Asteris Keystone Manual Manual/Keystone... · 2012. 2. 7. · Asteris Keystone Software Suite lets...

2012

Keystone

Asteris Keystone Manual2

© 2012 Asteris, Inc

Table of ContentsPart I Introduction 4

................................................................................................................................... 51 Overview

................................................................................................................................... 62 Getting Started

Part II Keystone Workstation 8

................................................................................................................................... 91 Studies

.......................................................................................................................................................... 9Quick List

.......................................................................................................................................................... 10Search

.......................................................................................................................................................... 11Workstation Toolbar

......................................................................................................................................................... 11IMAGES

......................................................................................................................................................... 12REPORTS

......................................................................................................................................................... 14PRINT

......................................................................................................................................................... 14BURN CD/DVD

......................................................................................................................................................... 16SAVE FILE

......................................................................................................................................................... 18EMAIL

......................................................................................................................................................... 20CONSULTATION

......................................................................................................................................................... 22IMPORT IMAGES

......................................................................................................................................................... 27RENAME STUDY

......................................................................................................................................................... 28DELETE STUDY

.......................................................................................................................................................... 29DICOM Viewer

......................................................................................................................................................... 30View er Tools

......................................................................................................................................................... 37Preview

......................................................................................................................................................... 38Thumbnails

................................................................................................................................... 392 Contacts

................................................................................................................................... 403 Settings

.......................................................................................................................................................... 40User

......................................................................................................................................................... 40User Settings

......................................................................................................................................................... 41Auto-Complete

......................................................................................................................................................... 41View er Options

......................................................................................................................................................... 42Workstation

......................................................................................................................................................... 43Account

.......................................................................................................................................................... 45Consultant

......................................................................................................................................................... 45Group

.......................................................................................................................................................... 45Admin

......................................................................................................................................................... 45Users

......................................................................................................................................................... 48DICOM Devices

......................................................................................................................................................... 49Archive Queue

......................................................................................................................................................... 49Server Log

Part III Teleradiology 51

................................................................................................................................... 511 Radiologist/Consultant

................................................................................................................................... 532 Referring DVM

Part IV Online Access 54

................................................................................................................................... 551 Product Admin

................................................................................................................................... 552 Access your Data

3Contents

3


Part V Trouble Shooting Guide 58



1 Introduction

Work Smarter.

Asteris Keystone Software Suite lets you review, report and email with just oneprogram.

Designed for veterinarians by veterinarians, Keystone Software Suite simplifies sending andreceiving images and reports. Quickly and easily download studies, regardless of the DICOMmodality used to capture the images. Keystone Software Suite communicates with anyprogram that supports query/retrieve. Manipulating DICOM images and delivering integratedreports has never been so easy and reliable.

Simplicity through Innovative Technology.

Centralized, secure study management. Reports and images all in one location.

Keystone Software Suite bridges the gaps between PACS; offsite data access; viewing anddiagnoses; reporting and HIS integration. Each of the Keystone components enables user-friendly image viewing and analysis with unsurpassed performance and reliability.

Keystone PACS Image Software

o Supports DICOM and non-DICOM modalities. o Archives images to off-site servers for remote access and disaster recovery. o Synchronizes data between facilities for multi-site practices or remote locations (e.g.,

DR system with internet connectivity). o Automatically updates itself whenever a new release is available, eliminating manual

patches and upgrades.o MDS plug-in enables fine-tuned monitoring, routing and handling of image data from

modalities and diagnostic software incapable of automatic or streamlined datatransfer.

o Eliminates manual image transfer, dramatically improving workflow.

Keystone Workstation

o Image manipulation and markup tools including windows leveling, zoom and areazoom, referential side-by-side analysis, angle measurement and savable text andfreehand annotations.

o Customizable reporting and seamless teleradiology features, including consultationrequest, status and history.

o Portable and seamless, Keystone Workstation detects whether it is connected to thenetwork at the practice. If not, it automatically connects to the Asteris off-site servers.Changes made to study data while away from the practice are sent to the offsiteservers and automatically reflected back to the practice with no user intervention.

o Self-updating; like Keystone PACS, Workstation automatically updates itselfwhenever a new release is available.

Keystone Online - Web-based interface

o Enables veterinarians to access studies and reports at anytime from any internet

Introduction 5


connection in the world.o Gives the option to view images in DICOM or other popular formats like JPEG.o Delivers complete image manipulation and emailing functionalities.

Connecting Veterinarians.

Collaborate with referring practices or individual veterinarians as if they were just down thehall. Keystone Software Suite allows you to schedule and create professional quality reports;integrate and manage images and reports seamlessly; and easily stay connected withcolleagues and clients. So you can work smarter, not harder.

[email protected]

1.1 Overview

This document has been prepared by Asteris, Inc. for its customers. The content of thisdocument is confidential. It may be reproduced only with written permission from Asteris, Inc.Specifications contained herein are subject to change, and these changes will be reported insubsequent revisions or editions.It is prohibited to use the software described in this document as a substitute for theknowledge, skill and experience of the competent medical personnel who are its intendedusers.Keystone™ is a trademark of Asteris, Inc. The names of other products mentioned in thisdocument may be the trademarks or registered trademarks of their respective companies.

Copyright © 2012 by Asteris, Inc.

All rights reserved. Unauthorized use, reproduction or disclosure is prohibited.

Keystone is manufactured for the U.S., Canada and Australia by Asteris, Inc.

Asteris, Inc.P.O. Box 285Stephentown, NY [email protected]

Considerations prior to use

The software is not intended to replace the skill and judgment of a qualified medicalpractitioner and should only be used by people who have been appropriately trained in thesoftware’s functions, capabilities and limitations. The user should be aware of the limitations



in the accuracy and correctness of the output data displayed on the screen, printed orexported from Keystone. The quality of the data is dependent on the correctness of the inputdata; the user’s interaction with the data; the quality, characteristics and settings of thedisplay device or printer; and the necessity to interpolate the data for display purposes.

