Table Of ContentUNITYTM RIS/PACS
Catapult™ Guide
for Technologists
Release 8.2
U.S. Patent Number 5,452,416
Copyright and Notice
Copyright © 1997-2009 DR Systems, Inc. All rights reserved.
All data and information contained in or disclosed by this document are confidential and
proprietary information of DR Systems, Inc. All rights therein are expressly reserved. By
accepting this material, the recipient agrees that this material and the information contained
therein will be held in confidence and in trust by the recipient, and will not be used, copied, or
otherwise reproduced in whole or in part, nor its contents revealed in any manner to others,
without the express written consent of DR Systems, Inc.
While reasonable efforts have been made to ensure the accuracy of this document,
DR Systems, Inc., assumes no liability resulting from any inaccuracies or omissions in this
document, or from any use of the information obtained from this document. DR Systems, Inc.
reserves the right to make changes in content herein, with no obligation to notify any person of
revisions or changes. DR Systems, Inc. does not assume any liability arising out of the
application or use of any product or software described herein; neither does it convey any
license or any other right under its patent rights or other intellectual property or proprietary rights
or the proprietary rights of others.
DR Systems, Inc. reserves the right to make changes in technical and product specifications at
any time, in its sole discretion, without prior notice.
Trademarks and Patents
Products and equipment by DR Systems described herein are manufactured under one or more
patents, including U.S. Patent #5,452,416, and other patents pending.
Ambassador, Catapult, CD Ambassador, Communicator, DICOM Guardian, Disk Array
Guardian, Document Scanning, Dominator, DR Mammography Reporting and Tracking, DR
Scheduler, DR Systems, Film Tracking, Guardian, Image Shuffling, Instant Reporter,
Management Reports, Media Ambassador, Messenger, Multiprocessor Communicator, Network
Media Ambassador, Patient Link, Patient Tracking, Pixel Tracking, Report Manager, Sentinel,
SmartForms, Smart Shuffling, Unity RIS/PACS, Universal Manager, Web Ambassador, Web
Dominator, and Web Transcription are trademarks of DR Systems, Inc., San Diego, CA.
Other trademarks used herein are the property of their respective owners.
License Agreement
The software described in this document is furnished under a License Agreement. The software
may be used or copied only in accordance with the terms of this agreement. It is against the law
to copy the software produced by DR Systems, Inc. on disk or any other medium for any
purpose other than that specifically allowed in the License Agreement.
Warranty
DR Systems, Inc. provides a warranty for the system that it configures. The specific warranty
terms for each product are included in the documentation provided by DR Systems, Inc. for such
product. Warranty services are provided only to the original registered owner of the equipment.
Warranty services are coordinated through the DR Systems Technical Services team.
Exclusions from warranty include: Unauthorized modification or misuse; operation outside the
stated environmental specifications for the product; and improper or unauthorized maintenance
by the customer.
Patient Confidentiality
DR Systems wants to remind its customers that there may be legal, ethical, and moral
obligations for medical care providers to protect sensitive patient information.
TCP-000259-A
Catapult Guide for Technologists - Release 8.2
Table of Contents
Chapter 1 Getting Started 1
Safety, Security, and Patient Confidentiality........................................1
About Maintaining Security and Patient Confidentiality........................................1
About HIPAA Compliance and Your Facility.........................................................1
General Cautions and Warnings........................................................................2
Patient Editing Warning...................................................................................2
Warnings for Reading Physicians......................................................................3
Logging in and Logging out...............................................................4
Logging in to the System the First Time............................................................4
Login Errors...................................................................................................6
Logging Out...................................................................................................7
Setting and Changing Passwords......................................................................8
Getting Started with Acquiring Exams ...............................................10
Keyboard Shortcuts - DICOM Catapult.............................................................10
Keyboard Shortcuts - Video Capture Catapult...................................................13
About the Electronic Requisition.....................................................................16
Chapter 2 Acquiring Images 19
Warnings for Technologists..............................................................19
Using the Video Capture Catapult .....................................................20
Acquiring Images by Video Capture................................................................20
Getting Started with the DICOM Catapult...........................................24
Introduction to the DICOM Catapult................................................................24
Preparing for the Exam.................................................................................24
Importing from the Imaging Device................................................................34
Associating Technologists and Exams with DICOM Images.................................36
Postprocessing Exams...................................................................................41
Additional Catapult Processes.........................................................................51
Mobile Catapults...........................................................................................52
Using the DICOM Catapult...............................................................53
DICOM Status..............................................................................................53
About Splitting Right and Left Images into Separate Series................................53
Importing and Associating an Exam from the DICOM Gateway...........................53
Capturing a Remote Image with the DICOM Gateway........................................54
Adding Images to an Online Exam..................................................................54
Adding Images to an Imported Exam..............................................................55
About Copying or Sending a DICOM Exam.......................................................56
Copying an Exam to a DICOM Device..............................................................58
Sending an Exam to a DICOM Device..............................................................61
Postprocessing Imported Exams.....................................................................63
Merging and Splitting Exams..........................................................................65
Managing Orders..........................................................................................84
Using the DICOM Catapult Locally...................................................................88
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Using the Film Digitizer Catapult.......................................................89
About Digitizing Film.....................................................................................89
About Digitizing Mammograms.......................................................................90
Digitizing Using Kodak LS40 or LS75...............................................................91
Digitizing Using VIDAR DiagnosticPro..............................................................94
