Synapse Mobility V. 7.1.3 User Guide

Synapse® Mobility 7.1.
3 User Guide
2020/03/10
Synapse Mobility V. 7.1.3 User Guide

for iOS
Confidential and Proprietary Information
FUJIFILM Medical Systems U.S.A., Inc.
Confidential and Proprietary 1

Synapse® Mobility 7.1.3 User Guide
Table of Contents
Table of Contents 2
Synapse® Mobility User Guide 6
Software User Profile 6
About this Release 7
About this User Guide 7
Fujifilm Disclaimer Statement 8
Revisions 10
Indications for Use and Regulatory Status 11
Indications for Use 11
Regulatory Status 11
Manufacturer, Distributor, and EU Importer 11
Important Safety and Security Considerations 13
Warnings 13
Precautions 13
Data Limitations 14
Patient Privacy 15
Risk of Potential Errors 15
Your Reading Environment 16
Training & User Familiarization 18
Privacy notice 18
Getting Started 20

Prerequisites 20
Installing the App 20
Exploring the Interface 20
Ending a Viewing Session 21
Getting Help 22
Supported Mobile Devices and Operating Systems 22
Configuring the Server 22
Server Settings 24
Configuring the App 24
Application Settings 24
Expected Performance 25
About the Search Interface 27
Performing Searches 27
Configuring Modalities 28
Selecting Archives 28
Browsing Search Results 29
Drilling Down the Results of a Search 29
Previewing Studies 30
Loading Data 32
Selecting recently loaded studies 33
Returning to the Search Interface 33
Using the Study Tray 33

About the Viewer 34
View Modes 34
Data Information 34
GSPS and CSPS 34
Unsupported Data 35
Source Image Compression 35
Key Image Series 35
Overview of the Viewer's Features 35
The Menu 35
Navigating Images 36
Configuring Metadata Display 36
Displaying Related Studies 37
Working with Measurements 37
Measurement Mode 38
Measurement Tools 38
Making Measurements 39
Measurement Calipers 40
Manipulating Measurements 41
Applying Presets 42
Adjusting Image Quality 43
Using Dictation 44
Sharing Studies 45

About 2D View Mode 45
Scrolling Through Images 46
Scrolling Manually 46
Using Cine 46
Changing Layouts 47
Linked Scrolling 48
About the 3D View 49
Magnifying Part of a Volume 49
Applying Presets 50
About MIP/MPR View Mode 51
Scrolling Through Images 52
About Collaboration 53
Hosting Sessions 53
Joining Sessions 54
Collaborating with Audio/Video 54

Synapse® Mobility User Guide

The Synapse Mobility software is a medical image viewer that enables professionals — such as
radiologists, physicians and other imaging experts — to view and analyze medical images and reports
from anywhere using a remote connection, either over the internet or using the hospital's network.
The software features an easy-to-use search interface, collaboration, and advanced visualization
functionality such as:
l 2D viewing
l Maximum Intensity Projection (MIP) including slabbing up to 50 mm
l Multi Planar Reformatting (MPR) for axial, sagittal and coronal views
l 3D volume rendering
Each view mode enables various interactions with images, data and reports, including split view,
linked scrolling, cine, pan and zoom, measurements, and more.
The solution has a client/server architecture. The centralized server hosts the main service
application, which is responsible for all data processing and image rendering. The service application
acquires images from a connected PACS or medical image archive, and loads these images into
memory.
You interact with the server-based application using a native iOS app that runs on your Apple mobile
device.
This guide describes the functionality of this client in detail, and outlines some considerations when
first getting started.
Software User Profile

There are two profiles for intended users of the Synapse Mobility software:
1. Referring physicians who refer their patients to the institution or organization controlling the
Synapse Mobility software for imaging studies. Referring physicians who wish to review images,
in addition to reviewing the radiologists' final report of findings, to enable them to confirm their
treatment plans and communicate with the patient.
2. Diagnostic imaging specialists at the institution or organization controlling the Synapse Mobility
software. The solution can be used for diagnostic reading of images.

About this Release

Product: Synapse® Mobility
Client Interface: native iOS app
Version: 7.1.3
Date of Last Document Update: 2020/03/10
Based on the server settings chosen, this configuration of the product is applicable for all regions, but
for demonstration and evaluation purposes only.
See the Indications for Use and Regulatory Status section for more information.
About this User Guide

This guide is distributed with the Synapse Mobility software in electronic form. You may request a
paper copy by contacting your system administrator.
Screenshots are for visual reference only.

Fujifilm Disclaimer Statement

No part of this document may be reproduced without prior written permission.
The information provided within this document is proprietary. Without prior written permission from
FUJIFILM Medical Systems U.S.A., Inc., the duplication or reproducing this document in whole or in
part is strictly prohibited. Without prior written permission from FUJIFILM Medical Systems U.S.A.,
Inc., disclosing the contents of this document, in whole or in part, to persons other than authorized
personnel, is strictly prohibited. Without prior written permission from FUJIFILM Medical Systems
U.S.A., Inc., the lending or transferring of this document, in whole or in part, to a third party is strictly
prohibited.
The information contained in this document may be subject to change without prior notice.
FUJIFILM Medical Systems U.S.A., Inc. shall not be liable for malfunctions and damages resulting
from improper installation, relocation, remodeling, maintenance, and repair performed by FUJIFILM
Medical Systems U.S.A., Inc. and all other FUJIFILM subsidiaries or distributors.
FUJIFILM Medical Systems U.S.A., Inc. shall not be liable for malfunctions and damages of
FUJIFILM Medical Systems U.S.A., Inc. products due to products of other manufacturers not
supplied by FUJIFILM Medical Systems U.S.A., Inc.
from remodeling, maintenance, and repair using repair parts other than those specified by FUJIFILM
Medical Systems U.S.A., Inc.
from negligence.
from natural disasters.
FUJIFILM Medical Systems U.S.A., Inc. may have patents or pending patent applications,
trademarks, copyrights, or other intellectual property rights covering various subject matters contained
in this document. The furnishing of this document does not extended any rights to said patents,
trademarks, copyrights, or other intellectual property rights, except as expressly set forth in any
written license agreement from FUJIFILM Medical Systems U.S.A., Inc.

