of pixels you can scroll
through without skipping any slices. Once you have scrolled through more pixels, skip-
ping may occur (depending on how quickly you are moving the mouse). Enter the
threshold number in the text box that is shown when this option is selected.
Slice per mouse wheel This sets the number of slices that are advanced when the mouse wheel is turned
rotation once. The higher the number, the more quickly the mouse wheel advances through
the volume.
Scrolling mode Pixels per slice: The number of pixels you must scroll through in order to advance one
slice through the volume.
Percent of screen: The percentage of the screen required to scroll through the entire
volume.
Normal and Shift Mode

In Normal mode, use the mouse without using the keyboard. In Shift mode, hold down the Shift key while
moving the mouse or the mouse wheel. Each of the above settings can be configured differently for
Normal and Shift mode. The two modes give you the ability to configure two different sets of actions for
the mouse. For example, you could set the scrolling mode to 1 pixel per slice in Normal mode, and 5 pixels
per slice in Shift mode. This would allow you to scroll at two different speeds as needed, without needing
to change the settings.
Reverse Scrolling Direction

When this box is checked, the upward motion scrolls through the images downward (from head to foot),
and the downward motion scrolls upward through the scan.
Window Level Settings

The window width is the full range of contrast values contained in the image. An increase in window
width allows more shades of gray and decreases contrast. The default for increasing the window width is
a rightward motion of the mouse.
The window level is the midpoint value of the the window width. An increase in window level makes the
image darker, a decrease brightens the image. The default for increasing the window level is an upward
motion of the mouse. To decrease the window level, move the mouse downward along the image.
The Increase Window Level and Increase Window Width menus allow you to change the default mouse
motion used to change the window width and level.
Note: If the default for increasing the window level is Up, and you change it to Down, the default
for decreasing the window level automatically changes to Up. If you change the axis
(horizontal versus vertical motions) for the window level, then the axis for the window
width must also change. For example, if you change the default for window level from Up
to Left, then the window width menu automatically changes to Down.
PET
Table 12: SUV Settings and Values
Setting Values (default bolded) Description

Default SUV type Save last used SUV type Select the default SUV type:
SUVbw
SUVlbm • The same type used previously
SUVbsa
• SUV body weight
• SUV lean body mass
• SUV body surface area

Windowlevel mode Use Min/Max
Use Window Width/Level
Automatically Invert Enabled/Disabled Open study with HU values inverted.
Initial WL (SUVbw) Min 0 Initial Window/Level (based on Min/Max

Max 5 values) for each of the three SUV types
Initial WL (SUVbm) Min 0

Max 5
Initial WL (SUVbsa) Min 0

Max 5
View Options
Note: The following options show only when a modality is selected in the left panel (circled in the
image above). Otherwise this panel is blank.
Table 13: Window/Level Options
Setting Values Description

Window Level Algorithm • Relative to recommended For most modalities, the default is Rel-
window level ative to recommended window level.
For Secondary capture images, the
• Min-Max default is Min-Max.
Use Modality LUT Enabled/Disabled Disable this setting if you would prefer
not to use the Modality LUT sequence
included in the DICOM header.
Use VOI LUT Enabled/Disabled The VOI LUT transforms modality pixel
values into pixel values that focus on
the clinically important areas of an
image. It changes the window/level
values so that the areas of interest are
brighter and the rest of the image is
darker.
Apply GSPS on load Enabled/Disabled If there are any GSPS series, apply
them to the data on load automatically.
Table 14: Multi-frame Options
Setting Value Description

Combine single images • Don’t combine single
frames
• Always combine single
frame
• Combine single frames if
series has Multi-frame
Sorting mode • Single frames first
• Multi-frame first
• By acquisition order
Table 15: Mammography Options
Setting Value Description

Chest wall alignment Unchecked Left and right images are not aligned
Checked Images are always aligned.
Undetermined (checkbox is solid Images are always aligned when the modal-
black) ity is MG.
Chest alignment algorithm The alignment algorithm menu items are

None, Vertical, Direct, and Rotate. See
Alignment Algorithms for descriptions.
Alignment Algorithms
• Vertical - The simplest and fastest algorithm.
Note: If the MG data contains body parts other than breast images, this algorithm might fail.
• Direct - Based on the detection of the nipple positions.
• Rotate - Also based on detection of the nipple positions, this eliminates any natural rotation found in
MG data. It is the most accurate algorithm.
Video
Table 16: Video Settings and Values
Setting Values Description

Format AVI Select which output format to use for the video.
MOV
Codec MSVC The data stream encoding.
File Path (Selected by user) Set a default folder where videos are saved to disk.
Compression 75 Compression percentage.
Frame Rate 25 The number of frames per second.
Width 640 Width of the frame.
Height 480 Height of the frame.
Navigation
Scrollbar Type
The scrollbar overlay allows you to scroll through a volume when you are accessing data using a
touchscreen tablet device.
Table 17: Scrollbar Settings
Settings Description
None No scrollbar
Embedded Scrollbar spans from the top to the bottom of the ruler (located on the right edge of the
viewport).
Full Screen Scrollbar spans from the top to the bottom of the viewport.
GSPS and KIN

Configure defaults for saving GSPS and KIN images.
Table 18: GSPS/KIN Settings
Settings Description
KIN Criteria This is how the system determines whether an image is marked as a Key image. The
criteria are:
• All images with a measurement

• All images with a text annotation
• Manual (Right-click on image and select Mark as KIN.)
Default Document Title Choose the most appropriate title from a list of standard titles in the menu. (See
Figure 4-18 on page 4-46 for an image of the opened menu.)
Save measurements and GSPS and KIN are automatically saved when the tab for the current study is closed.
key images when a tab is They are saved according to the KIN criteria (described above). You do not need to
closed. click the Save KIN icon when this setting is enabled.
Window/Level Presets
Configure window/level presets for each modality.
This screen allows you to configure window width and window level presets for different modalities.
Select the modality from the panel on the left, and then double-click on the value you would like to set or
change. A dialog is opened where you can enter new values:
Click OK when finished.
Display Protocols
Display protocols are used to configure default layouts for different kinds of data.
Stack Definitions ................................................................................................................................2-79

Display Protocols................................................................................................................................2-82
Loading a Study ..................................................................................................................................2-100
The following image shows the Series List of a selected study, which contains the results of a CT scan.
Display protocols allow you to structure the layout for each series in the study.
Figure 2-22: Series in a CT Cardiac Study
Stack Definitions
First you need to create a group of stack definitions for the protocol as a whole. Click the Stack Definitions
tab near the top of the screen.
In the Stack Definitions screen, click Add Group to create the protocol group (see Figure 2-23 on page 2-
80).
Figure 2-23: Add Stack Definition Group
In the dialog that opens, select the modality from the drop-down menu. Then enter a name for the group:
The name appears in the group list (see image at right).
For each series in the study, create a separate stack. This will allow you to place each series in a different
viewport, which is simply a section of the monitor screen defined by the layout.
To create a stack, click the Add Stack icon (see the previous image). The Edit rule dialog is opened. This
dialog is used for creating a rule so that iReview will recognize the desired series. See "Working With
Rules" on page 2-18 for instructions on creating the rule.
The first series shown in Figure 2-22 on page 2-79 is the topogram. For this series, as with every series in
this study, the study description contains the word “cardiac,” so you can include that in the rule. In the
menu beside Study description, select contains and then type in the word cardiac.
The second condition in the rule, Series description, should contain the word “topogram.” However,
because the description fields have been entered manually, it is recommended that you abbreviate the
search term so that there is a greater opportunity for the term to match the description in the DICOM
header of the study. As with the Study description, the comparator should be contains rather than
equals.
Click OK to save the rule. The Edit rule dialog closes and the Stack Definitions tab is shown.
The second series in the Series list is the calcium score. This rule is set up in the same way as the first. First
click the Add Stack icon. The Edit rule dialog is opened. Enter the search terms in the Study description
and Series description fields, using contains as the comparator. The study description should contain the
word “cardiac.”
Figure 2-24: Rule for Calcium Score Series
Click OK after entering the terms (shown in Figure 2-24), to close the Edit rule dialog.
The Stack Definitions tab should appear:
Continue to create rules for each series in the study, until you have rule definitions for each series:
Click OK to save the stack rules.
Display Protocols
Click the Display Protocols tab. The screen shown in Figure 2-25 is displayed.
Figure 2-25: Display Protocol Configuration Screen
Note: The column on the left in Figure 2-25 shows all modalities that have been selected for
display, including custom and multi-modalities. For information on customizing modalities,
see "Modality" on page 2-7.
To create a new display protocol, do the following:
1. First select the number of monitors that are available for the layout. In this example, the layout will be
configured for two monitors.
2. Click the 2 monitors icon and then click Add (both circled in Figure 2-25). The Edit Display Protocol
screen is opened.
3. Enter a name for the display protocol in the Name field.
4. If desired, select an orientation for the displays.
Create a Rule
In the lower part of the screen, create a rule that will cause any study that satisfies its conditions to open
using this display protocol.
To configure match terms, enter match terms in any of the fields in one of two ways:
1. Type terms in manually.
2. If a study has been selected prior to opening the Display Protocols configuration screen, you can click
the pencil icon at the far-right end of the field (circled in Figure 2-26). If the corresponding field in the
Patient List contains a value, that value is filled into the rule field (see Figure 2-26). This allows you to
create rules that search for specific strings.
Figure 2-26: Study Description Field in Rule Filled with DICOM Tag Value
Note: It is not necessary to enter a value in every field of the rule.
If you want to use this display protocol for all studies that have a match in any of these fields, select
Match any of the following. If you need to narrow the search to only those studies that match in all of the
fields, select Match all of the following.
3. When all desired match terms have been entered, click OK to save the new display protocol.
Define the Layout

Click the Protocol tab. The layout for the study is defined in this screen:
The display protocol must be associated with a stack definition group. On the left side of the Protocol
screen, under Stack, select the CT - Cardiac stack group from the drop-down menu (see the image at
right). This is the stack definition created in "Stack Definitions" on page 2-79. The list of stack definitions is
displayed beneath the menu (see below). Initially, the list is grayed out because a viewport has not been
selected.
In this example, of a two-monitor display, you have a choice whether to configure both monitors the same
way, or to allow each monitor to have a separate layout. In this case, the configuration will have different
layouts on each screen. Therefore, the Same layout on all screens setting must be disabled (unchecked).
The two black boxes in the center of the screen represent the two monitors. Click one of the boxes to
select it. The box turns gray to indicate it is selected, and the list of stack definitions, previously grayed-
out, is now displayed in a regular black color to indicate that they can be selected.
Figure 2-27: Selecting a Viewport
Click the down-arrow in the menu that is right above the two monitor boxes. The layout menu is opened:
Select Stack and then select the 2x2 layout, as shown in the previous image. The 2x2 layout is displayed
on the selected monitor.
Select the other monitor and then use the menu to select the 2x1 layout in Stack mode.
The layouts can now be seen on both monitors:
To assign a stack to a viewport, first select the viewport. In the example at right, the upper-left quadrant
of the left monitor is selected:
Note: If you are setting up a display protocol for a multi-modality such as CT/PT, it is important to
understand that stack definitions are configured for one modality each. You can still display
multiple modalities in the same display protocol, but you will need to select the modality
from the pulldown menu on the left, each time you configure a new viewport (see the
following figure). For more information about configuring multi-modalities, see "Modality"
on page 2-7.
From the CT - Cardiac stack definition group, select the stack that you would like to display in that
viewport. In this example, the topogram series is selected. The name of the stack definition is displayed in
the selected viewport.
Viewport Settings
On the right side of the Protocol tab, there is a list of settings that can be enabled for each viewport (see
Figure 2-28). As you configure the content of each viewport, you can also configure these settings to
determine the appearance and behavior of that viewport. The settings and their values are as follows:
Table 19: Viewport Settings
Setting Description (default values in bold text)

Skip this view if stack is not Do not display anything in this viewport if no match for the stack definition is
found found.
Enabled/Disabled
Zoom • 100% - The image is displayed in the original size of the DICOM
data.
• True size - The image is displayed in the real size of the patient.
• Quadrant view (fit) - The image is displayed to fit the screen.
Slice position • Ignore
• First - Display first slice on load.
• Middle - Display the middle numbered slice on load.
• Last - Display the last slice on load.
• Keep from last view
Initial Phase • First - Display the first phase when loaded.
• Last - Display the last phase when loaded.
• Number - Display a specific phase when loaded (entered in the
following setting).
Initial phase number Determines which phase to display when loaded. This setting becomes available
when the previous setting is Number. Any number is allowed, but if the number
entered is larger than the number of phases, the last phase is used.
Show MG CAD marker Show CAD markers on mammogram data.

Enabled/Disabled
Show Parametric Map Show the Parametric Map color overlay.

Enabled/Disabled
Allow same stack repeat Enabled/Disabled
Flip left and right Flip the image horizontally.

Enabled/Disabled
Flip top and bottom Flip the image vertically

Enabled/Disabled
Invert Invert the W/L values.

Enabled/Disabled
2D Blend mode • Original - Display in the original render mode.

• MIP - Display in MIP render mode.
• ThickMPR - Display in ThickMPR render mode.
2D Slab thickness Slab thickness of image when loaded.
Setting Description (default values in bold text)

Window Level Mode • None - No mode set. W/L info in DICOM header is used.
• Abd1, Abd2, Head, Lung, Bone. This is the preset list created in
the Window/Level Preset tab of the Viewer Configuration. Each
modality has its own presets (see "Window/Level Presets" on page
2-78).
• Custom - Use the following two settings to enter desired WW/
WL manually.
Window width Manual input for window/width
Window level Manual input for window/level
Cycle priors with mouse When enabled, the mouse wheel will cycle through prior studies rather than
wheel through the slices of the series in the active viewport.
Do not jump to next step Cycle through all of the priors before jumping to the next step in the protocol.
until you have priors
AQi work flow When AQi is configured to be launched from iReview, you can select a specific AQi
workflow here so that the study will be loaded into that workflow when AQi is
launched from this viewport. Click in the right column on this row to show a drop-
down menu of workflows.
Continue selecting viewports in the layout, and choosing a series to be displayed in each viewport. When
all viewports have been assigned a series, the display protocol layout looks similar to the following image:
Figure 2-28: Completed Display Protocol
Click OK to save the layouts.
Configuring a Display Protocol that Includes Prior Studies

You can configure a display protocol to show stacks from different studies in the timeline of the selected
study. When you are selecting stacks to go in each viewport, you must indicate which study contains the
desired stack.
This display protocol can include data from multiple modalities, but the protocol itself must be defined as
belonging to a single modality. That modality must match the modality of the study that will be loaded
from the Patient List (the “selected” study).
Current/Prior Overlay
You can configure the annotations to display the Current/Prior marker on each viewport.
Once the viewport annotations have been configured, the words “Current” and “Prior” will then be
displayed on each viewport. If there are two or more series from different prior studies loaded at the
same time, the priors will be sequentially numbered.
Instructions on how to configure the annotations for viewports are in the Viewer configuration section of
this chapter. See "Annotations" on page 2-48 for details.
Note: The Current/Prior marker must be added to the overlay for each relevant modality.
Example Display Protocol with Priors

To display a cardiac MR study that has three priors: an earlier cardiac MR study, a coronary CTA study, and
another MR study.
1. First, configure the stack groups in the same way you would for any other type of display protocol.
(See "Stack Definitions" on page 2-79 for instructions.)
Note: A stack group can contain only one modality.
2. Click the Display Protocols tab to create a new protocol.
3. Select the modality that matches the modality of the study that will be loaded from the Patient List,
and click Add. The Edit Display Protocol dialog is opened.
4. Name the protocol in the General tab.
5. Click the Protocol tab to configure the viewports.
a. Select a layout. (See "Define the Layout" on page 2-85 for instructions.) For this example,
the display protocol will have a 2x2 layout.
b. Click on the first viewport to be configured. In this example, the first stack will come from
the selected study and will be loaded into the upper-left viewport.
Viewport
c. Open the menu under Study, in the left panel. This menu contains selections that config-
ure the order in which studies are accessed in the timeline.
Note: Do not confuse the order of studies in the timeline with the order of series within a study.
This menu allows you to choose which study in the timeline will have a stack loaded into
the selected viewport.
d. Choose Selected from the menu (see image at right).
e. In the Stack menu below, choose the stack group that you configured for this display pro-
tocol (see image below).
f. Click a stack that belongs to the selected study. The stack is then associated with the
selected viewport:
There are three ways to determine which stack will go into the selected viewport:
• Prior by index
iReview creates an index of the prior studies in the timeline, and references them
sequentially. The Priors menu, located beneath the Study menu, contains a list of
numbers. Each number in succession corresponds to the following study in the timeline.
Note: This index refers to priors only. It does not include the selected study. When you select #1
from the menu, this refers to the first prior study. Prior studies are based on the date of
the selected study, and not on the date of the most current study in the Patient List.
Suppose, for example, that you have five related studies in the Patient List, as follows:
Study 1 (5/1/2010)
Study 2 (5/1/2011)
Study 3 (5/1/2012)
Study 4 (5/1/2013)
Study 5 (5/1/2015)
If you select Study 5 (the most current) to load, the priors’ indexes will be as follows:
Study 4 (5/1/2013) will have prior index #1

If you select Study 3 to load, the priors’ indexes will be as follows:

You can configure any prior study to be loaded into any of the viewports in your layout. If you do not
specify a stack to be loaded, the display protocol loads the first series into the viewport.
Configuring a Different Modality

To configure a stack from a different modality, you first need to access that modality in the stack list.
Currently the only modalities listed in the Stack menu are those that match the modality of the display
protocol.
1. Enter the name of the modality in the Modalities input box. If you are entering more
than one modality, separate them with a comma (but no spaces) in between. The
modalities named in this box then appear in the Stack menu.
2. Select the desired modality from the Stack menu.
Separate Indexes for Each Modality

Be aware that, when you configure priors by index in a multi-modality display protocol, iReview maintains
a separate index for each modality. This means that if you have, for example, three priors: an MR study, a
CT, and another MR, the first prior must be referenced as index #1, the second also as index #1 (because
it is a different modality), and finally, the third as index #2:
Selected Index #1 Index #1 Index #2

Study (for MR) (for CT) (for MR)
1. Configure the final viewport to show the older MR study. In this example, you would
need to reselect the MR stack group from the Stack menu, because that is where all
the MR stacks are listed.
2. Reselect Prior by Index from the Study menu.
3. Select prior index #2 from the Priors menu.
4. Select the desired stack from the Stack list.
5. Click OK to exit each configuration dialog.