For example, measurement values in Keystone are dependent on the calibration informationprovided by the modality in the DICOM header. While Keystone has been tested extensively,it is impossible to completely test any piece of software, and errors may remain in thesoftware. It is possible that an error could manifest as an incorrect measurement or image. Users must be aware of the potential for errors. Keystone saves images together withpatient information, both when saving to the local database and when exporting fromKeystone. It is important to protect this data from access by unauthorized persons.

Users should be aware that certain views make use of interpolated data. This is data that iscreated by Keystone based on the original data set. Interpolated data may give theappearance of healthy tissue in situations where pathology that is near or smaller than thescanning resolution may be present. On occasion, interpolated data may also include imageartifacts which should not be interpreted as real pathology. The image annotation function isintended to preserve annotations on images. Annotated images should not be used forprimary diagnosis.

1.2 Getting Started

You can start Asteris Keystone either from the desktop or through the Windows Start menu.

1. Select (double click) the Asteris Icon on your desktop OR navigate to Start All Programs Asteris Keystone Client.

2. The Keystone program automatically downloads updates when you open Keystone it will

apply those updates automatically.

3. When prompted, enter your user name and password and select login (or press enter).

a. If you do not have a user name/password, or have forgotten either of them, please

contact your clinic's account administrator or Asteris technical support at 1-877-

727-8374. Please have your clinic name and phone number ready to provide for

technical support.

b. For future reference, you recommend that you record your user name and passwordand keep them in a centralized, safe location for inter-clinic use.

Once you have successfully logged in, the first screen that will appear is the Keystone

Workstation home page. By default, the home page will display images taken today in the

Introduction 7


Study section.

Now you're ready to get started.



2 Keystone Workstation

Once you have successfully logged in, the first screen that will appear is the KeystoneWorkstation home page. By default, the home page will display images taken today in thestudies section.

Now you're ready to get started.

The Keystone Workstation is your "home page". From here you can:

Search studies.

View studies.

Write, review and print reports.

Burn CDs.

Save studies.

Email studies.

Request a consultation from a specialist.

Perform a DICOM send

Import images.

Perform administrative tasks like renaming studies or creating and managing useraccounts (if you have administrator privileges)

Keystone Workstation 9


2.1 Studies

For most users, Asteris Keystone Workstation will open to Studies. Note: if you have been

set up as a Specialist/Consultant, Keystone Workstation will open to the Teleradiology

section.

2.1.1 Quick List

To simplify frequent searches, Asteris Keystone has a Quick List tool that allows you toquickly search for recent studies

Today- Any studies taken today

Yesterday- Any study taken the previous day

Past Week- Any study taken the last seven days

All Studies- All studies taken or the last 500 -- whichever is fewer, for clinics with alarge database we recommend to narrow your search down by utilizing the Searchsection



Remote- Any study that is stored in another application or location e.g. Efilm, ClearCanvas, Fusion Server, etc.

Green Icon- To keep track of studies organized in Keystone Workstation, usethis handy tool to create "favorites" folders to file studies for quick reference (e.g.,hocks). You may also create sub folders for further delineation (e.g., hocks – normal,hocks – OCD).

o Click the Icon to create and name the folder.

o To create a sub-folder, select the “parent” favorite folder and click the +icon then name the sub-folder.

o To file studies in your favorites folders, simply click, drag and drop studiesinto the folder.

Favorites folders are listed alphabetically at the bottom of the Quick List pane. Studiesfiled in a favorites folder will come up in a general search as well as the specific folder youplaced it in.

Once studies are well organized in Keystone Workstation, it will be easier for you to findthem (e.g., for teaching, client education, etc.).

2.1.2 Search

Enter your search criteria into the appropriate fields and click search (or press the enter key). You may search by a single field, multiple fields or all fields.

Search Studies tips:

Depending on the modality and machine used to take the study, Patient Name andOwner Name are sometimes reversed. If you cannot locate an owner/patient, trysearching the last name of the owner in the owner name field first. If unsuccessful,delete the search entry, then enter the last name of the owner in the patient name



field.

We suggest conducting as broad a search as possible to take into account spellingerrors, inconsistencies in dates for taking images vs. the dates recorded in yourpractice management software, using patient barn names vs. show names, etc.

When you select a "from” date using the drop down calendar, a 24 hour period isautomatically pre-populated (e.g., 01.01.12 to 01.02.12). For a broader time periodsearch, simply select a different "to” date from the drop down calendar and clicksearch (or press the enter key).

If there are several studies associated with a single patient/owner (must be namedidentically), you will see tabs with the date of each study regardless of the modality. That wayyou can quickly review images from a previous study by doing a single search.

2.1.3 Workstation Toolbar

Toolbar Icons become active once you have selected a study. Simply hover over each iconfor a quick description of its function.

2.1.3.1 IMAGES

You are able to view study images in four convenient ways:1. Double click the line of the study you wish to view2. Double click a thumb nail image from a study3. Double click the images icon4. Drag and drop thumbnails from the work list to the viewer (easiest when working with

multiple monitors)



2.1.3.2 REPORTS

Keystone workstation allows you to create reports for a patients medical record.

The Report function works best when using two monitors (one to view the images, thesecond to edit the report). Otherwise, if working from a single monitor, you will need tominimize the DICOM Viewer, start/edit the report, and then toggle between the two windows.

To start the report process, double click the study for which you wish to do a report, open it inthe DICOM viewer, and then click on the Report Icon in the Workstation toolbar.

Keystone Workstation pre-populates as much information about the patient as possible fromthe DICOM tags from your modality. You will have to fill out the owner/responsible person’sfield for each report.

Mandatory fields are highlighted in red and must be completed.