Certain images/diagrams contained in this document may not appear clearly on high-resolution
monitors.
Synapse is a registered trademark of FUJIFILM Medical Systems U.S.A., Inc.
Synapse® Mobility is a computer program, which is protected by copyright law and international
treaties. Unauthorized reproduction or distribution of this program or any portion of this program, is
strictly prohibited. Copyright © 2006-2020 by FUJIFILM Medical Systems U.S.A., Inc.'s
SYNAPSE® Mobility software licensor. All rights reserved.
All brand, product and company names are trademarks or registered trademarks of their respective
companies or organizations.

Revisions
Rev A, 2020/03/10 Initial release of 7.1.3 user guide

Indications for Use and Regulatory Status

Product: Synapse® Mobility
Version: 7.1.3
Year of Software Release: 2020
Indications for Use

The Synapse® Mobility solution is an enterprise medical image viewer used with off-the-shelf servers,
web browsers, and specific mobile devices for the 2D display, multi-planar reformatting and 3D
visualization of medical image data and reports. It provides collaboration and integrated secure audio-
video communication, and displays DICOM and non-DICOM medical images and reports.
The software is intended for use as a diagnostic, review, and analysis tool by trained healthcare
professionals to drive clinical management. When interpreted by a trained physician, reviewed images
may be used to aid in diagnosis. When used on a mobile device, Synapse Mobility is not intended to
replace full radiology workstations.
This product is not to be used for primary mammography diagnoses.
Regulatory Status
The server is configured in demonstration mode or with an invalid combination of regulatory/language
settings and should be used for demonstration or evaluation purposes only.
Manufacturer, Distributor, and EU Importer
Manufacturer
Manufactured by:
Calgary Scientific Inc.
Suite 200, 119 6th Avenue SW
Calgary, Alberta, Canada T2P 0P8

+1.403.270.7159
www.pureweb.com
Distributed by:
FUJIFILM Medical Systems U.S.A., Inc.
81 Hartwell Avenue, Suite 300
Lexington, MA 02421
(800) 431-1850
www.fujifilmusa.com
EU Importer:
FUJIFILM Europe B.V.
Oudenstaart 1
TK 5047 Tilburg
The Netherlands
www.fujifilm.eu

Important Safety and Security

Considerations
This section provide important information about the software's intended use, capabilities and
limitations, as well as instructions to help you set up your device and your reading environment for
optimal results.
Because the Synapse® Mobility software is a medical device, it is imperative that you fully
understand this information before you begin using the product.
Warnings
The Synapse Mobility software should only be used by qualified professionals to review the pathology
relevant to the diagnosis. It must be used only in the context of the approved Indications for Use.
The software is not intended to replace the skill and judgment of a qualified medical practitioner and
should only be used by people who have been appropriately trained in the software’s functions,
capabilities and limitations.
When used on a mobile device, the software is not intended to replace full workstations and should be
used only when there is no access to a workstation. In addition, the software is intended to be used
with specific validated mobile devices (see Supported Mobile Devices and Operating Systems).
This product is not to be used for primary mammography diagnoses.
Precautions
To ensure the best use of the Synapse Mobility software and its features, you should always take the
following precautions into consideration.
Software features
You should ensure that the software features available on the device are appropriate prior to actual
use.

Lighting
The software should not be used in outdoor lighting or other high ambient light conditions. You should
familiarize yourself with the viewing characteristics of the device under various lighting conditions
prior to actual use.
For more information on optimal viewing conditions, see Your Reading Environment.
Screen size and resolution
You should ensure that the screen size and resolution of the device are appropriate prior to actual use.
Brightness settings
You should be aware that other applications can change the screen brightness setting and ensure the
recommended settings are in place prior to each use: the automatic brightness feature should be
turned off, and the brightness of the screen display set to maximum.
Battery life
You should be aware of expected battery life of the device under usage conditions relative to the
anticipated duration of usage of the Synapse Mobility application and ensure that the device is
adequately charged.
You should review information in this user guide prior to using the product in order to understand the
features, capabilities and limitations of the solution. If you have any questions on how to connect to
the solution or requirements for additional training, you should contact your system administrator.
Data Limitations
You should be aware of the limitations in the accuracy and correctness of the output data displayed on
the screen, printed, or exported from the Synapse Mobility software. The quality of the data is
dependent on the correctness of the input data, your interaction with the data, the quality,
characteristics, and settings of the display device or printer, the amount of ambient light in the vicinity
and the necessity to interpolate the data for display purposes.
Medical images are susceptible to magnification errors caused by differing patient sizes and projection
distances. If not corrected by the modality, these errors can affect the accuracy of the calibration

information contained in the image’s DICOM header. Measurement values in the Synapse Mobility
software are dependent on the calibration information provided by the modality in the DICOM header.
Accuracy also depends on the pixel spacing and slice interval values that are provided in the DICOM
header for the data set. Because of this, the software's measurements should be used for reference
only until the accuracy of the DICOM header information can be verified or the image information has
been calibrated through the use of a measurement instrument in the image.
When interacting with the worklist, you should be aware that while you are viewing any images and
reports, any real-time updates on image information or availability will not automatically be seen in
your current viewing session. These updates can only be viewed if you perform a new search and re-
access the updated study.
Patient Privacy
The Synapse Mobility software accesses images together with patient information. It is important to
protect this data from access by unauthorized persons.
To protect private patient information when accessing the software remotely, you should ensure that
transmissions are secure. This can be facilitated using a VPN connection to a hospital or healthcare
institute’s network. See the Privacy notice.
Risk of Potential Errors

While the Synapse Mobility software has been tested extensively, it is impossible to completely test
any piece of software, and errors may remain. It is possible that an error could manifest as an incorrect
measurement or image. You must be aware of the potential for errors.
Certain views make use of interpolated data. This is data that is created by the software based on the
original data set. Interpolated data may give the appearance of healthy tissue in situations where
pathology that is near or smaller than the scanning resolution may be present.