Problem Solving with VIDAR Digitizer..............................................................98
Using Features for All Types of Catapults...........................................99
Viewing and Adding Notes to Exams...............................................................99
Suspending an Exam...................................................................................100
Creating Window/Level Settings for a Series...................................................100
Confirming Adverse Reaction Warnings..........................................................101
Transferring a Remotely Captured Image.......................................................103
Restoring Prior Exams when Prompted...........................................................104
Recording Payments for Exams.....................................................................105
Chapter 3 Finding Records - Search, Sort, and Filter 111
Getting Started............................................................................111
About Searching, Sorting, and Filtering..........................................................111
Searching and Sorting...................................................................111
Searching and Sorting..................................................................................111
Sorting the Report Column...........................................................................115
Using Filters................................................................................120
About Using Filters......................................................................................120
Creating Temporary Filters...........................................................................126
Creating and Saving Filters...........................................................................129
Creating Filters that Exclude Values...............................................................134
Creating Filters for Upcoming Exams..............................................................135
Creating Filters by Patient Age......................................................................141
Creating Subfilters.......................................................................................148
Applying a Filter..........................................................................................151
Modifying a Saved Filter...............................................................................151
Deleting a Filter...........................................................................................153
Filtering for Active and Inactive Records..........................................154
About Filtering for Active or Inactive Records..................................................154
Filtering for Active or Inactive Records on Universal Manager Tabs....................155
Filtering for Active or Inactive Records on Search Lists.....................................156
Filtering for Notes.........................................................................162
About Filtering for Notes...............................................................................162
Filtering for Notes that Are Associated with Active Note Types...........................162
Filtering for Notes that Are Associated with Deleted Note Types........................163
Chapter 4 Scheduling, Registering, and Tracking Exams 167
Scheduling Exams........................................................................167
Scheduling Exams.......................................................................................167
Processing Patients for Exams and Tracking....................................................203
Generating Transport Slips from the Scheduled Tab.........................................214
Updating Exam Information..........................................................................217
Registering and Tracking Exams.....................................................236
About Patient Registration and Exam Tracking................................................236
Workflow for Registering Patients and Tracking Exams.....................................237
Other Exam Processing Functions Available from the Registration Tab................238
Managing Exams from the Registration Station...............................................239
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Monitoring Patient Flow in the Exam Process....................................298
About the Patient Flow Tab...........................................................................298
About the Components of the Patient Flow Tab...............................................298
About Color Codes on Exam Lists..................................................................300
Filtering on the Patient Flow Tab...................................................................301
Chapter 5 Working with Exams 303
Viewing Exam Properties...............................................................303
Managing Exam Status..................................................................305
Marking Exam Status...................................................................................305
Marking an Exam Checked Out......................................................................306
Marking an Exam for Archive........................................................................306
Clearing Web Locks.....................................................................................307
Clearing Edit and Grab-image Locks on the Scheduled Tab...............................307
Status and Archive Codes.............................................................................308
Using Exam Notes........................................................................310
About Information Notes and Task Notes........................................................310
Categories of Notes.....................................................................................310
Benefits of Notes.........................................................................................311
Examples of Notes.......................................................................................311
Required User Rights for Notes......................................................................312
Using Exam Information Notes......................................................................312
Using Exam Task Notes................................................................................367
Chapter 6 Tracking Films 395
Tracking Films .............................................................................395
About Film Tracking.....................................................................................395
The Film Tracking Workflow..........................................................................398
Accessing Film Tracking...............................................................................400
Viewing, Filtering, and Printing Film Jacket Records.........................................404
Chapter 7 Viewing Exams 413
Viewing an Exam..........................................................................413
Skipping Images while Scrolling .....................................................413
About skipping images while scrolling............................................................413
Skipping images while scrolling.....................................................................414
Viewing Exams on a USB Flash Drive...............................................414
Selecting Viewing Modes and Options..............................................415
Displaying a Series per Monitor.....................................................................415
Displaying a Series Per Square......................................................................415
Displaying One Image in Each Square............................................................416
Setting the View Options..............................................................................416