To comment on a specific image from the viewer click the report icon in the DICOM viewertool bar. This will allow you to add comments to the active image (if you have multiple panesopen click the image you wish to comment on).

All reports for a specific study are listed by date on the tabs across the top.



Editing and Finalizing Reports

If you have to walk away from a report before completing your comments, your work willautomatically be saved and made available when you want to continue your commentary( itwill have a water mark of DRAFT if printed before it is finalized).

Advanced reporting features for teaching and Teleradiology are available, they are controlledby user settings within Keystone. Example, create a user for your intern, with select permissions they can create reports but not finalize it. A resident or clinician must review thereport and finalize it.

Reports are not complete until you click on the Finalize button at the bottom of the screen. Afinalized report is considered part of a final medical record. However, you can open it at alater date and add an addendum to the report if necessary.

Standard report templates are provided for your convenience. Report headers can becustomized in the Settings section. However, you can create customized reports based onyour needs. Simply contact an Asteris representative at 877.726.8374 or by email [email protected]. and we’ll assist you through the process.



2.1.3.3 PRINT

This print button is not for image printing

When you want to print a report, select the Print Icon. A print preview will appear, you canchoose to print or save the file (as a pdf or excel file).Please note that until you finalize the report, a watermark of DRAFT will appear on thedocument.

See Settings to customize the header.

2.1.3.4 BURN CD/DVD

To burn a CD or DVD:

1. From the Keystone Workstation “home page”, search for the study you wish to share.

2. Select the study with a single left mouse click (double clicking will open the study).

3. If you want to save just the one individual study to a CD/DVD highlighted, insert a blankCD/DVD in your optical drive then click the Burn CD icon.

4. If a Microsoft Windows pop up box appears asking what to do with the CD/DVD, close itout and continue with the Asteris Keystone process.

5. However, if you want to save additional studies to the same CD/DVD, they must all belisted in the same search results. Select as many studies as you want by holding downthe Control key while simultaneously single left clicking the mouse. Then click the BurnCD icon.

Multiple studies can only be saved to a single CD/DVD if they are selected and burned



at the same time. You cannot burn a CD/DVD and then try to add more studies to thesame disk.The only limitation to the number of studies that can be saved on the same CD/DVDis the amount of space available on the disk.

6. After clicking the Burn CD icon, a customization screen will open, at which time you canspecify which study images to save (by default, all images in the study are pre-selected). To remove one or more images, click the red x. By clicking the red x it removes theimage and only the images with a red x next to them remain. If a report is associated withthe study, you’ll be able to select it along with the images by clicking the box next to thereport, if the box is unchecked it will not be burned to the disc. When you have selectedthe studies, images and reports to burn to the CD/DVD, click the Next button. An AsterisKeystone “write disk” dialogue box will open.

7. From the Asteris Keystone “write disk” dialogue box, select the CD/DVD burner drive andclick start

8. When Asteris Keystone has finished saving the images and/or reports to the disc, the

program will automatically eject your disk.



2.1.3.5 SAVE FILE

Asteris Keystone gives you the option to save DICOM files (with or without a DICOM viewer)to a flash drive, external hard drive or a network drive location.

1. From the Keystone Workstation “home page”, search for the study you wish to save.


3. If you want to save just the one individual study, click the Save File icon.

4. However, if you want to save additional studies to the same folder at the same time, theymust all be listed in the same search results. Select as many studies as you want byholding down the Control key while simultaneously single left clicking the mouse. Thenclick the Save File icon.

5. After clicking the Save File icon, a customization screen will open, at which time you canspecify which study images to save (by default, all images in the study are pre-selected). To remove one or more study images, click the red x. By clicking the red x it removesthe image and only the images with a red x next to them will remain. If a report isassociated with the study, you’ll be able to select it along with the images by clicking thebox next to the report you wish to add.



6. When you have selected the studies, images and reports to save, click the Next button. An Asteris Keystone dialogue box will open providing the DICOM file format followingchoices:

“DICOMDIR with Viewer” saves the files in a specific format called DICOMDIR andincludes a version of the Keystone viewer that will automatically open the images. Ifthe images are saved to the root folder on a USB drive and USB auto-run is enabled,then the viewer will open automatically when the USB drive is plugged into acomputer.

“DICOMDIR without Viewer” saved the files in a specific format called DICOMDIR butdoes not include a viewer, so the images will need to be imported into anotherapplication for viewing.

“DCM Files in study/series folders” will save all files in folders that separate theimages into folders named for the DICOM StudyInstanceUid and SeriesInstanceUidvalues. We recommend that you DO NOT rename the study/series folders tominimize conflicts when viewing/searching images using other PACS softwareprograms.

“DCM Files in a single folder” will save all files into a single folder. You can create andname the folder for easy search

Select the method you want to use to save your images then use the browse button tolocate the drive and/or folder into which you want to save the images. If you areunsure, select “DICOMDIR with Viewer”.



2.1.3.6 EMAIL

1. From the Keystone Workstation “home page”, search for the study you wish to email.


3. If you want to email just the one individual study, click the Email icon.

4. However, if you want to email additional studies in the same message, they must all belisted in the same search results. Select as many studies as you want by holding downthe Control key while simultaneously single left clicking the mouse. Then click the Emailicon.

Multiple studies can only be sent in the same email message if they are selected atthe same time. You cannot compose an email and then add more studies/images.

5. After clicking the Email icon, a customization screen will open, at which time you canspecify which study images to save (by default, all images in the study are pre-selected). To remove one or more study images, click the red x. By clicking the red x it removesthe image and only the images with a red x next to the image will remain. If a report isassociated with the study, you’ll be able to select it along with the images by selecting thebox next to the report. When you have selected the studies, images and reports to email,click the Next button.

6. A standard email dialogue box will open. The “From” field will auto populate based onuser login. The "To" and "Subject" fields are both required to proceed ( the send buttonwill not become active until these are filled in).