Your Reading Environment

It is essential that your reading environment be optimal for using the Synapse Mobility software. This
includes considerations such as screen brightness settings, viewing angles, and lighting conditions,
as described below.
Your Device's Screen
To ensure optimal viewing conditions, you must set the display brightness to the maximum value and
disable any automatic brightness features on the viewing device. Be aware that other applications can
change the screen brightness setting and you must ensure the recommended settings are in place
prior to each use.
View the screen straight on (perpendicularly) because image accuracy degrades with viewing angle.
Your device’s screen should be clean and free of dirt, smudges and fingerprints prior to viewing
medical images.
Lighting Conditions
You should familiarize yourself with the viewing characteristics of the device under various lighting
conditions prior to actual use.
The software should not be used in outdoor lighting or high ambient light conditions.
Position yourself and the device so that there are no visible reflections of objects or light sources on
the screen. To avoid specular reflections, take special care to move to a location without bright light
sources such as windows, light boxes, bright walls, and overhead lighting. Examine the display in
your device’s sleep or off mode for visible reflections and reorient yourself or the display until they are
not present.
The ambient lighting environment should be assessed such that illumination is equivalent to radiology
reading rooms.
Ambient Light Assessment
You should perform a light test as described below to ensure that ambient light conditions are
appropriate for use.

Validated mobile devices have been tested for diagnostic use at light levels up to 300 lux which is the
maximum recommended light level.
There are two patterns for assessing ambient light: TG18-CT and TG18-MP. These patterns were
developed by the American Association of Physicists in Medicine (AAPM) Task Group 181 , whose
purpose is to generate a document that provides guidelines to practicing medical physicists and
engineers for in-field performance evaluation of electronic display devices intended for medical use.
TG18-CT
This pattern is intended to support visual inspection of the luminance

response of a display device. It should be evaluated for visibility of
the central half-moon targets and the four low-contrast objects at the
corners of each of the 16 different luminance regions.
TG18-MP
This pattern is intended to support visual inspection of the bit-depth

resolution of a display device. It should be evaluated to ascertain the
horizontal contouring bands, their relative locations, and grayscale
reversals.
To assess the suitability of environmental lighting, you should review these patterns and determine
whether your ability to discern the above information is comparable to ideal lighting conditions. If you
are not able to perform this task, find a more appropriate environment before proceeding.
To perform ambient light user assessment on iOS devices:
1. Set your device’s display to maximum brightness and disable auto-brightness.

2. Tap Help.
3. Tap Light Test .

4. Tap Perform Light Test.
1Reference: AAPM ON-LINE REPORT NO. 03: ASSESSMENT OF DISPLAY PERFORMANCE
FOR MEDICAL IMAGING SYSTEMS, American Association of Physicists in Medicine, 2005.

Training & User Familiarization

It is strongly recommended that user training be conducted by each institution implementing Synapse
Mobility. This training should include:
1. Institutional on-call process for reviews to be performed using the technology.

2. Log-in protocols and security for access to the Synapse Mobility server.
3. Operation of the software and practice on various uses cases including use of the product under
various lighting conditions.
4. Review of labeling including indications for use, warnings, precautions, and directions of use.
5. Criteria for activation of fall-back procedures should access to imaging data not be available or
fail during attempts to access it.
6. How to access user and product support through the institution.
7. Review of criteria and procedures for reporting adverse events.
Privacy notice
The Synapse® Mobility application is an enterprise viewing platform that provides secure remote
access from personal devices to diagnostic-quality medical images and other patient data.
Institutions that use this product grant authorization to some users to access patient data stored in the
institution’s repositories by logging into the Synapse Mobility application with their credentials.
Access rights are set up and controlled by the institution.
Patient information transmitted through the application is controlled and maintained by the institution.
FUJIFILM Medical Systems U.S.A., Inc. exercises no authority over the institution’s privacy and data
collection practices. Patient information is never stored in the Synapse Mobility client application.
Upon logging into the Synapse Mobility application with verified credentials, users are able to search
and view information contained in the institution’s repositories. To establish the connection between
the application and the repositories, the application may collect information about the users
(username, password, contact information), but none of this information is transmitted to, or used by,
FUJIFILM Medical Systems U.S.A., Inc..
For technical support purposes, the application may collect select usage information (device or
browser version, hardware settings, and event information such as errors and system activity).

FUJIFILM Medical Systems U.S.A., Inc. designs, builds and runs its systems to make sure that all
data about the authorized users and the patients is as secure as possible at any stage, both while it is
processed and when it is stored. The company is committed to keeping user and patient data secure
and has set up systems and processes to prevent unauthorized access or disclosure. If FUJIFILM
Medical Systems U.S.A., Inc. incorporates a third party product, the third party is also required to
make sure that all data it processes about the authorized users and the patients is as secure as
possible at any stage, both while it is processed and when it is stored.

