OsiriX Quick Manual

Version 0.3

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 TABLE OF CONTENT

HOW TO IMPORT DICOM IMAGES IN OSIRIX? 3

HOW TO CUSTOMIZE YOUR WINDOWS? 4

HOW TO SIMULTANEOUSLY OPEN MULTIPLE SERIES? 5

HOW TO SIMULTANEOUSLY VIEW MULTIPLE SERIES? 6

HOW TO MANAGE YOUR LOCAL DATABASE? 7

HOW TO MAKE IMAGE FUSION? 9

HOW TO OPEN NON-DICOM IMAGES OR MOVIES? 11

HOW TO EXPORT DICOM IMAGES? 12

HOW TO USE THE 4D VIEWER? 14

HOW TO USE MULTI-PLANAR RECONSTRUCTION (MPR)? 15

HOW TO USE THE 3D RECONSTRUCTIONS? 17

HOW TO USE OSIRIX AS A PACS WORKSTATION? 20

HOW TO MAKE USE 2D THICK SLABS? 21

HOW TO NAVIGATE QUICKLY? 22

HOW TO MAKE OSIRIX RUN FASTER? 24

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 How to?
How to import DICOM images in OsiriX?

There are two ways to import DICOM images in OsiriX:

1) Through a network: If you are working in a PACS environment, this is

the easiest way to import DICOM images in OsiriX. OsiriX is a
DICOM Listener. This means it can passively receive DICOM
images. Images must be sent from a PACS workstation to a Mac
computer running OsiriX. OsiriX and the PACS workstation must be
first configured: Assign an AETitle and a Port number to OsiriX in the
Preferences window. Then contact your friendly PACS manager
to configure the PACS.

The DICOM Listener works only if OsiriX is active!

Preferences window to configure the DICOM Listener

2) By files: if you have DICOM files on your hard drive, or have a

DICOM CD-Rom, you simply need to click on the Import button of
the Local database window. You then select either files or folders
containing files. Multiple files and/or folders can be selected by
clicking while holding the shift key. You can also drag-and-drop
files directly from the desktop in the Local Database window.

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How to customize your windows?

OsiriX has many functions and it is sometimes useful to modify the Graphic
User Interface (GUI) for your personal needs. All windows in OsiriX are
customizable. You can modify the tools displayed in the toolbar. Select
Customize Toolbar from the 2D Viewer or 3D Viewer menus. You can
also directly click in the toolbar by holding the ctrl key. The Customize
window will appear. Then simply drag-and-drop any tools from this
window to the toolbar.

The Customize window is displayed. Simply drag-and-drop tools to

modify your toolbar.

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How to simultaneously open multiple series?

Open a patient file and select multiple series thumbnails by maintaining

the select key for a continuous selection or apple key for a non-
continuous selection. Click then on the 2D Viewer icon from the toolbar
to open all selected series.

The Local Database window

You can open a new series at any time. Simply go to the file menu and
select Local Database to open the database window.

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How to simultaneously view multiple series?

Select the Tile Windows from the 2D Viewer menu. This function will
arrange all opened windows and you will be able to see all opened series
at the same time.

4 series opened simultaneously. Note that if all series are from the same
study, you will able to see where the slice in the series you are navigated
in is located on the other series.

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How to manage your local database?

Two things are important to understand about your local database:

1) If you receive your images with the DICOM listener, they are stored
in the DATABASE folder in the OsiriX Data folder, located your
Documents folder. OsiriX will manage these files. This means that if
you delete them from the Local Database window, Osirix will
definitively delete these files.
2) If you import your files with the Import button or menu item, OsiriX
can either keep a link to these files or copy them in the DATABASE
folder. This means that if you delete them from the Local
Database window, OsiriX will either delete the links to files or delete
files located in the DATABASE folder.

OsiriX keeps information of all images in the DATA.DAT file. This file is
located in the OsiriX Data folder.

This file can be deleted. It does not contain any important data, only links
to DICOM files.

You can also rebuild the database at any time. It will delete the
DATA.DAT file and reconstruct a new one. Simply select Rebuild
Database from the File menu. This function will re-scan all files displayed
in the Local Database window, remove all unavailable files and add all
files available in the DATABASE folder (received from the PACS network).

You can modify the database management in the Preferences window.

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 The Preferences window.

The OsiriX Data folder:

DATABASE folder contains local DICOM files.

INCOMING folder contains temporarily files that are received
by the listener.
TEMP folder contains files during conversion time. This folder is
deleted when you exit OsiriX.
ROIs folder stores ROIs of DICOM images.

