FLASH User's Manual Rev H 271004

FLASH 1500- FLASH 2000

Digital Imaging System

USERS MANUAL (Ref : 47-40-002- Rev. H Date September 2004)

APELEM-DMS GROUP Parc Scientifique Georges Besse 175 Alle Von Neumann, 30035 Nmes cedex 1- France

Tl + 33 (0)4 66 29 09 07 - Fax +33 (0)4 66 29 71 23 - e-mail: [email protected]

FLASH 1500 FLASH 2000 - DIGITAL IMAGING SYSTEM

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This manual has been first written in FRENCH

FLASH 1500 FLASH 2000 - FLASH DIGITAL IMAGING SYSTEM

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Table of contents 1. SAFETY AND COMPLIANCE .................................................................................................................................................................................................................................................................................................................................................................................... 5555

1.1. Safety....................................................................................................................... 5 1.2. Transport .................................................................................................................. 5 1.3. Installation ............................................................................................................... 5 1.4. Operating................................................................................................................ 5 1.5. Cleaning and disinfection ...................................................................................... 5 1.6. Storage .................................................................................................................... 6 1.7. Life time ................................................................................................................... 6 1.8. Description of the safety labels.............................................................................. 6 1.9 Intended use of the unit ......................................................................................... 7 1.10 APELEM DMS Group Warranty ............................................................................ 7 1.11 Conformity and reference standards.................................................................... 7

2. PATIENT MANAGEMENT ........................................................................................................................................................................................................................................................................................................................................................................................................ 9999 2.1 Create a patient................................................................................................... 12 2.2 Create a study ...................................................................................................... 14 2.3 Rename a patient ................................................................................................ 15 2.4 Load a patient / study / series / image ............................................................... 16 2.3 Select a patient / study / series / image ............................................................. 16 2.4 Delete a patient / study / series / image ............................................................ 17 2.5 Lock a patient / study / series / image ................................................................ 18 2.6 Import Patient Data Using Dicom Worklist feature (Optional) ........................... 19

3. IMAGES MANAGEMENT................................................................................................................................................................................................................................................................................................................................................................................................ 21212121 3.1 Sequence review .................................................................................................. 22 3.2 Post Processing...................................................................................................... 22

4. DSA POST PROCESSING ................................................................................................................................................................................................................................................................................................................................................................................................ 31313131 4.1 Mask Selection ...................................................................................................... 32 4.2 Landmarking ......................................................................................................... 35 4.3 Pixel-shift ................................................................................................................ 37 4.4 MaxOp MinOp ...................................................................................................... 39

5. MEASUREMENTS AND ANNOTATION TOOLS ........................................................................................................................................................................................................................................................................ 41414141 5.1 Distance ................................................................................................................ 42 5.2 Angles .................................................................................................................... 43 5.3 Double Angles....................................................................................................... 43 5.4 Stenosis .................................................................................................................. 43 5.5 Line......................................................................................................................... 44 5.6 Annotation ........................................................................................................... 44 5.7 Erase an annotation ............................................................................................. 46 5.8 Duplicate annotations (not implemented) ......................................................... 46 5.9 Drag graphics ....................................................................................................... 46 5.10 Reset graphics....................................................................................................... 46

6. PRINTING IMAGES ................................................................................................................................................................................................................................................................................................................................................................................................................................ 47474747 6.1 Printer setup........................................................................................................... 47 6.2 Accessing Print screen.......................................................................................... 47 6.3 Print screen overview............................................................................................ 48 6.4 Configure Print settings ......................................................................................... 49


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6.5 Select image to print ............................................................................................ 50 6.6 Modify image treatment ...................................................................................... 51 6.7 Add image to film ................................................................................................. 52 6.8 Print preview.......................................................................................................... 53 6.9 Print film ................................................................................................................. 53

7. IMPORTING / EXPORTING ........................................................................................................................................................................................................................................................................................................................................................................ 55555555 7.1 Introduction........................................................................................................... 55 7.2 Importing Files ....................................................................................................... 55 7.3 Exporting Files ........................................................................................................ 58

8. COMPONENT IDENTIFICATION ............................................................................................................................................................................................................................................................................................................................................ 65656565 8.1 Infrared Remote Control ...................................................................................... 65 8.2 Control Panel ........................................................................................................ 66

9. CONFIGURATION SOFTWARE .................................................................................................................................................................................................................................................................................................................................................... 67676767 9.1 Startup ................................................................................................................... 67 9.2 Texts ....................................................................................................................... 68 9.3 Exams..................................................................................................................... 69 9.4 Services.................................................................................................................. 70


Ref : 47-40-002 Rev. H 5/70

1. SAFETY AND COMPLIANCE

The purpose of this user's manual is to provide a set of easy instructions for a proper use of the system. All of information contained herein is based on the current version of the system. APELEM-DMS Group reserves the right to improve and implement changes to the information herein in order to reflect any changes required by technological enhancements.

1.1. Safety This equipment is not intended to function in an atmosphere containing explosive gas. A check of the reliability and efficiency of the apparatus every 6 months is recommended for the safety of both patient and operator. Worn parts may become dangerous; they must be checked and replaced by new ones. Before using the unit, the operator must ensure that all safety devices are in working order. No modification has to be made to the apparatus without the authorisation of the manufacturer. The condition of the cables and connections must be regularly checked, and be replaced if they show signs of wear. In case of any doubt, call the Technical Department.

1.2. Transport Any time it is travelling, the device must be carried in its original packing and must not be moved without taking precautions. For more details, please contact APELEM-DMS Agent.

1.3. Installation The installation of the system must be done in a room exempt of humidity and dust. For more information, please, refer to the 1.1 safety mentioned above.

1.4. Operating The conditions of use are the following : - Ambient temperature : 10 to 40C - Relative humidity : 30 to 75% - Atmospheric pressure range : 500 to 1060 hPA This system is especially reserved for a radiological use.

1.5. Cleaning and disinfection Before cleaning the unit make sure that the power supply is disconnected, and the trolley is switched off. Clean the unit using a humid rag and tepid water. Do not use detergents or sprays abrasive or corrosive like Acetone or pure alcohol, only alkaloid solutions with a soft rag. Be careful not to allow water or liquid of any kind to enter the unit or in the trolley as this could cause a short-circuit or corrosion to occur.