7. We recommend that you select the "Notify Me When the Email Has Been Retrieved”option. It’s a good way to follow up with clients and/or specialists/consultants. You mayalso choose to receive a copy of the email notification by selecting the "Send Me a Copy"box.

8. You have the option to include a personal message with the images (e.g., patient history,request to follow up with the attending veterinarian, etc.), but it is not a required field.

If emailing images to a client, we suggest including verbiage in the email textinstructing the client to select the option to download images as jpeg. It is simplerthan the other options; and clients generally do not need the DICOM imagefunctionality the way a referring DVM might.

9. When you’re ready to send the email, click the Send button. Please note: emailedimages need to be archived to the Asteris server. You may get a pop up dialogue boxsaying that the request will be sent as soon as the images have archived. AsterisKeystone will send your email as soon as that process is complete

Asteris automatically makes a notation on the study that an email of the study has been sent(an envelope icon will appear on the far right hand side of the study).

Receiving Asteris EmailsIf the client has any issues with the email please refer them to Asteris Support for help.

The received email will contain a link in the body that will open up a web browser withviewer/download options



Hovering over each option with your mouse will give you a brief description of that iconsfunction. If you do not see the following options please refer to the trouble shooting guide forfurther assistance

2.1.3.7 CONSULTATION

Note: To request a consultation, you must first have Asteris technical support complete asimple and fast set up. If you haven’t already been set up, please contact Asteris technicalsupport at 877.727.8374 or [email protected].

Once you have been set up with one or more Specialists, you will see the CONSULTATION iconappear in the Keystone Worklist “home page”. For most users, Asteris Keystone Workstation willopen to Studies. Note: if you have been set up as a consultant, Keystone Workstation will open



to Teleradiology.

1. From the Keystone Workstation “home page”, search for the study you wish to email.


3. Select the Consultation Icon at the top of the screen

4. A dialogue box will display the Consultant’s contact information. It is possible to have more thanone Consultant at the same company. Click on the individual Consultant from whom youwould like to request a consultation.

5. Complete the Consultation Request form.

a. Each Specialist has the ability to customize the Consultation Request form fields, so theform may vary from Specialist to Specialist.

b. Asteris Keystone Workstation pre-populates as much information as possible (if the datais available).

c. Fields with a red box outline are mandatory and must be answered before submitting theconsultation request.

d. When all required fields have been completed, the Send button will become active.

5. If you want to include additional related studies, click Add Study and select one or moreadditional studies to send. Click Attach Studies. Note: unlike emailing or saving options,Consultation requests send an entire study (you do not have the option to select individual images



within a study).

6. Once you click send, a dialogue box will open up that allows you the option to add additionalemails to the report. If you have multiple associates working on a case or you are a Referralpractice and want the that referring DVM to receive the report as well you can enter their emailaddress in.

7. A message confirming that the Consultation request has been successfully sent will pop up. And aConsultation icon (envelope with a blue circle) will be annotated on the corresponding studies.

2.1.3.8 IMPORT IMAGES

Asteris Keystone Workstation lets you import images in a matter of a few clicks. You can



review, manipulate, create reports and email the images with ease.

1. When you receive images on a CD or thumb drive, insert the device into theappropriate slot in your computer. If a Microsoft Windows pop up box appears askingwhat to do with the new media, close it out and continue with the Asteris Keystoneprocess.

2. From the Keystone Workstation “home page”, click the Import icon. A dialogue boxwill appear that will start the import process.

3. You will be given two format options for importing the images:

a. DICOMb. NON DICOM (JPEG,TIFF,BMP,PNG only).

4. If you’re not sure what format the images are in, select option a) DICOM. AsterisKeystone will scan the data; if no DICOM images are available, proceed with option b)Non DICOM. Alternatively, you can explore the folder details. DICOM images willhave a .dcm file extension (vs. .jpg, .tif, .bmp, .png).

Importing DICOM Images

DICOM format for image imports is the default setting.

1. Choose “select files” and browse to the drive that contains the images to beimported.

a. As long as you want to import all the images in that drive location, you donot have to browse any further (e.g., you don’t need to open sub folders tofind .dcm files).



2. Click “OK” and Keystone will scan the specified drive for any compatible DICOMimages.

3. Keystone will display details about the DICOM images found. You are given theoption to rename the study (e.g., to match the client/patient information you havein Keystone or your practice management software, etc.).

4. To complete the image import, click Accept.

5. Imported images are stored based on the date they were taken, NOT the date they



were imported. To view images, use the Search feature from the AsterisKeystone Worklist “home page”.

Importing NON DICOM images.

Asteris Keystone easily accommodates the import of non-DICOM images like pdf, jpeg, tiffand png formats. You can even import photographs to add to a patient study.

1. When you receive images on a CD or thumb drive, insert the device into the appropriateslot in your computer. If a Microsoft Windows pop up box appears asking what to do withthe new media, close it out and continue with the Asteris Keystone process.

2. From the Keystone Workstation “home page”, click the Import icon. A dialogue box willappear that will start the import process.

3. You will be given two format options for importing the images:

a. DICOMb. NON DICOM (JPEG,TIFF,BMP,PNG only).

4. Select the NON-DICOM option.

5. You will be prompted to manually enter several fields to allow Keystone to create aDICOM “wrapper” so the images will be searchable within the software.

Red asterisks denote the four required fields. You can fill in the other optional fields,but it’s not mandatory. Note: you may have to browse the folder first to determine thepatient name, owner name, modality and date of study.

By default, the “Leave the Import Dialogue Open” box is checked in the event youneed to import multiple studies. You can uncheck that box to view the study as soonas its imported.



Once you enter the required fields the the "Select Files" button will become active. Browse tothe folder that contains the images and select them

To complete the image import, click "OK".

