Accessing PACS Images from PowerChart - Excela...

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Accessing PACS Images from PowerChart


At the end of the session, the participant will be able to:

• Explain how PACS will fit into the physician process.

• Demonstrate use of the application to:

Access an Image

Search for relevant priors

Manipulate the image

• Identify key policy and procedure changes with these application functions.

PACS Image Viewing

Objectives


How to view images from Orders

Trainer Notes:

To view the images from the Orders section in Powerchart:

1. Select Order from the Powerchart menu bar

2. Select the Radiology exam you wish to view.

3. Click on the Results tab on to view the orders activity flowsheet

4. Double-click on the exam for the report you wish to view

5. To view an image on the radiology report click on the view image icon located at the top

of the report

– If the exam includes an image, at the bottom of the report will be the statement “

This document has an image.”


How to view images from Orders

1

2 3

5

1. Click on Orders

2. Select the Radiology exam to view

3. Click on the Results tab

4. Double-click on the exam in the

Date/Time column

5. Click on Image Icon to view image

4


How to view images from the Results Review

Trainer Notes:

Key Points:

1. From the Powerchart menu screen select the Results Review.

2. Then from the Clinical Data screen select the Radiology tab.

• This will show all of the radiology exams in the flowsheet format.

3. Next select the radiology exam to display the radiology report.

4. Last if there is an image available for the report you will select the un-dithered Image

icon on in the lower right of the report.


Steps to pull-up images from

Clinical Data Flowsheet.

1. Click on Clinical Data

2. Select the Radiology tab

3. Select the Radiology exam

4. Select image Icon from Report.

How to view images from flowsheet view


Trainer Notes:

In order for PowerChart to have the ability to pull images, it

must load two different applications. The first is a java

applet that will run Cerner’s ProVision web viewer. The next

job is that it must load all of the image(s) in the the

ProVision view. Time may vary depending on the size of the

image study.

Load time for Java applet

• The first time you use PowerChart to view images there is an extended

Java load time (1-5 minutes). This will happen the first time you load an

image for each new Citrix session (each time you log into PowerChart).

Load time for Cerner ProVision Web

• There is a load time for images to the Cerner ProVision Web application.

• Load time will vary depending on the size and/or amount of images in the

series.

Load time expectations


Load time expectations

This is the load screen that displays when

you launch ProVision.

Image loading

screens

Blue progress

bar shows

images being

loaded


Trainer Notes:

The Cerner ProVision Web screen is made up of a number of

sections. These sections are the Menu Bar, thumbnails of

the image series, the View Port and Tiles (where the image

displays), the Navigation Bar and the Tool Bar.

Patient and exam information is displayed using DICOM

tags in white text at the corners of the images.

Overview of screen


Overview of screen

Menu bar

Slide View

View Ports / Tile – Image Window

Tool Bar


• Tool Bar

– View ports / Tiles

– Window Leveling

• Contrast

• Brightness

– Pan

– Zoom

– Magnifying glass

– Invert Contrast / Brightness

– Image orientation

– Measurement tools

Measurements made using the PowerChart

view are not saved to the image.

– Move forward one image & Back one

image

Trainer Notes:

Menu Bar

Search (Used to query images and related data)

• Patient Folder (F4)

• Patient Query Search (CTRL + F)

Action

• Such as print exporting and viewing DICOM information

View (used to hide different parts of the application)

• Hide toolbar

• Hide thumbnail

• Hide Menu

• Hide Image Text

• Hide DICOM overlays

Preferences - Please note that preferences are not saved from session to

Menu/toolbar


Menu/toolbar

Menu Bar Tool Bar

Series Selection and View ports


Trainer Notes:

Below is an example of a 1 view study. X-rays will display

in this manner.

If there are multiple x-ray images, the first image will

automatically load. To load other images, click on the

desired image thumbnail.

Scanned documents (from the DICOM scanners) will also

display as images associated with the study.

Pressing the “Esc” key will expand viewport to Full Screen

and toggle Back again.

Example of simple (chest 1 view)


Example of simple (chest 1 view)

1.

2.

3.

4.

Map of screen lay out

1. Menu bar

2. Series Selection

3. View port

4. Tool bar


Example of more complex (CT, MRI) with multiple views

Trainer Notes:

• Complex studies (CT, MRI) include the same sections with the addition of the Cine player and frame speed

control.

• The Cine player and Frame speed add additional functionality to play multiple images in a continues series

in the view port(s).

• First Image in the Series of Study is preloaded.

• CT and MRI defaults to a 4 tile view.


Example of more complex (CT, MRI) with multiple views

Complex view includes

Cine Player and

Frame Speed

Control.


Trainer Notes:

Pan – Click and hold down on the mouse wheel

Able to move image in view port

For mice that do not use the scroll wheel, you can use the Pan icon on

the Toolbar

Zoom – Right click and hold down on the mouse

Move mouse up to zoom out

Move mouse down to zoom in

Window Leveling

Move the mouse left to right to control the contrast

Move the mouse down or up to control the brightness

Mouse control


Mouse control

Pan – Click and

hold down on the

mouse wheel

Zoom – Right

click and hold

down on the

mouse

Window Leveling –

Left click and hold

down on the mouse


Pan

Trainer Notes:

• Panning

– Click and hold down on the mouse wheel and you will be able to move the image in the view port

– Or, Click on the Panning Icon (hand) in the Toolbar


Pan

Pan – Click and

hold down on the

mouse wheel


Zoom

Trainer Notes:

• Zoom

– Right click and hold down on the mouse

• Move mouse up to zoom out

• Move mouse down to zoom in

– Or, You can click on the Zoom icon on the toolbar


Zoom

Zoom – Right

click and hold

down on the

mouse

Zoo

m

Out

Zoo

m

In


Window leveling (brightness, contrast)

Trainer Notes:

• Window / Leveling – Window = Contrast, and Level or Leveling = Brightness

– Left click and hold down on the mouse

• Move mouse Left Decrease Window

• Move mouse Right to Increase Window

– Left click and hold down on the mouse

• Move mouse up to Decrease Level

• Move mouse down to Increase Level

– Or, You can click on the Window Leveling icon on the toolbar


Window leveling (brightness, contrast)

3

Window Leveling

– Left click and

hold down on the

mouse

Rt. / Increase

Window

Lt. / Decrease

Window

up to

Decrease

Level

Down

Increase

Level


Navigation bar image control (Cine Control Bar)

Trainer Notes:

• The image Navigation bar is broken down into three parts

1. The Cine controller is used to play the images in a continuous frame by frame view.

• The Cine controller allows you to play the images in a forward loop, reverse loop or as a Yo-Yo

effect.

2. The Frame speed control allows you to control the rate of speed at which the images are played

(Frames per Second).

• You can also restore back to the Default speed of 12.5 f/s by selecting the default icon.

3. The image frame bar allows you to see which image is currently loaded in the image viewer.


Navigation bar image control

Cine Controller / Frame Speed / Image Series


Trainer Notes:

• Play Cine Counter Counterclockwise (reverse)

– Plays the image series in reverse order from last image to first image (loops)

– Click once to start cine player / click again to pause

• Stop

– By Clicking on stop you will stop the series of images from playing and reset the series back to the first

image.

• Play Cine Clockwise (Forward)

– Plays the image series in order from first to last image (loops)

– Click once to start cine player / click again to pause

Play Reverse / Stop / Play Forward


Play Reverse / Stop / Play Forward

Play Counterclockwise / Pause

Play Clockwise / Pause

Stop / Reset


Yo-yo

Trainer Notes:

• You can play the Cine player with a yo-yo effect by clicking on the cine yo-yo icon.

– The yo-yo effect plays the image series forward from the first to the last image and then reverses and

plays the last image to the first image.


Yo-yo

Yo-Yo Icon


Frame speed

Trainer Notes:

• There are two selectable functions on the Frame speed toolbar

– The first is an adjustable speed controller (measured in Frames per second).

• By clicking on the slide bar and moving the bar to the right, the frame speed will increase.

• Or move the slide bar left to decrease frame speed.

– Second, you can click on the “Default” icon to reset the speed back to 12.5 F/s (frames per second).


Frame speed

Adjustable Speed control Reset to Default speed: 12.5 f/s


Using multiple view ports and tiles

Trainer Notes:

1. You are able to adjust the image viewer by selecting the View ports and Tile Icon located at the right of the

Tool bar.

2. You can customize your view ports by selecting the View port Icon. This will allow you to put multiple

studies or image series into different view ports that you have created.

3. You can also customize the amount of tiles you would like to view at the same time. The Tile feature allows

you to view multiple images of a study in a ordered sequence.

– Example: If you are viewing a study that has a large amount of images you can increase the amount of

tiles to view more images at the same time. (If you are selecting a CT with 40 images and you want to

view 10 images of that study at once, you can increase the amount of tiles to 10 and they will display

with one image in each tile.

4. The View port and Tile feature can be used concurrently, allowing for a very customizable user interface.

– But remember, as the number of view ports and tiles increase your viewable screen will be smaller for

each image.


Using multiple view ports and tiles

Example of a study that has multiple view port (2) with different studies in each. One

of the view ports is set up with multiple tiles (4) that display the images in sequence.

View port 1 View port 2

Tiles 4 Tiles 1


Searching for Relevant Priors

Trainer Notes:

Cerner ProVision web also has the capability to search through all images in a patient’s radiology image

history folder. This search feature, coupled with the customizable view ports and tiles, allows you to perform

side by side comparisons with patients’ relevant priors.

1. Select the the Search tab on the menu bar

2. Select patient folder query – This screen allows you to run a query against the exams that are in the

patient’s folder using different criteria such as modality type and study information.

3. Fill in the desired criteria and select show patient folder.

4. The results from the search will be displayed.

• You can select multiple exams

• You can sort by modalities or by study date.

5. Select the desired studies and then click on the show icon to display all selected studies.

6. Configure view port and tile.

• When viewing two studies at once, you would want to set the View Port to 2. You can view up to 3

studies at a time. If desired, you can also pull the same study into more than one View Port.

• Set the number of tiles to reflect how many images you want to see at a time from that study.

• Keep in mind that the more View Ports and Tiles that you use, the smaller the view of the image will be.

• Once you have the View Ports and Tiles set up, drag the thumbnail for the desired study series into the

desired View Port.



Returns all images in the patient folder.

- able to sort by modality type

Search By Patient Folder



Able to query by Date /

Time or Modality Type

Study 1: Original Study

Check marks are dithered

Study 2: New Comparison Study

Check mark to view side by side (Green check marks)

Search By Patient folder query



Example of a comparison study: Study 1 is loaded in view port (1) with four tiles.

Study 2 is in a single tile set up. With the View Port on the right selected, you can see

in the Toolbar the selected View Port/Tile setup. On the left the two boxes represent

the two View Ports. On the right, the single box depicts the single Tile setup.

Study 1 Study 2

Accessing PACS Images from PowerChart - Excela...

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