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HIGH VOLTAGE CURRENT 230 V

THIS EQUIPMENT HAS NO PARTS

WHICH CAN BE REPAIRED BY THE USER HIMSELF REMOVAL OF ANY HOUSING WILL RISK ELECTROCUTION

ALL REPAIRS MUST BE MADE BY QUALIFIED PERSONNEL ONLY

1.6. Storage

The conditions of storage are the following : - Temperature : 0 to 40C - Relative humidity : 10 to 80% - Pressure : 700 to 1060 hPA After a period of storage at a temperature inferior to 10C, it is recommended to place the turned-off device in place with a temperature of between 10 to 40C for a minimum period of 4 hours.

1.7. Life time The lifetime of the FLASH 1500 - FLASH 2000 is 10 years. Beyond this time, the Manufacturer does not guarantee technical specifications from origin . When the unit is out of order, it has to be recycled according to the country current regulations.

1.8. Description of the safety labels

SENSOR LABELS PROTECTION IDENTIFICATION FLASH 1500 CE Marking European Directive

93/42/CEE Serial number Number of the notified body for APELEM products B Type Power supply 120 or 230 V according The current legislation OR FLASH 2000 NAME AND ADDRESS OF THE MANUFACTURER Country of origin


Ref : 47-40-002 Rev. H 7/70

1.9 Intended use of the unit The FLASH 1500-2000 directly converts the radiation signal into a digital image that can be immediately processed, visualized and transferred.

1.10 APELEM DMS Group Warranty The validity of DMS-APELEM is 12 months from certificate receipt date and it covers mending or free replacement of spare parts as well as hand-work (except for the unload tubes which have a warranty in proportion to 12 months). APELEM DMS warranty is not valid for operations and mending caused by externals factors : Fire, explosion, floods, subsidence of buildings, Default of the device relative to the environmental conditions, Non respect or non observance of the prescriptions given by the manufacturer in the Users

manual, Operations or mending carried out by a non qualified staff and not agreed by APELEM

DMS Group

1.11 Conformity and reference standards This device is in conformity with the IEC 60601-1 and IEC 60601-1-2 standards and belongs to II b class according to the 93/42/CEE norm, appendix IX, regulation 10.


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2. PATIENT MANAGEMENT

This section will explain the various ways to create and access the patient data.

Fig 1 : Patient list Screen

1- Patient list 2- Management function 3- Validation / Cancel 4- Images preview 5- Patient and study information

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5


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The content of a patient file is hierarchically presented by respecting the DICOM 3.0 standard. The DICOM 3.0. hierarchy appears in the following form:

Image Image ...

Series Series ...

Study Study ...

Patient

...

Study ...

Patient

...

Patient ...

Fig 2 : DICOM 3.0 hierarchy

First of all, only the patient level is expanded. For each level, one graphic identifier is defined. These identifiers are the following :

- Symbolises a patient. - Symbolises a study. - Symbolises a series. - Symbolises an image.

Several possibilities are available in order to expand each level:

- Double click on the level to be expanded. - Click on the sign that is in front of the considered level, if this one contains data.

On the same way, it is possible to collapse the hierarchy :

- Double click on the level to be collapsed. - click on the sign that is in front of the considered level, if this one is expanded.

For each level, indicated data are the following :

Fig 3 : Hierarchy in the patient list

Patient name and first name

Studies, Series and images numbers

Identifiers Date and hour of creation

Modality

Sex

Doctor


Ref : 47-40-002 Rev. H 11/70

For the patient level, data presented in the previous figure are the one displayed when the user has chosen to sort the list by patients. A sort by studies is also possible. The choice of one or of the other is made by means of the following buttons situated under the list :

Fig 4 : Patient and study sort

Allows a sort by patients. Patients are displayed at the first level of the tree. This mode enables to display patients in alphabetical order or by date of creation.

Allows a sort by studies. Studies are displayed at the first level of the tree. This mode enables to display studies by practitioner or by creation date.

For each of these modes, clicking on the title of columns carries out the classification in the list by growing or by descending order. An arrow near the name of the column indicates the sense of the classification. For patients and studies levels, it is also possible to get more information by means of information cards. These cards are accessible when an element is selected in the hierarchy. For example, to obtain the information card, it is enough to click on the desired patient in the patients list. The corresponding information card displays at the bottom of the left hand corner of the patients list. It contains the following data :

- For the patient : the name, the first name, the identifier, the date and the creation hour, the sex and the birth date.

- For the study : the number, the identifier, the date and the insertion hour, the type of exam, the name of the practitioner, the age of the patient, his weight and height.

However, only information that have been filled in the patient card may appear.

Fig 5 : Patient and study card

When an item is selected in the patient list, corresponding thumbnails are displayed at the bottom of the list:


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Fig 6 : Thumbnails

Clicking on thumbnails can perform actions: Selected item

Displayed thumbnails Click on a displayed thumbnail

Double-Click on a displayed thumbnail

Patient First image of each series contained by this patient.

Opens the series corresponding to this thumbnail.

Load the series corresponding to this thumbnail.

Study First image of each series contained by this study.

Opens the series corresponding to this thumbnail.

Load the series corresponding to this thumbnail.

Series All images contained by this series.

Select the image corresponding to this thumbnail.

Load this series.

Image All images contained by this series. Thumbnail of selected image is highlighted.

Select the image corresponding to this thumbnail.

Load the series and displays the selected image.

The number of each small image corresponds to the following logic :

Study number . Series number . Image number (#number of images)

2.1 Create a patient From the Main Menu screen

1. Click the New patient button in the Standard Control box

2. The Patient Creation screen will be displayed.


Ref : 47-40-002 Rev. H 13/70

From the Patient Management Menu

1. Call the patient creation window by means of the Patient Management Create a patient menu

2. The Patient Creation screen will be displayed. From the Patient List

Fig 7 : Patient Creation

3. Click the New patient button in the Standard Control box

4. The Patient Creation screen will be displayed.

Fig 8 : Patient Creation

The capture of the patient name is compulsory, but other fields are facultative. However, if these fields are not correctly written, patient data and study data displayed in the information forms will be incomplete. If the identifier field is not informed, the system will attribute a default value

Click the left mouse button to position the cursor over each field where data is to be entered. Use the mouse or the tab key to move between entries.