Getting Started
This section will get you up and running with Synapse® Mobility in a few quick steps.
Prerequisites
Obtain the following information from your system administrator:
l Your login credentials to the Synapse Mobility server.

l The IP address/hostname and the port number of the Synapse Mobility server (you'll need to
enter this information in the settings when you configure the app).
l Whether SSL is being used (if it is, this will also need to be indicated in the app's settings).
To download the app, you'll need access to the internet, and an account with Apple's App Store.
To connect to the server over WiFi, you'll need to authenticate your mobile device on the WiFi
network.
Installing the App

The app should be installed on a validated device. See Supported Mobile Devices and Operating
Systems.
1. Download and install the Synapse Mobility app from the App store or from iTunes.
2. Configure the Synapse Mobility server as described in Configuring the Server.
3. Review the app's settings and adjust if needed. See Configuring the App.
Verifying the Installation
If you can launch the app, successfully connect to the Synapse Mobility server and interact with the
search interface, you're all set. Otherwise, contact your system administrator.
Exploring the Interface

Once your app is up and running, you can explore the solution's three main components.

Response time will vary depending on your data connection. If you'd like to know more, see
Expected Performance.
User Interface Feature Description
The search interface is the first view you will

see after you log in to the Synapse Mobility
The Search Interface solution. You use the search interface to
search for studies. See About the Search
Interface.
The viewer displays images and series from

the studies and provides access to tools for
The Viewer
interacting with the data in 2D, MIP/MPR and
3D view modes. See About the Viewer.
The collaboration features enable you to share

the current viewing session with other users,
The collaboration features
and provide audio/video conferencing. See
About Collaboration.
Ending a Viewing Session

Your viewing session will automatically close if you do not interact with the software for a period of
time (the default is 10 minutes), but you can also explicitly log out.
To log out
l Select Logout from the menu.

Getting Help
Information is available by selecting Help from the menu, which also includes this user guide,
Ambient Light User Assessment (“Light Test"), and the indications for use. To learn more about how to
perform a light test on your mobile device, see Your Reading Environment.
Maintaining the application is the responsibility of the site where it is deployed, such as a hospital or
other clinical environment. If you have any question or concern about the application, contact your
system administrator.
Supported Mobile Devices and Operating Systems

The Synapse® Mobility iOS client is accessed through an application that you must download and
install on your mobile device. See Getting Started.
The following mobile devices running iOS 12 or 13 are validated for use with Synapse Mobility:
l iPhone 5S*, iPhone 6*, iPhone 6 Plus*, iPhone 6S, iPhone 7, iPhone 7 Plus, iPhone 8, iPhone X

l iPad Air*, iPad Air 2, iPad Mini (2 generation)*, iPad Mini (3 generation)*, iPad Mini (4 generation),
iPad (5 generation), iPad (6 generation), iPad Pro (9.7"), iPad Pro (10.5"), iPad Pro (12.9"),
iPad Pro 2 generation (12.9")
*iOS 12 only.
Configuring the Server

On first load, the app will prompt you to add a server.
This is a necessary step to establish the connection with the Synapse® Mobility server.
To add a server, perform the following three tasks as described below:
1. Display the server list

2. Add a server
3. Edit the server's settings

To display the server list
1. Go to the app's settings on your device, and enable Prompt for Server.
2. Launch the app.
This should automatically display the server list. If not, from the search interface, select
Cancel.
From the server list, you can edit and add servers as well as set the default server.
To add a server
1. Display the server list.

2. Tap + .
3. Fill in the server information.
4. Tap Done.
To edit a server's settings

2. Tap Edit.
3. Tap the server you want to edit.
4. Edit the server information. See the Server Settings table below for a list of options that you can
configure from here.
5. Tap Done.
To set a default server

2. Tap Set Default Server.
3. Tap the server you wish to set as default.
To delete a server
1. Tap Edit.
2. Tap the - tool to the left of the server you wish to delete in the server list.
3. Tap Delete.

Server Settings
Setting Description
User-selected “friendly” name provided by your system

Server Name
administrator.
Address Server address and port number.
Secure Ask your system administrator if you will be using a secure

Connection connection.
Configuring the App

You can configure the app in iPhone Settings. The app appears in the list as Synapse Mobility.
Application Settings
Setting Description
Allow the app to access the microphone. Enable this

Microphone setting to use the dictation and audio/video
collaboration features.
Allow information from the app to appear in

Siri and Search
searches.
Version Version number for the app.
Prompt for Server Off by default. The app will access the default

Setting Description
server when this setting is off. Enable this setting to

be prompted for servers every time you launch the
app.
On by default. Populates the server list with demo

Show Demo Servers
servers. Turn off to use other servers.
Show Thumbnails Display thumbnail images in the worklist.
Your Nuance Dictation username (required to use

Username
dictation).
The settings in this section are intended for system

administrators. They can be used to enable the
Advanced Settings
display of the console log, and to view the server
version.
Expected Performance
Due to performance characteristics of remote and shared wireless data connections, you may
experience variable response times to searches and image interaction requests.
The Synapse® Mobility software does not require full DICOM images to be downloaded to your
mobile/desktop viewing device as studies/datasets are transferred between the PACS/VNA and the
Synapse Mobility server within the hospital network. The delivery of rendered images from the server
to devices over wireless networks will vary somewhat over different network types depending on
bandwidth availability (i.e. raw speed of the network, either Wi-Fi or 3G cellular, and network latency,
i.e. inherent delays on the network). In any case, we have observed that once communication is
established to the server, typical data sets are fully loaded on the server and available for initial
viewing on the mobile device in 8 to 15 seconds.

The following table characterizes the loading time in seconds for a “small” (38-slice, ~19MB) and
“medium” (426-slice, ~213MB) CT data sets under 3 network conditions: Wi-Fi, “Good” 3G and “Poor”
3G. 2 to 3 bars signal strength is considered “Poor” 3G connection. The loading times are calculated
by averaging the time taken by 3 consecutive loads of the data set.
Data Set Wi-Fi “Good” 3G “Poor” 3G
Small (38
8.3 9.7 13.5
slices)
Medium
(426 11.3 13.2 15.0
slices)
A progress bar is displayed across the screen as the data set is loading. If the connection is lost
during transmission, an error message is displayed.