Imported images are stored based on the date they were taken, NOT the date they wereimported. To view images, use the Search feature from the Asteris Keystone Worklist“home page”.



2.1.3.9 RENAME STUDY

Asteris Keystone gives you the option to make corrections after the fact with the RenameStudies tool.

1. To rename a study, search for the record from the Asteris Keystone Worklist “homepage”.


3. Click the Rename Study icon.

4. A dialogue box will open that will let you change the searchable fields for the study.

5. When you’re finished making your corrections, click Save Changes. Keystone will re-archive the images. Your changes will be reflected at all locations where Keystone isinstalled once a full synchronization has been completed.

Please note: if your modality "burns" the image information into the image itself, renaming the



study in Keystone will NOT correct or remove this information. To make corrections to datacontained directly in the image itself:

1. Make the corrections in the original modality.

2. Delete the incorrect study from Keystone Workstation (not all users have permission toDelete Study. Please see your account administrator or contact Asteris technicalsupport).

3. Perform a DICOM send of the corrected study to Keystone.

2.1.3.10 DELETE STUDY

The Delete Study option is only available to account administrators and permanentlyremoves the study from Keystone.

1. To delete a study, search for the record from the Asteris Keystone Worklist “home page”.


3. Click the Delete Study icon. If the Delete Study icon is not active (i.e., not present),please see your account administrator or contact Asteris technical support.

Please make 100% certain that you are deleting the correct study. The deletion ispermanent. The only way to restore the study is to perform a DICOM Send from the originalmodality.



2.1.4 DICOM Viewer

The DICOM Viewer is comprised of three components:

1. Viewer Tools

2. Preview

3. Thumbnails

You may customize the appearance and settings for each of the DICOM Viewer components:

pins the tool open all the time ( will always be displayed)

auto hides to a tab when click on another part of the DICOM viewer

selecting the down arrow or right clicking the header bar will give you 3 options

1. Floating: Allows any of the three tabs to be moved around the screen independentof the images in the DICOM viewer

2. Dockable: Allows any of the three tabs to be “fixed” (docked) as a toolbar to anyside of the screen



3. Autohide: Minimizes any of the three tabs when you select another part of thescreen

* If you select any of them to be floating and wish to return them to a docked position or wishto move it to another part of the screen, please click here for a brief video demonstration.

2.1.4.1 Viewer Tools

Asteris Keystone allows you to customize your mouse by assigning specific viewer tools tothe left and right mouse click (and any mouse button recognized by Windows). Tocustomize your mouse:

1. Choose a Viewer Tool to assign to the left click function of your mouse.

Place your courser on the Viewer Tool and left click once. The tool will now work whenyou left click and move the mouse.

1. Choose a Viewer Tool to assign to the right click function of your mouse.

Place your courser on the Viewer Tool and right click once. The tool will now work whenyou right click and move the mouse.

You can also customize any key on your keyboard to perform a specific Viewer Tool function(see Settings section).

And if you only want to see certain Viewer Tool icons (to de-clutter the tool bar or to simplifythe options for users at your practice), customize the icons with a right click on the emptyspace in the viewer tool bar. This will open the toolbar configuration and allow you to changethe order or, remove or add displayed Viewer Tool icons.



Window Leveling: lightens or darkens the image (to reset to the original values,double click the image).

Zoom Area: magnification box that magnifies only a portion of the image; controlthe Zoom Area tool with your mouse placement.

Zoom Image: by default, your mouse wheel is set to Zoom Image on CR/DXstudies and scroll through a series of images for MR/CT/US studies.

Image Pan: moves the entire image around the screen (click and drag image).

Invert: turns black to white and white to black. This can be useful when printingimages with a color printer, uses less black to print when inverted.

Reset: the “undo” button for changes; resets the image to its original settingsreceived from the modality.



Flip Horizontally: flips the image horizontally.

Flip Vertically: flips the image vertically.

Rotate Clockwise: rotates the image 90 clockwise each time you click the icon

Rotate Counter Clockwise: rotates the image 90 counter clockwise each timeyou click the icon

Stack and Scroll: stacks series of images for scrolling.

Link: links series with in a MR/CT study together based on the closest matchedcoordinates. Only series of the same orientation can be linked together.

Manual Link: allows you to set the matching point for each series, at differentimage counts so they are synchronized closer. Only series of the same orientation can belinked together.

Reference Lines: creates reference lines in a separate series for the same study.

Hounsfield Unit: displays the density readings on the image.



Previous Image: displays the previous image with in a series.

Next Image: displays the next image with in a series.

Previous Series: Click to view previous series. Each CR/DX image is a series,US/CT/MR contain images with in each series (alternatively, you can right click on the currentseries and use the drop down menu to select a different series in the study).

Next Series: Click to view next series. Each CR/DX image is a series, US/CT/MRcontain images with in each series (alternatively, you can right click on the current series anduse the drop down menu to select a different series in the study)

Toggle: on/off switch for the overlay data (the text found in the four corners of theimage). By default it is turned on and the information will be displayed.

DICOM TAGS: displays the DICOM tags for that image.

Copy: copies the image onto your computer’s clipboard so that you can then pasteit into another program (e.g., Paint, PowerPoint, Word, etc.). Note: remember if you want tointegrate images into a report, you don’t need to switch to another program like Word orPowerpoint; simply use the Reports.

Print: prints the active (selected) image to a local printer. If you have madeannotations, they will print with the image.



Email: email the active image. Clicking the Email icon gives you the samefunctionality and follows the same process as the Email icon on your Keystone Workstation“home page”.

Report: requires you to have an active Report open. If you have an active reportopen, this icon allows you to comment on the active image. You do not need to close andopen it for each image, Keystone keeps track of your comments so they will be displayednext to the correct thumbnail in your report.