Fill in the fields with as much patient information as it is available. Some fields are required

and are indicated by an asterisk (*).


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Several of the selections have drop-down menus for quickly selecting data and are indicated by a small downward arrow next to the field.

When data entry is complete, click on the OK button.

2.2 Create a study

Fig 9 : New study

It is possible to add new studies to existing patients like this :

From the acquisition window, load the desired patient coming from the patients list, (See patient loading), then call the study creation window by means of the Patient Management Create a study menu.

From the patient list : select the desired patient in the patient list and then click on the New Study button.

From the patient list: select the desired patient in the patient list and then click the right mouse button while the cursor is over this patient. Select New study through the menu displaying.

The window allowing to capture data concerning the new study displays :

Fig 10 : Create study

Once the new study is created, this one is selected in the patients list and must be loaded by means of the validation button. If the new study has been directly created from the acquisition window, it is now working. Series files of next acquired images will take place automatically in this study file.


Ref : 47-40-002 Rev. H 15/70

2.3 Rename a patient The system allows you to rename patients. Clicking the right mouse button, while the cursor is over a patient in the patients list, provides access to a convenient new menu. Select the Edit sub item:

Edit a patient.

The following window will display:

Editable data are:

- Last Name - First Name - Birth Date - Sex

Valid your change by clicking the OK button.

NOTE: Only patients that does not contain image can be edited.


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2.4 Load a patient / study / series / image From the Main Menu screen

5. Click the patient list button in the Standard Control

box 6. The Patient List screen will be displayed.

From the Patient Management Menu

3. Move the cursor on the menu Patient List and click 4. The Patient List screen will be displayed.

The loading of a patient or a study is made from the patients list. Select the desired patient or study by clicking on it with the left button of the mouse. The selected element appears highlighted in the list. Then click on the OK button.

Click the OK button to load the sequence. Desired sequence can also be loaded by double-clicking on it.

2.5 Select a patient / study / series / image

Fig 11 : Selection

The selection of elements in the list (patient, study, series or image) allows to define a group of images that will be processed together. This selection will be able to remove, archive, or send a defined group of images onto the network. The selection of an element in the list is made by a left click on the case situated at the left of the graphic identifier of each hierarchical level in the patient list. This case supply information on the state of the image :

- The image has not been subjected to a particular processing and it is not selected. - The image has not been subjected to a particular processing but it is selected. - The image has been stored on a CD-R and it is not selected. - The image has been stored on a CD-R and it is selected. - The image comes from a CD-R, but cannot be selected.

The selection may also be done by clicking on a patient with the left button of the mouse to highlight it, and then by pressing on the space key. When You select an element in the list by clicking in the case or pressing the space bar, others previously selected elements are unselected. To select multiple elements, keep the CTRL key presses while clicking in the case .


Ref : 47-40-002 Rev. H 17/70

The selection and the de-selection of all images of the list is possible thanks to the following buttons situated under the patients list :

Select all elements of the patients list.

De-select all elements of the patients list.

2.6 Delete a patient / study / series / image

Fig 12 : Delete

The deletion of elements of the list (patients, studies, series or images) may be carried out according the following ways :

DEL Key Highlight an element by clicking on it with the left button of the mouse, and then press the DEL key. The selected element and also all other sub-elements will be then removed.

Select one or several elements by checking the boxes at the left of the levels graphic identifier (See Select elements of the patient list), then click on the Delete Checked button. All elements that have been selected will be then removed.

Select the desired element in the list and then click the right mouse button while the curser is over the element. Select delete through the menu displaying.

Note: To remove all patients of the database, select the whole elements using the button

, then remove them by clicking on .

Warning! elements that have been removed will not be able to be recovered.


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2.7 Lock a patient / study / series / image

Fig 13 Lock

The lock of elements in the list (patient, study, series or image) allows to protect them from deletion. The lock and the unlock is possible thanks to the following buttons situated under the patients list. Lock and unlock are applied to the selected elements.

Lock selected elements of the patients list.

Unlock selected elements of the patients list.


Ref : 47-40-002 Rev. H 19/70

2.8 Import Patient Data Using Dicom Worklist feature (Optional)

Use the WorkList feature to search a database (usually a centralized database connected via a DICOM network) for patients based on specific criteria. Look for groups of patients, or a specific patient file. This feature is used to search by Patient Data only - not images. DICOM Worklist is an optional feature and if it is not enabled on your system, the Worklist tab will not appear on the Patient List screen.

Displays the worklist window.


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3. IMAGES MANAGEMENT The main screen contains all the tools needed to manage sequences.

1- Following functions :

Patient list Create a patient

Post processing*

Measures and annotations

Mosaic Print Zoom Shutters

2- Windowing functions 3- Filter functions 4- Image manipulation 5- Acquisition Radiography 6- Acquisition mode* 7- Disk status 8- Genecom 9- Menu 10- Patient information 11- Current image 12- Study/Series/Images information

In FLASH 2000 Digital imaging system only.

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6*

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3.1 Sequence review

Sequence to review may be selected in the Patient List Screen. (See Patient Management chapter to access and gain information about this screen.) and load by the Validation button. Frames for the current sequence are displayed sequentially from the beginning of the sequence. Navigation tool allows you to switch between series and images:

To move to the first series/image in the patient file, left click the First-Arrow. This button will allow single clicks even if held down.

To move to the previous series/image, left-click the Previous-Arrow button. This button will only allow multiple clicks if held down.

To move to the next series/image in the patient file, left click the Next-Arrow. This button will allow multiple clicks if held down.

To move to the last series/image in the patient file, left click the Last-Arrow. This button will allow single clicks even if held down.

3.2 Post Processing Prior to the application of processing features, an image must be selected from those acquired. Image processing feature buttons are located on the right panel in the main image screen. Processing features selected will be applied only to the series currently shown in the Main Image screen. Applied processing features can be saved with the series and will be shown each time the series is displayed.