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How to make image fusion?

OsiriX supports image fusion. You can mix any series with another serie:
simply open the two series you want to mix and then drag-and-drop the
window icon from one on the other:

The window icon is located at the left of the window name.

Image fusion between a CT and PET series.

You can control the fusion intensity with the Fusion Percentage slider
from the toolbar. Note that if you close one of the two series, the fusion will
be stopped. If you make a modification on the first series (CLUT, zoom,
rotation, ), these modifications will be applied to the second one.

Image fusion is also available for 2D and 3D reconstructions implying that

you can use image fusion along with MPR, Volume rendering, etc...

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Image fusion in the 3D MPR window

Image fusion in the 3D MIP window

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How to open non-DICOM images or movies?

OsiriX supports non-DICOM images and movies. It means you can handle
any images or image sequences in OsiriX as if they were DICOM images.
You can re-export them as TIFF or Quicktime formats to modify the zoom,
rotation, CLUT,

The Quicktime movie opened in OsiriX

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How to export DICOM images?

With OsiriX you can export your DICOM images in a TIFF image or a
Quicktime sequence. It allows you to show your images during
presentation with PowerPoint or Keynote software or import them in
Microsoft Word, by example.

To export a single image, you can either press apple-copy to copy it in the
clipboard or select Export to TIFF from the 2D viewer menu. OsiriX will
export the image as it appears on the screen at the same size, zoom,
rotation, window level, etc. You can find the exact size of the image on
the upper left corner of the window:

The exported image resolution will be

1266 x 709

The same principle applies for images sequence. Select Export to

Quicktime or click on the Quicktime button from the toolbar. With
Quicktime export, you have the possibility to export the image fusion
dimension of the 4D viewer dimension, if these modes are activated:

Select which dimension you want to export

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You can also change the compression mode and playing rate. We
recommend the JPEG compression for best quality.

Modify compression mode and playing rate (frames per second)

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How to use the 4D viewer?

OsiriX supports a 4D viewer. You can load multiple series of a study that is
acquired dynamically. For example, multiphase reconstructed series from
a cardiac CT can be loaded for a CINE mode review. Simply select all
series in the Local Database window and then click 4D viewer. All
series will be loaded into the same window. You can navigate and review
in a dynamic fashion by using the 4D player function from the toolbar.

Select multiple series and then click on the 4D viewer icon.

The 4D player function from the toolbar

The 4D player function is also available in MPR reconstructions windows.

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How to use Multi-Planar Reconstruction (MPR)?

OsiriX supports two different MPR modes: a classic 2D MPR and a 3D

orthogonal MPR viewer.

a) Classic 2D MPR

A
C
B
The 2D MPR window

This 2D MPR Viewer allows generating a MPR slice in any position of the 3D
volume: locate your point of interest in the A view. Move the center of the
lines by clicking/dragging the red square. Then change your slice rotation
by clicking in the blue or red line (X and Y rotation). The blue line
corresponds to the final image slice (C view) and the red line corresponds
to the perpendicular view (B view) of A view. The B view allows you to
modify the Z angle of the final slice (C view).

(This MPR mode is a quite computational intensive task. It cannot pre-

process images and all images are displayed with cubic interpolation.)

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b) 3D orthogonal MPR

3D orthogonal MPR mode

This mode allows you to display a 3D representation of the volume with 3D

orthogonal MPR slices. You can change orthogonal slices positions by
using 3 sliders located in the toolbar:

Positions of orthogonal slices

Hide or show slices by clicking in the check boxes.

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How to use the 3D Reconstructions?

OsiriX supports three 3D reconstructions modules:

1) Maximum Intensity Projection (MIP)

3D MIP Reconstruction

This reconstruction uses a ray-tracing technique to identify which pixel

has the maximum intensity on each ray. This technique is useful for
contrast MRIs or CTs, and bone CTs.

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2) Volume Rendering

3D Volume Rendering

This reconstruction uses a ray-tracing technique to apply a

transparency/opacity to each pixels depending on their position and their
intensity. This technique produces nice images of soft tissues for MRI and
CT. It is actually the most used 3D technique and will produce the nicest
images in many situations.

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3) Surface Rendering

3D Surface Rendering

This reconstruction produces surfaces that are based on an iso-contour

defined by the user. This technique is useful for virtual endoscopy and
bone CTs. The user can define two different surfaces to render.

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How to use OsiriX as a PACS workstation?

