| Organizing Exams, Images and Series |
To view the diagnostic images for a patient exam, simply double-click the exam's listing in a worklist or filter. Please note that the iSite Folder List and iSite Shortcuts are not visible when you are viewing diagnostic images. To return to the last worklist or filter you viewed, click the tab and left, as seen below.
iSite Enterprise View Exams Tab
Double-clicking
an exam listing will display that exam in the iSite Enterprise Canvas Page
(described below) but if you've switched to a different area of the program and
wish to return to the exams you selected, click the View Exams Tab, as seen
above.
If you had selected more than one patient, you can choose which patient to view by right-clicking the View Exams Tab and selecting the desired patient from the drop-down menu, as seen below.
The drop-down menu displays that patients' name, sex, date of birth and Patient ID. The last patient to be displayed is indicated with a check-mark. Choose any patient from the list and that patient's exams will be displayed. You can also close all open patients from this menu by selecting the "Close All Patient(s)" option.
The exams you selected are automatically laid out in rows within the
Canvas Page.
By default, each
exam is organized
horizontally in a row from left to right. (If you wish to view exams vertically,
there are two ways to accomplish this. If you wish to make this decision on an
exam by exam basis, you can right-click the left exam margin and select
"Vertical Rack" from the pop-up menu. For more information on the
Extended Exam Rack options, click here.
If you wish to set the vertical rack as your default view, you can set the "Rack Orientation" option to "vertical" in
the General Preferences section of the User Preferences Dialog, accessed by
clicking the Preferences Button in the upper right-hand corner of the iSite Enterprise
Control Strip. For more information on setting general preferences, click here.) Each
exam has its own horizontal
scroll bar that can be used to pan through the images and series in that exam. Use the vertical scroll bar at the right side of the screen to view the selected
exams if there are more than can simultaneously fit on the screen. Please note
that these scroll bars will only be present if there are images or image-series off-screen.
General Patient Information
General information about the patient whose exams you are viewing is displayed in the header of the Canvas Page. This information includes the patient's name, sex, date of birth, medical record number (MRN) and referring physician. Please note that this information is available only when it is provided by your image archive or DICOM devices.
The Patient History Timeline, seen above, is an integral part of the viewing images in iSite Enterprise. It provides a fast and intuitive way of navigating through a patient's clinical history of diagnostic exams and reports. The timeline presents a chronological listing of all of the patient's exams that are present on the iSite Enterprise Server.
In the bottom right and left-hand corners of the timeline are the most recent and least recent exam date. Detailed information regarding any of the exams displayed can be seen by momentarily holding your mouse cursor over the exam in question, as seen below. A pop-up window, will display the accession number, date and time, referring physician, procedure description and status of the exam.
Of the exams listed in the timeline, iSite Enterprise identifies exams that have been loaded into your Exam Racks with a gray background, as seen in the left and right exams shown below.
Exams that are present in your institution's archive but which are not loaded on the iSite Enterprise Server are displayed with an "A" as seen below.
To access these exams, double-click the listing in the timeline. iSite Enterprise will automatically query the available archives to retrieve the exam in question. An empty exam-row will load in the Canvas Page, as seen below, while the exam is being retrieved.
The upper portion of the Exam Information Area displays the modality, accession number, Referring Physician and Status. The bottom portion shows an estimate of how much time remains before the exam is retrieved and a display of which images are being requested. To cancel the archive retrieval, click the "Cancel" button.
Patient History Timeline Pop-up Menu
There are four functions available by right-clicking an exam listing in the Patient History Timeline, as seen below.
Load/Close Exam: Exams that aren't loaded into your Exam Racks can be loaded by right-clicking an exam and selecting "Load Exam" from the pop-up menu. The reverse is also true; exams that are currently loaded in the Exam Racks can be unloaded by right-clicking the exam icon on the Navigational Timelines and selecting the "Close Exam" option from the pop-up menu.
Show Report: The second function that can be accessed by right-clicking the exams in the Navigational Timelines is showing diagnostic reports. To view an exam's diagnostic report, right-click the exam and select the "Show Report" option from the pop-up menu. The appropriate diagnostic report will be presented in a separate, floating window. An example of a diagnostic report is shown below. Please note that if a report isn't yet present, the "Show Report" option will not be available.