3.2.1 Sequence replay

Sequence replay Start / Stop. Once clicked, sequence replay button remains pushed. Click on this button again to exit sequence replay mode.

The slider control allows to access Replay Rate.

Sequence replay can also be launch by the Post processing menu:

Sequence replay Start / Stop. Once clicked, sequence replay menu remains checked. Click on this menu again to exit sequence replay mode.

The whole series will loop at specified speed rate until the Sequence replay button is released.


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3.2.2 Display format

The display format discussed in this section only applies to the screen of the Primary Display monitor. The available display formats are:

1-on-1 4-on-1 16-on-1 64-on-1

The default screen display format is 1-on-1. Each time a new exam is opened, this will be the display format used. Other formats are available in mosaic screen, accessible from the right panel or from the patient management menu of the main screen.

Opens mosaic screen.

The menu Patient Management->Mosaic opens mosaic screen. The mosaic screen displays:


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Display formats are selected from the right panel:

Set 2X2 Multiple Image display for 4-on-1.



Click on any thumbnail to select it. It will then be framed with a white border. Multiple selection is allowed:

- Keep CTRL key pressed while clicking to select / unselect sequence. - Keep SHIFT key pressed while clicking to select a group of sequences: Click on the first

image of the group to select, press an keep pressed the SHIFT key, then click on the last image of the group. All images contained between the two-mouse click are now selected.

Mosaic sequences can be checked in order to be used for other purpose. Once you have selected images, just press SPACE bar. The thumbnail number of checked images is black on white written. To uncheck selected images, just press SPACE bar again. Its now possible to display only checked images in mosaic screen:

Displays all images.

Displays only selected images.

Double-click on any sequence to quit mosaic screen and display it in the 1-on-1-display format. Multiples mosaic pages are available. They can be switched with the navigation control :

Go to previous mosaic page.

Current mosaic page / Total number of pages.

Go to next mosaic page.

Update the display if needed.

Displayed images are the current study ones. To display only a series ones, select the desired series in the scrolling list. Selecting ALL in the list means all the study images are displayed.


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Selecting a specific study is needed for special functions, as setting series mask or creating Maxop/Minop series (Flash 2000 only). Click the Quit button to return to the main screen.

3.2.3 Series creation You had to check multiples images for series creation: Click on any thumbnail to select it. Once you have selected images, just press S key. A MRG mark is displayed on the thumbnail of checked image. To uncheck selected images, just press S key again. Multiple selection is allowed:


image of the group to select, press an keep pressed the SHIFT key, then click on the last image of the group. All images contained between the two mouse click are now selected.

All images checked with MRG mark will be used to create the new series. Once images have been selected, click on the Merge button on the right panel of the mosaic screen.

Create a new series from the selected images.

The following confirmation boxes will display:

Click on the OK button. The new created series is automatically displayed in the main image screen.


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3.2.4 Adjust image Brightness/Contrast The Brightness / Contrast adjustment applies to the whole series.

Full scale.

Automatic Brightness / Contrast.

To manually adjust the brightness of the image:

1- Click the W/L (Window/Level) button from the Panel. The cursor is now in the middle of the image. 2- Drag the cursor right to increase brightness or left to decrease brightness.

Slide the cursor bar right to increase brightness or left to decrease brightness

To manually adjust the contrast of the image:

1- Click the W/L (Window/Level) button from the Panel. The cursor is now in the middle of the image. 2- Drag the cursor down to increase contrast or up to decrease contrast.

Slide the cursor bar right to increase contrast or left to decrease contrast.

3.2.5 Invert Image polarity The Invert Black / White Button changes the polarity of an image from a positive image to a negative image or from negative to positive.

Invert image polarity.

Menu post processing : Invert image polarity.

3.2.6 Edge/Contrast Enhancement Edge Enhancement is a digital image-processing filter, which is used to make pictures look sharper than they really are. You can switch between eight levels of Edge Enhancement.


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Slide the cursor bar right to increase edge enhancement or left to decrease edge enhancement. Menu post processing Select desired Level of Edge Enhancement.

Contrast Enhancement is a digital image-processing filter that is used to make pictures look more contrasted. You can switch between eight levels of Contrast Enhancement.

Slide the cursor bar right to increase contrast enhancement or left to decrease contrast enhancement. Menu post processing Select desired Level of Contrast Enhancement.


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3.2.7 Zoom The Zoom feature allows magnification of the currently displayed image.

Activates image magnification.

Menu post processing Select desired Level of Zoom.

Once image magnification is activated, you can switch between five levels of zoom:

- X 1 - X 1.5 - X 2 - X 3 - X 4

Just scroll the wheel mouse up and down to increase or decrease the zoom level. While image magnification is activated, it may be necessary to view a part of the image that is not shown on the screen. Just move the mouse to the desired part of the image. To quit image magnification mode, click on the image with left mouse button.

3.2.8 Electronic shutters Each of the four sides of the black area surrounding the image may be extended to match the exact image area to better view the image. Shutter settings are applied to the whole series.

Electronic shutters.

Menu Post Processing Electronic shutters.

1- Click the electronic shutters button. 2- Position the mouse cursor to the top left corner of the image across the area that should not

be covered by the shutters. 3- Mark this first position by clicking with left mouse button one time 4- A box will be drawn on the image as the cursor is dragged, having the first position as origin.

This box represents the border of the area to which the shutters will be drawn. 5- Position the mouse cursor to the bottom right corner of the image. The outbox represents

the parts of the image that will be covered by the shutters. 6- Mark this last position by clicking with left mouse button one time. 7- The shutters are drawn.


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3.2.9 Save image to reference screen Save image to the reference screen.

Menu Post Processing Copy AB


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4. DSA POST PROCESSING DSA Post processing is only available in FLASH2000 Digital imaging system.

1- Subtraction post processing button 2- Subtraction options 3- Mask options 4- Pixel shift 5- Landmarking

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4.1 Mask Selection Also referred to as Masking, this feature allows for the subtraction of the current image from a mask image in order to enhance viewing dye contrast within the vein. DSA Post Processing tools are available from the DSA Post Processing toolbox:

Opens the DSA post processing toolbox.

