Media Viewer

Visage 7 ®

All product and company names are trademarks or registered trademarks of the respective companies. Information in this manual may be subject to changes without prior announcement.

Manufacturer Visage Imaging GmbH Lepsiusstraße 70 12163 Berlin, Germany Phone: +49 30 700968-0 Email: [email protected]

For contact information and a list of our world-wide office locations visit www.visageimaging.com. Visage Imaging is a wholly owned subsidiary of Pro Medicus Ltd. www.promedicus.com. Copyright © 2010 Visage Imaging GmbH. All rights reserved. Document Version 01.00

Table of contents Starting Visage 7 Media Viewer .........................................3

Viewing images ..................................................................5 Viewing plain film and ultrasound images ............................................................... 5 Browsing images .................................................................................................. 6 Image display ....................................................................................................... 7 Measuring distances and angles .......................................................................... 9 Comparing images ............................................................................................. 11 Closing a session ............................................................................................... 11 Viewing CT, MR, and other cross-sectional images ............................................. 12 Scrolling one series at a time ............................................................................. 13 Comparing images ............................................................................................. 14 Image display and measurements ...................................................................... 14 Showing more tools ............................................................................................ 14 Closing a session ............................................................................................... 15

Overview of media viewer tools .......................................17 Basic navigation and image manipulation tools .................................................... 17 Tools for scrolling images ..................................................................................... 18 Tools for adjusting the display size ....................................................................... 19 Tools for rotating and flipping images ................................................................... 20 Annotation and measurement tools ...................................................................... 21 Data handling tools ............................................................................................... 23 Tools for linking viewers ........................................................................................ 23 Tools for toggling image text and graphics ........................................................... 24

Visage 7 Media Viewer

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Visage 7 Media Viewer

Starting Visage 7 Media Viewer Visage 7 Media Viewer is a software for viewing DICOM images from patient CDs, DVDs, or other storage media, such as USB sticks. Note Visage 7 Media Viewer is not intended for diagnostic use. Starting Visage 7 Media Viewer

When you insert a CD, the Visage 7 Media Viewer might start automatically. -OrClick the Media Viewer icon on the CD.

If the CD contains only one study, the program loads this study immediately. If the CD contains more studies, the Study Browser is shown.

Study Browser

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Starting Visage 7 Media Viewer

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Visage 7 Media Viewer

Viewing images Visage 7 Media Viewer can read all image types. This section explains the basic workflow for viewing typical image types.

Viewing plain film and ultrasound images In Study Browser, double-click a study or series. -OrSelect more than one study or series and click View.

Computed radiography (CR) study

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Viewing plain film and ultrasound images

Viewing images

Tip If you have loaded a current and one or several prior studies, red study labels tell you which of these studies are the prior examinations.

Browsing images Immediately after you have loaded data, the program selects a layout that shows all images of your study next to each other. If the study contains more images than fit on the screen at a time, you can scroll through the images. Use the wheel mouse for fast scrolling.

-OrUse the up and down arrows on your keyboard to scroll one image at a time. -OrSelect Browse Slices on the toolbar and use the left mouse button for scrolling images.

Scrolling replaces the images in the viewers with new images further on in the study. Tip If images are shown too small, switch to a layout that shown images larger.

-OrDouble-click a viewer to show this image fullscreen. Double-click again to return to the last selected layout.

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Viewing images

Viewing plain film and ultrasound images

Image display Immediately after you have loaded a study, the Window Level tool is automatically active. You can tell this from the toolbar button, which appears selected, and from the shape of the cursor when you move the mouse across a viewer.

Standard mouse buttons

Unless you select a different tool, you can use the mouse buttons to change the image display as shown below. •

Window/Level: drag the left mouse button

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Zoom: drag the middle mouse button or wheel button

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Pan: drag the right mouse button

Alternatively, select a tool from the toolbar or tool palette and always use the left mouse button after that. Windowing images

1. Click a viewer. 2. Hold the mouse button down, and drag the mouse left or right to change the window width (contrast). -OrDrag the mouse up or down to change the window center (brightness). While the Window Level tool is active, a histogram of grayscale values is shown in the lower left corner of a viewer. A small white bar indicates the window settings graphically. This bar moves when you shift the window center and expands or shrinks when you change the window width.

Zooming images

1. Select the Zoom tool.

2. Click a point in an image. 3. Hold the mouse button down, and drag the mouse up to zoom in, or down to zoom out. The zoom focus is on the point where you clicked.

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Viewing plain film and ultrasound images

Viewing images

-OrClick Zoom 100% to show an image in its original pixel size.