The completed display protocol, shown below:
The loaded stacks, using this display protocol, are shown in the following image:
• Latest prior/oldest prior
You can select priors based on how recently the studies were performed. As with Prior by
Index, priors are accessed separately from the selected study.
1. To display priors, select a viewport and then select either latest Prior or oldest Prior
from the Study menu:
2. Select the stack group associated with this display protocol from the Stack menu.
3. Choose a stack to be displayed in the selected viewport (circled in the image at right).
If you want to display a stack from another modality, enter (type in) that modality in
the Modalities input box, and then select the stack group that contains the stack you
want to display. You can then choose the stack from the stack list below.
4. Configure the other viewports as desired.
Note: There can be any number of oldest Prior stacks, but only one latest Prior.
5. Click OK to save the display protocol.
• Prior by time
This option is used for when you know the study dates of the
stacks under examination, to within specific time intervals. The
priors are linked to viewports in the same ways they are in Prior
by index and Latest/Oldest Prior ordering. You can configure
different viewports to hold studies that are successively older
with each study.
For example, if you know that a certain exam is done annually,

you could load prior exams that are current, older than 1 year,
older than 2 years, and so on. The image at right shows the
Priors menu when Prior by time is selected from the Study
menu.
Show Only Relevant Priors

The Timeline tab is used to identify which prior studies are relevant to the selected study. Those studies
not tagged as relevant will not be shown in the timeline.
Note: If you want the display protocol to show all prior studies, you do not need to use this tab.
The Timeline configuration tab uses rule groups. These are configured somewhat differently from the
standard rule dialog. For more information on rule groups, see "Advanced Rules" on page 2-22.
All conditions on this tab are configured in the following way:
1. Use the pull-down menu on the left to select a DICOM tag to use as a search rule:
2. Enter a value to compare with corresponding values in loaded studies in the text box on the right (see
image below).
Studies that are opened into this display protocol will consider any prior study that has the word
“Relevant” in the Study description tag to be a relevant prior and the icon for that study will be displayed
in the timeline when any more recent, related study is loaded.
Cycling Through Priors

You can use display protocols to compare multiple prior studies with the selected study. This is not much
different from display protocols that have been configured to show the selected study in one view, and
priors in the others, except that this configuration uses only two views: the selected study in one, and the
priors in the others. It allows you to keep the selected study constant in one view, while cycling through
the priors for comparison.
Note: Before using the following instructions, it is recommended that you familiarize yourself
with the process of configuring display protocols that include prior studies. The section
that describes this in detail begins at "Configuring a Display Protocol that Includes Prior
Studies" on page 2-90.
Configuration
1. Configure the layout. In a dual monitor system, configure a 1x1 layout on each monitor. For a single
monitor, configure a 2x1 layout.
2. In the viewport that will show the selected study, pick Selected from the Study menu and configure
the stack filter for the viewport as you would with any other display protocol.
3. In the viewport that will contain the priors, select Prior by index from the Study menu, and assign the
first prior index #1. Configure the stack filter as you would with any other display protocol. The display
protocol automatically lines up all priors for the study by index.
There are two ways to cycle through the priors:
• Using the keyboard shortcut
The default shortcuts are defined in the Viewer>Appearance screen in the system configuration:
Table 20: Default Shortcuts in Viewer>Appearance Menu
Command Default Shortcut Key Description

DisplayProtocol.PriorNext CTRL+PageDown Cycle to the next prior
DisplayProtocol.PriorPrev CTRL+PageUp Cycle back to the previous prior
As with all default shortcut keys, you can assign any other key to either of these commands. (See
"Default Keyboard Shortcuts" on page A-1 for more information.)
• Using the mouse wheel
To use the mouse wheel for cycling through priors, you will need to enable a setting in the viewport
settings panel, located to the right of the display protocol layout. Click on the viewport you want to
configure (in this case, the Prior by index viewport). The settings panel will be redisplayed in regular
(not grayed-out) text, indicating that you can change the settings.
Check the box next to Cycle Priors with mouse wheel. The box displays a checkmark inside it and the
value changes to True.
Using either of these methods to cycle through the priors, as you step from one prior to the next, that
prior is displayed in the priors viewport. See the following image for an illustration of this process.
Prior #1 - Loaded initially
Prior #2 - First step in cycle
Prior #3 - Second step
Prior #4 - Third step
Selected
Study
Loading a Study
Load a study that meets the requirements configured in your display protocol. Each series should be
loaded into the two monitors as follows:
Figure 2-29: Left-hand Monitor, Configured for 2x2 Layout
Figure 2-30: Right-hand Monitor, Configured for 2x1 Layout
Integration
Configuring AQi Integration ...............................................................................................................2-102
Third-Party Application Launch..........................................................................................................2-106
These settings allow you to configure the iReview integration with the AqNET Thin Client and the iNtuition
Client (AQi), making it possible to launch those applications from iReview.
Figure 2-31: Thin Client Integration Settings
Configuring AQi Integration

The Aquarius iNtuition settings allow you to configure how the AQi client can be launched from iReview,
and what kind of access you will have to the database from AQi.
Figure 2-32: AQi Integration Settings
• Enable integration with Aquarius iNtuition
This setting must be enabled to launch AQi from iReview.
• Allow access to Aquarius iNtuition study list
This setting must also be enabled to launch AQi from iReview. When AQi is launched, you will be able
to access the study or series that is selected in iReview.
• Show in Patient List Toolbar
When a study is selected whose DICOM tags satisfy a rule created for Workflows, those Workflows
are displayed in the Patient List Toolbar:
The following settings are selected from a pulldown menu that determines the Workflow information
that will be displayed in each of the menus and toolbars listed below when a qualifying study or series
is selected. The selections are as follows:
• None
Workflow information is not displayed in the toolbar or menu currently being configured.
(In the following figure, the Viewer Toolbar is being configured.)
• Workflow
The Workflows that are available for the selected study or series are displayed in the
toolbar or menu currently being configured.
• Workflow Element
The Workflow Elements (WFEs) that make up the available Workflows are displayed
when you hover the mouse over the Workflow icon or menu item. You can select a
workflow element from the icons on the right, and the data will be opened in that WFE.
• Show in Viewer Iconbar
When the mouse is hovered over the 3D icon (located in the top-left corner of the iReview screen) a
menu is displayed that shows the workflows:
Viewer Iconbar
• Show in Viewer Toolbar
The Launch icon in the top toolbar shows the workflows in menu:
Viewer Toolbar
• Show in Patient List Context Menu
Workflows show in the right-click menu on selected series:
Context Menu
• Show in Viewer Context Menu
Workflows show in the right-click menu on the image:
Context Menu
Embedded AQi Integration

Embedded AQi means that when AQi is launched, it opens inside of the iReview window, rather than
creating a separate process and window. Embedded AQi must be enabled through a configuration file on
the iNtuition Server. Contact your system administrator if you need to have Embedded AQi enabled.
The configuration screen for Embedded AQi is similar to the non-embedded AQi configuration screen,
with a few exceptions:
Figure 2-33: Embedded AQi Configuration Screen
Setting Description
Application folder and filename The full pathname and executable name of AQi on your client sys-
tem.
Detected version The version number of the AQi client
Integration type • No integration - AQi cannot be launched from

iReview
• Launch process - Standard launch process, not
embedded
• Embedded integration -
Launch Aquarius iNtuition automatically (Present only when embedded integration is selected.)
in background
Screen Number which is used for Aquar- (Present only when embedded integration is selected.) Currently,
ius iNtuition the only selection is 1.
Note: You must restart iReview for these changes to take effect.
Third-Party Application Launch

You can configure other applications to be launched from iReview.
1. Click the Other tab to show the third-party integration screen.
Figure 2-34
Add a New Application
1. Click the Add icon.
2. Type in the name that will show in the right-click menus in the Patient List or Viewer.
3. Enter the full pathname of the application. This can be typed in manually, or you can click the browse
button ( ) on the right to navigate to the folder where the application resides. When you open
that folder, be sure to select the application file itself before clicking Open in the Windows Open
dialog.
Configure a Filter
1. Create a filter that specifies which studies or series, when selected, will allow the application to be
accessed. For example, the application might be intended for MR data only, so the filter should
specify that only MR studies can be opened in that application. To open the Edit Rule dialog, click the
pencil icon on the right.
The Edit Rule dialog is opened. For instructions on how to construct rules, see "Working With Rules"
on page 2-18.
2. Specify where you would like the application to appear. Check Show in Patient List if you want the
application name to appear in the right-click menu of relevant studies or series. Check Show in
Viewer if the application name should appear in the right-click menu on the image in the Viewer.
Command Line Arguments

Some applications require a specific set of information to be supplied when they are launched. In order to
launch this application successfully, you must enter this information here.
3. Enter the command-line arguments. You can type them in manually, or open the Edit Command Line
Arguments dialog by clicking the “...” button ( ) to the right.
This dialog allows you to add a variable to the command-line string. The value of each variable is
obtained from the selected data when you launch the application. In the example provided here, the
WebViewer application requires a URL that includes the Patient ID, the user name and the password.
Each argument requires a tag so that the application can identify which argument in the command
line each value belongs to. This application expects three tags: PID, l and p (Patient ID, Login name
and Password).
If your application needs a value that is not on this dialog, you can click the Dicom Tag button to open
another dialog that allows you to add any DICOM tag to the command-line string.
See "DICOM Tag Options" on page 2-39 for information about this screen.
4. If your application requires additional information such as where to get the data, you can insert a
value that provides the correct pointer. These arguments are located in the Download Options section
at the bottom of the Edit Command Line Arguments dialog. You can select the appropriate argument
from the menu:
• Folder containing the first DICOM file.
• Full file path of the first DICOM file.
• Full file path of the selected DICOM file.
• Root folder containing the downloaded data.
• File path of the DICOMDIR file.
5. If the application expects to find study data on your PC, check the Download Study box.
6. When you are finished entering information into the Edit Command Line Arguments dialog, click OK.
The application and its command-line string are now entered in the Command Line Arguments
section of the third-party application configuration tab (Other).
7. Add more command lines as needed, depending on the application.
8. When the configuration is complete for the application, click OK to save it.
Launching the Application

If the application has been configured to be accessible from the Study List, you can launch it by right-
clicking on a relevant study. The application display name will appear at the bottom of the right-click
menu:
Chapter 3 The Patient List

Topics in this chapter:
The Study List .....................................................................................................................................3-2

The Series List and Thumbnail List .....................................................................................................3-22
Study Management Tools...................................................................................................................3-28
Patient History....................................................................................................................................3-31
The Datasource Panel.........................................................................................................................3-32
The Task Log .......................................................................................................................................3-33
When you have successfully logged into the local server, the iReview Client opens the Patient List:
Study List
The Data Source Panel
(Folders, Filters, and
Remote nodes)
Study Management Icons
Series List
Patient History
Logs
Thumbnail preview
Figure 3-1 The Patient List Screen
Aquarius iReview User Guide The Patient List
The Study List

The Filter Bar......................................................................................................................................3-2

The Patient Information Row .............................................................................................................3-4
Viewing Local and Remote Data in the Study List ..............................................................................3-9
Resizing Components of the Patient List Screen ................................................................................3-21
The Filter Bar

There are two ways to create filters for displaying studies in the Patient List:
• In the Folder and Filters components (see "Chapter 2Folders" on page 2-31 and "Chapter 2Filters" on
page 2-29 for details).
• Using the top bar filters, located above each column in the Patient List.
Figure 3-2: Top Bar Filters (partial view)
To create filters for some of the columns, such as the Patient ID or Patient Name, text is entered in a text
input box. All studies whose corresponding column contains the string that was entered as filter text are
displayed. For example, if “AAA” is entered in the Patient Name text filter, all studies that contain the
string “AAA” in the Patient Name are displayed:
The filters for other columns are created using pull-down menus. These include the Date of Birth, the
range of Study Date and Time (start and end dates), Gender, Modalities and others.
Figure 3-3: Left - Modality Filter; Right - Gender Filter
Note: The modalities listed in the menu on the left, shown in Figure 3-3, include all modalities,
including custom and multi-modalities, that have been configured for display. For
information on customizing modalities, see "Chapter 2Modality" on page 2-7.
Enterig Dates
There are two ways to enter dates or date ranges. One is by selecting an item from the pulldown menu.
The Study Dates column allows you to select from several starting points of date ranges that end on the
current day; for example: studies done in the past day, the past week, the past month, and so on.
If none of the dates or date ranges available in the menu is appropriate for your needs, another way to
specify a date or date range is to use the calendar tool.
You can type the date (a single date, or the start and end dates of a range) in the input box. Or you can use
the forward and back arrows to select the month and year, and click on the date.
Change month Change year
Change date
Figure 3-4: Calendar Tool
After defining your filters, you can save them to use again. Click the yellow star in the top-left corner of
the Patient List to open a pull-down menu.
Save the filters as favorite Remove Filters
• Select Add current query to favorites to save the current filter. You can save up to eight
different filters.
• Select Save current query as default to set the current filter as the default.
• Select Reset to default query to revert to the default filter.
The Patient Information Row

The patient information row contains all the categories of information about the patient and the study,
such as the Patient ID, Patient Name, and Study Date.
Figure 3-5 Patient Information Row (partial image)
Right-Click Options
Right-click anywhere on the patient information row to open the menu. The menu contains the title of
each column in the Patient List. To display a column in the Patient List, check the corresponding box for
that column.
Below is a description of each column in the Patient List.
Note: You can rearrange the order of the columns in the Patient List (see "Change column order"
on page 3-6). Therefore, the order shown here might be different from the order on your
system.
The very first (leftmost) column in the patient list contains checkboxes that allow you to select studies.
This column cannot be moved.
• Read status
The Read Status icon indicates the stage of examination of the study. To update the status, right-click
the icon. A menu of options is opened, allowing you to change the read status. Select the appropriate
status. The icon in this column will change accordingly.
• View status
The View Status lets you know if anyone else has a study open. If someone else is working on that
study, you can find out how long that user has had it open, and on which host.
• Note
If any notes have been added to a study, the Note icon appears in this column. You can view the notes
by hovering the mouse over the icon.
• STAT
You can change the STAT setting to indicate that the study is urgent and should be given top priority.
Right-click on the STAT column in that row to set or remove the STAT icon.
Figure 3-6: Marked emergency status
• Publish status
You can modify the Publish status of a study. Right-click on the Publish icon and select Publish or
Unpublish.
• Number of frozen columns
This setting determines how many columns will remain frozen and displayed on the screen as you use
the slider to scroll toward the right. Unfrozen columns will disappear behind the frozen columns as
you move the slider rightward.
• Change column order
This option allows you to change the order of the columns in the Patient List. When you select this
item, a dialog is opened that shows the current order of the columns. To change the position of a
single column, click and drag it up or down to move it. You can continue to move columns until the
desired order is reached. Click OK to save the new order.
Note: Changing the order of the columns might affect which information will remain visible when
the Patient List is scrolled to the right. After changing the column order, make sure that the
currently selected number of frozen columns continues to keep the desired columns
visible.
• Save layout settings - Save the currently defined layout.