Setting the Number of Columns and Rows Displayed........................................417
About Configuring the View Layout for Comparing Exams.................................418
Configuring the View Layout for Comparing Exams..........................................421
Viewing Reports...........................................................................422
About Viewing Reports.................................................................................422
Viewing Reports..........................................................................................422
Configuring External Reports for Automatic Printing and Faxing.........................428
Comparing Exams........................................................................428
Comparing Exams - Viewing.........................................................................428
Comparing Exams - Tools.............................................................................442
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Chapter 8 Viewing Mammography Exams 465
About Mammography and the DR Systems PACS ..............................465
Compliance with federal regulatory requirements............................................465
Quality control for mammography.................................................................465
Methods for image acquisition in mammography.............................................466
Compression and mammography..................................................................467
Reading tools for mammography...................................................................467
Creating reports..........................................................................................469
Distributing reports......................................................................................469
Archiving and mammography........................................................................469
Using Mammography Tools............................................................469
About Mammography Annotations.................................................................469
Display Options for Mammograms and Comparison Exams...............................471
Display Options for Mammograms without Comparison Exams..........................473
Examples of Mammography Annotations........................................................474
Magnifying Portions of Adjacent Images Simultaneously...................................475
About Displaying Mammograms....................................................................478
Applying Smart Shuffle 1:1 while Viewing Exams.............................................484
Comparing Mammograms.............................................................................485
About Sorting Historical Mammogram Images for Comparison...........................487
Sorting Historical Mammogram Images for Comparison....................................489
Comparing Mammograms..............................................................490
About Displaying Mammograms....................................................................490
Setting Reading Preferences for Comparing Mammograms................................496
Previewing Primary and Comparison Mammograms.........................................498
Comparing Mammograms.............................................................................499
Applying Smart Shuffle 1:1 while Viewing Exams.............................................501
Comparing to Historical Mammograms...........................................................503
Using Mammography CAD .............................................................505
About Mammography CAD Structured Reports................................................505
About the Typical Mammography CAD Workflow..............................................507
About Workstations that Support Display of CAD Structured Reports..................509
Mammography CAD Notes for the Technologist...............................................509
Example of CAD Markers..............................................................................509
Displaying Details of CAD Markers.................................................................511
Displaying CAD Markers...............................................................................512
Hiding CAD Markers.....................................................................................513
Selecting a Specific CAD Structured Report to View.........................................513
Deleting a CAD Structured Report..................................................................513
Showing DICOM Code when Selecting a CAD Structured Report........................514
Chapter 9 Using Viewing Tools 517
Getting Started with Tools.............................................................517
About Viewing and Editing Tools....................................................................517
About the Status Bar...................................................................................519
Using Window/Level and Image Processing......................................520
About Window/Level....................................................................................520
Adjusting the Window/Level of an Image........................................................520
Mouse Shortcuts for Window/Level................................................................524
Keyboard Shortcuts for Window/Level............................................................525
Creating Window/Level Settings for a Series...................................................526
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Applying Image Processing............................................................526
Using Image Processing to Enhance Contrast..................................................526
Creating and Applying Custom Edge-Enhancement Settings..............................528
Applying Image Processing to Multiple Images................................................530
Canceling Image Processing..........................................................................532
Cropping.....................................................................................532
Cropping Images.........................................................................................532
Magnifying and Roaming ...............................................................534
Magnifying Images......................................................................................534
Magnifying a Portion of the Image.................................................................535
Magnifying Portions of Adjacent Images Simultaneously...................................536
Roaming.....................................................................................................538
Roaming Adjacent Images Simultaneously......................................................539
Pixel Tracking.............................................................................................541
Inverting, Rotating, and Flipping.....................................................547
Inverting an Image......................................................................................547
Rotating and Flipping an Image.....................................................................548
Flipping between Images for Comparison—Quick Flip.......................................550
Using Scout Insets........................................................................553
Creating a Scout Inset for Specific Images in a Series......................................553
Selecting a Scout Inset to Display..................................................................553
Moving and Resizing Scout Insets..................................................................553
Viewing Scout Insets at Full Resolution..........................................................554
Removing a Scout Inset from a Series............................................................554
Scrolling .....................................................................................554