About the Search Interface

The search interface is the first view you see upon logging in. You use it to search for studies.
Tap Search to display the search interface on iPad in portrait orientation.
Within the search interface, you can perform a search for studies using the search fields, by modality
and by date. You can choose from a list of additional modalities using the Modality Options Tool
and additional dates using the Calendar Tool . Once you have identified your search criteria, you
can execute the search by tapping Search.
Multi-PACS functionality queries multiple PACS systems and integrates the query results together
into a single unified worklist.
Performing Searches
The search interface supports the following search criteria:
l General criteria (always available): Patient Name, Patient ID, Accession Number, Modality, and
Date Range.
l Additional criteria (depend on server configuration): Referring Physician, Study Description,

and Date of Birth.
You can narrow your search to a modality. By default, the search interface displays three modalities,
but this is configurable. See Configuring Modalities.
You may also be able to choose which archives to search. See Selecting Archives.
To perform a search
1. Enter one or more search criteria.

2. Tap Search.
If the search returns a VIP patient dataset, you must be an authorized viewer to see the search
results. If you are not an authorized user, you will be redirected to an external VIP authorization
service to request access.

To narrow your search
After entering the patient name, but before clicking Search, you can narrow your search by date:
l Use the Date Within Last field enables you to restrict your search using preset date ranges.
The Date within last field shows all results from midnight of the last day (e.g. 1d shows all
results since midnight of the current day).
l Use the calendar tool to specify a custom date range. You will be prompted for a start date and
an end date.
To toggle thumbnails
1. At the Home screen, tap to open the Settings app.

2. Tap Synapse Mobility.
3. Tap to toggle thumbnail images ON or OFF.
To reset a search
l Tap the Reset tool .
Configuring Modalities
You can choose up to five different modalities to be visible in the search interface.
To choose modalities
1. In the Search Interface, tap the Modality Options tool .

2. Toggle selected modalities by tapping them.
3. Reorder the modalities (by dragging from the handles ) up and down the list.
4. Tap Close.
Selecting Archives
If you have access to multiple archives, you can choose which archives to search.
To select archives
1. Tap Archives .
2. Tap to toggle preferred archives in the archive list.
3. Tap Close.
The Archives field in the search interface indicates the number of active archives.

Browsing Search Results

Once you have completed a search, the application displays a list of results based on your search
criteria. If the application queried multiple PACS systems, it will integrate the query results together
into a single unified list.
You can browse and sort the results list, preview the content of individual studies, and load series
directly into the viewer.
Once you have loaded studies, you can use the study tray to quickly view the series for the currently
open study and to access previously loaded studies. See Using the Study Tray.
Drilling Down the Results of a Search

The search results will be organized by study.
Each entry in the search results will display a summary of the study's information (patient name, ID,
sex and date of birth, and study acquisition date) to help you determine at a glance if this is the study
that you are interested in.
To sort results
l Tap the column heading that you wish to use as the sort criteria.
Clicking the same search criteria again reverses the sorting order of the search results.

Previewing Studies
Expanding a study will help you find exactly what you want to view, and gain a good idea of what a
study contains before loading any actual images from the server.
If the system administrator has enabled auto-loading, you will not be able to expand a study from the
search results list, since selecting a study will automatically load its first series in the image viewer.
However, you will still be able to view the content of the study after it has been loaded. See Using
the Study Tray.
When you expand a study, you will see the individual series, reports, and other patient documents that
it contains.
To expand a study
l Tap the desired study in the search results.
The table below summarizes the types of content that can be included in studies.
Type of Content Description
Series are how the DICOM model organizes images,

Series
based on modality and timestamp. A series can

contain one or more images.
For modalities that contain multi-frame datasets, such

as US, XA and NM, the system administrator may
choose to configure the server so that all single-frame
images are grouped into a single series. This makes
the study list less overwhelming and easier to
navigate. The series that contains the grouping of
single-frame instances will appear at the bottom of the
series list within the study.
In the study's preview, the thumbnail shows a

miniature of the first image in the series.
A combination of all images in a study, as if it were a

single stack. Series of type "All Images" are best
All Images series suited for viewing studies that contain multiple single-
image series, such as CR or DR studies, to avoid
having to load single images individually.
Any study that contains DICOM images will also

contain a special All Images series.
Restricted exams If the selected study is a restricted exam, you will be

prompted to re-authenticate and provide a reason for
accessing it.
Sensitive images If the selected study contains sensitive images, you will
be asked to check your work environment before
accessing it.

A non-image file that provides information about the

patient or the study, for example notes from the
Reports referring physician.
The software supports a number of report formats,

such as Basic Text Structured Reports, encapsulated
PDF, native PDF, and FHIR. The thumbnail will give
an indication of the type of report.
Audio files A sound file, for example a dictated report.
When you load a audio file, a dialog box opens, where

you can control file playback and volume.
Videos
The application can play any non-DICOM video file
included in a study.
Loading Data
Once you know which image or report you'd like to view, you can load this data directly in the image
viewer.
If you attempt to load unsupported data, you will be able to view the data, but there will be a
persistent warning in red that you are viewing unsupported data.
To load data
l Tap the desired entry (series, report, and so on).
If there is more than one stack in the series, you will be presented with a stack list from which
you must choose before proceeding.