• Load layout settings - Load a saved layout.
• Reset layout settings - Reset to default layout settings.
Sorting the Study List

By default, the Study List is sorted on the Patient ID in ascending order. You can sort the Study List based
on the ascending or descending order of any column. Click the header of the column you want to use as a
basis for sorting, and the Patient List will be ordered according to the values in the chosen column. Click
the same header again to sort the list in reverse order.
Federated Query
Federated query is a mechanism that allows you to query multiple PACS and other systems efficiently. It
returns a list of all available studies or results throughout the system. You can then retrieve a study from a
specific source in a timely manner.
The DICOM Query List

The DICOM Query list is part of the Data Source panel, located in the upper-left section of the Patient List
(see "The Datasource Panel" on page 3-32 for a description of the panel).
To display studies from other connected DICOM servers, select one or more query nodes in the below the
DICOM Query header (see image at right).
To show data from another node together with local data in the Study List, right-click on the server name
and then choose List in All Images.
Figure 3-7: Change Federated Query
Nodes whose data is combined with local data in the Study List are displayed in bold text (see image at
right). Studies appearing in the Study List can come from the local server or any of the selected remote
nodes.
To reset the federated query back to the default for your user group, right-click on any node in this list
and select Reset federated query to default. This will remove any changes you have made to the query
(see Figure 3-7).
Date and Time Range

The default date+time range for queries that include remote nodes is Last 7 days. To change this range,
use the pulldown menu.
To reset the query range back to the default, click the star icon in the upper-left corner of the study list
and select Reset to default query.
The default itself can be changed in the Patient List configuration screen. See "Default QR Date Range" on
page 2-26 for instructions.
Viewing Local and Remote Data in the Study List

iReview provides the ability to select one or more DICOM query nodes so the Study List displays the
combined studies from all selected nodes, both local and remote.
Note: If the same study is found in the local database and a remote node, only the local study is
listed. To determine whether two studies are the same, the StudyInstanceUID and number
of series in each are compared. Both must be equal for the studies to be considered the
same.
When you click a study to load it into the Viewer, the behavior is the same whether the data is on the
local server or on a remote server. However, it might be helpful to determine easily where a study resides.
There are two features that allow you to do this.
The Datasource Column

The DataSource column in the Study List shows where the study resides:
In the case shown in the previous image, some of the studies listed are from the local database, indicated
by DB. Other studies are from a remote node, 490WIN2008R2_AE.
Using Color to Distinguish Data Source

By default, the text is colored black for studies in the local database, and blue for studies from remote
nodes. You can also configure the Patient List so that studies are listed in a different color for each remote
node. This is done in the Patientlist Configuration screen under Appearance. From there, you can create a
rule that checks the Datasource to determine which colors to apply.
See "Appearance" on page 2-27 for instructions on configuring the Patient List appearance.
Remote Studies in the Study History

Remote studies are shown in the study history, if the selected study has priors stored on any remote
servers. Remote studies in the study history do not have an icon.
Remote study
has no icon
Remote Series Icons

Remote series do not have icons available. A text-based generic icon, using only the modality name, is
shown to indicate that there is data available.
Datasource Shown in Tooltip

Hover the mouse over any study or series thumbnail icon to show the tooltip. The data source of the
images is listed in the series or study information:
Hover over thumbnail
Selecting Multiple Studies Simultaneously

When Federated Query is enabled, you will still be able to select multiple studies, but under certain
circumstances, some of the functions will not work. If one of the items selected causes a command to be
disabled, then that command is disabled for the entire selection.
For example, the Retrieve function is not visible for local data selections, and the Download function is
disabled when remote data is selected.
Therefore, if a multi-selection contains some remote studies and one local study, the Retrieve icon is
disabled for all of the data. If a multi-selection contains one remote study, the Download icon is disabled
for all selected studies, even if most of them are local.
If a multi-selection contains data from more than one patient, whether or not they are from the same
source, the Load icon is disabled.
Right-Click Options in the Study List
• Load
Load one study into the Viewer. If more than one study is selected, this item is disabled (grayed out).
• Add
Load one or more studies into the viewer.
If the Viewer is empty when Add is selected, the Viewer is automatically opened when the study is
loaded.
If data is already loaded when Add is selected, the Viewer is not automatically opened. You will need
to click the Viewer icon in the top right corner of the iReview application. The new study will be
loaded, and you will see the tab and icons for that study, but the focus will remain on the study that
had previously had the focus.
• Edit Keywords
Keywords are used to mark patients in the Study List as belonging to a defined category. The keywords
can be used for searches through the Study List for all patients identified by the keyword.
• Read status
Change the read status of the selected study.
• Anonymize study
This option allows you to anonymize the selected study, giving it a new patient name and ID, and then
saving it to a local drive, the AqNET server or a TeraRecon server.
• Download study
This option allows you to down the highlighted studies to your local drive. Optionally, you can include
DICOMDIR and Free viewer in the download.
Click OK to begin the download. The download progress bar, shown in the following image, is
displayed. If desired, click Run in background to continue working in iReview.
• Push study
This option allows you to push the selected studies to the selected remote servers.
• Delete study
This option is supported for privileged users. Locked items cannot be deleted and must be unlocked
prior to deletion. A pop-up menu will ask you to confirm if you want to unlock the study.
• Create study URL Link
Create a URL link for the selected studies to be viewed with the Thin Client, Web Viewer, AQi or iEMV.
Note: If this item is not visible in the right-click menu, that means your user group does not have
access to the Create URL Link feature. Please see your system administrator if you require
this feature.
• Import Files
Import DICOM and non-DICOM files to the iNtuition server. See "Importing Files" on page 3-15 for
details and instructions.
• Publish study
Publish selected studies for use by EMR and other applications.
• Save study info to file
Save the study info of the selected studies to a text file on your hard drive.
Importing Files
iReview provides the ability to import files from a storage device into the application, where the files are
then uploaded to the iNtuition Server. You can import both DICOM and non-DICOM files.
Importing DICOM Files

When importing DICOM files from another institution, it might be necessary to modify some of the
DICOM tags so that they match the naming conventions of your institution. In addition, you might not
require all of the data included in the import. The data consolidation dialog allows you to make these
changes.
The Import Tree

When DICOM data is imported, the Import Files dialog is opened:
Figure 3-8: The Import Files Dialog for DICOM Files
Description of the dialog:

• The left-side panel contains a list of all the files in the imported data. The files are
organized in a tree structure, with patient-specific data at the top, down to series-specific
data at the bottom level.
• The right-side panel is initially a copy of the left panel. This changes as you modify the
data.
• The middle panel is where you make changes, using the menus and text-input boxes:
• At the patient level, the modifiable tags include the patient ID, patient name, gender
and date of birth.
• The study level includes the modality, study date and study description.
• The series level includes the series number, modality, study date, series description
and number of images.
To change tags for a specific patient, study or series, click the line in the left panel that refers to the
portion of the study you need to change. For example, to change some of the tags in a particular series,
click that series line in the left panel. The input fields in the middle panel are activated for series-level tags
and deactivated for patient- and study-level changes.
Patient- and
Selected study-level tags
Series (not activated)
Series-level
tags (activated)
Import Options
At the top of the dialog there are several icons that determine where data will be imported from (see
Figure 3-8 on page 3-16). These are as follows:
• Open CD/DVD/USB
This scans external data sources for files and displays the results in the trees. If a DICOMDIR is
present, it will first try to build the tree from that. If multiple drives are available, a dialog is
displayed that allows you to select a specific drive.
• Add Directory
Searches the directory for DICOM files and integrates the results into the existing tree. If there are
any non-DICOM files in the directory, those files are not imported. A list of the files not imported
appears at the bottom of the dialog.
• Open Directory
Scans a directory for files and displays the results in the tree. If a DICOMDIR is present, iReview
attempts to build the tree from that first.
• Open DICOMDIR
Reads a DICOMDIR file and displays the results in the tree. If the DICOMDIR file is invalid, you
then have the option of scanning the directory manually.
To import a DICOM file using the right-click menu, select Import and then select Import DICOM Files.
The Import Files dialog opens. Initially, it is empty because no data has been selected yet. Use one of the
icons described in "Import Options" on page 3-17 to select files to import.
Note: When done, you must click Update to make your changes permanent. After you have
updated the data, the right panel will reflect your changes.
Importing Non-DICOM Files

When a non-DICOM file is imported, a DICOM header is constructed for it so that the file will appear to
AquariusNET as a DICOM file.
Select a file in the Study List or Series list and right-click. Select Import from the menu. A sub-menu is
opened:
When one of the three choices for non-DICOM files is selected, a dialog is opened where you can enter
information that will be saved to the newly created DICOM header. How much information is added
automatically and how much is user-defined depends on which item you selected from the sub-menu.
Note: If you select any of the Import Non-DICOM Files items from this menu, and then select a
DICOM file to import, a warning dialog is displayed, informing you that patient information
in the import might be updated to match the selected study. The dialog gives you a choice
between changing your import selection to Import DICOM Files, or exiting without
importing (see Figure 3-9).
Figure 3-9: About to Import DICOM Warning
• Create new patient - Patient information is left blank so that you can enter a new Patient
ID, Name, Gender and Date of birth. Study and series information also needs to be added.
• Create new study - The patient information is already added to the DICOM header. The
values were taken from the study that was selected when you opened the right-click
menu. This dialog allows you to enter study and series information.
• Add to study - Patient and study information have been taken from the selected study
and automatically added to the DICOM header. You can enter series information in this
dialog.
Drag and Drop

Another way to import files is to drag and drop the file from the local disk to the Patient List.
Drag-and-Drop DICOM Files

Drag a DICOM folder onto the Patient List. See Figure 3-10 on page 3-20:
Figure 3-10: Drag-and-drop DICOM Folder onto Patient List
The Import Files dialog is opened. The patient and study information in the dialog is already filled in,
because by dragging a DICOM folder, you have already selected the data. Modify the DICOM tags for
consolidation in the same way you would if using the right-click menu. See "Importing DICOM Files" on
page 3-15 for instructions.
Drag-and-Drop Non-DICOM Files

You can also drag a non-DICOM file to the Patient List to import it.
A dialog is opened to ask whether you want to create a new patient, new study or new series. Follow the
same directions that are found in "Importing Non-DICOM Files" on page 3-18.
Resizing Components of the Patient List Screen

To resize any component of the Patient List screen, hover the mouse over the double line that separates
one component from another. The mouse cursor changes to the resize icon (circled in the images below).
You can then move the boundary line up and down or left and right.
Changing the Column Width

The width of individual columns in the Patient List is configurable. Hover the mouse over the boundary
between two columns. The mouse cursor changes to the double-arrow icon shown in the following
image. Clicking and dragging the mouse changes the width of the column on the left. Dragging leftward
narrows the target column and dragging rightward widens it. You can then save the layout by selecting
Save layout settings from the right-click menu.
In the following image, the mouse is hovered over the boundary between the Patient ID and Patient
Name columns. The cursor has changed to the double-arrow icon. Clicking and dragging the mouse to the
left or right will affect the Patient ID column only.
The Series List and Thumbnail List

Features of the Series and Thumbnail Lists........................................................................................3-22

Right-click Options in the Series List ..................................................................................................3-25
Right-click Menu in the Thumbnail List ..............................................................................................3-27
The Series List displays all the series information for (one or more) selected study. The thumbnail list
displays all the series in thumbnails.
Features of the Series and Thumbnail Lists

Studies from different dates are displayed in separate rows, and scenes are also displayed separately.
When a series is selected, associated thumbnails are highlighted. If a series has multiple subseries, all the
subseries are displayed as separate thumbnails.
If all the subseries have the same image number, there will be only one thumbnail displayed with a label
containing the number of subseries times the number of images for each subseries in the same folder.
When you hover the mouse over the thumbnail, a small window with images and series information is
opened and all subseries are automatically played as a cine.
If a series has preprocessing results from AquariusAPS, the letter A is displayed to the left of the series
item in the list. If you hover the mouse over the letter A, it displays the APS results that are included in
this series.
Sorting the Series List

You can sort the Series List by clicking the header of the column you want to use as a basis for sorting. The
Series List will be ordered according to the values in the chosen column. Click the same header again to
sort the list in reverse order.
When the Series List is sorted, the thumbnails are also sorted in the same order. For example, suppose the
Series List is initially sorted in date and time order. If you then click the Series Number column header, the
thumbnails are also resorted in series number order.
Figure 3-11: Top - Thumbnails sorted by time/date; Bottom - sorted by series number
Non-DICOM Aux Files

iReview supports non-DICOM files that have been added to a study as Aux files, using the AquariusNET
Thin Client. The following image shows three Aux files attached to a study in the AqNET Thin Client:
These files are shown as series thumbnails in the Patient List:
Double-click on one of the thumbnails to open the file. The file will open in the application that has been
configured in Windows to open with that file’s extension.
Thumbnail Size
You can change the display size of the thumbnails representing the series and scenes in the selected study
(in the Patient List) or the loaded study (in the Viewer).
In the upper-right corner of the thumbmail icon bar there is a “resize” symbol:
Click the symbol to enlarge the thumbnails. Click again to enlarge the images again. The third click will
return the images to their originial size.
Right-click Options in the Series List

The following items in this menu are similar to those in the Study List right-click menu. See "Right-Click
Options in the Study List" on page 3-11 for information about corresponding functions in the Study List:
• Anonymize series
• Download series
• Push series
• Delete series
• Create series URL link
• Publish series
• Save series info to file
• Import
Menu items specific to the Series List are described below:
• Additional iNtuition 3D protocols
Select a Workflow and open the series in the AQi 3D Viewer.
• Lock/Unlock Series
Lock the series for the selected amount of time to prevent accidental deletion.
• Show DICOM Header

Display the DICOM header information for the selected series.
You can display the DICOM header for more than one series. Values for each series are listed in separate
columns. You can also view only those items that are different in each series by checking the Show only
differences box in the lower-left corner. You can also limit the display to only those items of interest by
using the filter at the top of the list:
You can copy the entire header to plain text or XML by clicking on Copy as text or Copy as XML,
respectively. Save as XML saves the DICOM header as an XML file on your hard drive. You can also right-
click on an individual line to copy it or its value.
Enter keywords in the filter field to display only the items that match the filter.
Click Show dictionary (located in the upper-right corner of the DICOM header display window) to show
the standard DICOM header information. This list can be narrowed down by group or by keywords.
Right-click Menu in the Thumbnail List

These are similar to other right-click menus in the Patient List.
Study Management Tools

The Study Management Icons are used to perform basic management functions such as searches,
downloads, anonymization and more. In addition, there are user-configurable Workflow icons used to
load studies in the AQi Client. All of these icons are located in the Patient List, between the Study List and
Series List (see Figure 3-1 on page 3-1).
Basic Management
This group of icons consists of basic management functions and are displayed by default. Below is a
description of each function.
• Refresh
Reloads the Study List. This will reflect any changes made to the list, such as imports or deletions,
since the previous time the list was loaded.
• Search
Allows you to search the Patient List based on attritbutes configured in the Search Filter. For detailed
information about searches, see "Searching the Patient List" on page 3-30.
• Push, Download, Anonymize, Import, and Load
Details about these functions can be found under "Right-Click Options in the Study List" on page 3-11.
Workflow Loading Icons

There are two kinds of workflows, 2D and 3D.
2D Workflows
The 2D workflows correspond to Display Protocols that have been configured in iReview. When a selected
study matches the rules in any Display Protocol, the name of the protocol appears in the 2D Workflows
group. You can choose any one of the workflows displayed. Click the desired workflow and the study is
loaded into the corresponding Display Protocol.
In the following figure, two Display Protocols have been configured to display CT studies. A CT modality is
the only criteria for the protocols. The selected study is also CT, so both workflows are shown:
If no 2D workflows are shown when you select a study, there are two possible reasons for this. One is that
the study does not match the rules of any Display Protocol currently configured. The other is that the
study matches the rules of only one Display Protocol. In that case, there is no need to display them,
because there is only one choice of workflow. Double-click the study to load it into that Display Protocol.
3D Workflows
You can configure iNtuition Workflows to load studies into the AQi Client, using a specific workflow in AQi.
By configuring rules that will compare specified values to the values of the corresponding tags in the
selected study, and then associating the rules with AQi workflows, you can make those workflows
available for studies that satisfy the rules. Then, when you select a study that satisfies the rules, the
selected workflows for those rules are displayed next to the Study Management icons:
When you select a study and click on one of the Workflow icons, the Aquarius iNtuition Client (AQi) is
launched, that study is loaded and the Workflow is opened. To see more AQi viewer loading options, click
on the More icon (to the right of the Workflow icons). When you click any of these icons for the AQi
viewer, the AQi Patient List is opened, showing only the selected study. You can load the study from AQi.
For information on how to configure Workflow rules, see "Workflows" on page 2-33.
Searching the Patient List

Opens a dialog where search filter rules can be entered.
Figure 3-12: Search Filter Dialog
The Search filter contains a list of DICOM tags commonly shown in some of the Patient List columns (for
example, the Modality column). When a search is being performed using this filter, studies in the
database are checked against the rules in the filter. If all specified fields in the filter match the
corresponding tags in a study, that study is a match, and will be shown in the Patient List.
Configure the search filter as follows:
1. For each DICOM tag that must be matched, select a comparator (for example: equals, not
equal, starts with, contains). Click the down-arrow in the input box of the tag to be
matched and select the comparator (see image at right).
2. Enter the DICOM value or values required for the match. Depending on the field, data
may be entered by typing, checking a checkbox or selecting an item from a menu.
Note: To find studies that match any or all of the words in a single tag, type each word on the
same line, separated by a space. To find studies that match an exact phrase or sequence of
words, enclose the entire group of words in single quotes. Searches are not case-sensitive.
3. Click OK when finished configuration.