The type of information provided in the report will vary from institution to institution. However, certain information, such as the the patient's name and ID number, will always be displayed when available.
Navigate through the report using the scroll bar at right. There are several sections of information including the Report, Findings, Impression, participating radiologists' contact information, Diagnosis, History, Comments and the contact information of the Requesting and Attending Physicians.
If related exams are present on the iSite Enterprise server, these will be listed below, as seen above. This list of exams is interactive. The list can be sorted by clicking a column head. An exam's report can be viewed by double-clicking that exam entry.
If you wish to view a list of all exams belonging to the patient in question click the "all exams" button. To toggle back to a list of only related exams, click the "related exams" button.
When you have finished reviewing the report, close the window by clicking the close button at upper-right.
Note that diagnostic reports can also be viewed by clicking the report button, located in the upper left-hand corner of every exam row. Please see the Viewing Diagnostic Reports section of this manual for more information on diagnostic reports.
Send Via DICOM: The third function available from the right-click menu is Send via DICOM. This function is for use in sending exams or images to a DICOM device such as a 3-D imager or a CD-ROM burner. External DICOM devices must be specified and connected by your iSite System Administrator. If no devices are connected, this option will be grayed out, as seen above.
When the option is available, iSite Enterprise will display a list of associated exams which are available for export, as seen below.
Select the exams that you wish to export and then click the "Next>" button. The following screen will appear.
Select the DICOM device or devices to which you want the exam(s) sent and then click the "Next>" button. The following window will appear.
Revise the exam and destination information in the dialog to confirm that they are correct. When you are sure enter in additional optional information if desired. You can notify any number of people via email by typing in the addresses in the email section of the Notification box. You can also add a description or denote the exam as "High Priority." If you would like to check the queue to see how busy it is, click the "Queue" button. If you are finished, click the "Finish" button. You will be returned to the exam racks.
You can return to any part of the Send Via DICOM process at any time by clicking the "< Back" button. You can cancel out of the Send Via DICOM process at any time by clicking the "Cancel" button.
Add Exam to Folder: This feature allows you to add a patient exam to a folder from the Patient History Timeline. When you select the option, the following dialog will appear.
Navigate to the desired folder where you wish to place the new exam, as seen below.
Highlight the desired folder and click the "OK" button. Add the exam to the CD Manager folder if you wish to add it to a Direct Media project. The exam will be visible in the folder you have selected the next time you open it.
If you wish to change the height of images and series in a particular
exam, place the cursor on the border separating the exam-row you wish to change from the
exam-row below it. The normal pointer will automatically change to a
resize pointer ( 
). Click and drag the pointer to change the height of the
exam row. When you resize the height of the exam row to half or double it’s original size,
iSite Enterprise automatically changes the size of the images and
series in that row.
Exams are displayed in chronological
order, in descending order from most recent at the top to least recent at the
bottom. If you have configured the canvas page to display exams vertically, the
most recent will be displayed on the left.
You may reposition the horizontal position of images and series within a given exam-row by dragging and dropping them. Click the header of the image or series you wish to move and drag it to the desired location.
Annotation of Series and Images
The margins above and below each image contain information about that image or
image-series. The contents of the information will vary according to the information that is normally distributed by your image archive or DICOM devices.
The information displayed will often include Window Width/Window Level
indications, the date and time the image was captured and body part information.
If you are viewing a series, in addition to the normally displayed data,
information about the total number of slices in the series and the current slice
will be shown.
There are several ways to close an exam. First, you can right-click the exam listing in the iSite Enterprise Patient History Timeline and select the "Close Exam" option. You can also select the "Close Exam" option from the Extended Exam Rack options pop-up menu, seen below. Finally, if you return to the Patient List and deselect that exam listing, the exam will be closed when you return to the diagnostic racks.
To close all of a patient's exams, click the circular button on the right side of the Patient-Name Tab. If no more patients are being displayed, clicking this button will return you to the Patient List.
Returning to the
iSite Folders
You can return to the iSite Folders
without closing the
exams you are viewing by clicking the Folder List Tab at the upper left-hand corner of the
iSite Enterprise Control Strip.