Save: saves all changes made to the active image (e.g., annotations, windowsleveling, zoom, etc.). This does not create a new image and all saved annotations can beremoved at a later date.

Erase Single: deletes the annotation you click on.

Erase All: the “undo” button for annotations (note: does NOT reset non-annotational changes like windows leveling, zoom, etc.; see Reset button).

Annotations

Note: Most Keystone Annotation tools have similar functionality as in Microsoft Officeprograms like Word or PowerPoint. If after making an annotation you want to adjust thelength or start/end location, click (your cursor will change from a arrow to a hand) and dragthe start/end point. To relocate text annotation, click in the center of the text and drag to thedesired location.

Line: draws a line annotation between two points on an image.

1. Click the Line icon.

2. Single click a start point on the image – do not release the button.



3. While holding down the button, drag the mouse to the desired end point thenrelease.

Ellipse: draws a variable elliptical annotation on an image.

1. Click the Ellipse icon.


3. While holding down the button, drag the mouse to adjust the desired width and size ofthe elliptical annotation.

Note: unlike the Line and Arrow annotation functions, if after making an ellipticalannotation, you cannot click and drag the ellipse to a different location in the image. Ifyou need to move or adjust the ellipse, you need to erase it and then redraw it.

Arrow: draws an arrow annotation on an image.

1. Click the Arrow icon.



Freehand: allows you to free form an annotation shape.

1. Click the Freehand icon.


3. While holding down the button, drag the mouse to the desired end point then release.

Text: click anywhere on the image and start typing. Again to change the locationof the text annotation, click and drag it to the desired new place on the image.

Measure: measurements are approximate based on DICOM tags from themodality.



1. Click the Measure icon.



Calibration: calibrates measurements for objects on an image that has a knownsize used for relative sizing (e.g., a coin, a radiographic marker, etc.).

o Note: to use this tool, you have to first know the size of the calibration (you will need toenter the measurement). Your accuracy of measuring will determine the accuracy ofmeasurements once calibrated.

1. Record the measurement of the calibration object.

2. Click the Calibration tool.

3. Single click a start point on the object – do not release the button.

4. While holding down the button, drag the mouse to the desired end point of theobject then release.

5. In the box that appears, enter the measurement taken in step 1. The entire imagewill then be calibrated based on the know object.

Angle: draws an angle on the image.

1. Click the Angle icon.


3. While holding down the button, drag the mouse to the desired end point then release.

4. Move the mouse to an unrelated point on the image to show the angle.

Auto-Angle: automatically determines angles between all line annotations on aimage. Left click on the icon and then draw your line annotations, the angle will be calculatedand appear on the scren (will project the intersection of the two lines if the line annotationsthemselves do not actually intersect as drawn on the image itself).



Full Size: displays the image in its actual size. Note: ultrasound images aregenerally enlarged to fit your screen size. The Full Size tool will reduce the ultrasound imagedisplay

Single Pane: view the active image in a single full size pane.

Multiple Pane Selector: select the number of panes for displaying multipleimages simultaneously. You can choose from a single pane up to a 4 x 4 pane grid pattern.

Close Study: closes the current study but leaves the DICOM Viewer open (returnsyou to the Keystone Workstation “home page”).

Cine Loop Player: this tool is only active when viewing studies with multiple images within a

series e.g. MR/CT/US.

2.1.4.2 Preview

The image preview displays the active image and the percentage of zoom it is currentlydisplayed at. If you zoom in on a image the box will shrink to display the active viewing areabeing displayed in the DICOM viewer.



2.1.4.3 Thumbnails

To view a thumbnail image, either double click it or drag and drop the thumbnail into theDICOM Viewer.

Thumbnails are helpful in navigating through multiple study images. To help keep track ofwhich of the thumbnails is actively being viewed, look for the corresponding colored boxaround the thumbnail.

Thumbnails can be displayed in two places:

1. Thumbnail Toolbar: DICOM Viewer dockable, floating or autohide toolbar.

2. When working with multiple monitors they can be configured in the settings section. Youcan drag and drop or double click on thumbnails to open them in the DICOM Viewer.

*Note: You may have multiple studies open in the viewer; they will be displayed by date in thethumbnail strip in the viewer or by tabs in the worklist screen when working with multiplemonitors. When opening an additional study you will be ask if you want to add it to theexisting study, click yes to be able to view images side by side



2.2 Contacts

The contact section allows you to manage the email addresses that are auto-saved whenyou email a study to a new address. Select contacts in the lower left and it will open for you.

You will see all the address listed in this section. You may add, delete, or edit accounts here. To add an account select add and then enter as much information as you wish. To delete oredit the account, select it with a single left mouse click.

Once you have chosen the account you can add or remove information in any of the fields. Once you have entered the fields you want, select save at the bottom of the screen. If youwish to delete it entirely, select delete at the top of the screen.



2.3 Settings

the settings section, depending on your permissions will allow you to: modify your user,modify your workstation settings, optimize your viewer, monitor archiving, and monitorKeystone connectivity. These things will be managed in 3 areas; User, Consultant, andAdmin.

2.3.1 User

In the User section you can customize and modify your account and viewer for the bestperformance and/or appearance.

2.3.1.1 User Settings

By selecting the box and entering your email address you will receive email notifications forTeleradiology request/responses depending on your user

You can also enter your cell phone number @ your carrier to receive text messagenotifications AT&T – [email protected] – [email protected] – [email protected]



Sprint PCS - [email protected] Mobile – [email protected] Cellular – [email protected] - [email protected] - [email protected] – [email protected]

2.3.1.2 Auto-Complete

In the auto-complete section you can create a keyword that will trigger a full description in itsplace. In the example above you can see if you type add it will replace it with that message. These are completely customizable to fit your needs. Simply click Add and enter yourKeyword and then the Message, when you are done click save at the bottom

2.3.1.3 Viewer Options

In the viewer options you can customize any key on your keyboard to perform a specificfunction in the DICOM viewer.