Selecting recently loaded studies

Depending on how the system administrator configured the server, you may have access to a History
section in the search panel. It will appear under the search results or below the list of related studies,
depending on the type of search you last performed.
The history displays a list of recently loaded studies (the maximum number of entries in this list is also
configured by the system administrator). This can be a time-saver, as it eliminates the need to repeat
recent searches.
This list is organized in reverse chronological order, with the most recently loaded study at the top.
You can navigate this list the same way you would any other search result, such as expanding studies
to view their content and loading studies directly in the viewer.
Returning to the Search Interface

You must return to the search interface if you wish to perform another search.
To perform another search
l Tap the Search tool .
Using the Study Tray

The study tray provides access to series, studies, and the search interface. You can also access
previously loaded studies from the study tray.
To show/hide the study tray
l Tap the Study Tray Tool .
The study tray contains the series list for the currently open study.
To navigate to the search results
1. Show the study tray.

2. Tap the Studies button.

About the Viewer

The viewer displays images and data, and provides tools for interacting with these images and data in
various view modes. Some viewer features are only available in specific view modes.
The viewer consists of a main view, where you can see the image currently selected, as well as
interface elements that give you access to additional features. See Overview of the Viewer's
Features.
View Modes
There are three different modes to view data — 2D, MIP/MPR, and 3D.
The 2D view mode displays data in a two-dimensional format, the 3D view mode displays data in a
three-dimensional format, and MIP/MPR view mode enables you to display data simultaneously in
different orientations.
Images are initially displayed in the 2D view mode, but you can switch view modes at any time.
To switch to the 2D View Mode
1. Tap the Menu Tool .

2. Select a view mode.
Data Information
Please be aware of the following information regarding the data.
GSPS and CSPS

Some data sets may contain measurements and annotations saved from another viewing system as
GSPS (Greyscale Softcopy Presentation State) or CSPS (Color Softcopy Presentation State)
information. GSPS and/or CSPS objects, when avaiable, are displayed by default.

To toggle GSPS display
l In the menu, you will see either the option GSPS On or GSPS Off, depending on whether the
display of this data is currently enabled or not. Tap this option to toggle the display on or off as
needed.
Unsupported Data
The Synapse Mobility software will notify you if you attempt to load unsupported data. You will be able
to view the data, but there will be a persistent warning in red that you are viewing unsupported data.
Source Image Compression

A persistent indication appears in all views if source images are compressed. In 2D view mode, the
compression ratio is also displayed.
Key Image Series

Studies containing key images (images of particular interest) appear in the worklist as a large key
preview icon. Series that contain key images are marked with small key symbols beside the series
name.
Overview of the Viewer's Features

The viewer consists of a main view, where you can see the image currently selected. This view also
contains a menu that gives you access to additional features.
The Menu
Once you have opened a data set, you can perform various functions (like changing views and
selecting a layout) using the menu. The menu options available depend on the screen you are currently
on and the task you are currently performing.
To display the menu
l Tap the Menu Tool .

To hide the menu
l Tap anywhere outside of the menu.
To select an option from the menu
1. Display the menu.

2. Select the desired option from the menu.
Navigating Images
The following table describes the touchscreen interactions for manipulating views in all view modes.
Functionality Touchscreen Interaction
Tap, then drag

Window/Level
See also Applying Presets
Panning Drag with two fingers
Zooming Pinch
Reset Shake
There are also methods to navigate in the viewer that apply only to certain view modes. See About
2D View Mode, About the 3D View, and About MIP/MPR View Mode.
Configuring Metadata Display

In 2D and MIP/MPR view modes, you can configure the desired level of metadata displayed in the
image viewer.

To configure metadata display
l Tap the Metadata Display option in the menu until you see the icon that represents the desired
level of metadata detail:
l None
l Limited
l Full
Displaying Related Studies

When you retrieve related studies, any studies with the same Patient ID as the study you are viewing
will appear in the study tray. This is useful when choosing series to display in split view layouts. See
Changing Layouts.
Depending on server configuration, related studies may be displayed automatically, or you may need
to explicitly select this option.
To retrieve related studies
l Select Related Studies at the bottom of the search results list.
Working with Measurements

The software provides measurement functionality.
Medical images are susceptible to magnification errors caused by differing patient sizes and
projection distances. If not corrected by the modality, these errors can affect the accuracy of the
calibration information contained in the image’s DICOM header. Measurement values in the Synapse
Mobility software are dependent on the calibration information provided by the modality in the DICOM
header. Accuracy also depends on the pixel spacing and slice interval values that are provided in the
DICOM header for the data set. Because of this, the software's measurements should be used for
reference only until the accuracy of the DICOM header information can be verified or the image
information has been calibrated through the use of a measurement instrument in the image.

Measurement Mode
The measurement mode provides several tools to perform various measurements in 2D view mode
such as pixel values, object size and angles.
Slice scrolling and window/level adjustment are disabled in measurement mode.
To enter measurement mode
l Select Measure from the menu.
To exit measurement mode
l Tap Done.
Measurement Tools
The following measurement tools are available in the 2D view mode.
Measurement Tool Description
Measures the distance

Linear between two points in the
view
Measures the area, mean

signal intensity, and
ROI standard deviation within an
ellipsoid region of interest
(ROI)
Measures the signal

Point intensity of a selected pixel
in the view

Measurement Tool Description
Measures the angle between

Angle
definable segments
Measures the Cobb angle

Cobb Angle
between definable segments
Making Measurements
To make linear measurements
1. Tap to select the Linear measurement tool.

2. Drag your finger over the image and use the magnified view to precisely position the first
endpoint of the measurement. The first endpoint will be placed when you stop moving your finger.
3. Drag your finger to the second endpoint of the measurement. The second endpoint will be placed
when you take your finger off the screen.
To make ROI measurements
1. Tap to select the ROI measurement tool.