Scrolling Images.........................................................................................554
Using Cine...................................................................................555
Using Cine for Continuous Viewing of a Series.................................................555
Applying Image Subtraction Masks..................................................557
About Applying Image Subtraction Masks.......................................................557
Accessing Exams to View Subtracted Images..................................................559
Determining if Images Have a Subtraction Mask Defined..................................560
Viewing Subtracted Images..........................................................................561
Disabling Subtraction Masks.........................................................................562
Activating Image Subtraction........................................................................564
Opacifying Subtracted Images.......................................................................565
Using Image Interpolation.............................................................566
Controlling Image Interpolation for Display.....................................................566
Using Bilinear Interpolation and Pixel Replication ..............................566
Using Bilinear Interpolation and Pixel Replication.............................................566
Working with Multiframe Images ....................................................567
Paging through Multiframe Primary and Comparison Images.............................567
Chapter 10 Using Annotations 569
Annotating Images.......................................................................569
About Adding Annotations............................................................................569
Adding Arrow Annotations............................................................................570
Adding Text Annotations..............................................................................570
Adding a Region of Interest Annotation..........................................................572
About Standard Uptake Value (SUV) Annotations............................................573
Adding SUV Annotations...............................................................................574
Editing Annotations......................................................................................574
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Deleting Annotations....................................................................................575
Deleting all Annotations...............................................................................575
Setting Image Annotation Layout....................................................577
About Setting the Annotation Layout..............................................................577
About Annotations Available for Display..........................................................578
Sample Annotation Layout............................................................................583
Viewing the Annotation Layout......................................................................584
Adding Annotations to the Layout..................................................................586
Changing Annotations Displayed in the Layout................................................588
Deleting Annotations from the Layout............................................................589
Adding Custom DICOM Annotations...............................................................590
Removing Annotations from the List of Tokens................................................592
Annotating Images with Numbers...................................................593
Adding Sequential Number Annotations..........................................................593
Adding Number Annotations to Exams............................................................595
Adding Number Annotations to the Whole Series.............................................596
Restarting the Number Annotation at 1..........................................................597
Setting the Start Number.............................................................................597
Adding a Prefix to the Number Annotation......................................................598
Reversing the Numbering Order....................................................................599
Typing Numbers Manually.............................................................................599
Editing Number Annotations.........................................................................599
Deleting Number Annotations........................................................................600
Chapter 11 Using Measurements 601
About Measurements....................................................................601
Types of measurements...............................................................................601
Adding measurements to scanned film or projection modalities.........................601
Images Must Be Calibrated............................................................602
About Measurements and Calibration ..............................................602
Relationship between measurements and calibration........................................602
What happens to measurements when you recalibrate.....................................602
Adding Measurements...................................................................603
Adding Measurement Annotations..................................................................603
Adding 3-point Angle Measurements..............................................................603
Adding Cobb Angle Measurements.................................................................604
Adding Line Measurements...........................................................................604
Adding Poly Line Measurements....................................................................605
Adding Stenosis Measurements.....................................................................606
Deleting Measurements.................................................................607
Deleting Measurements................................................................................607
Chapter 12 Calibrating Images 609
About Calibrating Images..............................................................609
Types of calibration.....................................................................................609
What you can calibrate.................................................................................610
User-applied calibration................................................................................610
About Warning Labels...................................................................610
Measurement based on imprecise DICOM calibration........................................611
Measurement based on user recalibration.......................................................611
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Calibrating Images - Standard Calibration........................................611
Calibrating Images - Catheter Calibration.........................................612
Recalibrating Imprecise DICOM Images...........................................615
Resetting User Calibration to DICOM Calibration ...............................616
Chapter 13 Working with Series 619
About Working with Series.............................................................619
About applying imaging tools to the series......................................................619
Caution when using the "Apply to Whole Series" keyboard shortcuts..................619
Applying keyboard shortcuts.........................................................................619
Keyboard shortcuts for image viewing - Apply to whole series...........................620
Keyboard shortcuts to apply to specific tools...................................................620