Clicking any of the following icons activates the same function as selecting the corresponding item in the
right-click menu on the Study List (see "Right-Click Options in the Study List" on page 3-11 for a
description).
Patient History
When you select a study in the Study List, iReview searches the database and lists all relevant studies
having the same patient ID in the Study history list, located just below the Study Management icons
(shown below). You can then select additional studies from the Study history list and load them along
with the current study. They can all be viewed side by side for comparison.
Options in the right-click menu of the Study history list are similar to those in the Study List.
The Datasource Panel

The datasource panel is located on the left side of the iReview screen (see Figure 3-1 on page 3-1). Items
in this panel determine which subsets of the total data available are listed in the Patient List, and where
that data resides.
Elements of the Panel
Filters
Folders
Remote Servers
Figure 3-13: Folder and Filter Panel
• All images - List all available data.
• Filters - List all studies that satisfy the selected filter’s rules.
A filter is a set of rules that compare configured attributes (usually DICOM tags) with the
corresponding tags in the study. If the study matches the rule, then the study is displayed in the Study
List. Filters that are listed in this panel all have a search icon to the left of the name.
Note: If you are unable to access the contents of a filter, you might not have access rights to that
filter. See your system administrator if you need access.
• Folders - List studies that have been manually selected by the user.
A folder contains studies from the Study List that have been manually added to the folder. When you
click on that folder, only the studies in the folder are displayed in the Study List. Folders have a folder
icon to the left of the folder name. See Figure 3-13.
In the following example, the TDA study is being added to the Neuro folder by drag and drop:
The TDA study is then listed in the Patient List when that folder is selected.
Other than the All images filter (which lists all available data), the filters and folders in this list are
user-configured. For instructions on configuring Filters, see "Filters" on page 2-29. For instructions on
configuring Folders, see "Folders" on page 2-31.
• DICOM Query - A list of remote DICOM nodes from which data can be accessed. For more informa-
tion, see "The DICOM Query List" on page 3-7.
The Task Log

Tasks performed in the Patient List are logged in the Task Log component. This component is located in
the lower-left corner of the Patient List screen (see Figure 3-1 on page 3-1).
iReview logs the following DICOM tasks:
Table 1: Icons and Tasks
Icon Task Comments
Download Download data to local storage.
DICOM Retrieve Retrieve data from remote DICOM server.
DICOM Send Send data to remote DICOM server.
Import (DICOM Send) Imports are sent to the local server, so this is logged as a
DICOM Send.
Save Key Image (DICOM Send) Save Key Image sends the image to the local server, so this
is logged as a DICOM Send.
Save GSPS (DICOM Send) Save GSPS sends the current state information to the local
server. It is logged as a DICOM Send.
The log shows the current status of each task:
Filtering the Task Log

To see the status of a specific type of task, click the Filter icon and select the desired type of task.
In this example, download logs have been selected for filtering. The download logs are displayed. Hover
the mouse over an item in the list to see more information about that item.
Figure 3-14: Task Log
Chapter 4 The Viewer
Elements of the Viewer

The iNtuition Review (iReview) Viewer is where the main clinical examination and diagnosis is performed.
The Viewer consists of several principal components, each of which is labeled in Figure 4-1. Each
component label is referenced and described in the table that follows.
Clickable
Annotations
Right-click menu Viewports
Figure 4-1: The iNtuition Review Viewer
Descriptions of Viewer Elements

Viewports ...........................................................................................................................................4-2
Toolbar ...............................................................................................................................................4-2
Thumbnail Bar (Stacks).......................................................................................................................4-2
Clickable Annotations.........................................................................................................................4-3
Right-click menu.................................................................................................................................4-4
Aquarius iReview User Guide The Viewer
Patient History List .............................................................................................................................4-4

2D and 3D View Mode .......................................................................................................................4-5
Host Collaboration .............................................................................................................................4-6
Log Out...............................................................................................................................................4-6
Icons in the Top-Right of the Viewer ..................................................................................................4-6
Viewports
A viewport is a section of the main viewer where an image can be displayed. The number of viewports on
the screen depends on the layout chosen. In Figure 4-1, the layout is 2x2, so there are four viewports. In
the case of 1x1 layout, the entire main viewer is a single viewport.
Toolbar
The Toolbar icons activate many of the functions that are important for layout, image manipulation and
clinical review. These functions and many more are described in the following sections.
If you display iReview in a small screen, or if you are using Portrait mode, there might not be enough
room horizontally to display all the icons in the Toolbar. In that case, iReview displays as many icons as
there is room for. The remaining icons are displayed vertically. To see them, click the down-arrow at the
far right end of the Toolbar.
Thumbnail Bar (Stacks)

Each thumbnail represents a single series in the study. You can open a series into a viewport by double-
clicking on the thumbnail, or by drag-and-drop into the viewport. When prior studies are loaded, you can
click the thumbnail for one of the prior studies (or drag it to the Viewer), and the series from that study
are shown in the thumbnail bar. You can then drag individual stacks to different viewports in the Viewer.
Drag-and-Drop on Multi-Monitor Systems

There are two scenarios that occur when dragging a study or series onto a viewport using a multi-monitor
system.
• Dragging onto the primary monitor - If you drag-drop onto the primary monitor, the study or series
will display on all monitors, replacing any other data currently displayed on them.
• Dragging onto a non-primary monitor - If you drag-drop to a non-primary monitor, the study or series
will display only on that monitor. Content on other monitors will not be changed.
Image Caching Progress Bars

When a study is loaded, the images are cached to the local system. Depending on the size of the data files
and the size of the cache, this might take some time. The progress of the caching of each stack is indicated
by a bar at the top of the thumbnail.
Not cached Fully cached
Partially cached
If not all images are able to be cached at the same time because the data size is larger than available
cache space, you can increase the size of the cache in the user configuration screen. See "Chapter
2Display/Memory" on page 2-3 for more information.
Vertical Progress Bars for Caching

In addition to the progress bars at the top of the thumbnails, caching progress is also indicated by a
vertical bar along the right side of the viewport where the stack currently being cached is displayed. The
bar begins at the top of the scroll are and progresses downward.
The color and size of these progress bars is configurable.
Clickable Annotations
These annotations are displayed in green text to indicate that when they are clicked, a function or menu is
activated. Some of the menus might contain functions that are also available in the Top Toolbar. This gives
you the ability to choose which style of working is most convenient for you.
Right-click menu
When you place the mouse on a data image and click the right mouse button, a menu of functions is
displayed. As with the selectable annotations, there is some duplication of functions, allowing you to
choose the most convenient way to work.
Note: Not all functions are duplicated and some might be accessible in only one way.
Patient History List

There are three ways to show the patient history in the Viewer:
• Timeline - This is the default view. Studies (priors, or other related studies) are shown as thumbnails,
arranged horizontally just above the viewing windows.
• Listview with buttons - The studies are listed in a vertical list form, similar to the Patient List. You can
filter the studies by modality, by clicking on the desired modality icon on the right (see figure below).
To display the full list, click the same modality icon again to toggle it off.
The list shows the Modality, Study date and time, and Study description columns.
• Listview with filter bar - This is another list view, but instead of modality icons, the list is filtered using
the filter menus and input box at the top of each column. These are the same columns shown in the
Listview with buttons: Modality, Study date and time, and Study description. The filters work exactly
the same way the column filters work in the Patient List. See "Chapter 3The Filter Bar" on page 3-2 for
details.
Note: There are no column headers displayed to identify each column. Columns can be identified
by their contents.
To change the study history view, open the system configuration settings, click Viewer to open the Viewer
settings, and then click the Timeline tab. For configuration details, see "Chapter 2Timeline" on page 2-65.
Note: After configuring the patient history list view, you must restart iReview for the change to
take effect.
2D and 3D View Mode
• 2D view mode refers to the iReview Viewer. This is the default viewer when iReview is launched.
When a 3D client is running and in view, you can click the 2D icon to return to the iReview viewer.
• When the 3D icon is clicked, iReview launches a 3D VR client such as AQi, if one is configured. (See
"Chapter 2Configuring AQi Integration" on page 2-102 for instructions on how to configure AQi, and
"Chapter 2Third-Party Application Launch" on page 2-106 to configure another 3D viewer client.)
Host Collaboration
The Collaboration feature allows you to launch iNtuitionEMV (iEMV) from the Viewer in iReview. iEMV is
launched into your default browser and is connected to the server that you are connected to through
iReview. The image that is currently loaded in the active viewport is loaded into iEMV when it is launched.
Information about the state of the image (GSPS) when collaboration was started is applied to the image.
An email is automatically generated so that you can make the data available to someone who is working
remotely. The email contains a link to iEMV on your server. You will need to address the email by filling in
the To: field, and then send the message.
For instructions on using the Collaboration feature, see "Collaboration" on page 4-85.
Log Out
Click this icon to log out of iReview without exiting the application. The login screen is displayed
automatically. You can log into another account, or to another server.
Icons in the Top-Right of the Viewer

These are located above the Toolbar, on the right.
Table 1: Icons in the Top-Right of Viewer
Icon Description
This log keeps track of activity such as sending, downloading, importing and
Input/Output Log anonymizing data.
This displays all measurements that have been performed on all currently
Measurement Viewer loaded data. You can view a list of the measurements performed on all cur-
rently loaded patient data, or on all studies for the same patient, or only on the
current study or current series.
NOTE: These measurements will be deleted from the Measurement

Viewer when another study is loaded.
This allows you to print what is on the screen.
Print Icon
Navigating This Chapter

The topics covered in this chapter are grouped together by function. For example, the User Interface Tools
section describes the icons, menus and mouse operations needed to perform basic operations in the
Viewer. To find out how to set up layouts, protocols for scrolling through images, synchronization among
different views, displaying annotations and other functions related to the presentation of data, go to the
Presenting and Viewing Data section. The Clinical Modules section describes the specific clinical tools
available in the Viewer, such as Parametric Map or Registration.
User Interface Flexibility

To meet the needs and preferences of many different users, iReview provides more than one way to
perform most of the functions described in this chapter. For example, some functions can be accessed
using a right-click menu, a icon in the top toolbar, a clickable annotation or a keyboard shortcut. Each
function description lists all ways it can be accessed in the subsection titled How to Access This Function.
To find the section you need, turn to the page listed below. If you are viewing this manual online, you can
click the desired title:
User Interface Tools ...........................................................................................................................4-7

Presenting and Viewing Data .............................................................................................................4-21
Performing Measurements ................................................................................................................4-50
Output................................................................................................................................................4-81
Other Tools.........................................................................................................................................4-83
User Interface Tools

This section presents the basics of the Viewer’s user interface, such as the mouse functions, the icons on
the screen, icons, menus and annotations.
To find the section you need, turn to the page listed below. If you are viewing this manual online, you can
click the desired title:
Mouse Operations..............................................................................................................................4-7
Manipulating Images..........................................................................................................................4-12
The Series Thumbnail Panel ...............................................................................................................4-18
Mouse Operations
Hover the mouse over the Slice icon. The Mouse mode allows you to select the function of the left mouse
button.
You can also display this as a context menu by right-clicking on the image. Initially, only some of the
function symbols are displayed, at the top of the context menu. To see the entire menu, hover over the
right-arrow in the top-right corner of the context menu. (Figure 4-2)
The upper portion of the full menu contains the Mouse Mode section.
Figure 4-2 Left Mouse Settings
Mouse Mode Descriptions
• No Mode
In this mode, mouse clicks do not activate any iReview tool.
• Slice (Scroll)
• Single Phase (3D)
On a multi-image series, hold down the mouse button, and move up to scroll through the
slices toward the start point of the scan. Move down to scroll toward the end of the scan.
• Multiphase (4D)
When multi-phase, multi-slice images are loaded into a viewport, you can either scroll
through slices, or scroll through the phases within a single slice.
• Drag the mouse horizontally to scroll through the phases within a slice. Left-to-right
scrolls in a forward direction, and right-to-left scrolls backward. When you reach the
end of a set of phases, the display automatically advances to the next slice (left-to-
right), or the previous slice (right-to-left).
• Drag the mouse vertically to scroll through slices. This works the same way that
scrolling works with single-phase series. It does not advance to the next phase when
the end of the slices is reached.
You do not need to move the mouse in a precisely horizontal or vertical direction. The
viewport is divided into four sections by two (invisible) diagonal lines that cross in the
middle of the screen. If you scroll more or less horizontally within the range defined by
the diagonals, iReview responds as if you were moving exactly along a horizontal line. The
same is true for vertical scrolling. See the following diagram.
• Zoom
Click and hold the mouse, and then move up to make the image larger, down to make it smaller.
• Window/Level
Move the mouse up to make the image brighter, down to make it darker, left to give the image higher
contrast, and right for lower contrast.
• Pan
Click and hold, and then drag to move the image around in the window.
• Magnifier and Bright Light
When either Magnifier or Bright Light is selected, click and drag on the image to display a rectangle
on the image that magnifies or brightens, respectively, the area inside the rectangle. You can move
the rectangle around the image as desired. (Figure 4-3)
Magnifier
Bright
light
Figure 4-3 Magnifier and Bright Light
• Window/Level ROI
Change the WW/WL of the entire image using a ROI.
Click and drag the mouse on the image to draw a rectangle around the ROI. The WW/WL of the image
is changed, based on the pixel values inside the rectangle. The values are changed according to the
following formula:
new WW = (maximum pixel value inside ROI - minimum pixel value inside ROI) + 1
new WL = minimum pixel value inside ROI + (new WW / 2.0)
• Shutter
The shutter shows a narrow horizontal area of the image. Click and drag the mouse to show the
shutter area. You can move the shutter up and down to show different areas of the image. These two
figures show the shutter in two different places on the same image:
• Cine
Cine mode scrolls through slices as a movie. Select the Cine item from the menu and then click on the
image. To begin scrolling, move the mouse up or down.
Moving the mouse over the image while it is scrolling changes the speed. To increase the speed, move
the mouse up. To decrease, move down. As you approach the middle of the image (vertically), the
speed slows down to a stop, and if you continue moving the mouse in the same direction, the
scrolling reverses direction. There is no need to hold down the mouse while changing the speed or
direction. You can move the mouse just by hovering.
Click the image once to stop the cine.
• Triangulation: Two Methods
• Click-and-Drag
Click on the image and drag the mouse across an ROI. This triangulates but does not pan
the image. Related stacks are scrolled to the image that is closest to the location of the
mouse position.
Initial click position
Final position of mouse
Figure 4-4: Click-and-drag triangulation
In Figure 4-4 above, the screen capture on the left shows the four stacks in their initial
positions. The upper-left image is clicked on the starting point and dragged to the end
point, demonstrated by the red dotted arrow. This image does not pan, but the upper-
right and lower-left images are scrolled to their new positions. Two images change
because the drag direction is diagonal. If the mouse were dragged horizontally or
vertically, only one other image would be scrolled.
• Single Click
Click anywhere on an image, and the image is panned so that the click point is at the
center of the viewport. In the example below, the image on the left is on the right side of
the viewport. The triangulation cursor is in the center of the image (circled). The image
on the right has been panned so that the click point is now at the center of the viewport.
Figure 4-5: Single-click triangulation
Manipulating Images
These functions allow you to change how images appear on the screen, by altering the orientation, size,
color, overlays, and other changes to the appearance.
desired title:
Orientation.........................................................................................................................................4-12
Zoom ..................................................................................................................................................4-12
Color...................................................................................................................................................4-14
2D Image Format................................................................................................................................4-17
Show/Hide DICOM Overlays ..............................................................................................................4-17
Show Series ........................................................................................................................................4-31
Show Phase ........................................................................................................................................4-32
Window Level.....................................................................................................................................4-30
Orientation
There are four orientation functions:
• CW - Rotate 90 degrees Clockwise
• CCW - Rotate 90 degrees Counter-Clockwise
• Flip V - Vertical Flip
• Flip H - Horizontal Flip
How to Access This Function
• Top toolbar
In the Top Toolbar, click one of the icons in the Orientation group to perform the desired operation.
• Right-click menu - Select Orientation.
Zoom
iNtuitionReview (iReview) has three zoom options:
• 100% - The image is displayed in the original resolution. One pixel of the original image is displayed on
one pixel of the monitor.
• Fit - The image is zoomed to fit the viewport it is displayed in. The actual zoom percentage will vary
with each image.
• True - The system uses available information to approximate the physical size of the patient.
Note: If the monitor has not been calibrated, the True display size is not available. In that case,
the message shown in Figure 4-6 is displayed. For information on how to configure
calibration, see "Pixel size calibration" on page 2-16.
Each Zoom icon corresponds to one of the three types of zoom values: 100%, Fit, and True. When one of
the icons is clicked, that icon is displayed in the enabled state.
Figure 4-6: Fit Zoom Enabled
Note: The enabled/disabled state of the Zoom icons applies only to the currently selected
viewport.
If you zoom an image using another tool, such as the clickable annotation or the middle mouse button,
the zoom value may no longer correspond to the value of any of the preset zoom icons. In that case, all
three icons are displayed as disabled.
If two or more of the preset zoom icons have the same zoom value, both of those icons are displayed as
enabled.
• Top toolbar
In the Top Toolbar, click one of the icons in the Zoom group (see image at right) to perform the desired
operation.
• Clickable annotation - Click the Zoom annotation in the upper-right corner of the image.
• Right-click menu - Select Zoom.
Color
• Invert - Invert the color scale for the image. This applies to both grayscale and color
images.
Figure 4-7: Left - Original Grayscale; Right - Color Inverted
• Color - Apply the selected pseudo-color template to a grayscale image. (This also applies
to color images.)
To add customized color templates, click on Customize color templates. The color
template manager dialog is opened (see the image below):
Click the Add icon (circled in the image above). The add template dialog is opened. Type
in a name for the template in the Name field.
Figure 4-8: Add Template Dialog
You can now add colors to the template. Just under the color bar, there are two small
square markers, one at each end (circled in the previous image). To add another marker,
do the following:
1. Click on or just under the colorbar. A third marker is added under the colorbar. You
can move it to the position where you want the color to change.
2. To add a color, you can either change the RGB values in the corresponding fields
below the colorbar (see Figure 4-8), or double-click the marker. Double-clicking opens
the color palette:
3. Select a color from the Default colors tab, or click the Custom color tab to create your
own.
4. Click OK. That color is now added to the colorbar, starting at the marker:
5. You can continue adding markers and colors until the template is completed. When
done, click OK.
6. The new template is added to the bottom of the existing template list.
7. Click OK to exit the template editor.
• Top toolbar
Click one of the icons in the Color group to perform the desired operation.
2D Image Format
Display the image in one of three formats: the original format, MIP and ThickMPR.
• Clickable annotation - Click the Original annotation. A menu is opened to select another
rendering format:
Show/Hide DICOM Overlays

Show or hide DICOM overlays on the image.
Note: If the loaded data does not have any DICOM overlays, the Overlays menu item will be
hidden.
• Right-click menu - Select Overlays, then select Show overlays.
The following example shows a DICOM overlay used for dual energy scans. It is a circular outline that
shows the FOV of the energy source that is not shown in the image.
DICOM
Overlay
Select Hide Overlays to hide the overlay.
The Series Thumbnail Panel