DSA Post Processing tools are also available from the DSA Post Processing menu:

DSA post processing menu. Activate subtraction


Ref : 47-40-002 Rev. H 33/70

DSA - Activation / Deactivation To Activate Subtraction: 1- Click the DSA Post processing button in the DSA Post processing toolbox to activate subtraction mode. 2- The button will appear depressed on the screen To Select Mask for whole series: 3- Click the Mask button to set current image as mask for the whole series. 4- Mask image number for the current image is updated. To Select Mask for single image: 5- Select left and right arrows to view the previous/next mask image for the current image. To Select Mask for whole series from the mosaic screen: 6- Click the Mask from mosaic button to access mosaic screen and follow the step DSA Mask selection in mosaic screen bellow. To Deactivate Subtraction: 7- Click the DSA Post processing button again to deactivate subtraction mode. 8- The current image will be displayed un-subtracted, using that images default image processing settings. 9- The mask button will return to its previous state.


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DSA Mask selection in mosaic screen. Click the mosaic mask button. The mosaic screen displays, showing the images of the current series:

Displays mosaic screen.

In mosaic screen, select the image to set as mask for this series by clicking on it with left mouse button. This image is then framed with white borders. Then click on the Set Mask button on the right panel of the mosaic screen.

Set selected image as mask for the current series.

A confirmation box will display. Click on the OK button. Images are updated, showing the series subtracted with the new image mask. Double-click on any sequence to quit mosaic screen and display it in the 1-on-1-display format.


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4.2 Landmarking Once the MASK button is selected, the Landmarking button will be activated on the screen. Landmarking allows the selection of the percentage of the mask image that is to be added back into the subtracted composite image. This will enable the visualization of some background image data for orientation or other purposes. Landmarking is available from the DSA Post Processing toolbox:


Landmarking is also available from the DSA Post Processing menu:

DSA post processing menu - Landmarking


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Landmarking - Activation / Deactivation To Activate Landmarking: 1- Click on the arrow on the right of the list box to select desired value of Landmarking. 2- Available settings for this feature are: 0% - 25% - 50% - 75% The higher the %, the higher the visibility of the mask image. To Activate Landmarking: 1- Click on the arrow on the right of the list box and select 0% value of Landmarking.


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4.3 Pixel-shift This feature allows to shift the mask in order to correctly fit the image. Pixel shift tools are available from the DSA Post Processing toolbox:


Pixel shift tools are also available from the DSA Post Processing menu:

DSA post processing menu. Activate pixel shift


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Pixel shift - Activation / Deactivation To Activate Large Pixel shift: Large Mask shifting is done with mouse. 1- Click the Pixel shift Post processing button in the DSA Post processing toolbox to activate pixel shift mode. 2- Move the mouse cursor on the screen to shift the mask. 3- Click with left mouse button to validate the shifting. 4- The mask shift in x and y-axis is updated. To Activate Fine Pixel shift: Fine Mask shifting is done with buttons paddle. 5- Use the four arrows to move mask up, right, down and left. 4- The mask shift in x and y-axis is updated. To Apply current image Pixel shift for whole series: 6- Click the Apply All button to set current image pixel-shift for the whole series. To Deactivate Pixel shift: 5- Mask shift can be cancelled for current image by pressing ESCAPE key when pixel-shift mode is activated 6- Mask shift can be cancelled for whole series by clicking Reset All button at any time. 7- The mask shift in x and y-axis is updated.


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4.4 MaxOp MinOp In DSA, x-ray images of arterial blood vessels are taken both before and after the introduction of a dye. The computer "subtracts" one set of data from another with the resulting image showing only the dye and, therefore, the shape of the artery through which the blood is flowing. Arterial shape is important in the determination of possible circulatory problems aiding in the diagnosis of heart disease and other circulatory disorders. Use the Image Stacking feature to consolidate a series of images into a single image showing the blood vessel completely filled with contrast media. The term Image Stacking is used as a general term covering the following specialized features: - Maximum Opacification - Minimum Opacification Theses functions are available from the main display screen and the DSA post processing toolbox:


1- Launch the Maxop / Minop. 2- The button will appear depressed on the screen 3- The mosaic screen displays, showing the images of the current series.

Maxop / Minop operations are also available from the DSA Post Processing menu:

DSA post processing menu. Maxop / Minop operations


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You had to check multiples images for Maxop / Minop series creation: Click on any thumbnail to select it. Once you have selected images, just press M key. A MXP mark is displayed on the thumbnail of checked image. To uncheck selected images, just press M key again. Multiple selection is allowed:


image of the group to select, press an keep pressed the SHIFT key, then click on the last image of the group. All images contained between the two-mouse click are now selected.

All images checked with MXP mark will be used to create Maxop / Minop series. Once images have been selected, click on the Maxop or Minop button on the right panel of the mosaic screen.

Create Maxop series from selected images.

Create Minop series from selected images.

The following confirmation boxes will display:

or Click on the OK button. The new created series is automatically displayed in the main image screen.


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5. MEASUREMENTS AND ANNOTATION TOOLS

1- Predefined text box 2- Measures and annotations toolbox 3- Measures and annotations button 4- Add predefined text box

The annotation tools enable the user to add text to the image. The measurement tools are used to measure distances, angles and percent stenosis within the active image window. The drawing tools enable the user to draw lines and arrows. The number of measurements, drawings and annotations is unlimited. The user may access to these tools : From the control bar:

Displays measures and annotation toolbox.

From the Measure and text annotations menu:

Displays Add predefined text box

1 3

4

2


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5.1 Distance

Distance.

Role: allows the user to determine distance in mm between two points. Method: to draw a distance, position the cursor on the desired beginning point of the distance line and click on the left button of the mouse. Moving the cursor will draw the segment from the first point to the cursor position. Clicking again on the left mouse button will position the segment and display the distance in millimetres. The distance is computed according to a default pixel dimension defined in the DICOM file. Warning ! The distance tool computes an approximation of the real world size and is provided as an indication in function of a default pixel size. For a better calculation, use the calibration customization. Calibration customization: To customize calibration of the pixel size, select Calibrate distance in the context menu. The following calibration dialog pops up:

Type the real world size of the calibration object in the size of the reference object field of the dialog box (in millimetres) and click the OK button. The Calibration cursor is then active. Draw the calibration line by clicking first on the left mouse button to select the desired beginning point. Then, draw the line and click again on the left mouse button to confirm the lines position. The distances previously drawn on the image are automatically updated. Only one calibration can be used on each image.