Imaging tools that require extra caution.........................................................621
Series functions...........................................................................................621
Viewing a Series...........................................................................621
Applying Roaming to All Images in Series ........................................622
About applying Roaming to all Images in Series..............................................622
Realigning all images in a series....................................................................623
Creating a Virtual Series................................................................624
About creating a virtual series.......................................................................624
Creating a virtual series...............................................................................624
Inserting a Series Break................................................................626
Replacing the Viewed Series ..........................................................627
Selecting a Series to Display..........................................................628
Selecting Series from Thumbnails...................................................629
About selecting a series from thumbnails........................................................629
Selecting a series from thumbnail..................................................................630
Selecting and Dropping a Series or Image........................................631
Specifying an Image in a Series to View ..........................................632
Simultaneously Paging through Series Across Monitors......................633
About paging through series across monitors..................................................633
Paging through multiple series across monitors...............................................633
Sorting a Series...........................................................................633
About Displaying Slice Lines...........................................................634
The purpose of slice lines.............................................................................634
Reading physician preference for displaying slice lines.....................................635
Slice lines are temporary..............................................................................635
Thickness and spacing of slice lines...............................................................636
Displaying Slice Lines....................................................................637
Displaying slice lines while reading an exam...................................................637
Keyboard shortcut for displaying slice lines.....................................................637
Editing a Series............................................................................637
Renaming a Series .......................................................................638
Deleting a Series..........................................................................640
Adjusting the Series Window Level and Width...................................641
Viewing the Series Default Protocols ...............................................642
About viewing the series protocols.................................................................642
Viewing the series protocols..........................................................................642
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Chapter 14 Using Presentation States 645
About Presentation States .............................................................645
Common use of Presentation States...............................................................645
Relationship of Presentation States to images.................................................645
DR Systems and Presentation States.............................................................645
About Importing Presentation States...............................................646
Ideal method - create virtual series at time of import.......................................646
Other methods - create virtual series after import...........................................646
About Viewing Presentation States..................................................646
How the system indicates that a Presentation State exists................................646
Viewing Images with Presentation States.........................................647
Applying Presentation States to Images...........................................648
Applying Presentation States to Series.............................................649
Applying Additional Edits to an Image with Presentation States...........650
When you reapply the Presentation State.......................................................650
Creating a Virtual Series with a Presentation State............................650
About Creating Virtual Series with Presentation States.......................652
If virtual series were not created during auto-import.......................................652
Result of creating virtual series with Presentation States..................................652
Automatically Creating Virtual Series...............................................652
Clearing Presentation States from Images........................................653
About Exporting Presentation States...............................................653
Exporting images using DICOM Copy.............................................................653
Which DR Systems image attributes are exported............................................654
Exporting Presentation States with an Exam.....................................655
Exporting DR Systems image attributes as Presentation States.........................655
Chapter 15 Using Advanced Image Processing 657
About Orthopedic Templating - TraumaCad......................................657
Develop Preoperative Surgical Plans..............................................................657
Complete Digital Solution for Orthopedic Procedures........................................658
TraumaCad orthopedic modules....................................................................658
About Advanced Image Processing Using Vitrea® 2...........................659
Medical diagnostic system............................................................................659
Multidimensional digital images.....................................................................659
Image processing options.............................................................................659
Workstations where available........................................................................660
Integration features.....................................................................................660
About Advanced Image Processing using Voxar 3D............................660
Workstations where available........................................................................660
Imaging processing features.........................................................................661
Other features............................................................................................661
Chapter 16 Critical Results 663
About Critical Results....................................................................663
Description.................................................................................................663
DR Systems Critical Results feature...............................................................663
Related Documents and Training Aids............................................................663
About Guidelines for Tracking and Reporting Critical Results...............663
Joint Commission initiative...........................................................................663
ACR (American College of Radiology) guidelines..............................................664
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Description:any time, in its sole discretion, without prior notice. Ambassador, Catapult, CD Ambassador, Communicator, DICOM Guardian, Disk Array. Guardian