Just beneath the Top Tool Bar, the studies and series currently loaded are displayed as thumbnails. The
name of each study is shown on a tab that contains the Patient ID, Patient Name, Study Date and
Description. To view a different study, click the corresponding tab.
Loaded Stacks
Study tab
Series Icons
Figure 4-9: Stack Thumbnail
Each thumbnail represents a single series in the study. You can open a series into a viewport by double-
clicking on the thumbnail, or by drag-and-drop into a viewport.
A colored border around a thumbnail indicates that the series is loaded into a viewport. A red border
indicates that the series is loaded into the active viewport (see thumbnails labeled “Loaded Stacks” in
Figure 4-9).
If there are too many thumbnails to be visible all at once, use the slider bar to scroll:
When you hover the mouse over the thumbnails, a tooltip containing detailed information about the
stack is displayed:
Remote Studies in Timeline

Remote studies are shown in the timeline, if the study loaded has priors stored on any remote servers.
Thumbnails in the timeline representing remote studies are shown in a blue font.
Remote Series Thumbnails

Remote series do not have thumbnails available. A text-based generic thumbnail, using only the modality
name as a label, is shown to indicate that there is series data available.
Show Relevant Priors

When a study is launched into a display protocol that is configured to display only relevant prior studies,
the timeline shows the thumbnails of relevant priors only:
To see all priors, right-click anywhere on the timeline and select Show All Priors in the menu.
If nothing is configured in the display protocol editor for relevant priors, then all priors for the current
study are visible in the timeline.
For information on how to configure a display protocol to show only relevant priors, see "Show Only
Relevant Priors" on page 2-98.
KIN Series
If a Key Image series has been saved in the study, a special thumbnail is shown in the thumbnail bar. You
can load this series into the viewer by either double-clicking the thumbnail or by drag-and-drop into the
viewer.
Thumbnail Size and Scroll Direction
Resizing Thumbnails
You can change the display size of the thumbnails that represent series and scenes in the currently loaded
study.
In the upper-right corner of the thumbnail bar there is a “resize” symbol:
Click the symbol to enlarge the thumbnails. Click a second time to enlarge the images again. The third
click will return the images to their original size.
Show/Hide the Thumbnail Bar

The Toggle Thumbnail Bar function allows you to show and hide the thumbnail bar as needed.
To hide the thumbnail bar, select the arrow to the left of the study tab, below the mouse tool selection
icon, and select Toggle Thumbnail Bar. The thumbnail bar will be hidden from view.
Figure 4-10: Hide the Thumbnail Bar
To show the thumbnail bar, select Toggle Thumbnail Bar again.
Changing the Scroll Direction

Right-click on the resize symbol to show the scroll menu. The images below show the position of the
scrollbar when Scroll left to right is selected (image on left), and when Scroll up/down is selected (right).
When Scroll up/down is selected, you can also select the number of rows, from one row to three, that
will be shown at one time.
Presenting and Viewing Data

This section describes how to set up your views and place images on the screen for the data presentation
you want.
desired title:
Layout.................................................................................................................................................4-22
Display protocol .................................................................................................................................4-25
Navigation ..........................................................................................................................................4-26
Localizer .............................................................................................................................................4-26
Sync ....................................................................................................................................................4-28
Cine ....................................................................................................................................................4-29
Scroll...................................................................................................................................................4-29
Annotations........................................................................................................................................4-30
Show Series ........................................................................................................................................4-31
Show Phase ........................................................................................................................................4-32
Key Image Note ..................................................................................................................................4-45
GSPS (Grayscale Softcopy Presentation State) ...................................................................................4-47
Layout
There are two kinds of layouts, Compare and Layout. Layout allows you to display images from different
series within a single study. Compare is used to compare different studies.
• Top toolbar
Click one of the icons in the Layout group (see image at right) to perform the desired operation.
Layouts in a Multi-Monitor Setting

In a multi-monitor display, you can change the layouts independently for each monitor. Each monitor that
is showing the Viewer has its own Layout icon on the toolbar (see the following figure). Each icon affects
only the monitor it is shown on.
Standard Layouts
Layout has three subgroups: Stack, Tile and 4D.
• Stack
The Stack layout is used to compare multiple series. Standard layouts are pictured in the dialog shown
in the following image. Each window of the layout is called a Viewport, which displays one series, or
stack.
Select a layout that provides a viewport for each series in the study.
• Tile
Tile mode is used to view slices from a single series. This way you can view multiple slices at the same
time. The 1 Localizer layout provides a localizer image in the upper-left viewport.
The Side by Side layout is used to view multiple slices from two series, side-by-side. SbS + 1 Localizer
provides a localizer image in each of the series’ upper-left viewport.
• 4D
The Time based 4D layout is used for viewing the contrast change over time in a single position.
Position based 4D is used to view a set of slices (for example, from the apex to the base in a heart)
within the same phase.
User-defined Layouts
The Select layout panel allows you to choose the dimensions of a desired layout of the same type. For
example, in the following image, dimensions will be chosen for a layout in single-series Tile mode.
To define the dimensions of the new layout, hover the mouse over the top-left square and move the
mouse across, down, or diagonally to the right and down through the squares, until the number of
squares in the desired dimensions has been marked. In the following image, the user is creating a 7x6
layout in Tile mode:
Changing Layouts
You can change layouts to accommodate more or fewer images on the screen. iReview will remember
which image was displayed in each viewport, so that if you change from a larger layout (more images) to a
smaller one, and then back to the larger one, the images in the larger layout are redisplayed correctly.
For example, if you display nine images in a 3x3 layout, and then change to a 2x2 layout, only the first four
images of the nine are displayed in the smaller layout. But if you then go back to the 3x3 layout, iReview
will remember what was displayed in each of the nine viewports before you changed to 2x2.
Note: iReview remembers only one previous layout. If you change layouts multiple times and
then change back to the initial layout, the display results are unpredictable.
Compare Mode
Compare mode is used to compare different studies at the same time. A dual monitor system (at the
minimum) is required to use this layout mode. Compare mode is used primarily when you want to load
two studies to be viewed side-by-side.
Note: If each study has a different modality, you must use compare mode to view them at the
same time.
There are two categories of layouts: 2 monitors combined and 2 monitors separated.
By default, the two screens are linked in the 2 monitors combined layout category. There is only one
layout choice in this category, Single study layout. If you choose a tile layout, you can see multiple images
from a single series displayed across the two monitors.
In the 2 monitors separated category, you can choose 1x1, 1x2, 2x1 or 2x2
layout, and display up to four studies on a single monitor. (Therefore, eight
studies is the maximum number of studies, total, that can be displayed on
two monitors.)
The synchronize layout icon links both screens when changing to a
Compare layout.
Display protocol
This tool allows you to step from one protocol step to the next (or the
previous) step.
• Top toolbar
In the Top Toolbar, click one of the icons in the Display Protocol group (see image at right) to perform
the desired operation.
Click the right-arrow to advance to the next step in the protocol (or the left-arrow to go back to the
previous step).
You can also use the Select protocol step panel to select a protocol step out of order. Click the down-
arrow to open this panel. Then click the desired protocol.
Navigation
This feature allows you to step from one image or group of images to the next. You can step through the
slices of a series, from one series to the next or from one phase to the next in a 4D image.
• Top toolbar
In the Top Toolbar, click one of the icons in the Navigation group (see image at right) to perform the
desired operation.
The function of each icon is as follows:

• Image - Navigate to the previous or next image in the same series.
• Stack - Navigate to the previous or next series in the same study.
• Phase (shown only when a multiphase study is loaded) - Navigate to the previous or next
phase in the same multiphase series.
Localizer
Select the display setting of the reference lines (cutlines) in the localizer image.
• No cutlines
Do not show any reference lines.
• First and last cutline
Show the first and last reference line, which bound the location of the start and end of the slices in
one of the perpendicular images.
• All cutlines
Show a reference line for each slice in the perpendicular image. Also show the movement of the
active line in a different color.
• Active cutline only
Show only the active reference line, which moves as the perpendicular image is scrolled through
slices.
Reference Line
Figure 4-11: Active Cutline (Reference Line) Only
Sync
The sync icons enable or disable the currently configured synchronization settings in the Synchronization
page of the Preferences. When a sync icon is disabled, all synchronization is disabled for the
corresponding data (study, series or phase).
• Top toolbar
In the Top Toolbar, click one of the icons in the Sync group to perform the desired operation.
The function of each icon is as follows:

• Studies - Enable/disable synchronization for images from different studies, for example,
when loading prior and current studies on the same patient.
• Series - Enable/disable synchronization for images from different series, for example,
when loading multiple series of the same exam.
• Phase - Enable/disable synchronization for images between multiple phases of a 4D
series.
You can change the setting temporarily by using these icons. This change remains in effect while the study
or series is loaded. Click the appropriate icon to toggle the synchronization on or off, for the desired sets
of data. For example, to disable synchronization of two series within a study, click the Series icon.
When synchronization is enabled, the icon has a light color and appears sunken. When it is disabled, the
color is darker and the icon appears flat. See Figure 4-12 below.
Figure 4-12: Series Synchronization Icons; Left: Enabled; Right: Disabled
To have greater control over different kinds of synchronization, you must configure the settings in the
Preferences. See "Synchronization" on page 2-57 for details.
Cine
Scroll through slices in a 2D series or play the phases of a multiphase image.
• Top toolbar
Use the Cine tool in the Top Toolbar. There are two Play icons in the Cine tool. The first (leftmost)
plays through the slices of a single series. The second Play icon plays a multiphase image as it changes
over time, while remaining in the same image position.
• Clickable annotation - The Cine tool is also available on the image as annotation. The top annotation
plays a 2D cine. The bottom annotation plays a 4D cine. The expanding arrows open a small dialog
(see the following image) containing extra controls, including one for speed.
Play slices
Multiphase
Scroll
Select the mode for scrolling in series images.
• Top toolbar - Use the Scroll icon.
The scroll option has two settings, single and multi.
• Single scroll - Scroll through one series only.

• Multi scroll - Scroll through all loaded series.
Annotations
Show or hide all annotations on images. The Standard annotation configuration is shown by default. If
Extended or Minimum annotations are also enabled, those will also show in the menu:
Length Limits on Annotation Text

If any of the text in the annotations (text overlay) overlaps any other overlay text, the text is truncated
and is followed by an ellipsis. This indicates that there is more text than what is showing on the image.
You can see all of the text by hovering the mouse over the truncated text. The full text is displayed in a
tooltip.
See "Annotations" on page 2-48 for instructions on configuring annotations.
Window Level
Select different options to apply to the Window Width and Window Level.
• Right-click menu - Select Window Level from the menu.
• Clickable annotation - Click on the W:<value> L:<value>annotation.

A menu is opened with the following items:
• Edit window level presets - Add, change or remove one of five preset W/L values.
• Linear - The standard linear curve.

• Sigmoid - Sigmoid uses an S-shaped curve for the Window/Level. The contrast then
appears more like an X-Ray film.
• Input Value - Arbitrary LUT stored in the DICOM files (often used with CR, DX and MG).
The curve is calculated and optimized on the scanner to provide the same perceived
image on the console, monitor and in print. You can select Input Value only if the LUT is
stored in the DICOM header.
• Full Range - Displays the full acquisition range of HU.
• Min-Max - Selects a Window/Level range that displays the image so that the full range of
HU values in the data can be seen.
• Invert - Invert the color scale for the image. This applies to both grayscale and color
images.
• Reset - Return to the color values at load time.
Keyboard Shortcuts for W/L Presets

W/L presets are accessed by typing the numbers 1 through 5 on either the keyboard or the numpad.
Note: If you use the numpad, make sure that the Num Lock is enabled.
Figure 4-13: Example W/L Presets - Left: Preset 1; Right: Preset 4
The keyboard shortcuts can be changed or removed. For instructions on changing default keyboard
shortcuts, see Appendix A: "Default Keyboard Shortcuts".
Show Series
Show a selected series from the current study.
To view a series, click on the thumbnail that has the desired series number.
• Clickable annotation - Click the Se:<number> annotation in the image:
A window is opened containing a set of thumbnails, one for each series in the study:
Show Phase
Show another phase of the currently loaded series.
• Clickable annotation - Click the T<number/total> annotation in the image. A list of phases in the
series is displayed:
Select another phase of the 4D image to display.
Register
The Register tool is used to align all currently displayed data.
• Click the Register icon in the Top Toolbar.
Warning: When registration is completed, the following message dialog is displayed: “Automatic
registration is finished. Please verify the slices are better aligned. If anything is wrong,
please synchronize the position manually.” Click OK to dismiss the message.
Parametric Map
Parametric Map is a color-coded visualization of the change in intensity over time.
Note: The ability to view Parametric Maps is available only if you have purchased Advanced
Processing (APS). Parametric Map is optional and requires a separate license. Please refer
to the AquariusAPS iNtuition Edition user manual for the Indications for Use.
Warning: Default values used to display the parametric map are generic and have no significant
meaning. Please adjust the threshold from the slider bar.
• Top toolbar - To see the parametric map, click the PMAP icon.
To analyze the time-density curve, two thresholds are used in the Parametric Map module. One is the
uptake value, which describes how fast the intensity changes between the pre-contrast and peak phases
(also known as the initial phase). It is usually the case (depending on the scanning protocol, scanner, and
contrast media used), that areas with wash-in below 40-60% can be ignored. This threshold is set using
the uptake bar.
The second map shows the speed of the contrast washing out, also called the delayed phase. Each post
phase pixel (post phases are identified by comparing the last post enhancement phase to the pre-contrast
phase) is divided by the peak phase (first post-enhancement phase compared with the pre-contrast
phase), to derive the difference in intensity for that pixel. There are three possible results:
• Type I: The pixel intensity has increased gradually.
• Type II: The pixel intensity has not changed.
• Type III: The pixel intensity has decreased gradually.

Each of these three types is represented by a different color. By default, Type I is represented by blue,
Type III by red, and Type II by the rainbow in the middle. There is no official standard that defines the
percentage borders between each of the 3 types. By default, the border between Type I and Type II is set
to 20% in iReview. This means that an increase in contrast of 20% or more is shown with the blue overlay,
a decrease of 20% or more is shown with red, and values in between use the rainbow overlay. These
borders can be changed, as can the colors themselves.
Setting the Uptake and Color Map

The uptake bar and color bar are displayed on left and right sides, respectively, of the image. These
determine the colors used to show the changes in intensity during the delayed phase:
Uptake bar Color bar
Figure 4-14: Parametric Map
The Color Bar

The color bar shown in Figure 4-14 controls the color map of the delayed phase. There are three color
areas, one for each type of change. Between each pair of adjacent colors is a slider that allows you to
change the percentage border for both colors.
To change the percentage border between two colors, click and drag the slider up or down (see Figure 4-
15 on page 4-35). For example, to lower the threshold between the Type I and Type II colors, drag the
upper slider downward. As this threshold is lowered, the amount of the Type I color will be increased on
the image.
Type I
Percentage
border sliders Type II
Type III
Figure 4-15: Color Bar
To change the colors used for the delayed phase, do the following:
1. Click the color bar. A menu is opened:
2. The alternate color maps are shown under the Rainbow color map. Click a different color map to
select it.
The following images show (from left to right) how the Red/Green/Blue, Red/Blue/Green and Red/Yellow/
Blue color maps highlight different uptake rates:
The Uptake Bar
The Uptake bar allows you to control how much color overlay to show
on the image.
Drag the threshold slider up and down to increase or decrease the
percentage threshold at which color is shown on the image. Any pixel
Threshold
whose percentage change is below the threshold will not show any
slider
color.
A lower threshold allows more color to be displayed. This makes it less
likely that diseased tissue will be missed, but there will also be more
noise on the image. The Uptake bar allows you to try different
percentages until the amount of color suits your needs.
The Initial Phase Bar

To access the initial phase bar, click the color bar to display the menu.
Then click Initial Rainbow, at the top of the menu:
The Initial Phase bar is then displayed on the left side of the viewer. The color map for the initial phase is
displayed on the image:
You can use the sliders to change the borders between the colors, as described in "The Color Bar" on page
4-34. However, no other colors are available for the initial phase. Note that the percentage ranges on this
bar are different from those on the delayed phase color bar.
Save and Reset

These items appear at the bottom of the menu.
Select Save to make the current color map the default map for future studies. If you change the colors or
the borders between colors in the color map and then save it, the saved color scheme is used by default
the next time a study containing Parametric Map APS data is loaded.
Select Reset to restore the original default color map (Delayed Rainbow).
CAD
This is an image display feature of pre-processed CAD markers.
Note: This is not a CAD processing feature. The pre-processed CAD markers are displayed on the
image.
Top toolbar - Click the CAD icon.
• iCAD SecondLook® software
For the CAD algorithm design, function, processing steps, classifiers, reference standard, scoring
methodology and image review method refer to the iCAD SecondLook Instructions for Use.
Calcification cluster
High-density area
• Ellipse markers identify a high-density area.
• Rectangular markers identify a calcification cluster.
Warning: For safe and effective use of this CAD marker display feature, review the iCAD
SecondLook Instructions for Use prior to use.
• Hologic R2 Software
Viewing Mammographic Data

iReview supports all DICOM format images, including mammographic data. However, MG images require
high resolution monitors. You can configure a display protocol to display the MG data in the way it is
normally viewed. See "Display Protocols" on page 2-82 for information.
Dotted White Line

