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PACS Viewing Via CareWeb Click Mouse to Advance PACS Viewing Via CareWeb The purpose of this tutorial is to provide an overview of how to view and manipulate radiology images through CareWeb Click to continue What is PACS Web Viewing Downloading Software Accessing PACS Images

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PACS Viewing Via CareWeb

Click Mouse to Advance


Pacs viewing via careweb l.jpg

PACS Viewing Via CareWeb

The purpose of this tutorial is to provide an overview of how to view and manipulate radiology images through CareWeb

Click to continue


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What is PACS Web Viewing

Downloading Software

Accessing PACS Images

Selecting Exams to View

Different Image Views

Adjusting Window/Level

Removing Overlay

Navigating Around Images

Comparing Two Exams

Zooming an Image

Displaying Cine

Measuring Distances and Angles

Displaying Pixel Values

Using Magic Glass

Setting Display Options

Understanding TruRez

Miscellaneous Manipulations

Resetting the Display Reset

Changing Interpolation Modes

Image Information Display

Save Image to Disk/Clipboard

Color Display Limitations

Select a Topic

Click your browser’s back button to exit

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What is PACS Web Viewing?

  • Most radiology images captured at BIDMC are stored in electronic form in a Picture Archiving and Communications System (PACS). PACS Web Viewing allows these images to be viewed using a PC and a Web Browser conveniently from home or office.

  • PACS images displayed via the web are for reference only and are not approved for primary diagnostic use.

Back to Menu

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Downloading Software

  • Before starting, you may need to download extra or updated software. Click here to see if you do. If the screen you see looks like this just follow the instructions.

  • Once the downloads are complete, the screen should look like this. Don’t click on the button, just close the window and return to this screen.

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Accessing PACS Images

  • Start at the CareGroup Home Page http://home.caregroup.harvard.edu

Select CareWeb in the blue panel on the left hand side

Select Careweb Clinical Lookup from the list displayed (or click here)

Back to Menu

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Accessing PACS Images (cont.)

  • You will need a CCC key to log into CareWeb. (If you do not have one call 617-754-8080).

  • If you are accessing the web from outside the hospital you will also need a SecurID. (If you do not have one call 617-754-8080).

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Accessing PACS Images (cont.)

  • Enter your CCC key

Back to Menu

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Accessing PACS Images (cont.)

  • Enter the Name or MRN of the patient. If there is more than one match, select the correct patient from the list

Back to

Menu

Click to

continue


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Accessing PACS Images (cont.)

  • Select Xrays from the tabs

Click to

continue

Back to

Menu


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Accessing PACS Images (cont.)

  • Select a Report to view it if you wish

Click to

continue

Back to

Menu


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Accessing PACS Images (cont.)

  • Click the BACK button when done

Click to

continue

Back to

Menu


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Accessing PACS Images (cont.)

  • Select “Show Radiology Images”

Click to

continue

Back to

Menu


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Accessing PACS Images (cont.)

  • The following screen will appear.

If you have followed this tutorial from the beginning, you have already downloaded all required software, so click to view images.

Back to Menu

Click to continue


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Selecting Exams to view

  • A list of exams will be displayed

  • Select the Exam you wish to view

  • If the exam is not on line, (Online Status of N), it will be fetched from the archives. This could take a few minutes depending on the size of the study.

  • Click on “Display Images” button

Back to Menu

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Series View

  • A new browser window will open. If there is more than one series in the exam, you will see a series browser screen

  • Select a series, either to view thumbnail images or full size images

Back to Menu

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Default Image View

  • The default view will look something like this, depending on how many images there are

  • To exit image viewing, just click “Close Window”

Back to Menu

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Adjusting Window/Level

  • Right click on the image and select Tools/Window from the menu

  • Drag the mouse left-right to change window setting

  • Drag the mouse up-down to change the level setting

  • Select the Region Of Interest (ROI) Calculate tool, find your ROI and click. The Window/Level will be set to the optimum level

  • When you have a suitable Window/Level for the image, click on the button to propagate the setting to other images in the series.

Back to Menu

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Setting Window/Level Manually

  • You can set Window/Level manually. Right click over the image and select Set Window/Level form the menu.