Zoom 100% means that each pixel that is shown on the screen corresponds to one pixel in the image. -OrClick Fit Height/Width to return to a display size that fits the image optimally in the viewer.

Tip Right-click and select these tools from a tool palette rather than the toolbar. This method might be faster because you do not have to travel all the way across the screen to select a tool. Panning images

After you have zoomed in on an image, portions of the image might no longer be displayed in the viewer. To redisplay these portions of the image you pan the image. 1. Click Pan.

2. Drag the mouse across a viewer to move the image within the segment. Using the magnifying glass

Instead of zooming an entire image you might choose the magnifying glass as a fast way of examining details. 1. Click Magnifying Glass.

2. Click the portion of the image that interests you and hold the mouse button down. A rectangular area is displayed which is magnified by a small magnification factor initially. 3. Rotate the mouse wheel while still holding the left mouse button down. The magnification factor in the rectangle increases. 4. Move the mouse while you keep holding the left mouse button down. This gives you the impression of holding a magnifying glass in your hand.

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Visage 7 Media Viewer

Viewing images

Viewing plain film and ultrasound images

5. Release the mouse button to turn the magnifying glass off again. Inverting images

Inverting an image means to show light areas dark and dark areas light. 1. Click the viewer with the image that you want to invert. 2. Click Inverse.

Showing more tools

When you load plain film or ultrasound images, the toolbar of the View window shows the tools most frequently used for these image types. If you need more tools, right-click the toolbar section and select more toolbars.

Refer to Overview of media viewer tools (page 17) for a detailed description of all tools.

Measuring distances and angles In Visage 7 Media Viewer you can measure distances and angles in images but you cannot save or export your measurements. Measuring distances

1. Show the image in which you want to measure a distance. 2. Zoom in on the image as much as you can, or select Zoom 100%.

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Viewing plain film and ultrasound images

Viewing images

3. Click Distance.

4. Click the start point of the distance line. 5. Drag the mouse to the endpoint of your measurement and release the mouse button.

Tip Measuring distances makes sense in calibrated images only. You can tell whether images are calibrated by the units in which distances are shown. Millimeters (mm) indicate calibrated images, mm* indicate projection images, and pixels (pix) indicate image, in which no distance measurements are possible. Measuring an angle

1. Show the image in which you want to measure an angle. 2. Zoom in on the image as much as you can, or select Zoom 100%.

3. Click Angle (Two Lines).

4. Click and drag to create the first line. 5. Release the mouse button to finish the first line. 6. Click and drag to create the second line. 7. Release the mouse button to finish the second line.

If your two lines intersect within the image area, the program calculates both the acute angle and the obtuse angle. 10

Visage 7 Media Viewer

Viewing images

Viewing plain film and ultrasound images

Comparing images 1. Switch to a series layout 2x1 Series.

2. Drag a series from the thumbnail section at the bottom of the View window into one of the the two blank viewers.

3. Also drag a series into the other viewer. If your study contains only one series, load the same series twice. 4. Now browse slices in both viewers until the two images you want to compare are shown side by side.

Closing a session When you have finished reviewing a study, close the session.

Closing a session returns you to Study Browser.

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Viewing CT, MR, and other cross-sectional images

Viewing images

Viewing CT, MR, and other cross-sectional images In Study Browser, double-click a study or series. -OrSelect more than one study or series and click View.

The View window opens and the system selects an initial layout that shows all series side by side. Localizers are not shown initially. If you also want to see localizers, drag these into a viewer from the thumbnail section.

Computed tomography (CT) study

Tip If you have loaded a current and one or several prior studies, red study labels tell you which of these studies are the prior examinations.

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Visage 7 Media Viewer

Viewing images

Viewing CT, MR, and other cross-sectional images

Scrolling one series at a time 1. Click the viewer that shows the series in which you want to scroll. 2. Scroll with the wheel mouse.

-Or1. Select Browse Slices.

2. Hold the mouse button down and drag the mouse up or down to scroll through the images of this series. -OrUse the up or down arrow keys on your keyboard. When you scroll, scoutlines are shown in the images of one or several of the other viewers. Scoutlines indicate the location of the slice that is currently displayed in the viewer in which you scroll.

Tip Display of scoutlines requires that series were acquired with different image orientation, for example, sagittal and axial. Scoutlines cannot be shown in coplanar series.

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Viewing CT, MR, and other cross-sectional images

Viewing images

Comparing images 1. Select the 2x1 Series layout.

2. In the thumbnail section select the first of the two series that you want to compare. 3. Drag the thumbnail into one of the viewers.