When an image is panned or zoomed so that part of it is not displayed in the viewport, a dotted white line
is displayed along the edge or edges of the viewport to show that there is more data beyond those edges.
In the previous figure, the image on the left shows the entire image of mammographic data. Since the
entire image is visible, there are no dotted lines along any of the viewport's edges. The figure on the right
is zoomed in to a size that is larger than the viewport, so part of the image is not visible. In this example,
all four edges of the viewport have dotted lines because the image extends beyond each of those borders.
To see the rest of the data at the current size, pan the image so that the hidden data is shown in the
viewport. When all of the image that is outside that edge of the viewport becomes visible, the dotted line
on that edge disappears.
Quadrant View
Quadrant view allows you to display portions of the image at that size, in such a way that it is easy to
navigate around the image and view all sections.
This image shows mammographic data at original size:
To see the image in quadrant view, type the W key (the keyboard shortcut). Typing W once shows the first
(upper-left) quadrant on the entire screen. Continue to type the W key to cycle through each quadrant.
When viewing multiple images with a mirrored orientation, quadrant view displays the same field of view
from each side of the "mirror" in each quadrant.
The images below show each of the four quadrant views in the same image (as shown above).
Vertical Alignment
Left and right breast images are vertically aligned automatically.
Automatic vertical alignment is available in the following cases:
• When only one stack is displayed
• When an extra stack is loaded into a viewport via drag-and-drop
Note: Only a newly loaded stack is realigned. However, all valid stacks will be aligned if the study
is reloaded.
The stacks will not automatically be realigned if:
• The layout is changed while a study is loaded
• Zoom, Pan, Orientation, or Flipping is performed on the image

To set the desired parameters for chest alignment, see "View Options" on page 2-74.
Dark Mode
Dark mode removes everything from the iReview screen except the image itself. This removes all
extraneous sources of light on the screen.
To enable dark mode, type CTRL-E. This key toggles dark mode on and off.
Note: If you need to access any iReview tools or thumbnails located in the darkened section at
the top of the screen, hover the mouse in that area, and it will become temporarily visible.
The section disappears again when you move the mouse out of that area.
Localizer for 2D and Tomosynthesis Images

A localizer icon is displayed in the viewport where a tomo series has been loaded. The icon contains a
reference line that moves through the icon image as you scroll through the series images.
Reference
Line
The localizer icon is always placed on the opposite side of the viewport from the breast.
Viewing ECG Waveforms

iReview provides the ability to view 12-lead ECG objects and General ECG object waveforms with a grid
background.
The black bar located under the thumbnail bar contains menus that allow you to reconfigure some
aspects of the display of the waveforms, such as the layout or the scale. To access a menu, click the green
triangle to the right of the desired attribute.
If the loaded data has multiple multiplex groups, you can select a different group.
If not all the data is visible, scroll the waveform using the scrollbar that appears on the right end of the
bar. (See image below.)
Select group Select layout Change scale Scrollbar
A single square in the grid is equivalent to 1mm for both the vertical (amplitude) and horizontal (time)
axes.
Note: Mouse operations and measurements are disabled in ECG view.
Loading and Viewing Multiple Studies

It is possible to load many studies at once into the viewer. The studies are automatically separated into
multiple study tabs. You can then move quickly from one tab to the next, after completing the
examination of a study.
Selecting a New Tab

There are three ways to access the other studies in the viewer:
• Keyboard shortcut
You can use keyboard shortcuts to step sequentially from one tab to the next. The default shortcuts
are defined in the Viewer->Appearance configuration screen (see the following image). The Tab key is
configured to step forward one tab in the row of study tabs. Shift+Tab steps back one tab. However,
you can reconfigure any key you choose to perform the same function. See "Appearance" on page 2-
43 for more information about configuring keyboard shortcuts.
When the shortcut keys are configured as shown in the image above, you can step to the next tab
using the Tab key, or to the previous tab using Shift+Tab:
Tab Tab Tab
• Click on desired tab
To view a different study, click on the tab for the desired study.
• Down-arrow menu
You can also select a study using the pulldown menu that opens when you click the down-arrow at
the far-left end of the tab row:
Figure 4-16: Study Tab Menu
Arrow Indicating More Tabs

When there are more studies loaded than there is room to display all the corresponding tabs, a right-
arrow is displayed next to the far-right edge of the iReview screen (see image at right). This arrow
indicates that there are additional tabs that are not visible. Click the arrow to see a list of all tabs,
including hidden tabs.
Closing Studies
There are two ways to close studies:
• Click the “X” on the right end of the tab that is open. This closes only the currently displayed study.
• Click the down-arrow to the left of all the tabs and select Close All from the menu. (See Figure 4-16
on page 4-44.) This closes all studies, and returns to the Patient List. You can also use a shortcut key to
close all tabs. The default is Alt+X, but you can change the key configuration if desired. See Appendix
A: "Default Keyboard Shortcuts" for information.
Key Image Note

Key Image Note (KIN) allows you to flag certain images as significant for further examination, referral, or
other purposes. You can then create notes and link them to the study.
• Top toolbar - Click the Save KIN icon.
• Right-click menu on image - Select Mark as KIN.
Marking an Image as KIN

To mark an image as KIN, right-click the image and select Mark as KIN from the menu.
You can also use the keyboard shortcut K, which toggles the marking and unmarking of an images a KIN.
Make sure that the keyboard shortcut profile currently in use is properly configured. See Appendix A:
"Default Keyboard Shortcuts" for information about using and configuring keyboard shortcuts.
In addition, depending on your configuration, any image on which you have performed a measurement,
or have added text or an arrow, will automatically be marked as KIN. See "GSPS and KIN" on page 2-77 for
information on how to configure iReview to mark an image as KIN automatically.
When an image has been marked as KIN, an annotation is added to the upper-right corner of the viewport
in which the image is displayed. This annotation is added only to slices that have been marked as KIN.
Saving KIN Images

The image is saved as a series when Save KIN (in the top toolbar) is clicked. The Save Key Images dialog is
opened:
Figure 4-17: Save Key Images Dialog
Note: If you have configured the viewer to save measurements and key images when a tab is
closed, you do not need to click the Save KIN icon. They are saved automatically. See "GSPS
and KIN" on page 2-77 for details.
1. Select the relevant document title from the menu:
Figure 4-18: Document Titles for KIN Series
Note: All Key Images having the same document title are saved as a single series. The series is
identified by a single series in the thumbnail list.
2. Enter a description for the key images (optional). This will appear in the annotations when the key
image series is loaded into the Viewer.
3. Enter a series description (optional). This will appear in the series description column of the Series
List.
4. Check the Append to existing series box if you want the key image series to be appended to an
existing series. If this is not checked, the key image series is saved as a separate series.
Remove KIN Images

If an image has been marked as KIN and you would like to unmark it, right-click on the image and select
Remove KIN from the menu.
DICOM Send
After the KIN series is created and saved, it is sent to the server you are connected to and will appear in
the series list as it is being received. You can view the progress in the series list:
Figure 4-19: KIN Series DICOM Send
The timer icon on the left of each row shows how much has been received (black). When the send is
completed, a new thumbnail appears in the thumbnail bar.
You can also check the task log, in the lower-left of the iReview screen (see Figure 3-14 on page 3-34).
When this series is loaded, the description you entered in the Save Key Images dialog (see Figure 4-17 on
page 4-46) is now shown in the annotation in the upper-right section of the image. The image is also
identified in the annotation as a Key Image.
Saving Multiple Images at One Time

You can also mark any number of images from multiple series, and then save them all together in one
Save KIN operation. All images that are marked as Key images at the time of the save are saved together
as a single series.
GSPS (Grayscale Softcopy Presentation State)

The Grayscale Softcopy Presentation State captures image manipulations such as W/L, zoom, flip, rotate,
measurements performed, or annotation text added to a loaded series. After you have created a
presentation image from the series, you can save the set of changes you have applied to the image so that
it can be applied again later to show the presentation state of the series.
Saving GSPS
The Save GSPS function creates a new series for each original series that is currently open in the viewer.
The GSPS series has a modality of PR, and will be saved to the Series List. The series number starts at 9000
for GSPS.
Figure 4-20: GSPS Saved in Series List
Note: It might take a few minutes for the GSPS series to be saved on your system. The Logs
window on the Patient List screen shows the progress of the data transfer (see Figure 3-1
on page 3-1).
• Top toolbar
Click the Save GSPS icon.
• Right-click menu - Select GSPS and then Save from the menu.
Both of these operations open the Save GSPS dialog.
• Presentation Description - Text entered in this box identifies the specific set of operations that have
been performed on this image prior to opening this dialog. The same text is shown in the right-click
menu under GSPS.
• Series Description - This is displayed in the Series Description column in the Series List.
Operations That Can Be Saved With GSPS

The following image operations can be saved using GSPS:
• Zoom, Orientation, Window/Level
• Magnification, Display Shutters, Size (Fit, True or 100%)
• Horizontal Flip
• Overlays
• Measurements:
• Distance
• Ellipse
• Oblique Ellipse
• Circle
• Polygon
• Arrow or Text Annotation
Applying GSPS
Once a GSPS has been saved on a series, it can be applied to that same series later.
Right-click on the image and select GSPS from the menu. This opens a sub-menu where you can choose
which GSPS to apply.
Saved GSPS
Note: If no GSPS is listed in the sub-menu, then no GSPS were saved for that series.
Figure 4-21: Left: Before “Measurements” GSPS applied

Right: After GSPS Applied
You can also configure the Viewer so that GSPS is applied automatically when appropriate data is loaded.
See "View Options" on page 2-74 for more information. When GSPS is applied automatically on load, this
state is indicated by an annotation, located in the lower-right corner of the image.
Performing Measurements
This section describes the different types of measurements that are available in iReview.

You can access the measurement features in either of the following ways:
• Top toolbar - Hover the mouse over the Slice icon, on the left end of the Top Toolbar. The measure-
ment menu is opened below the Slice icon.
• Right-click (context) menu - When the menu opens, hover over the right-arrow in the upper-right cor-
ner of the right-click menu to open the measurement menu (see figure below).
Measurement Properties
Every type of measurement has a set of properties that can be modified when needed. To see the
properties of a measurement, right-click on the measurement result and select Properties from the pull-
down menu.
All measurement types share a few common properties. For any measurement, you can configure:
• Color - The color of the box that contains the measurement results.
• Background color - The background color inside the box that contains the results. If a color is chosen,
the image will not be visible beneath the measurement. You can choose Transparent to show the
image through the box.
• Width - The width of any lines drawn on the image, such as an arrow, or the box drawn around the
results.
• Label - Text added to label the result.
Many measurement types also share these properties:
Intensity Mean - The mean value of the intensity of all pixels inside the bounded area
Intensity Minimum - The minimum intensity value of all pixels inside the bounded area
Intensity Maximum - The minimum intensity value of all pixels inside the bounded area
Intensity Standard Deviation -
Each measurement type also has its own set of properties that are relevant to its function.
Measurement Descriptions
The following is a description of each type of measurement used in the Viewer. To find the section you
need, turn to the page listed below. If you are viewing this manual online, you can click the desired title:
Pen .....................................................................................................................................................4-53
Distance..............................................................................................................................................4-53
Line Segment......................................................................................................................................4-54
Ellipse .................................................................................................................................................4-54
Oblique Ellipse ...................................................................................................................................4-55
Circle ..................................................................................................................................................4-57
Polygon...............................................................................................................................................4-57
TT-TG Distance Measurement............................................................................................................4-57
Ratio ...................................................................................................................................................4-60
Parallel Ratio ......................................................................................................................................4-61
Pelvis Swing........................................................................................................................................4-61
Center Angle.......................................................................................................................................4-62
Angle ..................................................................................................................................................4-64
Cobb Angle .........................................................................................................................................4-65
Spine Labeling ....................................................................................................................................4-67
Vertebra Size ......................................................................................................................................4-68

Arrows and Text .................................................................................................................................4-70
Intensity .............................................................................................................................................4-72
Time-Intensity Measurement.............................................................................................................4-75
The Measurement Viewer..................................................................................................................4-77
Pen
This is a freehand drawing tool that allows you to draw any shape on an image.
Note: This feature allows you to freehand draw on the image. It does not calculate any
measurement, and is used for collaboration. See "Host Collaboration" on page 4-6 for
more details.
1. Click on the image near the area to be identified, and hold the mouse button down.
2. Draw any shape on the image; for example, draw a circle around the area to be identified.
3. Release the mouse button when you are finished.
Pen drawing is automatically run in continuous mode, meaning that even after
you are done drawing, the mouse is still in pen mode, and will begin drawing if
you click the mouse button again.
Figure 4-22: Freehand Drawing in Pen Mode

(Left: In Progress; Right: Completed)
Distance
This feature calculates the distance of a line drawn on the image.
To draw a line, do the following:
1. Click on one edge of the area to be measured.
2. Drag the mouse across the area.
3. Release the mouse to finish drawing.
Properties
Length - Unit of measurement used to express the length.
Line Segment
This allows you to draw a series of connected line segments by clicking on the image, moving the mouse
to another point on the image, and clicking again at a new point, repeating those actions as many times as
required. The measurement given is the sum of the lengths of all line segments on the image.
To place a Line Segment measuring tool onto an image, do the following:
2. Move the mouse to the endpoint of that segment.
3. Click on that point to complete the line segment.
4. Repeat steps 1-3 to draw a new line segment, as many times as needed.
Double-click to finish drawing.
Properties
Length - Unit of measurement used to express the length.
Ellipse
This feature calculates the average HU value within an area, defined by the ellipse drawn on the image
(see the figure at right).
To draw an ellipse, do the following:
2. Drag the mouse across the area to be measured.
3. Release the mouse to finish drawing.
Properties
Area - Unit of measurement used to express the area inside the ellipse
Circumference - The length around the edge of the ellipse
Oblique Ellipse
This feature calculates the area of the ROI, the maximum and minimum intensity values within the ROI,
the mean intensity, the standard deviation, the lengths of the major and minor axes that define the
ellipse, and the circumference of the ROI.
To draw an oblique ellipse, do the following:
1. Click on the edge of the area you are going to measure.
2. Release the mouse.
3. Draw a line across the area to the opposite edge. You do not need to click the mouse
again to draw the line.
Line Drawn
4. Click the mouse when finished drawing the line.
5. Move the mouse in a direction different from the line just drawn. The ellipse will expand
in the perpendicular direction.
Second
Line Drawn
Initial Line
6. Click when done drawing the ellipse.

You can modify the ellipse after completing the initial drawing to get a more accurate measurement.
Resizing the Ellipse

There are eight control points on the rectangular box that bounds the ellipse. When you hover the mouse
over any of these control points, the cursor becomes a plus (‘+’) sign. These points allow you to resize and
reshape the ellipse.
Four of the control points are on the midpoint of each side of the box that bounds the ellipse. Click on any
of these control points to widen or narrow the ellipse (see figure below).
Note: Moving any of these control points will also move the control point on the opposite side of
the bounding box, in the opposite direction.
The other four control points are at each of the corners of the bounding box. These allow you to make
minor adjustments to the shape of the ellipse.
Rotating the Ellipse

The midpoint control points also allow you to rotate the ellipse about the center. Click on
any of these and move the mouse in a clockwise or counterclockwise direction. While
rotating, you can also change the size.
Two of the midpoint control point have green dots next to them. Hovering the mouse
over the green dots changes the cursor to a rotation symbol. If you use one of these
points to rotate the ellipse, you cannot change the size of the ellipse. This is useful for keeping the size
stable while moving the mouse around.
Circle
1. Click the center of the ROI and move the mouse in any direction.
2. Click again when the region of interest is encircled.
Properties
Edit Mode - Begin drawing from the edge of the circle (point-to-point) or from the center.
Area - Unit of measurement used to express the area inside the circle
Circumference - The length around the edge of the circle
Diameter - The distance across the center of the circle
Polygon
Polygon allows you to draw an outline around a region of interest by clicking on the image, moving the
mouse to another point on the image, and clicking again at a new point, repeating those actions as many
times as required.
To measure the region of interest, do the following:
2. Move the mouse to the endpoint of the segment.
3. Click on that point to complete the line segment.
4. Repeat steps 1-3 to draw a new segment of the polygon, as many times as needed.
5. Double-click to finish drawing.
The software connects the final point to the initial point to form a closed area.
Properties
Area - Unit of measurement used to express the area inside the polygon
Perimeter - The sum of the lengths of all lines drawn
TT-TG Distance Measurement
1. Click one end of the distance to be measured, and move the mouse to the other end of
the distance being measured.
2. Click the endpoint of the line. This line is called the baseline.
Note: The initial measurement can be approximate, because the measurement can be edited
later.
3. Move the mouse away from the baseline. A line perpendicular to the baseline is
displayed automatically.
4. Position the perpendicular line at one end of the distance to be measured. Click once
when done.
5. Move the mouse again. A third line, parallel to the second, is displayed. In addition, a
dotted line is displayed, connecting the two parallel lines. This is the actual distance
measurement.
6. You can move the second parallel line anywhere along the baseline. As it is moved, the
dotted line increases or decreases in length, and the measurement result changes to
reflect the distance between the two parallel lines.
7. Position the third line at the other end of the distance. Click once when done. The
measurement result is displayed on the screen:
Figure 4-23: Completed TT-TG Measurement
Editing the TT-TG Distance Measurement

Moving the TT-TG Measurement: To move the measurement, hover the mouse over the baseline or one
of the two perpendicular lines (but not over any of the endpoints). The cursor changes to the move
symbol ( ). Click and hold. You can move the measurement to any other place on the screen. Release
the mouse when done.
Changing the TT-TG Measurement Distance: To change the measurement distance, hover the mouse over
the endpoint of one of the parallel lines. The cursor changes to a plus ( ) symbol. You can move the
parallel line so that it increases or decreases the distance measurement. The dotted line increases and
decreases with the movement of the parallel line, and the numerical value also changes accordingly.
Rotating the TT-TG Measurement: To rotate the measurement, hover the mouse over one of the
endpoints of the baseline. The cursor changes to the plus symbol. Click and drag the mouse in the
direction of rotation. The dotted white line is rotated.
Note: You might need to readjust the start or end of the measurement, or move the entire
measurement, after rotation.
Properties
TT-TG - The length of the measurement