You can also adjust the viewer settings for zoom amount and size. Also you can adjust theImage quality while zooming in and out, please remember that the higher quality renderingrequires more performance from your computer.

2.3.1.4 Workstation

In Workstation you can adjust the overall performance of Keystone Workstation. You canadjust the memory high and low watermark (how much RAM Keystone can use). You canenable a local DICOM Server, this allows someone to send to you only when you haveKeystone up and running at your computer.

Multiple monitors can also be configured here, Keystone will support as many monitors asyour computer can run: Worklist, Primary Viewer and Viewer. The monitors will be displayedand number the same as they are in your windows configuration. The Primary Viewer willdisplay an images that you double click on the thumbnail, Viewer will only support drag anddrop or right click and selecting the image you wish to view.



2.3.1.5 Account

Once logged in you can change any of your user's values except the user name, in theaccount section.

All fields with red asterisks are required, to be setup as a consultant you must also enter aaddress and phone number before Asteris can set that up for you.



A user may also add there signature in to there account, it must be saved as a jpeg, png,bitmap, or tiff. Here are the steps for creating and saving the signature.

1. Use a tablet or touchscreen computer that has a stylus for you to sign.2. Open a program like paint3. create a new project and then use the stylus to sign your name in the blank screen4. crop the image into a box just big enough for your signature and then save as one of the

above formats5. transfer the format to your keystone workstation, sign in and open Settings->Account and

click the white box that says "Click Here to add Logo" next to signature6. Browse to the folder path that contains your signature file, select that file and press enter or

select okay7. Your signature will appear in the above white box

Additionally if your user is setup as a consultant you will have an option to add your logo.1. Click the box that says "Click Here to add Logo" next to Logo2. browse to the file location your logo is stored, highlight it and click ok or open



3. you logo will appear in that box

2.3.2 Consultant

Enter topic text here.

2.3.2.1 Group

Enter topic text here.

2.3.3 Admin

The user you login with will have different privleages seup by your account administrator.

2.3.3.1 Users

This section will only appear in your settings if you have account administratorprivileges.

Once logged in as an administrator you can can add/edit delete any user account.

Add1. Login as an account administrator, go to settings in the lower left of Keystone Workstation2. Select users under the ADMIN section

3. Select add at the top of the page 4. Fill in the username, password, and any field with a red asterisks. All other fields are

optional5. In the Permissions area you have 2 choices, you can pick a category that has basic

recommendations or you can check the box next to the permission you wish the new userto have. The checked box will always overrule the category choices.

6. Once you have entered everything select save at the bottom



Server Admin: This gives access to all advanced system configuration options: server settings,DICOM tag mapping, bulk rename, device names, email templates.

User Admin: This permission will let the user add/edit/delete user accounts in Keystone. Thispermission is also required to configure consigners when using the sales repository module.

Delete Study: Users with this permission can delete studies from Keystone.

Rename Study: Users with this permission can rename individual studies within Keystone.

Import Data: Users with this permission can import images into Keystone from CD, email, USB driveor folder on their computer.

Teleradiology Data: This allows the user to see all teleradiology data in the system. The user cannotedit anything, but can view all teleradiology drafts and reports regardless of the consultant/specialistwho is working on the report.

Send Email: Users with this permission can send studies, images and reports via email.

Send DICOM: Users with this permission can send studies and images to DICOM peers.

Export Data: Users with this permission can save DICOM files to a folder, USB drive or CD/DVD.

Send Teleradiology: Users with this permission can create new teleradiology requests.

Create Reports: Users with this permission can create new “normal” reports that are attached to



studies.

Sales Repository: Converts the user account to a sales repository viewer. They will see the salesrepository study list and viewer instead of the normal Keystone interface

Edit1. Login as an administrator, go to settings in the lower left of Keystone Workstation2. Select users under the ADMIN section3. Select the user you wish to edit4. You can change any value except the username5. Click save at the bottom when finished

Delete1. Login as an administrator, go to settings in the lower left of Keystone Workstation2. Select users under the ADMIN section

3. Select the user you wish to delete and select Delete at the top of the page 4. Confirm the Delete by selecting yes. This removes that user from your Keystone

Account.

Because usernames are part of our global system you maynot re-use that same username.



2.3.3.2 DICOM Devices

Select DICOM Devices to configure Keystone to Query/Retrieve other PACS Software.

Select ADD at the top of the screen and enter the above fields with that information from thePACS you wish to Query/Retrieve. Please note that you will have to enter the Keystone AETitle, Port and Hostname (IP Address or computer name) in that PACS Software before it willwork correctly. Once you have the information entered, select the test button to verify that itis a valid connection ( you may need to open the ports in your firewall or contact your ITadmin to perform that task). Once the connection is successful select save so it will appearin the device list.



2.3.3.3 Archive Queue

Select the Archive Review to view how many images/studies are left to archive.

They will be listed out in order from newest to oldest. Meaning if you return from the field it willarchive the last study taken first and the first study taken will archive last. If you wish tochange that order, select the study and select the up arrow to the right of the screen. If thereare any errors, those images will be listed at the bottom of the screen. If this occurs pleasecontact Asteris Technical Support

Once all the images have archived Keystone will display "Nothing is currently archiving"

*Please not that Keystone will re-verify all studies archived so you may see the studyagain in the list, as long as there are no errors at the bottom this is NORMAL.

2.3.3.4 Server Log

The Server Log provides diagnostic information to Asteris Technical Support when you call in



with a issue.