The exam margin contains the diagnostic report button, located at the top. In addition, several notification icons may appear in this portion of the Canvas Page during the course of your iSite Enterprise session.
The diagnostic report button ( 
) is
locate at the top of the margin. From top to bottom, the icons are the Warning
Icon ( 
), the New Images Arrived ( 
, image added to exam in the last 30 seconds), and Remote Study ( 
). Please note that these icons will only appear if necessary. In other words,
you may never see them.
Several additional functions and options, including presentation states and rack layout, are available by right-clicking the left border of the exam rows, as seen below. To access these option, right-click the margin area directly below the Report button. (Please note, when the Exam Racks are in Vertical Rack mode, you must click the top margin to view the pop-up menu.)
Presentation States: A presentation state is a preserved configuration of a certain exam. This configuration may include annotations and measurements or it may just be laid out in a certain way. For example, if you open an exam, cine to particular slices in a series and adjust the Window Width and Level values, then save the presentation state, this configuration of the exam will be preserved.
The presentation states option allows you create a presentation state or to load a pre-configured presentation state that has been created by a radiologist or technologist at your institution. From the menu, click the "Presentation States" option, as seen below.
To create a presentation state, make the necessary adjustments to the exam, right-click the exam margin and select the "Save Presentation State" option from the "Presentation States" option in the pop-up menu. The following window will appear:
Enter a name for the presentation state and then choose a type for the Presentation State. Examples of the different types are given below:
Technologist: If you are a technologist and you are configuring the exam to be read by a radiologist, click this type.
Pre-read: This type is for radiologists who are performing a preliminary review of an exam via iSite Enterprise, possibly doing measurements remotely from home. In this way, when the radiologist creates the final diagnostic report, the exam will contain the preliminary measurements.
User: This type is for users creating presentation states after the exam has been read and a "Marked Read" presentation state is already present.
When you are done, click the "OK" button to save the presentation state or "Cancel" to exit without saving. The presentation state will now be visible along with the previously available presentation states. The listing will include the presentation state's name, your user name and the date and time that you created the presentation state.
The initially displayed presentation state of an exam depends on which presentation states are available. There are five types of Presentation State in iSite Enterprise: 'Original DICOM', technologist, intern, radiologist and user. These types are weighted. For example, if no presentation states have been created, the initial presentation state is the "'Original DICOM'" state. If a technologist has created a presentation state, that will be presented initially instead of the Original DICOM. If a radiologist has created a presentation state, that will be presented initially instead of the technologist's presentation state.
iSite Enterprise will specify when the original DICOM was generated. If other presentation states have been created by technologists or radiologists, they will be displayed with the 'Original DICOM' listing. The types of available presentation states will vary from site to site. For more information on which types of presentation states are available at your institution, please contact your iSite System Administrator. To select a different state, select that option from the menu.
Please note that if additional images have been added to the exam since the default presentation was last saved, the Original DICOM will be presented. In this instance, the following message will be displayed.
Close Exam: To close the exam, select the "Close Exam" option.
Minimize Images: If you wish to minimize all the images in that exam row, select the "Minimize Images" option. Please note that once this option has been selected, if you wish to re-enlarge the images, you must do it by hand.
Horizontal/Vertical Rack Configurations: The Horizontal Rack and Vertical Rack options allow you to quickly reconfigure the Exam Rack orientation. A vertical rack configuration can be seen below.
Hide/Show Scout Toggle (CTs Only): The Hide/Show Scout option allows you to show or remove all scout images associated with a CT exam.
Add Exam to Folder: This feature allows you to add a patient exam to a folder from the Patient History Timeline. When you select the option, the following dialog will appear.
Navigate to the desired folder where you wish to place the new exam, as seen below.
Highlight the desired folder and click the "OK" button. Add the exam to the CD Manager folder if you wish to add it to a Direct Media project. The exam will be visible in the folder you have selected the next time you open it.
Exam Information: Finally, the Exam Information option allows you to view extended information (DICOM metadata) about the exam in question, as seen below.
When you have finished looking over the information, click the "OK" button.