Baseline - The length of the baseline.
Note: The baseline need not be the same length as the measurement result.
Ratio
This measurement calculates a ratio between two or more distance measurements and the first, or
baseline measurement.
First
measurement
Ratio
Second
Second
measurement
measurement
1. Obtain a distance measurement. This measurement will serve as a baseline.
2. Obtain a second distance measurement. The result will display the ratio of the new
measurement to the first.
3. You can continue to perform distance measurements on the image. Each new
measurement result will display the ratio between the new measurement and the
original.
4. Double-click to finish.
Properties
Base Length - Unit of measurement used to express the base measurement length.
Length - Unit of measurement used to express the length (of subsequent measurements).
Parallel Ratio
This measurement works exactly like the Ratio measurement, except that all measurement distances
drawn on the image are forced to be parallel.
Ratio
Second
measurement
First
measurement
Pelvis Swing
Pelvis swing measures the difference between the height of one hip and the other. To perform this
measurement, do the following:
1. Open a pelvic study and select the Pelvis Swing measurement from the context menu on the image.
2. Click the highest point on the femoral head of one hip. A horizontal line is displayed on the image that
passes through that high point.
3. Click the highest point on the femoral head of the other hip. A similar horizontal line is displayed on
that point.
The vertical distance between these two parallel lines, shown on the image, shows the amount of
pelvis swing. See Figure 4-24 on page 4-62.
Vertical distance between

top of each hip.
Figure 4-24: Pelvis Swing Measurement
Center Angle
The center angle measurement tool calculates the degree of the angle between two lines, using the
center of a circle as the vertex of the angle.
To measure an angle using the Center Angle tool, do the following:
1. Click on the image near, but not directly on, the junction of the two sides of the angle to
be measured.
Junction
Initial Click
Point
2. Move the cursor toward the junction. The circle will grow larger as you move away from
the initial click point. At the same time, the center point will follow behind the cursor as
you move it.
3. When the center of the circle is directly on the junction in the image, click once to stop
drawing the circle.
The following image shows the center of the circle on the junction of the angle, just before it is clicked:
4. Draw a line to the endpoint of one side of the angle. Click on the endpoint.
In the following image, the cursor is over the endpoint of the first line of the angle:
Endpoint of
first line
Length of
first line
5. Draw a line to the endpoint of the other side of the angle, and click on the endpoint.
The measurement result is displayed:
Figure 4-25: Final Measurement Result
Angle
The angle measurement tool calculates the degree of the angle between two intersecting lines. To
measure an angle, do the following:
1. Click on the endpoint of the first line.
2. Move the mouse to the vertex point of the angle and click that point to complete the first
line.
3. Move the mouse to the endpoint of the second line and click to complete the second
line.
Cobb Angle
A Cobb angle provides the angle between two unconnected lines. The following example shows how to
measure the angle of curvature between two vertebrae.
Note: If your version of iReview does not have the Cobb Angle tool option, you can still measure
a Cobb angle by using the Angle tool (see Angle, above).
Click the image on the following four points:
1. On the start point of the first edge
2. On the endpoint of the first edge:
3. On the start point of the second edge:
4. On the endpoint of the second edge (see the following figure).
Alternate Method
You can also measure a Cobb angle by clicking and dragging the mouse.
1. Click and drag along the edge of one vertebra so that the line is parallel with the edge:
2. Release the mouse when finished drawing the line.
3. Click and drag along the edge of another vertebra. The angle between the two lines is
shown in the measurement:
Properties
Angle - Display the numerical value of the angle
Spine Labeling
1. Open a CT or MR study that contains a scan of the spine, and then drop a sagittal-view
series into a viewbox.
2. Right-click on the image and select the Spine Label icon from the menu.
The label panel is opened so that you can select the starting label on the spine:
3. Click the button for the first vertebra you are going to label.
4. On the image, click the vertebra. The label is automatically added to the image at that
location:
5. Continue moving up or down the spine, clicking each vertebra in succession. You do not
need to open the panel again, because iReview knows which vertebra you are clicking on,
relative to the first label.
6. When you are finished labeling, double-click on the image. The label pickers (circles on
each vertebra) are displayed on the image:
Vertebra Size
To obtain the correct height of each vertebra, you must resize each circle so that it sits entirely inside of
the vertebra.
1. Hover the mouse over the edge of the first circle to be resized. The cursor changes to
indicate that the circle can be resized. Click on the circle edge.
2. If the circle exceeds the height of the vertebra, move the mouse in toward the center of
the circle. The entire circle shrinks as you move inward.
3. If the circle was not perfectly centered on the vertebra, it might be necessary to pan the
circle so that the perimeter lies directly on both the top and bottom border of the
vertebra:
Figure 4-26: Left - Circle Exceeds Borders; Right - Circle Fits Within Borders
4. When all circles are sized correctly, press the Escape (Esc) key. The circles are removed
from the image, and the labels remain.
Viewing the Labels on the Axial View
1. Click on the Axial view and scroll through the slices.
As you scroll, the reference line moves on the Sagittal image, and passes through each
labeled vertebrae. The corresponding slices of the Axial view show the same label.
Other Features
• Labels can be moved to other places on the images
If label text obscures an area of the anatomy that is being examined, you can click and
drag the label to any other location on the image.
• Stopping and restarting labeling
If you need to stop labeling in the middle of the process, you can save the labels you have
already added by pressing the Esc key. You can then do anything else with the loaded
study in the Viewer.
Note: If you load a different study from the Patient List, the labels you have already added will
not be saved.
If you would then like to continue labeling, right-click on the viewport where you were labeling and select
the label icon again. The following dialog is displayed:
If you want to continue labeling, select Continue adding labels.

You can also delete existing labels and start over.
Cancel will cancel your selection of the labeling tool. To begin labeling again, right-click and select the
label icon from the context menu.
Arrows and Text
To add an arrow to an image:
1. Select Arrow from the menu.
2. Click on the spot that you want the arrow to point to. The arrow is always drawn from the
pointing end.
3. Drag the mouse away from the initial spot.
4. Release the mouse when the arrow has the desired length.
To add text:
1. Select Text from the menu.
2. Click on the spot where you want to place the text. The following dialog is opened:
Figure 4-27: Add Text Dialog
3. Type in the desired text and click OK.

The text is shown inside a box whose upper-left corner touches the spot you clicked on:
To add an arrow and text in one step:
1. Select Arrow + Text from the menu.
2. Click on the spot that you want the arrow to point to. The arrow is drawn from the
pointing end.
3. Drag the mouse away from the initial spot.
4. Release the mouse when the arrow has the desired length. The Add Text Dialog (see
Figure 4-27) is opened.
5. Type in the desired text and click OK.
The text is shown inside a box whose lower-left corner touches the endpoint of the
arrow.
Properties
No additional properties.
Intensity
Select this measurement from the measurement menu, and then click on the desired point in the image.
The Intensity measurement shows the intensity at the click point:
This measurement is supported on these modalities: CR, CT, MR, US, and XA.
Mirror Measurements
These measurements allow you to draw an ROI on an image, while a mirror image of the ROI is
automatically drawn on the reflection area. To designate where the reflection will be drawn, you first
must draw a line on the image that will serve as the “mirror,” around which the two ROIs will reflect each
other. This line can be drawn anywhere on an image.
There are three mirror measurement tools: Mirror Circle, Mirror Polygon and Mirror Ellipse. These ROIs
are drawn in the same way as the Circle, Polygon and Ellipse measurements.
1. Draw a line on the image to establish the center of the reflection.
2. Using one of the three mirror measurement tools, begin drawing an ROI on one side of
the line. As you draw, you will see a reflection of the ROI being drawn on the other side of
the line.
When the measurement is complete, two boxes containing results are displayed, one for each ROI. The
dimensions, area and perimeter should be identical for each, but the intensity measurements will vary,
depending on differences in the tissue enclosed in each ROI. Results for ROI2 also show the ratio of each
value to the same value in ROI1.
Reflection line
ROI2
(mirror image)
ROI1
(drawn manually) Measurement results
and ratio to ROI1
SUV Measurement
This tool is used to obtain the standard uptake value on PET data that has used.
Use one of the closed-shape measuring tools (circle, ellipse, oblique ellipse or polygon) to draw a ROI on
the image. The area and perimeter, along with the uptake values, are displayed in the measurement
results:
SUV Types
There are three types of SUV measurement:
• SUV body weight (SUVbw) - Body weight is used as a basis for calculations.
• SUV body surface area (SUVbsa) - Body surface area is used as the basis.
• SUV lean body mass (SUVlbm) - The lean body mass is used.
You can change the SUV type after a measurement has been completed. To do so, right-click on the
measurement and select another SUV type from the menu.
The results are changed:
Changing SUV Parameters

By default, the SUV parameters are shown in the upper-left corner annotations of PET studies. If any of
the parameters are incorrect or incomplete, they can be changed.
Click on any of the parameters, and then select Edit from the menu that is displayed. This opens the
following dialog:
Enter the new parameter for the patient’s gender, weight or height, or the total dose of FDG, and click OK
when done.
Setting or Changing W/L Presets

You can set Min and Max W/L values for up to five presets. Please see "Window Level" on page 4-30 for
instructions.
Time-Intensity Measurement
There are four kinds of time-intensity measurements: point, ellipse, circle and polygon. These objects are
drawn in the same way as described above.
The following two images show the time-intensity point (left) and time-intensity ellipse (right).
Figure 4-28: Time-Intensity Measurement Results and Graphs
If the number of phases plotted in the graph is below 20, the graph is displayed as in Figure 4-28. For
time-intensity measurements having 20 or more phases, only the current phase and value is displayed.
Measurement Calibration
The Properties dialog is opened. Enter the correct length in the Value field. By doing this, you are telling
the Viewer that the length of the line has the value you have specified, and that all other measurements
should be calculated relative to this value.
Managing Measurement Results

Right-click on the measurement result to display a menu of tools for managing the result.
Figure 4-29: Measurement Result
• Delete - Delete the selected measurement.
• Delete all measurements - Delete all measurements in the series, including measurements on other
slices.
• Copy - Copy the measurement to the clipboard.
• Set as base - Set this measurement as a base against which other measurements can be compared (to
obtain a ratio to this measurement).
• Export - Export to a file on the local drive, to a text, XML or AIM file.
• Properties - See below for a complete explanation.
• Change Font and Color - Change the font or color of the measurement text.
• Show on all slices - Show this measurement in the corresponding position on all slices in the series.
• Edit Label - Change the text that labels the result:
Measurement label
The Measurement Viewer

The Measurement Viewer allows you to view consolidated results of measurements performed on a
currently open case. Results can be shown for all measurements performed on every patient in the
currently open case, at the most inclusive level, to all measurements performed on the selected series in
the current case, at the most specific level.
The tabs at the top of the screen have the following functions:
• All Patients - Show all measurements from every patient in the currently open case.
• All Studies - Show all measurements from the selected patient in the currently open case.
• Current Study - Show all measurements from the selected study in the currently open case.
• Current Series - Show all measurements from the selected series in the currently open case.
Note: When the current case is closed, the measurements are not saved. However, the
measurements can be exported to storage or to the clipboard.
Other Measurement Features
• Measurement Mode
After selecting and performing a measurement, the mouse remains in that measurement mode, until a
different mouse mode or measurement is selected.
• Enabling/disabling mode
To enable mode, go to Preferences > Viewer > Measurements and check the Enable
Measurements checkbox. To disable measurements, uncheck the box. See Chapter 2:
"System Configuration" for configuration instructions.
When mode is disabled, measurements are never . You will need to select the
measurement again if you need to perform more than one of the same measurement.
• Ending mode
Press the Escape (Esc) key on your keyboard. The left mouse function will return to
whatever mode it was in previously. This ends the mode for the currently selected
measurement. However, when you select another measurement, that selection will be.
• Show Measurement on the Image

Double-click an entry in the Measurement Viewer to display the measurement on the image where it was
taken.
• Show Ratio
When a measurement in the Measurement Viewer is selected, it can be used as a base for a comparison
with another measurement, producing a ratio between each of their corresponding values.
1. Select the base measurement.
2. Check the box in the ratio column (indicated by “%” in the column header) of the
measurement you want to obtain the ratios for.
The ratios appear in the Measurement Viewer:
Ratio
Column
Calculated
Ratios
The ratios also appear on the image:
Ratios
Base
measurement
• Synchronize Measurement Size and Shape

When one measurement is selected, a second measurement of the same type can be synchronized to the
same dimensional values.
Initially, the two measurements are of different sizes:
Measurements of
different sizes
1. Select a measurement to serve as a base. This measurement will not change.
2. Check the box in the synchronize column (indicated by “<->” in the column header) of the
measurement to be synchronized with the base.
Sync
Column
Base
measurement
In the image, the dimensions of the second measurement are synchronized to the base measurement’s
dimensions (see the following image). In the example below, the area, circumference and diameter are
the same. However, the intensity values (mean, min, max and sdev) do not necessarily match, because
each ROI encircles different tissue.
• Exporting Measurements
To export measurements in the Measurement Viewer, click the export icon for the desired output
format: plain text (.txt), XML (.xml) or AIM (aim.xml).
You will not receive confirmation when the export is completed. Therefore, it might appear as though
nothing has happened. To verify that the measurement data has been exported, open the export
folder to see whether the file is there. The output folder is configured through the System
Configuration. If you do not know where the export folder is, see "Measurements" on page 2-57 for
more information.
Note: If an export folder has never been configured, a Windows dialog is opened for you to
navigate to the right location.
Output
Image Capture
Right-click on the image and select one of the following to capture images to the Output Panel or to disk.
• Capture
Capture the selected image.
• Capture all
Capture all images currently displayed in the viewer, and place each image in a separate cell of the
Output Panel.
• Capture all in one
Capture all images currently displayed in the viewer, and place them all in a single cell of the Output
Panel.
• Capture to folder
Save the image to a folder on your hard drive. If you have configured a location for it to be stored, the
capture automatically saves the image there. Otherwise, a dialog is posted asking you to provide the
pathname to the folder.
Structured Reports (SR)
This is a structured report viewer. If there is an SR series included in the study, click the SR icon in the
Toolbar to display it (see Figure 4-30 on page 4-82).
Note: This icon is visible only when data containing a structured report is loaded.
Figure 4-30: Structured Report
Auto-Open SR Viewer
There are two conditions in which the SR viewer is automatically opened when a study is loaded:
• The study contains one or more SR series, and the iReview configuration setting, Show SR Viewer
automatically after open study is enabled.
• The study contains only SR series. The viewer opens automatically, whether or not Show SR Viewer
automatically after open study is enabled.
For more information, see "SR" on page 2-68.
Other Tools
Click the one of the following links to jump to the desired section. If you are using a printed copy of the
manual, turn to the page listed for the section.
Importing Files ...................................................................................................................................4-83

Collaboration......................................................................................................................................4-85
Show DICOM Header .........................................................................................................................4-88
Launch Application.............................................................................................................................4-89
Importing Files
You can import a file by drag-and-drop to the image in the Viewer. This can be either a DICOM or non-
DICOM file.
The Import Files dialog is opened (see image below). You can add the imported data to the selected
patient, as a new study, or you can add the data as a new series in the selected study.
Create New Study

If you selected Add to selected Patient, Create new Study in the Import Files dialog, the following dialog
is opened. This dialog allows you to consolidate imported data with the current patient. You can change
study DICOM tags (date, time, ID, description and accession number). You can also modify series tags
(modality and the series number, date, time and description).
Add to Study
If you selected Add to selected Study in the Import Files dialog, a consolidation dialog, as shown in Figure
4-31 on page 4-85, is opened. This dialog allows you to modify series tags, but study tags are fixed
because this data is being added to the study.
Figure 4-31: Add to Study Dialog
Collaboration
A collaboration takes place between iEMV running locally on your system, and one or more instances of
iEMV running on remote systems. However, you can initiate the collaboration from iReview. This launches
iEMV in your default browser. The study that is loaded in iReview is loaded into iEMV, using the same
image layout as in iReview. Additionally, the measurement, positioning, zoom factor, and window level
contexts that are present in iReview when collaboration is initiated are saved as GSPS. This context is then
applied to the study in iEMV.
iReview Inactivity Timeout

While iEMV is open and in collaboration, the inactivity timeout for iReview is paused. As long as iEMV is
open, iReview will not time out due to inactivity. Once iEMV is closed, the timer will restart.
Starting Collaboration from iReview