4. Drag the thumbnail of the second series into the second viewer. 5. Start scrolling until the images that you want to compare are shown side by side.

Image display and measurements When reviewing CT or MR images, you can change the way images are displayed in various ways. You can window, zoom, or pan images, for example. Moreover, you can measure distances and angles. Remember, however, that you cannot save or export measurement results. When reviewing images, proceed in the same way as when you review plain film images. See Image display (page 7) and Measuring distances and angles (page 9).

Showing more tools When you load cross-sectional images, the toolbar of the View window shows the tools most frequently used for these image types. If you need more tools, right-click the toolbar section and select more toolbars.

Refer to Overview of media viewer tools (page 17) for a detailed description of all tools. 14

Visage 7 Media Viewer

Viewing images

Viewing CT, MR, and other cross-sectional images

Closing a session When you have finished reviewing a study, close the session.

Closing a session returns you to Study Browser.

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Viewing CT, MR, and other cross-sectional images

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Viewing images

Visage 7 Media Viewer

Overview of media viewer tools This section provides a quick overview of a media viewer tools.

Basic navigation and image manipulation tools Visage 7 Media Viewer shares basic image navigation and image processing tools with the full Visage 7 software. Window Level

With this tool you can change the contrast and brightness in images. 1. Click Window/Level. -OrUse the left and right mouse button to window images without selecting the Window Level button on the toolbar first.

2. Click a viewer segment and hold the mouse button down. 3. Drag the cursor left or right to change the window width (contrast). -OrDrag the cursor up or down to change the window center (brightness). While the Window Level tool is active, a histogram of grayscale values is shown in the lower left corner of a viewer. A small white bar indicates the window settings graphically. This bar moves when you shift the window center and expands or shrinks when you change the window width. Zoom

With this tool you can enlarge or reduce images interactively. 1. Click this button to select the tool. 2. Click a viewer and hold the mouse button down.

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Tools for scrolling images

Overview of media viewer tools

3. Drag the cursor up to zoom in. -OrDrag the cursor down to zoom out. -OrUse the middle mouse button (or wheel button) to zoom images without selecting the Zoom button on the toolbar first. Pan

With this tool you can move an image within a viewer segment. You typically use this tool after you have zoomed an image and relavant image information has moved out of the viewer segment. 1. Click this button to select the tool. 2. Click and drag the mouse across a viewer to move the image within the viewer segment. -OrDrag the right mouse button to pan images without selecting the Pan button on the toolbar first. Inverse

This tool inverts the image in the active viewer. Inversion means that light areas are displayed dark and dark areas are displayed light. Inversion is not possible for the 3D viewer.

Tools for scrolling images The tools in this section help you with navigating through the loaded data. Browse Slices

With this tool you can use the left mouse button to scroll through an image stack. 1. Click Browse Slices to select the tool. 2. Click and drag the mouse up or down to scroll forward or backward through the image stack.

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Overview of media viewer tools

Tools for adjusting the display size

Scroll Page by Page

If you have loaded 2D images from modalities other than CT (computed tomography) or MR (magnetic resonance), images are arranged next to each other. If a study also contains a large number of images, more images have been loaded than can be shown on the screen at a time. Two modes exist for scrolling images in such studies. •

Scroll Page by Page selected Browse Slices or the wheel mouse replaces the contents of the entire screen with images that were previously hidden.

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Scroll Page by Page not selected. Browse Slices or the wheel mouse scroll one image up or down at a time.

Triangulation

Use this tool to focus on a particular point in all viewers that show images containg this point. 1. Click the Triangulation button to select the tool. 2. Click a point in any of the viewers. Tip The Triangulation tool is particularly useful when you are reading multiseries MR datasets.

Tools for adjusting the display size In addition to interactive zooming (see Zoom, page 17) Visage 7 Media Viewer offers a number of additional tools to switch to optimized image sizes quickly. Fit Height/Width, Fit Width, Fit Height These tools resize images so that they fit optimally in their viewers (Fit Width/ Height), or so that they make optimum use of the viewer width (Fit Width) or viewer height (Fit Height). Zoom 100%

This tool shows images in their original size. This means that one pixel from the image file corresponds to one pixel on the monitor.

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Tools for rotating and flipping images

Overview of media viewer tools

Magnifying Glass

Use this tool to be able examine details in the displayed images more closely and without having to zoom the entire image. 1. Click Magnifying Glass to select the tool. 2. Click an image and hold the mouse button down. A rectangular area is displayed magnified by a factor of 2. 3. Drag to move the rectangle over the image. This gives you the impression of holding a magnifying glass in your hand. 4. Turn the mouse wheel while still holding the left mouse button down to inrease or decrease the zoom factor of the magnifying glass. 5. Release the mouse button to turn the magnifying glass off. The tool is still selected and you can click another viewer to use the magnifying glass there. 6. Click the tool on the toolbar a second time. Only now is the Magnifying Glass tool turned off again.

