1. iSite 3.5: User Preferences

2. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Learning Objectives General Preferences Window Width/Center Image Processing Filters Display Preferences Hanging Protocols (iSite Radiology only) Canvas Page (iSite Radiology only) Understand the purpose and configuration of:

3. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Table of Contents Preferences Dialog General Preferences Window Width/Center Image Processing Filters Display Preferences Hanging Protocols (iSite Radiology only) Canvas Page (iSite Radiology only)

4. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Preferences Dialog

5. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 User Preferences User Preferences configure preferences for the currently logged in user System Preferences configure system-wide settings for every user Machine Level Preferences configure settings for the machine on which the user is currently logged in User Preferences are associated with the Security Code ISTUSRPREF

6. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Importing and Exporting Preferences Many preference settings can be imported and exported to facilitate setting up User and System Preferences The User Preferences that can be imported and exported are Window Width/Center and Filters The System Preferences that can be imported and exported are Window Width/Center, Filters, Annotation, DICOM Sources, Screen Overlays, Paper Printing, Organization Dictionary, Location Dictionary and Body Part Dictionary Please note that importing preferences will override any preferences in the system

7. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Preferences Dialog Preferences can be accessed by selecting the ‘P’ icon in the upper- right corner of the iSite Control Strip

8. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 General Preferences

9. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 General Preferences To configure your General User Preferences, click the ‘General Preferences’ listing and edit the options as desired for your iSite Radiology account

10. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Main Exam Monitor Layout Main Exam Monitor Layout allows users to specify the monitor on which current exams (versus prior exams) will be displayed

11. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Main Exam Monitor Layout ‘Two Monitor’ (dual diagnostic monitor workstations) selection allows current exams to be displayed on the left or right monitor

12. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Main Exam Monitor Layout ‘Four Monitor’ (four diagnostic monitor workstations) allows current exams to be displayed on the left two monitors, the right two monitors or the middle two monitors

13. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Main Exam Monitor Layout For customers who have the ‘Monitor Split Mode’ option enabled The ‘Monitor Split Mode’ option will display the active exam as specified in the ‘Four Monitor’ option in the ‘Main Exam Monitor Layout’

14. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Main Exam Monitor Layout The ‘Monitor Split Mode’ is enabled on the fourth (and last) page of the Hanging Protocols Wizard The ‘Monitor Split Mode’ is used to emulate two or four diagnostic monitor workstations for one and two diagnostic monitor workstations respectively

15. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Canvas Page Mode “Canvas Page Mode” options specify whether exams displayed in your Canvas Page are organized by patient or by exam

16. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Canvas Page Mode ‘Patient Based Mode’ will allow only one “Main Exam” per patient to be open at a time ‘Exam Based Mode’ will allow multiple “Main Exams” per patient to be open at a time

17. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Automatically Open Next Exam If you wish iSite Radiology to automatically open the next exam in Worklist Filters when you mark an exam “Read” click the corresponding checkbox

18. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Show Tips at Startup The ‘Tip of the Day’ may be disabled by un- checking the “Show tips at startup” button

19. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Tip of the Day Alternatively, If you wish to disable the ‘Tip of the Day’ uncheck the “Show tips at startup” checkbox while viewing the ‘Tip of the Day’

20. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 New Features The ‘New Features’ dialog will display upon the first log-in following a system upgrade

21. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Disable Navigation Rectangle Splitting Users who wish to disable Navigation Rectangle Splitting for Canvas Page Navigation Rectangles may select the “Disable Navigation Rectangle Splitting” checkbox

22. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Disable Navigation Rectangle Splitting The red rectangles shown on the Canvas Page indicate which images are displayed on the diagnostic monitors The rectangles may be split in order to display nonadjacent series or even series within prior exams

23. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Disable Navigation Rectangle Splitting Demonstrated at left are series from two exams The Navigation Rectangles in the upper left corner of each series indicate the placement of each series on the diagnostic monitors If the ‘Disable Navigation Rectangle Splitting’ option is active then this is not an option

24. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Show Measurements Palette Users who wish to display the measurements palette automatically when viewing images, may select the “Show Measurement Palette” checkbox

25. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Display Key Image Stack Users who wish to display the Key Image Series at the beginning of the Exam Rack, may select the “Display Key Image Stack” checkbox

26. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Anatomical Right on Left Side of Image Window Please note that the visibility of this option is dependent on the System Preferences set by your institution's iSite System Administrator

27. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Anatomical Right on Left Side of Image Window Users who wish to automatically display axial and oblique CTs with the anatomical right displayed on the left, regardless of the initial orientation of the image, may select the “Axial/Oblique CT:…” checkbox

28. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Window Width/Center

29. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Window Width/Center Users may select the Window Width and Center dialog to add, modify or delete the default preset window width and center values display

30. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Add Window Width/Center The Add Window Width/Center may be used to create new Window Width/Center presets by establishing a name, indicating the Modality and settings the Width and Center

31. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Window Width/Center To edit a window width and center setting “double click” a listing or highlight a listing and click the ‘Properties’ button When you have finished making changes, click ‘Apply’ and then ‘OK’ to save and exit the Dialog box

32. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Window Width/Center Window Width/Center settings are mapped to the number keys in the order displayed on the list

33. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing

34. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing Edge Enhance: Uses a Laplacian method to increase the visibility of edges in the image Edge Detection: Provides an alternative to the Edge Enhance tool, using a Sobel operator to increase the visibility of edges Median Filtering: Uses a common filtering method to reduce noise in an image CLAHE (Contrast Limited Adaptive Histogram Equalization): Utilizes an adaptive form of histogram equalization that enhances the contrast adaptively across the image

35. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing Image Processing Filters have several configurable parameters which may be configured by each individual user

36. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing Image Processing Filters can be applied manually (via a right mouse click option) Any time an Image Processing Filter is applied to an image, iSite displays a “P” (Processed) Icon in the meta data area of that image

37. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing – Edge Enhance ‘Edge Enhance’ is performed with a Laplacian operator to discriminate the edges; the result is scaled and added back into the original image data

38. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing – Edge Enhance The intensity of ‘Edge Enhance’ is controlled by the “degree” parameter which can be “Light”, “Medium” or “Strong” Edge Enhancement is applicable on any monochrome image

39. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing – Edge Enhance The image on the right side has the ‘Edge Enhance’ filter applied

40. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing – Edge Detect This class of algorithm accentuates the rising and falling components of edges This is done with a Sobel operator; the result is scaled and added back into the original image data

41. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing – Edge Detect The intensity of ‘Edge Detect’ is controlled by the “degree” parameter which can be “Light”, “Medium” or “Strong”

42. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing – Edge Detect The image on the right side has the ‘Edge Detect’ filter applied

43. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing – Median Filter ‘Median Filter’ is used as a noise reduction filter Neighborhoods around each pixel are sampled and the central pixel is replaced with the median value of the neighborhood

44. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing – Median Filter The image on the right side has the ‘Median Filter’ applied

45. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing - CLAHE Contrast Limited Adaptive Histogram Equalization (CLAHE) is a variant of histogram equalization The draw back of the general histogram equalization method is that the computation is performed across the entire image

46. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing - CLAHE In medical images, the local behavior of the histogram can be radically different than either the global, or non-local behavior This class of method performs the histogram equalization on a parameterized region-by-region basis and stitches the results to prevent any boundary edges

47. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing - CLAHE The following parameters can be set via the “Preferences” Contextual Region Dimension Number Of Bins Clip Limit Map Level

48. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Image Processing – CLAHE The image on the right side has ‘CLAHE’ applied

49. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Filters

50. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Filters Filters allow you to create custom search criteria for Worklists

51. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Filters Filters can be used to create Reading Worklists to meet specific needs Exercise care in creating filters so exams are not accidentally excluded To create a filter click ‘Add’

52. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Filters This screen allows the user to generate a filter Users are not required to fill in all the fields because the default for an empty field is ‘all’ When you have finished making changes, click ‘Apply’ and then ‘OK’ to save and exit the Dialog box

53. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Filters The Filter shown will provide a worklist which includes: –“CARDIAC” subspecialty (as defined in the Exam Dictionary) –Unread –All Exam Statuses

54. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Filters The Filter shown will provide a worklist which includes: –“CR” and “DX” (DR) images for patients in –“Critical Care” Units –For Body Part “Chest” –“Stat” priority –“Unread Only” –“Completed” Exam Status

55. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Filters The Filter shown will provide a worklist which includes: –“CR” and “DX” (DR) images for patients in –“Outpatient” Units –For Subspecialty “BONE” –“Non-Stat” priority –All Exam Statuses, except “In Progress” –For 30 Days –Ordered by Dr.’s Smith, Jones, or Davis

56. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Display Preferences

57. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Display Preferences The Display Preferences allow you to set several options

58. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Font Sizes Users may select from the Screen Overlays Font Sizes menu in the User Preferences Display Preferences The value of each selection is determined by the Machine Preferences Font Size settings

59. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Font Sizes ‘Small Font,’ ‘Medium Font,’ and ‘Large Font’ control the font size of the Screen Overlays

60. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Font Sizes The Screen Overlay is shown at left with 30 font size

61. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Font Sizes ‘Cine Playback Resolution’ controls the matrix size of images displayed during cine playback The default setting is “Full Resolution”

62. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Font Sizes ‘Default Cine Rate’ controls the frame rate of the cine loop playback ‘Default Cine Rate’ will be used if the “Recommended Frame Rate” (DICOM Attribute 0008,2144) or “Cine Rate” (DICOM Attribute 0018,0040) are not present

63. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Font Sizes The ‘Scout Line Mode’ defines which scout line method is used Single: a scout line showing the location of the slice being reviewed

64. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Font Sizes Bracket: a single scout line, showing the location of the slice being reviewed, as well as the two lines showing the limits of the series being reviewed All: a line for every slice in the series being reviewed

65. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Font Sizes The ‘Localizer Mode’ option defines whether or not scout lines are displayed when the Localizer Mode is active

66. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Hanging Protocols

67. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Hanging Protocols The Hanging Protocols preference area allows the user to view the iSite Radiology Hanging Protocols and to delete them if necessary

68. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Hanging Protocols All of the Hanging Protocol properties windows are ‘Read Only’ and cannot be edited from the Preferences page Hanging Protocols must be edited from within the Radiology canvas page

69. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Canvas Page

70. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Canvas Page Canvas Page allows the user to activate the display of information on the iSite Radiology Canvas Page

71. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Patient Information Area Patient Comments (DICOM Tag 0010,4000) Patient History (DICOM Tag 0010,21b0) Study Comments (DICOM Tag 0032,4000)

72. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 Exam Information Area Reason for Study (DICOM Tag 0032,1030) Impressions (parsed from report messages)

73. CONFIDENTIAL TRN-0035-04 Rev 04/18/06 For assistance, please call customer support at 1-877-328-2808 or 1-877-328-2809

74. CONFIDENTIAL TRN-0035-04 Rev 04/18/06