1. Load a study.
2. Click the Host Collaboration icon on left end of the top toolbar.
Note: A study must be loaded to initiate collaboration. If no data has been loaded, the
collaboration icon is disabled.
iReview saves the state of the study to the Image server, using GSPS. Be aware that this might take some
time. You can track the progress of the save by viewing the task log in the Patient List.
When the progress bar turns green and says Completed, the collaboration has been started. iEMV is
launched on your system with the same study loaded and GSPS applied.
Note: If an error occurs while the GSPS information is being saved to the image server, it is logged
on the server. No error message is posted in iReview.
Your default browser (configured in Windows on your PC, laptop, or mobile device) is opened, and iEMV is
launched. It is then automatically connected to the server that iReview is connected to, and the study that
was loaded in iReview is also loaded in iEMV.
Figure 4-32: iEMV Host
Note: When it is first launched, iEMV might display a different image from what was displayed on
iReview.
All context that was saved in iReview as GSPS is applied to the study in iEMV. The following image
operations can be saved using GSPS:
• Zoom, Pan, Orientation, Window/Level
• Current Layout
• Stack position and slice position
• Magnification, Display Shutters, Size (Fit, True or 100%)
• Horizontal Flip
• Overlays
• Measurements:
• Distance
• Ellipse
• Oblique Ellipse
• Circle
• Polygon
• Arrow or Text Annotation
For more details about what can be saved in GSPS, see "GSPS (Grayscale Softcopy Presentation State)" on
page 4-47.
Note: If there was an error when GSPS was being saved on iReview, the study is loaded in iEMV
with no GSPS applied.
An email is opened for you to invite attendees. Address the email, add any optional comments in the body
of the email, and send it to the attendees.
Attendee Participation
When an attendee receives the email, he or she can connect to the server by clicking the link. iEMV is
launched in the attendee's default browser, with the image loaded. Only a single image is accessible to
the attendee: the image that was loaded in iReview's active viewport when collaboration was initiated.
The GSPS that was saved on the image server is then applied to that image.
Controlling the Session

When iEMV is started on your device in collaboration mode, it is hosting the collaboration. This means
that you are in control of what attendees will see in their browsers. iEMV tools are shown along the right
edge of the browser, which allow you to perform measurements, draw on the image with the pen tool,
zoom and pan the image, and change the W/L using the tools in iEMV (see Figure 4-32). Whenever you
make a change, the attendees will see the change on their screens.
An attendee can assume control of the session by clicking the collaboration icon, which appears in the
upper-right part of the iEMV screen. If an attendee assumes control, you are no longer the current
controller. If you can see the collaboration icon on your screen, and you do not have access to iEMV
viewer tools, that means that someone else is controlling the session. You can control the session again by
clicking the collaboration icon.
No viewing tools
Figure 4-33: Not Controlling the Collaboration
Show DICOM Header

Opens a window containing the full DICOM header for the study.
• Right-click the image and select Show DICOM Header.
Launch Application
With this tool, you can work with the 3D imaging tools available on the iNtuition Client (AQi) or the
AqNET Thin Client.
Click the Launch icon in the Top Toolbar.
A menu is opened that contains AQi Workflows (bounded in dark blue) and Thin Client modules (bounded
in light blue).
To use AQi, select a Workflow from the menu. This launches AQi and loads your study into the selected
Workflow.
The AqNET Thin Client has some specialized functions such as Fusion, which also provides advanced 3D
imaging tools. The bottom section of the menu has options for opening the Thin Client. The number of
options listed in the menu depends on the study you currently have loaded.
The Thin Client is launched with your study:
Chapter 5 Output
When images are captured, they appear at the top of the Output Panel, under Captured images:
To delete a series from the Output Panel, right-click on it and select Delete.
Output Panel Functions

DICOM Store
Send the captured images to the AqNET server as secondary captures.
Options
Click the Options icon (circled in the previous figure) to show or hide the following DICOM Store options:
Note: If the Options icon is not visible, this means that the Create New Study option has been
configured to “Never create new study”. For instructions on changing that setting, see
"Output" on page 2-62.
Aquarius iReview User Guide Output
• Create New Study
This feature allows you to create a new study from the captured data. Click the checkbox to enable
the feature. The study will be created according to the system configuration. (See "Output" on page 2-
62 for more information.)
Note: If this checkbox is not visible, that is because Create New Study is configured to “Always
create new study”.
• Add to Folder
Add the captured file to a folder in the Folders and Filters list. All folders that have been created in
that list will appear in the following menu:
Select the folder where you want to save the captured images, or select Do not save the import to a
folder.
• Read Status
Set the read status of the captured file.
• Study Description Input Box
This option allows you to enter a description for the newly created study.
Saving the Capture as a Series
• Add Series
When the DICOM Store tab is initially opened, the first series in the captured list has been added by
default to the list of series to be sent to the server. To add more series to the send list, click the Add
series icon. The second series in the captured list is added to the send list. Each time you click Add
series, the next series in the captured list is added. When all series have been added to the send list,
the Add series icon is hidden.
• Series Number
The default new series number is 200. You can change it to any other number.
Sending Data
When the send list contains all the data you want to send to the server, click the Send icon. A progress
dialog is opened:
From this dialog you can run the task in the background it. Depending on the number of images being
sent, the task might take a long time. Running the DICOM send in the background frees iNtuitionReview
(iReview) for other tasks. You can monitor the progress of the send task in the input/output log. Click the
log icon, located in the top bar of the screen. The log is opened. The send task currently in processed is
circled in the bottom image of Figure 5-1.
Figure 5-1: Top - Open Log Icon (circled); Bottom - Input/Output Log
When the DICOM send is complete, you will be able to see the secondary capture in the Series List:
Save File
Save a series or image on your local hard disk.
To save an image, click the image and then click Save. A Windows navigation dialog is opened so you can
specify where to save the file. A folder is created in that location and is given a filename consisting of the
date and time. The file itself is named with the patient name.
Clicking on an image toggles the selection. (Click once to select, click again to deselect.) To select all
images, click the Select all icon. Click Clear selection to deselect all selected images.
Print
The print feature provides flexibility in the format and layout of the printed pages.
• Printer - Select a local or network printer.
• Properties - Opens a Windows dialog that allows you to modify printer properties.
• Format - Select the type of paper to be used, and select portrait or landscape pages.
• Layout - Configure the number of images, and where the images will be positioned, on each page.
• Add page - Create a new blank page.
• Delete page - Delete the currently displaying page.
• Delete all - Delete all pages. (Does not delete images from the Output Panel.)
• Print current page - Print the currently displaying page.
• Print all - Print all pages.
Drag and Drop Images on Pages

You can add an image from the captured images panel to a page to be printed. If the page already has an
image in the location where you want to place the new image, the old image is overwritten.
Email
To email captured images, do the following:
1. Check the box next to each image that you plan to send. If you want to send all images, you can click
Select all (circled in the following image).
2. Click the Send mail icon (circled in the previous message). This opens a new message in your default
email client. The captured images are inserted as attachments to the message.
For example, if your default email client is Outlook, the new message appears:
3. Address the message, enter any desired text in the body, and send.
Clipboard
To move an image to the Clipboard, click on the image and then drag it to the bottom of the Output Panel.
(Figure 5-2)
Clipboard region
Figure 5-2 Left - Dragging Image to Clipboard; Right - Image Captured
The image can then be pasted into another application.
Clear Image on Clipboard Panel

To clear the image from the clipboard panel, right-click on the clipboard panel and select Clear.
Integration With AquariusNET Thin Client

iReview shares images with the Thin Client viewer. If you open the Thin Client from iReview, any images
captured in the Thin Client can be moved to the iReview Output Panel after you exit the Thin Client.
Exiting the Output Panel

Images in the Output Panel are not deleted automatically. If you return to the Patient List without clearing
the Output Panel, and then try to load another study, a warning message is posted to alert you that the
captured images are still in the Output Panel. You can choose to load the new study while keeping the
images of the previous study in the Output Panel, or you can clear the Output Panel at this time. If you
choose to keep the old images, any newer captures are kept separate from the old ones if they are from a
different patient.
Appendix A Aquarius iReview User Guide
Appendix A: Default Keyboard Shortcuts
Note: There are also default values for keyboard shortcuts based on the Aquarius iNtuition
ThinClient.
Default Keyboard Shortcuts

Name of Shortcut Description Keystrokes
Annotation.ChangeMode Toggle annotations on or off. =
Application.Logout Log out of iReview. The login screen is dis- F12

played for another login.
Application.ToggleViewerAndPatientlist Switches between the Viewer and the CTRL+SHIFT+P

Patient List.
Capture.Capture Capture image in active window. C
Capture.CaptureAllInOne Capture all images on screen to one cell in CTRL+ALT+C

the output panel.
Capture.CaptureAllVisible Capture all images that are currently visible CTRL+SHIFT+C

on the screen.
Capture.CaptureToClipboard Capture image in active window to the Win- CTRL+C

dows clipboard. The image can be pasted in
another application.
Capture.CaptureToClipboardWithCrop Like CaptureToClipboard, but allows you to SHIFT+C

select a rectangular area in the image to be
captured.
Capture.CaptureToFolder Opens a Windows navigation dialog for you CTRL+S

to select a folder where captures will be
stored.
Cine4D.Toggle Toggles a 4D cine on or off. SHIFT+‘ or SHIFT+F3
NOTE: For SHIFT+‘, hold down the Shift key

and press the backquote key.
Cine.Toggle Toggles a cine (not 4D) on and off. F3 or ‘
Darkmode.Toggle Toggles the top bar and thumbnails on and CTRL+E

off. In dark mode, only the data images are
displayed.
DisplayProtocol.GotoNextStep Display the images in the following stack in Numpad .

the display protocol.
NOTE: This is the period (or Del key) in the

number pad.
DisplayProtocol.GotoPreviousStep Display the images in the previous stack in Numpad 0

the display protocol.
AQ-iREV-USER-US-4.4.13.P6 A-1
Aquarius iReview User Guide Appendix A

DisplayProtocol.PriorNext Prior cycler - Step to the next prior CTRL+PageDown
DisplayProtocol.PriorPrev Prior cycler - Step to the previous prior CTRL+PageUp
Fullscreen.Toggle Toggles full screen mode on and off. F11
Image.Reset Reset image to original orientation, win- SHIFT+R

dow/level, and zoom.
Image.ResetOrientation Reset image to original orientation. SHIFT+O
Image.ResetWindowLevel Reset image to original window/level. SHIFT+W or 0
Image.ResetZoom Reset image to original zoom level. SHIFT+Z
Image.SetFixedWindowLevel(1) Apply window/level preset 1 1 or Numpad 1
Invert.Toggle Toggle image invert on and off. CTRL+I
NOTE: This is the letter ‘I’, not ‘L’.
MammographyCAD.ToggleVisible Toggle CAD markers on and off. \
NOTE: This is the backslash character.
Measurement.Angle Begin an angle measurement. SHIFT+,
NOTE: This is Shift + comma.
Measurement.Arrow Draw an arrow on the image. M
Measurement.Distance Begin a distance measurement. D
Measurement.Ellipse Begin an ellipse area measurement E
Measurement.Polygon Begin a polygon area measurement. CTRL+P
Measurement.Text Open a text box to add text to the image. T
NOTE: After pressing the T key, you must

also click on the image where the text will
go.
QuadrantView.Next Move the image so that it is centered in the W

next quadrant.
ScrollMode.Toggle Toggles between single and multi scroll Q

modes.
ShowMeasurementViewer Open the measurement viewer. CTRL+M
A-2 AQ-iREV-USER-US-4.4.13.P6
Appendix A Aquarius iReview User Guide

Sync.Toggle Toggles synchronization between viewports Space
on and off.
Timeline.CloseAllTabPages Close all studies and return to the Patient ALT+X

List.
Viewer.GotoFirstImage Display the first image in the stack. Home
Viewer.GotoLastImage Display the last image in the stack. End
Viewer.OpenLayoutMenu Show the layout menu on the screen. L
Viewer.OpenLayoutSubmenu Show the layout submenu on the screen. CTRL+L
Viewer.ShowNextImageOrStack Show the next slice in the stack. If in multi Down Arrow
scroll mode, and the last slice in the stack is
on the screen, show the following stack.
Viewer.ShowNextStack Show the following stack in the thumbnail Right

list.
Viewer.ShowPreviousImageOrStack Show the previous slice in the stack. If in Up

multi scroll mode, and the first slice in the
stack is on the screen, show the previous
stack.
Viewer.ShowPreviousPhase Display the previous phase. PageUp
Viewer.ShowPreviousStack Show the previous stack in the thumbnail Left

list.
Viewer.ToggleKIN Mark or unmark an image as a Key Image K

Note (KIN).
AQ-iREV-USER-US-4.4.13.P6 A-3
Aquarius iReview User Guide Appendix A
A-4 AQ-iREV-USER-US-4.4.13.P6
Index Aquarius iReview User Guide
Index I
Initial phase 4-33
Institution information 2-3
Numerics Integration
4D layouts 4-23 AQi 2-102
Thin Client 2-102
A
Advanced rules 2-22 K
Analytics configuration 2-6 Keywords 2-35, 3-12
Angle measurement 4-64
Annotation configuration 2-48 L
Anonymization 3-12 Layout
Appearance User-defined 4-24
Viewer 2-43 Layouts
AQi 3D Workflows 2-33, 3-29, 4-89 4D 4-23
AQi Integration 2-102 Compare mode 4-25
Configuration 2-78
B Dual monitor 4-25
Basic rules 2-20 Stack mode 4-22
Tile mode 4-23
C Left mouse modes 4-7
Calibration, Monitors 2-16 Line segment measurement 4-54
Capture settings 2-60 Logging configuration 2-6
Circle measurement 4-57
Color templates 4-14 M
Contact TeraRecon i Marking studies 2-38
Creating Rules 2-18 Measurement tools 4-50
Customer Support i Angle 4-64
Cycling Through Priors 2-99 Calibration 4-75
Circle 4-57
D Distance 4-53
Default login 2-5 Ellipse 4-54
Delayed phase 4-33 Line segment 4-54
Delete user 1-3 Polygon 4-57
Display configuration 2-3 Time-Intensity 4-75
Display protocols 2-78 Memory configuration 2-3
Multi monitor 2-86 Monitor calibration 2-16
Stack definitions 2-85 Mouse modes 4-7
Distance measurement 4-53 Multi monitor display 2-86
Download study 3-12
N
E Network configuration 2-5
Ellipse measurement 4-54
O
F Output options 2-63
Filter 3-2
Folders 2-31 P
Patient List
G Appearance 2-27
General system configuration 2-2 Column order 3-6
AQ-iREV-USER-US-4.4.13.P6 1
Aquarius iReview User Guide Index
Columns 3-4 W
Filters 2-29, 3-2 Wash-in phase 4-33
Keywords 2-35 Wash-out phase 4-33
Refresh 3-28 Workflows
Sorting 3-7 Configuration 2-33
Polygon measurement 4-57 Icons 3-28
Priors 2-99 Launch AQi 4-83
Cycler 2-99 Workflow Elements 2-103
Publish status 3-6
R
Read status 3-5
Refresh Patient List 3-28
Right-click menu
Series List 3-25
Rules 2-18
Advanced 2-22
Basic 2-20
S
Searches 3-30
Show DICOM header 3-26
Stack
Definitions 2-85
Filters 2-34
Groups 2-80
Layouts 4-22
STAT setting 3-6
Study URL link 3-14
Synchronization 4-28
Functions 2-57
Layout 4-25
T
Thin Client Integration 2-102
Thin Client modules 4-89
Tile layout 4-23
Time-Intensity measurement 4-75
TT-TG Distance Measurement 4-57
U
Uptake 4-33
User switching 1-2
V
View status 3-5
Viewer
Appearance 2-43
Viewport 2-87
2 AQ-iREV-USER-US-4.4.13.P6

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Aquarius iReview User Guide

The CE 0197 mark applies to iNtuition and AquariusAPS Software.

Authorized Representative in the European Community

Technical Support: 877.996.0100.

Indications for Use

iNtuition-TDA, TVA, and Parametric Mapping Indications for Use

iNtuition-T1 Mapping and T2/T2* Mapping Indication for Use

iNtuition-T1 Mapping and T2/T2* Mapping Accuracy Statement

iNtuition-T1 Mapping and T2/T2* Mapping Supported Data

T1 Mapping T2/T2* Mapping

Modality MRI MRI

Series Type Look-Locker or Modified Look-Locker T2 or T2* with or without offset

Number of series One or Two, multiple slices One, multiple slices

Structural Heart Indications for Use - Available only in the USA

Structural Heart Accuracy Statement

Structural Heart Supported Data

Precautions Relating to General Use

Precautions Relating to Display Hardware

Precautions Relating to Interpretation

Precautions Relating to Magnetic Resonance Imaging Machines

Precautions Relating to Risk of Loss of Data

Precautions Relating to Computer Software and Hardware

Microsoft Windows Operating System Updates

Precautions Related to Image Output Option

Conventions used in this Manual

Additional Typographical Conventions

Page Numbering Conventions

This style indicates Chapter 3, page 1.

Customer Support ........................................................................................................................ i

Chapter 1 Introduction ................................................................................................................ 1-1

Chapter 2 System Configuration .................................................................................................. 2-1

DICOM Tag Options..................................................................................................................2-39

Chapter 3 The Patient List ........................................................................................................... 3-1

Chapter 4 The Viewer .................................................................................................................. 4-1

Chapter 5 Output ........................................................................................................................ 5-1

Appendix A Default Keyboard Shortcuts ..................................................................................... A-1

• High-performance full-resolution display

• True size display and print

• Support for High brightness, High resolution medical displays

• Display of MG CAD markers

3. Click Login to connect to the server.

Click the user name to log in to that user account.

Top Bar Tools

Left Top Bar Tools

Logoff Start Collaboration

Click this icon to log off iReview.

• Start Collaboration icon

Right Top Bar Tools

Input/Output Log About Page

• System Configuration - Configuration settings for all aspects of iReview.

Open user manual

Chapter 2 System Configuration

User Management .............................................................................................................................2-9

The System Configuration screen is displayed:

If desired, enter information about your institution.

• Allow GPU interpolation

• Sync with vertical refresh

• Interpolate 16 bit before WindowLevel

• Image Streaming cache options

Click the down-arrow in the menu to show the options.

• Cache Current Study

This must be enabled for caching to work.

Select the default user for logins.