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5.2 Angles

Angles.

Role: allows the user to determine an angle within the image. Method: To draw an angle, the user clicks a first time on the left mouse button to select the corner of the angle, then a second time to select the end of the first segment. The second segment is drawn with the same method with two clicks. The fourth click on the left mouse button ends the angle position and displays the angle in degrees (with the complementary angle in parenthesis).

5.3 Double Angles

Double angles.

Role: allows the measurement of 2 angles as following: 3 5 1 2 38 deg. / 40 deg. 4 6 Method: Draw the angles with 6 left mouse button clicks (order as indicated on the above outline).

5.4 Stenosis

Stenosis.

Role: used to compute a percent stenosis. Method: to draw the diameters, the user clicks a first time on the left mouse button to select the first point of the first diameter, then a second time to select the end of the first segment. The second segment is drawn with the same method with two clicks. The fourth click on the left mouse button ends the stenosis position and displays the percent stenosis.


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5.5 Line

5.5.1 Standard line

Standard line.

Role: used to draw a line on the image. Method: To draw a line, position the cursor on the desired beginning point and click on the left mouse button. Moving the cursor will draw the line from the point clicked on to the cursor position. A second click on the left mouse will end the line.

5.5.2 Horizontal line

Horizontal line.

Role: allows the user to draw an horizontal line with a single mouse click. This tool is a time saving function to draw a reference straight line. Method: A single click with the left mouse button determines the position of one extremity of the line. (for a better drawing, dont click on the centre of the image).

5.5.3 Arrow

Arrow.

Role: used to draw an arrow within the image. Method: to draw an arrow, position the cursor on the desired beginning point and click on the left mouse button. Moving the cursor will draw the arrow from the point clicked on to the cursor position. Clicking the left mouse button will end the arrow. The edge of the arrow is at the second point.

5.6 Annotation

5.6.1 Write text The user has two ways to write text on the active image.

The text button on the toolbox opens the following box


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The user is able to type its own annotation in the edit box and add it on the active image by clicking on the Write button. If the user clicks on a sticker, the caption of the sticker is automatically added as an annotation on the active image. To add new stickers or modify the existing ones, see next paragraph Configure list of pre-defined annotations

Launch the Annotation function in the Measures and Annotations menu. The Annotation dialog pops up.

To write an annotation on the active image, select the annotation in the combo box and click on OK.

5.6.2 Configure list of pre-defined annotations A list of predefined annotations is available. The user is able to modify the list:

Launch the Annotation function in the measures and annotations menu. To add an annotation to the predefined list, type it in the edit box and click on ADD to list

button. To remove an annotation from the predefined list, select it in the combo box and click

on REMOVE from list button.


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5.7 Erase an annotation

Launch the Eraser function in the Measures and Annotations menu.

Role: used to remove a measurement, a drawing or an annotation within the image. Method: click on the desired measurement or annotation to erase. A graphic item can also be deleted with click on item + DEL key on keyboard, or with double click with the left mouse button on the item.

5.8 Duplicate annotations (not implemented)

Duplicate annotations

Role: allows to duplicate on the current series the annotation added on the previous series.

5.9 Drag graphics Role: allows the user to move graphics in the active image. Method: To modify the position of a graphic item, the user press on the left mouse button to select the desired item and move the mouse to displace it. Releasing the left mouse button confirms the new items position.

5.10 Reset graphics

Reset Graphics

Role: allows to erase all measurements of the current image.


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6. PRINTING IMAGES

6.1 Printer setup System printers are added or deleted within the Config tool. Refer to the system Technical manual section for complete instructions.

6.2 Accessing Print screen From the Patient List screen The Print screen is accessible from the Patient List screen by selecting the desired patient in the list and clicking the Print button above the list.

From the Main image screen Once the desired patient is opened in the main image screen, click the Print button in the right panel.

Display Print Screen.

From the main menu:

Display Print Screen.

NOTE: a trained service representative must only perform ServiceApplications


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6.3 Print screen overview Print screen allows you to access all patient images in order to print them. Each image can be treated separately and added to the film. Many film configuration are available by setting print setup options.

1- Image preview 2- Post processing tools 3- Patient information 4- Series 5- Images 6- Film preview 7- Check box to subtract the image* 8- Zoom percent and lock button 9- Print setup 10- Print commands

* Only in FLASH2000 Digital imaging system

9

1

2

3

4

5

6

10

7*

8


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6.4 Configure Print settings At this window, the processing defaults used for printing images can be changed.

Click on down arrow to display available printers and highlight to select printer for job to be performed.

Click on down arrow to display available film sizes and highlight to select film size for job to be performed.

Click on Select decoup button to access enhanced number of images to be printed on each film.

Choose which configuration should be used for the printed image by clicking on associated picture.

Select number of images to be printed on each film. Left box represents number of columns, right box represents number of rows. To display options, click on down arrow.

Enter number of copies to be printed. To display options, click on down arrow. Ranges from 1 to 5. Use up and down arrows within sub-menu to display all available values.

Select film orientation. When Landscape is enabled, a checkmark will appear in the box.

When the Auto Filming feature is ON, the system sends image to the printer automatically once the film is full. When Auto Filming is enabled, a checkmark will appear in the box.

Click on Film information button to access text information to be printed on each image on the film.


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Choose which text information should be printed on each image on the film by checking the associated box.

6.5 Select image to print Using the two images list at the bottom of the Print screen does selection of image to print.

1 : List of series owned by the current patient. 2 : List of images contained in the selected series. Click on desired series in list 1 to display associated images. The first image of the selected series is automatically loaded in the preview place. Then click on list 2 to load the desired image in preview place.

Click on View All button to display all images in list image.