2. Drag your finger over the image and use the magnified view to precisely position the first corner
of the ROI. The corner will be placed when you stop moving your finger.
3. Drag your finger to the opposing corner of the ROI. The corner will be placed when you take your
finger off the screen.
To make point measurements
1. Tap to select the Point measurement tool.

2. Drag your finger over the image and use the magnified view to precisely position the first corner
of the ROI. The point will be placed when you stop moving your finger.
To make angle measurements
1. Tap to select the Angle measurement tool.

2. Drag your finger over the image and use the magnified view to precisely position the vertex of the
angle. The vertex will be placed when you stop moving your finger.

3. Select and move the handles to adjust the angle as required. (See Working with
Measurements)
To make Cobb angle measurements
1. Select Cobb from the measurement panel.

2. Drag your finger to define the first line. (See To make linear measurements)
3. Drag your finger to define the second line.
4. Drag the endpoints to adjust the angle as required. (See Manipulating Measurements)
Measurement Calipers
Measurement calipers are visible in the 2D and MIP/MPR views. The calipers are a series of marks
indicating millimeters or centimeters, depending on the current zoom factor of the image. The spacing
of the calipers will adapt to the zoom factor of the image so that measurements are always accurate.

Manipulating Measurements
While any measurement tool is selected, you can select and make changes to existing
measurements.
To select a measurement
l Drag your finger over the image and use the magnified view to position the red cross hairs over
an endpoint or label. The cross hairs will turn yellow when they are within range of a selectable
element. Hold the yellow cross hairs over the endpoint or label until they turn green (selected).
No endpoint selected (red)
Endpoint in selectable range (yellow)

Selected endpoint (green)
To move a measurement
1. Select an endpoint or label using the above procedure. Do not take your finger off the screen.
2. Drag the now-selected endpoint or label with the green cross hairs to the desired location and
take your finger off the screen.
To delete a measurement
1. Select an endpoint or label using the above procedure.
2. Tap the Delete tool .
Applying Presets
For some images, window/level or color palette adjustments help get a clearer picture.
To help you quickly make these adjustments on-the-fly, the software comes with pre-loaded presets
for window/level and color palette. Which presets are available depends on the modality and view
mode of the displayed images:
l In 3D view mode, window/level presets are available for all modalities

l In 2D and MIP/MPR view modes, color palette presets are available for NM and PT modalities,
and window/level presets are available for all other modalities.
For modalities with color palette presets, it is still possible to adjust window/level using mouse or tap
gestures. See Navigating Images.
To select a preset
1. Select Presets from the menu.

2. Select the desired preset.
The presets for Window/Level are as follows:

Preset Window Width Window Level
Body Soft Tissue 350 50
Body Lung 1600 (-)500
Body Bone 1500 300
Body Liver 200 60
Head Post Fossa 200 40
Head Mid Brain 80 40
Head Blood 700 80
Head Bone 4000 600
Head IAC 3200 250
CTA MIP 700 250
Adjusting Image Quality

Depending on the quality of your network connection, you may want to adjust the image quality to fine
tune performance.
The interactive quality slider adjusts the image quality during interaction with the volume and reduces
the amount of network bandwidth used. The final quality slider adjusts the quality of the image after
interaction.
User-selected quality settings may result in information loss from the original imagery. Diagnostic
interpretation should not be formed from the interactive images but only from the static, final-quality
resulting image.

To adjust image quality
1. Select JPEG Quality from the menu.

2. Adjust the quality sliders.
Using Dictation
The Synapse® Mobility solution provides the ability to dictate a report while viewing studies. The
Synapse Mobility software currently supports Nuance Dictation.
Dictation requires microphone access, a Nuance Dictation account and the username and password
for the Nuance dictation service. Be sure to correctly configure these settings before using dictation.
(See Configuring the App)
To enable dictation
l Select Dictation from the menu and begin speaking. The Dictation tool will appear above
the view.
To pause and resume dictation
1. Tap the Dictation tool to pause dictation. The Dictation tool will flash when dictation is paused.
2. Tap the Dictation tool again to resume dictation.
To view the report
l Tap and hold the Dictation tool to open the report.
You can edit the report with the keyboard.
To submit the report
l Tap Submit. The report will be saved to PACS with the original study as a structured report
(DICOM SR).
To delete the report
l While viewing the report, tap the Delete tool .
The Dictation tool will disappear from above the view when you submit or delete the report.

Sharing Studies
The study share feature facilitates sharing studies with other clinicians. The Share Study action
enables you to share study information through third-party services, like BEAM or DatCard. You can
access this feature by clicking on the Share Study button in the worklist menu for the desired study in
the worklist.
The Share Study action will only be available if sharing study actions have been configured.
To open the Share Study panel
l Select Share Study from the menu.
To share a study
l Open the Share Study panel and select the desired sharing action. A new browser tab will be
opened where you can specify the required information to share from the selected study.
Only one study can be shared at a time.
About 2D View Mode

Once a study and its series are selected for viewing, its contents (data sets) are automatically listed
and displayed in 2D view mode.
In this mode, you can interact with images in a two-dimensional format.
A small key symbol on the left side in the main view indicates a key image.

Patient orientation (superior, inferior, anterior, posterior, left, or right) is indicated using letters at the
edges of the image.
The letters displayed as orientation labels come from the DICOM source data, and could vary
depending on the data set (if the data was generated in a different language, for example).
All of the methods of navigating the data described in Navigating Images apply in 2D view mode. In
addition to those interactions, you can go to the next/previous image stack by swiping left or right.
Scrolling Through Images

In 2D view mode, you can scroll through images manually or by using cine mode.
Scrolling Manually
l To scroll through several images, drag up/down

l To scroll through single images, tap near the top or bottom of the view
Using Cine
Cine mode automatically scrolls through images once all are loaded at the current window/level and
zoom settings.
To enter cine mode
l Select Cine from the menu.