Viewer Download Log for when images open in the DICOM viewerAnnex Connection Logs each time Keystone checks in with Asteris servers in ColoradoDICOM Listener Logs each time a modality sends a DICOM image. *Note when troubleshooting select Verbose at the topFile Importer Logs the image import processData Synchronization Logs the steps when synchronizing between Keystone and AsterisServersImage Archive Logs archived imagesArchive Verification After images are archived Keystone verifies them, that is logged hereImage Download Logs images as they download from Asteris ServersFile Compression Logs the compression of the Data folder where images are keptAuto-Upgrade Logs each time Keystone checks for updates and logs when they are appliedDisk Space Clean-up Logs the High and Low water mark for image removal from your localhard driveCustom Commands Rob can you provide infoDICOM File Changing Rob can you provide infoMonitor Rob can you provide info

Stop Server Stops the Keystone service from runningStart Server Starts the Keystone service when stopped

Teleradiology 51


3 Teleradiology

Teleradiology is comprised of two or more constituents working together, connected through AsterisKeystone:

Referring DVM (rDVM):o Individuals or practices seeking consultations, reports, opinions, etc. from

Consultants (e.g., radiologists, surgeons, etc.).

Consultant:o Individuals from whom referring DVMs request reports, consultations, opinions, etc.

In many instances, referring DVMs have preferred Consultants with whom they workfrequently. To expedite the process of sending and receiving consultation requests, AsterisKeystone provides a Teleradiology feature.

If you are interested in establishing you or your practice as an rDVM and/or Consultant,please contact Asteris technical support at 877.727.8374 or [email protected]. The set upprocess is simple.

3.1 Radiologist/Consultant

Note: If you are interested in establishing yourself or your practice up as a Consultant,eligible to receive consultation requests, please contact Asteris technical support at877.727.8374 or [email protected]. The set up process is simple, we require a currentrequest form so that we can tailor the Keystone software to fit your needs. We also will needto know what fields are required for each request.

For most users, Asteris Keystone Workstation will open to Studies. However if you havebeen set up as a Consultant, Keystone Workstation will open to the Open Request section ofTeleradiology.



1. A single left mouse click will load the referring DVM's consultation request formsubmission.

2. Double click on the thumbnail to load the study in the DICOM Viewer.

3. If previous consultation requests have been submitted (and reports generated), theywill be shown in chronological order in tabs across the top of the study.

4. Enter your report comments in the Interpretation field (can be named anything youwant with a customized report). (see the Settings section for tips on creatingShortKeys to streamline the report process. Asteris Keystone also works with theDragon Naturally Speaking software).

5. If you have to walk away from a report before completing your comments, your workwill automatically be saved and made available when you want to continue yourcommentary. (need instructions on how to pick up where they left off; or review/editsomeone else’s reports).

6. Reports are not finalized until you click on the Finalize button at the bottom of thescreen. A finalized report is considered part of a final medical record. However, youcan open it at a later date and add addendums to the report if necessary.

7. Click Send to notify the referring DVM that your report is complete (your report will beattached to the email Keystone sends).

Teleradiology 53


3.2 Referring DVM

To initiate a consultation request to a Consultant please refer to Consultations

rDVMs can track a history of all consultation requests sent.

1. To track and manage the requests you have submitted, clickTeleradiology.

2. The Teleradiology worklist will be displayed.

A. By default the worklist opens to the Open Request section of QuickList. You may select Today, Yesterday, Last Week or All Requests toview a consultation status and the corresponding report.

B. You can search older consultation reports using one or more of theSearch fields.

C. Highlight the consultation report you want. Open it with a single leftmouse click. The report will open at the bottom of the screen.



D. If there are several consultations for the same patient (irrespective ofmodality) they will appear as tabs across the top of the study. Thisallows for quick access to each report without the need to conductadditional searches. You can view both the history and the response(s) for each request.

3. To view the images upon which the Consultant is commenting, doubleclick the thumbnails at the bottom of the report.

4. To print a report, select the corresponding tab and click Print. You will get aprint preview as you did in the Print section.

4 Online Access

Asteris Keystone archives all your images to an offsite secure location, since this is done viathe internet you also have access to those same images from any internet location by goingto www.asteris.biz. Once you are there look to the bottom left of the page and you will seetwo options.

http://www.asteris.biz

Online Access 55


1. Access your data2. Product Administration

Access your Data allows you to use the same username and password as Keystone to seeevery study you have archived with Asteris

Product Administration allows you to manage users remotely and pay your bill online. Pleasenot you must be an account administrator to access this section.

4.1 Product Admin

Once you select product administration from the Asteris home page enter the username and passwordthat you utilize with Keystone and hit <enter> or select submit under the login boxes. Once you are inthe admin area you can select the drop down arrow to manage users or select Add New User to theright. You may also choose to Pay your invoice at under "Other Tasks"

Once you select Pay Invoices, follow the onscreen instructions to complete the task.

4.2 Access your Data

Once you select Access your Data from the Asteris home page, enter the same username andpassword that you utilize for Keystone. Once you have entered that hit <enter> or select submit. This



will open the online search page and allow you to retrieve, view, email, or DICOM send any study thatyou have archived with Asteris.

Once you have entered your search criteria to the left side of the page select <search> at thebottom and the results will appear to the right.

As you move your mouse over each study they will turn blue, once you have got to yourdesired study right click the study and choose from the list of options.

Online Access 57


As you mouse over those options they will turn blue as well. Select the desired action and ifnecessary follow the onscreen instructions. If you choose to download or view DICOMimages you will see a download manager appear on your screen. It provides your connectionspeed, percentage of each image and the percentage of the study. In the upper left you cansee how many images their are and how many you have downloaded.

Once this complete the images will open in the same DICOM viewer you utilize in Keystone. If there are reports associated with that study they will appear in a tab form similar tothumbnails and preview sections of your Keystone DICOM viewer.



5 Trouble Shooting Guide

This is a basic guide to common issues that may arise with Keystone Workstation.

Connection ErrorUnable to ArchiveClient not SyncingCan't Find a StudyUnable to SendConsultationUnable to send Email

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