Tools for rotating and flipping images With the tools in this section you can rotate or flip images. Rotate Clockwise, Rotate Counterclockwise These tools rotate the image in the active viewer by 90° clockwise or counterclockwise. Rotation is applied only to the viewer in which you clicked, images in linked viewers are not affected. Flip Horizontally, Flip Vertically These tools rotate the image in the active viewer around its vertical or horizontal axis. Rotation is applied only to the viewer in which you clicked, images in linked viewers are not affected.

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Visage 7 Media Viewer

Overview of media viewer tools

Annotation and measurement tools

Annotation and measurement tools With this set of tools you can annotate and evaluate image information. Note In Visage 7 Media Viewer you cannot save, send, or export annotations and measurements. Arrow/Text Annotation

Use this tool to add annotation text or to draw an arrow and add text to point to and highlight observations. 1. Click Arrow/Text Annotation to select the tool. 2. Click a point in an image. 3. Type your annotation txt in the Edit Annotation dialog box. -Or1. Click Arrow/Text Annotation to select the tool. 2. Click a point in an image. 3. Hold the mouse button down, and drag the mouse across the image to create an arrow. 4. Release the mouse button and type your annotation text in the Edit Annotation dialog box. Circle Annotation

Use this tool to draw a circle around an area of interest and add annotation text that comments your observation. 1. Click Circle Annotation to select the tool. 2. Click a point in an image. 3. Drag in or out to make the circle smaller or larger. 4. Release the mouse button and type your annotation text in the Edit Annotation dialog box.

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Annotation and measurement tools

Overview of media viewer tools

Distance

Use this tool to measure distances in images. Tip For optimum accuracy select Zoom 100% or even a larger zoom factor before you start measuring distances. 1. Click the Distance button to select the tool. 2. Click where you want to start your distance measurement. 3. Hold the mouse button down and drag the mouse across the image. 4. Release the mouse button at the endpoint of your distance line. Angle (Two Lines)

Use this tool to measure an angle in an image. Tip The accuracy of angle measurements depends on the length of the shorter of the two angle legs. The longer the angle legs are, the better the accuracy. For optimum accuracy select Zoom 100% or even a larger zoom factor before you start measuring angles. 1. Click Angle (Two Lines) to select the tool. 2. Click and drag the first line. 3. Release the mouse button to finish the first line. 4. Click and drag the second line. 5. Release the mouse button to finish the second line.

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Visage 7 Media Viewer

Overview of media viewer tools

Data handling tools

Data handling tools These tools help you with various data handling tasks. Study Navigator

This tool opens the Study Navigator dialog box, from where you can select and load more studies of the current patient. The tool is available only if more than one study is stored on the CD or DVD for this patient. Study Information

Use this tool to show the study information dialog box.

Tools for linking viewers These tools are available for cross-sectional images only. Automatically Link Viewers In CT (computed tomography) and MR (magnetic resonance) images, this tool links all viewers that show image stacks with the same frame of reference. You can now scroll in these image stacks simultaneously. 1. Click Automatically Link Viewers to select the tool. Linked viewers show images of a corresponding image position now. 2. Start scrolling.

Toggle Linked Navigation This tool turns synchronized scrolling off again.

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Tools for toggling image text and graphics

Overview of media viewer tools

Tools for toggling image text and graphics These tools show or hiode text and graphics overlays in all viewers. Toggle All

Use this to show or hide any texts or graphics. Tip Alternatively, use the Space key on your keyboard to turn text and graphics on an off. Toggle Patient/Study Data Use this tool to show or hide patient or study information text in all viewers. Toggle Scale

For calibrated image types (for example, CT images) a scale can be shown on the right edge of the viewers. The scale looks like a small ruler and indicates centimeters or millimeters when you zoom in. Use this tool to hide or redisplay the scale. Toggle Annotations

Use this tool to show or hide annotation text, annotation arrows, and measurement text and graphics in images. Toggle Scoutlines

Use this tool to show or hide scoutlines. Scoutlines are dahed lines that indicate the location of a slice shown in one of the other viewers. Toggle DICOM Overlays, DICOM Shutters Use these tools to show or hide DICOM overlays or DICOM shutters. These tools are available only if images contain these information layers.

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