Click on Only Selected button to display only selected images in list image. Images can be selected in Mosaic screen. Refer to the system user manual for more information.

1111

2

Series Patient name

Study Image


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6.6 Modify image treatment Print screen allows you to modify some of the selected image treatment.

Select level of Level by sliding the cursor.

Select level of Window by sliding the cursor.

Select level of Edge Enhancement by sliding the cursor.

Select level of Contrast by sliding the cursor.

Select Polarity by pushing Invert W/B button down.

Electronic shutter: sliding the cursors of the bars surrounding the image preview can modify Electronic shutter.


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6.7 Add image to film

The current image can be added to the film by double clicking on its preview at any time. The wheel mouse allows you to zoom the image before adding it to the film. Just place the mouse pointer over the image preview and turn the mouse wheel. The rectangle in the preview shows you the resulting image. Once the zoom adjusted, double click on the image preview. The resulting image then appears in the film preview. To select the place where to add the image, just click in the film preview on the desired square before adding it. The selected place is then highlighted, it means that the future image will be added there.

Printed images are marked with a printer logo at top right corner.

Click on Clear button to clear image displayed in highlighted square.

Click on Clear All button to clear entire film.

Double Click on image preview to add selected

f l

Film destination can be selected by a click in the desired square. Next film destination is highlighted.


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6.8 Print preview A print preview is available by clicking on the Impression Tab on the top left of the screen.

6.9 Print film If Auto filming is not active ( refer to Configure print settings for more information ) click on the Print button to start print job. Be aware that the correct printer, film size and number of copies are selected before starting the print.

Click on Print button to start print job.


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7. IMPORTING / EXPORTING

7.1 Introduction

The system offers several image transfer options providing ample flexibility for patient data handling. These features allow both images and patient data to be sent and received between the Digital imaging system and a DICOM 3.0 compatible network device or a Compact Disk Recorder/Player. The archiving of images prevents loss as well as keeps the system from becoming full. Additionally, networking allows for images to be retrieved from any station on the network.

7.2 Importing Files

When images are archived to a separate device (central storage network or CD for example), it is sometimes necessary to bring back (import) the patient files and images to the system for review or for comparison with more recent studies. Images can be imported from a network location using a DICOM network connection or imported directly from a DICOM CD using the system CD drive.

7.2.1 Import From CD NOTE: The system does not provide the capability to review images directly from a DICOM CD. It does allow you to import the patient file and images into the local database for review.

Fig 14 : CD-R re-reading

Re-reading of images archived by the system is performed from the patients list. Insert the CD-R in the recorder. The following window displays :


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Fig 15 : CD-R Mounting

In case the CD-R was yet inserted before you call the patient list, this window does not immediately appear. To call manually this window, you have just to click on the Mount submenu.

The CD-R mounting starts up when the button YES is selected. Mounting a CD-R recorded by the system allows to transfer all images and relative data into the patients list. This operation takes a few minutes. Patients data, studies, series and images will be accessible from the patients list tree diagram such as the ones that have been acquired. In this way, they will be able to be re-read and to be re-proceeded, however new processing will not be saved on the CD-R. In the patients list, elements loaded from a CD-R are recognizable by the icon, which is combined with them : The traditional box to be selected is replaced by an CD-R icon, which cannot be selected.

- represents an image coming from a CD-R. When the read CD-R is removed from the recorder, the system displays the following window :

Fig 16 : Umount CD-R

The CD-R umount starts up when the button YES is selected. Unmount a CD-R allows to remove all data relative to a CD-R previously mounted from the system. If the system has been stopped before the CD-R has been removed, or if this one has not been unmounted at the eject time, it is still possible to manually unmount it by clicking on the Unmount submenu.


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7.2.2. Import from network The system allows you to import network patient files and images into the local database. From the patients list:

Imports images from network.

When new images are available for importation, the above button turns to green.

Importing images allows you to transfer all received images into the patient list. This operation takes a few minutes. Patients data, studies, series and images will be accessible from the patients list tree diagram such as the ones that have been acquired. In this way, they will be able to be read and to be proceeded.

Click on the Import button to start the importation. The following dialog displays:

Click on the Yes button to confirm.


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7.3 Exporting Files

The system can send patient data and images to a remote device using the DICOM standard. Typically, data is sent to a DICOM compliant network device such as a remote PC, a storage server, or media device (CD-R). The system can be configured to communicate with multiple devices. Each device must be entered using the Service Applications mode before files can be exported. Contact your Service Representative if the device to which you want to export is not listed. Once a patient file is created and images acquired for that patient, there are several opportunities to export patient files/studies/images to a remote device. Each is described in the following sections:

7.3.1 Export to DICOM CD/DVD

Fig 17 : Archiving

Selection of Parts to be Archived

All elements of the list (patients, studies, series or images) can be archived: it is possible to archive a group of patients (in the limit of a CD-R size available) as it is possible to archive one single image. For that, select desired elements by selecting boxes at the left of the graphic identifier of levels (See Select elements of the list), then follow the archiving procedure described in the following chapters.


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Archiving Archiving of images on CD-R takes place when all desired elements have been selected . To launch the archiving, click on the Archive submenu.

The following window displays :

Fig 18 : Request for archiving on CD-R

Validate your choice by clicking on the button Yes. The archiving is starting. The following window displays :

Insert a blank CD-R or DVD in the recorder, then click OK button. A progress bar indicates the progress report of images saving on CD-R. It is possible at any time to stop the archiving by clicking on the button Cancel of this window.

Fig 19 : Archiving progress report on CD-R/DVD

When archiving is finished, the system displays the saving result :


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Fig 20 : Archiving result

When elements have been archived on CD-R, their display in the patient list is changed. The box to be selected on the left of the level identifier is shown with a CD-ROM icon in the upper left hand corner so that :

- or shows an element, which has no particular, processing. - or shows an element, which has been archived on CD-R.

The selection mode of these elements is the same than those that have not been archived. Now the system is free to perform new tasks.

CD-R Eject Push on the recorder eject box or click on the Eject submenu.

Now you can get back it, annotate it and put it in its box. The CD-R eject leads the display of the following window :

This option is useful when a CD-R has been re-read by the system (See CD-R re-reading). Reply No to this invitation.