  • Enter Window and Level values in the dialog box

  • Suggested values:

    • LUNG WINDOW 1600 LEVEL –450

    • SOFT TISSUE WINDOW 400 LEVEL 40

    • BONE WINDOW 3000 LEVEL 500

    • BRAIN/SINUSWINDOW 155 LEVEL 42

    • ABD/LIVERWINDOW 342 LEVEL 56

  • common window/level for mri are: 

    • GRADIENT ECHO T2 WINDOW 240 LEVEL 135

    • T1 WINDOW 1450 LEVEL 508

    • T2 WINDOW 1410 LEVEL 625

    • PD WINDOW 775 LEVEL 519

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Removing Overlay

  • If desired, you can remove the overlay information displayed with each image. Click the button. Click it again to restore the information display.

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Viewing Different Images

  • The arrow buttons control which images are displayed. You can move one image at a time or one page at a time, forward or backward.

  • The lower buttons allow you to navigate to other series in the exam.

  • Images designated as significant Images from any series are gathered together and can be viewed by selecting a link next to this flag . In addition, Individual images which have been designated as Significant Images are marked with this flag.

Back to Menu

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Comparing Two Exams

  • Select the first exam from the list. Then, holding down the Ctrl key, select the exam to compare. The “Display Images” button changes to “Compare Exams”. The image display screen splits in half, showing each exam in its own window.

  • Use the button to lock the image controls between the exams so that moving to the next image on one exam automatically advances the other.

Back to Menu

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Zooming an Image

  • Right Click on the mouse and select the Continuous Zoom tool from the Tools menu The cursor shape for the Continuous Zoom tool is:

  • Hold the left mouse button down and move the mouse up to increase the zoom and move the mouse down to decrease the zoom.

  • When in zoom mode, you can switch to pan / scroll mode by holding down the Shift key. You can switch back to zoom by releasing the Shift key. Fixed zoom factors can also be selected using Zoom Presets.

Back to Menu

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Panning a Zoomed Image

  • Right Click on the mouse and select the Pan tool from the Tools menu. The cursor shape for the Pan tool is:

  • If an image has been zoomed, hold down the left mouse button to move the image within the viewing area. If the image has not been zoomed, the pan tool has no effect. When in pan mode, you can switch to Continuous Zoom mode by holding down the Shift key.

Back to Menu

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Zoom Preset

  • Right Click on the mouse and select Zoom Preset. This allows you to select specific zoom values.

  • Fit to View This is the default display mode, where the image is zoomed to be as large as possible while still fitting in the display area.

  • Full Res 1x This option displays the image at its full size and with 100% of the image data (i.e. TruRez: Full).

  • 1x, 2x, 3x,4x These options set the zoom for the image by factors of 1, 2, 3, and 4 respectively.

Back to Menu

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Cine through an MR or CT

  • Right Click on the mouse and select the Manual Cine tool from the Tools menu

  • The cursor shape for all the Manual Cine tool is:

  • The manual cine tool allows you to scroll forward or backward through a stack of images. To use the Manual Cine tool, hold down the left mouse button over an image. Drag the mouse down to scroll forward through the images and upwards to scroll backwards through the images. This looks something like a short movie, or cinema.

  • Hold down the Shift key and the click the left mouse button once to step backward through the stack of images at a rate of one image per click. Click the left mouse button once (without holding down the Shift key) to step forward through the stack of images at a rate of one image per click.

Back to Menu

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Cine (cont.)

  • Images are loaded one at a time when displayed using the Manual Cine tool. You can use the Load Stack Function to preload all images in the series into the cache. To use the Load Stack option, place your cursor over an image and right-click. Select Load Stack. Note that the Load Stack function may not be available until you first select the Manual Cine tool.

  • While using the Manual Cine tool, you can display a particular image immediately if you know the image number by using the Go to Image option.

  • To select the Go to Image option, place your cursor over an image and right-click.

  • Select “Go to Image…” A following dialog box will appear. Enter the image number that you want to go to and click OK. The image associated with the entered number is displayed on the screen

Back to Menu

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Measuring Distances

  • To select the Measure Distance tool, place your cursor over an image and right click.

  • Select Tools and Measure Distance.

  • The cursor shape for the Measure Distance tool is:

  • To draw a line, press the left mouse button to set the first point and then drag the mouse while holding the left mouse button down. When you have completed the line, release the mouse. The length of the line is displayed, in mm, unless the pixel size is unknown, in which case the length will be shown in pixels (px).

  • To erase a distance line, you can use the Delete Tool using the Shift key.

Back to Menu

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Measuring Angles

  • To select the Measure Angle or Cobb Angle tool, place your cursor over an image and right-click.

  • Select Tools and Measure Angle or Cobb Angle. The cursor shapes for the Measure Angle or Cobb Angle tool are:

  • This is a 4-point angle measurement tool, allowing it to be used for Cobb angle measurements, in addition to standard angle measurements.