Yes, you can use OsiriX as a PACS workstation! You dont have to to buy a
multi-thousands $$ PACS workstation licenses! Save your bucks and buy
Macintosh computers instead!

You only have to configure your modalities to automatically send exams

to your OsiriX computer: configure the AETitle and Port number in OsiriX
(see How to import DICOM images in OsiriX?).

Your next PACS workstation...

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How to make use 2D thick slabs?

OsiriX supports a 2D thick slab mode in the 2D viewer. This mode is

particularly interesting if you are working with multi-slice CT. It will allow you
to navigate more efficiently through huge series.

Thick slab mode is controlled in the tool bar:

Thick Slab controller

There are actually 3 modes:

Mean: all slices are added and the mean is computed.
Maximum Intensity: maximum intensities of all pixels are extracted
and displayed.
Minimum Intensity: minimum intensities of all pixels are extracted
and displayed.

You control the number of slices with the slider. You can view thick slabs
information in the window lower left corner:

Images 1 to 9 are displayed,

and the total thickness is 27 mm.

For more information about thick slab, read the following articles:

Gruden JF, Ouanounou S, Tigges S, Norris SD, Klausner TS. Incremental benefit of maximum-
intensity-projection images on observer detection of small pulmonary nodules revealed by
multidetector CT. AJR Am J Roentgenol. 2002 Jul;179(1):149-57.

Coakley FV, Cohen MD, Johnson MS, Gonin R, Hanna MP. Maximum intensity projection images in
the detection of simulated pulmonary nodules by spiral CT. Br J Radiol. 1998 Feb;71(842):135-
40.

Remy-Jardin M, Remy J, Giraud F, Marquette C-H. Pulmonary nodules: detection with thick-section
spiral CT versus conventional CT. Radiology 1993;187:513520.

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How to navigate quickly?

To quickly and efficiently interpret images you have to use different

functions: window level adjustment, translation, zoom, rotation, serie
browse, measurements, regions of interest,...

These small icons in the toolbar represent these basic functions:

Basic functions

You can simply click on them. To save time, you can also do one the
following:

a) Mouse + keys
You can change your current mouse functions by using following
combinations:
Option + Click = Window level adjustment
Apple + Click = Translation
Ctrl + Click = Zoom
Apple + Option + Click = Rotation

b) 3 buttons mouse + wheel

We highly recommend to use OsiriX with a multi-buttons and wheel
mouse. You will be able to navigate more efficiently than by using a
simple unique button mouse.
Left button = currently selected function
Right button = zoom
Wheel = navigate in the serie

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c) Jog-wheel
OsiriX is compatible with these new jog-wheel devices from Contour
Design (http://www.contourdesign.com/). OsiriX is able to fully
exploit these devices to quickly navigate in 5 dimensions.

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How to make OsiriX run faster?

There are two limitations to OsiriX: memory and processor power.

1) Memory: OsiriX requires a lot of memory if you try to open large

series of images! If OsiriX does not have enough memory, MacOS X
will try to free memory by using the Virtual Memory (VM) mode: it
will use your hard drive as RAM But VM is about 1000 times slower
than RAM!! You see the problem Here is how to compute memory
the amount you need: do the following simple calculation for the
number of images you want to view and handle at the same time:

- Height X Width X Number of images x 4 / 1048576

For example: 512 x 512 x 100 x 4 / 1048576 = 100 MB of RAM for 100
CT images

This means that you need at least 100 MB of RAM ONLY for your 100
CT images. MacOS X requires a minimum of 256 MB to work
normally. You will need at least 256 + 100 MB = 356 MB to avoid
Virtual Memory mode.

2) Processor power: OsiriX needs high processing power for 3D

reconstruction: MIP and Volume Rendering. OsiriX is a multi-
threaded application that can use all processors available in your
computer. If you want the best performance you should buy a dual-
G5 computer!

Another solution is to use a computer cluster with the Apple X-Grid /

MPI technology. The software package is available at
http://www.apple.com/acg/xgrid/. Run and install the package.
You then need to install the OsiriX plugin: copy it in the Plug-ins
folder of Xgrid folder located in your Library folder. More
information about this technology in future releases.

Another solution would be to use a VolumePRO PCI graphic board

from TeraRecon (http://www.terarecon.com/). This solution is
currently under investigation to make OsiriX run faster than a Vitrea
3D workstation! All 3D reconstructions in OsiriX are based on VTK and
VTK fully supports the VolumePRO graphic board

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