7.3.2 Export to non DICOM format Images can also be shared between non-DICOM computers (for use in a web page, Word document or other Windows application, etc). Images can be exported in a variety of formats such as BMP, JPEG or AVI format.


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BMP (Bitmap)

BMP is the standard bit-mapped graphics format used in the Windows environment. By convention, graphics files in the BMP format end with a BMP extension. To select this feature for a specific image frame (not a sequence): 1- Select Save To Disk Current image in Post Processing Menu from the main screen:

Save to BMP Format

2- A new screen appears, called, File Save As. 3- At this new screen, select a directory folder where you want to save the file, enter a filename, select the BMP extension, then click the SAVE button.

JPEG Short for Joint Photographic Experts Group, the JPEG file format is a compressed format. Although it can reduce files sizes to about 5% of their normal size, some detail is lost in the compression. To select this feature for a specific image frame (not a sequence): 1- Select Save To Disk Current image in Post Processing Menu from the main screen:

Save to JPG Format

2- A new screen appears, called, File Save As. 3- At this new screen, select a directory folder where you want to save the file, enter a filename, select the JPG extension, then click the SAVE button.

Export Sequence in AVI Format The AVI (Audio Video Interleave) format is a common format on PC's, and comes with the Windows operating system. The format is used for video formatting. It captures a series of images for dynamic replay. To select this feature for the current sequence of images: 1- Select Save To Disk Current series in Post Processing Menu from the main screen:

Save to AVI Format

2- A new screen appears, called, File Save As. 3- At this new screen, select a directory folder where you want to save the file, enter a filename, then click the SAVE button. 4- A new screen appears, called, Compression video.


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5-. Compress the sequence of images or leave them uncompressed. Compression reduces the overall memory size needed to store the sequence but is accomplished by sacrificing some image quality. To compress the image, select a compressor model in the scrolling list. 6. Click the OK button to save the settings and create the selected sequence of images for export.

7.3.3 Transfer on the Network

Fig 21: Transfer on the network

Selection of elements to be transferred All elements of the list (patients, studies, series or images) can be transferred : the transfer of a group of patients is allowed as the transfer of only an image. For that, select first the desired elements by ticking the boxes situated on the left of the levels graphic identifier. (See Selection of elements in the list), and then, follow the transfer procedure described in the next chapters.

Choice of the Transfer Target The choice of the target on which images will be transferred is performed from the patients list. The pull down list situated under the push button contains all possible network targets on which the system is connected. Select the desired target in this list by means of a left click.

Click on down arrow to display available push targets and highlight to select.

The system is ready for images transfer.


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Transfer Images transfer on the network is performed when all desired elements have been selected and when a target is chosen in the pull down list. To launch the transfer, click on the push button.

Start Push.

The following window displays :

Fig 22 : Request for confirmation of transfer on the network

Validate your choice by clicking on the button Yes. Transfer starts up. A progress bar indicates the progress report of the selected images sending on the network. At all time you have the possibility to stop the transfer by clicking on the button Cancel of this window.

Fig 23 : Progress report of the transfer on the network

When the transfer is completed, the system displays the sending result :

Fig 24 : Transfer result

The system is now free to perform new tasks.


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8. COMPONENT IDENTIFICATION

This section of the manual describes the component parts of the system.

8.1 Infrared Remote Control

Available in FLASH Digital imaging system only.

Acquisition natural Single Manufacturer Automatic windowing Full scale Polarity reverse Natural DSA Series - Series +

Rate + Rate Window + Level Level + Window Edge + Contrast + Edge Contrast A B Cineloop

Acquisition natural Acquisition RDM

First image Image Image + Last image


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8.2 Control Panel

SHIFT CTRL ALT F1 Create a patient Create a study F2 Patient list Software

revision

F3 Automatic windowing F4 Full scale Power off F5 Shutters Shutters recopy F6 Zoom F7 Measures tools Text box Default text box F8 Polarity inverse F9 Contrast filter F10 Edge filter F11 Mosaic Config software F12 Cineloop Help Pause/Attn Genecom software Right arrow Image + Left arrow Image - Page Up Cadence + (during acquisition) Page Down Cadence - (during acquisition) Home Roadmapping* Inser RAD ACQ* Suppr DSA ACQ* H Horizontal reverse(acquisition)* Hide menu V Vertical reverse(acquisition)* M Maxop selection* End Copy aB Espace Image selection in mosaic

screen

P Print

* In FLASH 2000 Digital imaging system only.


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9. CONFIGURATION SOFTWARE

9.1 Startup Configuration software allows you to manage the initialisation files on the system. This program is launched from the Utility Configuration menu.

Launch the configuration software

9.1.1 Password Once started, Config asks for the password.

Only Texts and Exams are available without entering password. Just click on Text and exams edition to access related tabs.

9.1.2 Save / Cancel changes For all tabs, three buttons are available at the bottom of the dialog box. These buttons allows you to save or cancel the changes applied to the initialisation files: OK Saves all changes and quit the configuration program. Cancel Quit the configuration program without saving changes. Apply Only activated when a modification has been done: saves the changes.


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9.2 Texts

Text tab allows you to manage texts that can be displayed on the image: New Add a new text to the list Edit Edit the selected text for modification Remove Remove the selected text(s) Remove All Remove all the texts in the list To select multiple texts in the list:

- Keep CTRL key pressed while clicking to select / unselect item. - Keep SHIFT key pressed while clicking to select a group of items: Click on the first item of the

group to select, press and keep pressed the SHIFT key, then click on the last item of the group. All items contained between the two-mouse click are now selected.


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9.3 Exams

Exams tab allows you to manage exams that are specified in the create study window: New Add a new exam to the list Edit Edit the selected exam for modification Remove Remove the selected exam(s) Remove All Remove all the exams in the list To select multiple exams in the list:




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9.4 Services

Services tab allows you to manage services that are specified in the create study window: New Add a new service to the list Edit Edit the selected service for modification Remove Remove the selected service(s) Remove All Remove all the services in the list To select multiple exams in the list:



FLASH User's Manual Rev H 271004

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