  • To measure an angle, first draw 2 lines on the image. To draw a line, press the left mouse button to set the first point and then drag the mouse while holding the left mouse button down. Note that the number 1 is shown beside the cursor to indicate that you are drawing the first line. When you have completed the line, release the mouse. The number will now change to a 2 and you can then draw the second line in the same manner.

  • Once both lines are drawn, the angle between them is calculated. Note that two angles are shown, in the format A/B, where A is the interior angle and B is the exterior angle. The lines do not need to intersect or touch to calculate the angle.

  • To erase an angle, you can use the Delete Tool using the Shift key.

Back to Menu

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Displaying Pixel Values

  • Select the Pixel Lens tool, place your cursor over an image and right-click. Select Tools and Pixel Lens.

  • The cursor shape for the Pixel Lens tool is:

  • To use the pixel lens tool, press and hold down the left mouse button while over an image and move the mouse over the image. The value of the pixel directly underneath the center of the cursor is displayed.

  • Note that the value shown is converted into the appropriate units if necessary, e.g. Hounsfield units for CT images.

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Magic Glass

The magic glass tools allow a rectangular subsection of the image to be selected and viewed differently- magnified, inverted, or sharpened.

  • Select the Magic Glass tool, place your cursor over an image and right-click.

  • The cursor shape for all the Magic Glass tools is:

  • Select Tools and either Magic Glass 2x, Magic Glass Invert, or Magic Glass Sharpen.

    • Magic Glass 2x displays the selected region at 2x magnification.

    • Magic Glass Invert displays the selected region with an inverted grayscale.

    • Magic Glass Sharpen displays the selected region with a sharpening filter applied.

Back to Menu

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Magic Glass (cont.)

  • To use the Magic Glass tool, press and hold the left mouse button over an image and move the mouse pointer around the image to view other areas of the image

  • To change the size and shape of the selected region, hold down the Ctrl key while moving the mouse.

  • To change the Window Level of the selected region, hold down the Alt key while moving the mouse.

  • To change the magnification of the selected region, hold down the Shift key while moving the mouse.

  • Any window level or magnification changes made to the displayed region are temporary and do not affect the way the image is displayed.

Back to Menu

Click to continue


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Display Options

The Display options allow you to show the graphics and annotation associated with the images selected. To select the Display options, place your cursor over an image and right-click. Click Display and the desired option:

  • Image Overlay: To select the Image Overlay option, click Display and Image Overlay. This option turns the system overlay text (e.g. Patient Name and ID) on or off. The overlay text is always turned on by default. The size of the font used decreases with the image upcount, to minimize the area of the image obscured by the text. If the selected image upcount makes the images too small (e.g. 9 on 1), then the overlay text is turned off automatically.

  • Local Annotations: To select the Local Annotations option, click Display and Local Annotations. This option toggles on or off any user-created distance/angle lines. This option is always turned on by default.

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Display Options (cont.)

  • Overlay Graphics: To select the Overlay Graphics option, click Display and Overlay Graphics. This option turns on or off the display of any DICOM 6000 graphical overlay information that was part of the original image. This option is always turned on by default.

  • Text Annotations: To select the Text Annotations option, click Display and Text Annotations. This option toggles on or off the display of any text annotations that were created and saved by the PACS Workstation and that are part of the original image. Text annotations cannot be permanently modified in any way using PathSpeed Web. This option is always turned on by default.

  • All On / All Off : To select the All On or All Off options, click Display and All On or All Off. These two options toggle all of the annotations ON or all of the annotations OFF. All of the annotations are set ON by default.

Back to Menu

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TruRez

  • TruRez enables the display of images without transferring 100% of the image data. Only the necessary amount of image data is transferred for the monitor size being used. TruRez reduces network load.

  • The lower left corner of the image indicates if an image is TruRez. If so, two numbers, such as 4/6 will show. If an image is not stored in TruRez format, the display in the lower left corner shows FullRes.

  • To select the TruRez level, place your cursor over an image and right-click. Select TruRez Levels and a level of image data transmitted.

  • The Continuous Zoom tool automatically retrieves the next level of TruRez data when needed.

  • The Magic Glass 2X tool does NOT alter the TruRez level of the image being displayed.

Back to Menu

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Other Manipulations

  • All the manipulations, except Invert Gray Scale,can be applied more than once. To select the Manipulations options, place your cursor over an image and rightclick. Select Manipulations and one of the following options.

  • Flip Horizontal This option flips the image left/right around the vertical axis through the middle of the image.

  • Flip Vertical This option flips the image up/down around the horizontal axis through the middle of the image.

  • Rotate 90 CCW This option rotates the image 90 degrees counter-clockwise.

  • Rotate 90 CW This option rotates the image 90 degrees clockwise.

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Other Manipulations (cont.)

  • Invert Gray Scale This option inverts the grey scale of the image, so that areas that were black are now shown in white, and vice-versa. Invert Gray Scale is a toggle state. If the image’s gray scale is inverted from its normal state, then the menu item has a check mark next to it. If the image is in its normal gray scale state, no check mark is present.

  • Continuous Zoom 2x This applies a relative zoom of 2 to the image, making it larger. This command automatically retrieves the next level of TruRez data, if needed, to maintain image quality.

  • Continuous Zoom 1/2x This applies a relative zoom of 0.5 to the image, making it smaller.

Back to Menu

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Display Reset

  • Options are available to reset the display state of the image. A check mark next to an option indicates that the image is already being displayed in the reset state for that option. To select a Reset option, place your cursor over an image and rightclick. Select Reset and either Window Level or Orientation.

  • Window Level This option restores the window and level settings to the original values (when the image was first displayed). This is also available via the reset button.

  • Orientation This option restores the flip and rotate settings to the original values (when theimage was first displayed).

Back to Menu

Click to continue


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Interpolation Modes

Scaling options are available to change the interpolation mode used when images are displayed. A check mark next to the option indicates the current scaling mode. To select a Scaling Mode option, place your cursor over an image and right-click. Select Scaling Mode and one of the following options:

  • Nearest Neighbor This option applies nearest neighbor interpolation to images. This method is fast, but gives poor results for significantly zoomed images.

  • Bilinear Interpolation This option applies bilinear interpolation to images. This is the default setting for RGB images. This method gives better results than Nearest Neighbor, but is slower.

  • Bicubic Interpolation This option applies bicubic interpolation to images. This is the default setting for monochrome images. This method may give better results than Bilinear Interpolation, but is slower.

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Image Information Display

  • The Image Information option displays a window that shows information about a particular image. The window displays attributes from the PACS database, as well as the image header, and identifies any header values that differ from the PACS database values displayed (values may differ due to the profiling used, or if exams or patients have been merged). To select the Image Information option, place your cursor over an image and rightclick. Select Image Information.

  • Note that multiple image information windows can be displayed at the same time. 

Back to Menu

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Image Printing

  • The Print Image option allows you to print the displayed image to a local printer.

  • To select the Print Image option, place your cursor over an image and right-click. Select Print Image.

  • Note: Images are printed "fit to page", regardless of display size or zoom factor.

Back to Menu

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Image Save to File

  • The Save Image options are available to save a displayed image to a bitmap (*.bmp) file or to the clipboard. To select a Save Image option, place your cursor over an image and right-click. Select Save Image and one of the following options.

  • Whole Image In Bitmap Format Selecting this option brings up a standard save dialog to choose the folder and file name to save the image to. This option saves the entire image, even portions that may not be displayed, to a bitmap (*.bmp) using the currently applied display options. Any overlay information or measurement lines currently displayed on the image are not saved. Any overlay graphics that came with the image are saved if they were displayed when this option was selected.

  • Image Display In Bitmap Format Selecting this option brings up a standard save dialog to choose the folder and file name to save the image to. This option saves only the portion of the image that is displayed to a bitmap (*.bmp) using the currently applied display options. Any overlay information or measurement lines currently displayed on the image are also saved. Any overlay graphics that came with the image are saved if they were displayed when this option was selected.

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Image Save to Clipboard

  • Select Save Image and Image Display To Clipboard This is the same as the Image Display In Bitmap Format option, except that the output goes to the clipboard instead of a file and does not bring up a dialog. This option saves only the portion of the image that is displayed to a bitmap (*.bmp) using the currently applied display options. Any overlay information or measurement lines currently displayed on the image are also saved. Any overlay graphics that came with the image are saved if they were displayed when this option was selected. 

  • Note: These options only save a copy of the displayed image as a picture that can be used elsewhere. PathSpeed Web cannot save and/or modify images on the PACS system.

Back to Menu

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Color Display Limitations

  • RGB color images can be displayed, but the following tools and options are not available for RGB color images:

  • • Tools > Window Level

  • • Tools > Pixel Lens

  • • Tools > Magic Glass Invert

  • • Tools > Magic Glass Sharpen

  • • Tools > ROI Calculate Window Level

  • • Set Window / Level

  • • Transforms > Invert Gray Scale

  • • Reset > Window Level

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