To start scrolling
l Tap the Play button. (You may start scrolling even while the data set is being buffered.)
To reverse scrolling
l Tap FPS.
l Enable the option Playback Reversed.
To pause scrolling
l Tap Pause.
Changing Layouts
If your device has a sufficiently large screen (which is the case for most tablets, with the exception of
those with screens smaller than 10.5" such as iPad Minis), you can view two images simultaneously.
This feature is called Split View, and can be very useful for comparing images.
In Split View mode, the images will display either side-by-side (1x2 layout) or top-bottom (2x1 layout),
depending on device orientation.
Split View is not available on phones, due to the limited screen space.
You can change the layout at any time.
To toggle the layout
l When in single view mode, select Split View from the menu to change to split view.
l When in split view mode, select Single View from the menu to change to single view.

When changing from a single view to a split view, the currently loaded series will appear in a view
position and you will need to assign another series to the empty view position.
To assign a series to a view position
1. Open the study tray and navigate to your desired series.

2. Tap to select the series. The app will display a selector for view positions, select whether you
want the series to appear at the top or the bottom of the split view.
You can always load and assign new series to view positions of your choice by selecting them from
the study contents.
Yellow reference lines appear when viewing and interacting with orthogonal reconstructions in other
views.
Reference lines are to be used for clinical reference only.
Linked Scrolling
When scrolling is linked, images in different views that share a common frame of reference will scroll
together.
Typically, you would scroll by slice position. But if the data set does not contain slice position
information, you have the option to scroll by slice number.
To link scrolling by slice position
1. Select Linked Off Position from the menu.
The label will change to "Link On Position", which confirms linked scrolling by slice position is now
enabled.
To link scrolling by slice number
You must manually align the views visually by scrolling to the desired parts of the anatomy before
linking the views.
1. Scroll each of the views to the respectively desired slices.

2. Select Linked Off Number from the menu.
The label will change to "Link On Number", which confirms linked scrolling by slice number is now
enabled.

About the 3D View

In 3D view mode, you can interact with images in a three-dimensional format.
All of the methods of navigating the data described in Navigating Images apply in 3D view mode. In
addition to those interactions, you can you can rotate the image by dragging your finger on the screen.
Magnifying Part of a Volume

On iPad tablets, you can use the lens tool to magnify a select portion of the volume in the 3D View
Mode while keeping the entire volume in the main view. A magnified view is displayed in the upper-
right corner.
The lens tool is made up of a lens and a magnified view. The magnified view shows a close-up of the
area covered by the lens.

To enable the lens tool
l Select Lens from the menu.
The lens tool is only available in 3D View Mode.
To move the lens over the volume
l Drag the lens.
To adjust the magnification of the lens view
l Pinch or spread two fingers on the magnified view.
Applying Presets
For some images, window/level or color palette adjustments help get a clearer picture.
To help you quickly make these adjustments on-the-fly, the software comes with pre-loaded presets
for window/level and color palette. Which presets are available depends on the modality and view
mode of the displayed images:
l In 3D view mode, window/level presets are available for all modalities

l In 2D and MIP/MPR view modes, color palette presets are available for NM and PT modalities,
and window/level presets are available for all other modalities.
For modalities with color palette presets, it is still possible to adjust window/level using mouse or tap
gestures. See Navigating Images.

To select a preset
1. Select Presets from the menu.

2. Select the desired preset.
The presets for Window/Level are as follows:
Preset Window Width Window Level
Body Soft Tissue 350 50
Body Lung 1600 (-)500
Body Bone 1500 300
Body Liver 200 60
Head Post Fossa 200 40
Head Mid Brain 80 40
Head Blood 700 80
Head Bone 4000 600
Head IAC 3200 250
CTA MIP 700 250
About MIP/MPR View Mode

In MIP/MPR mode, you can interact with images and display them in different orientations.

All of the methods of navigating the data described in Navigating Images apply in MIP/MPR mode. In
addition to those interactions, you can change slab thickness and orthogonal view.
To change thickness
1. When in MIP/MPR view mode, select Slab Thickness from the menu.
2. Select the desired thickness.
To change orthogonal view
l Swipe left or right in the main view.
Scrolling Through Images

In MIP/MPR view mode, you can scroll through images manually.
l To scroll through several images, drag up/down.

l To scroll through single images, tap in the top or bottom third of the screen.

About Collaboration
Collaboration functionality enables you to share the current viewing session with other users on the
web or on mobile devices.
From the collaboration panel, you can also access Spaces by PureWeb, if your institution subscribes
to it. This will launch a cloud-managed collaboration service where you can share and discuss content
from multiple applications.
IMPORTANT: In a collaboration session, only the host’s view is of diagnostic quality.
Hosting Sessions
The host controls the layout and permissions for all participants of the collaboration session.
The Collaboration panel contains all the permissions and status of the participants in the session.
To invite a user to a session via email
1. Select Collaboration from the menu.

2. Click +. This will create a message in your default email client.
3. Enter the recipient’s email address in the To: field of the message.
4. Send the message.
The list of participants will be visible in the Collaboration panel. Participants will be able to see all your
interactions with the image view as long as the session is active.
The host can grant permission for participants to interact with the session.
To grant or revoke a participant's ability to interact with the session
l Tap the Interaction Tool in the Collaboration panel.
The host and participants can see each others uniquely colored cursors if they are enabled by the
host.

To show or hide the host's or participant's cursor
l Tap the Cursor Tool in the Collaboration panel. The participant’s cursor will be the same
color as the square next to the participant's name.
To use your cursor as a pointer without interacting with the image
l Toggle the Pointer Tool by tapping it. (The tool changes to when enabled.)
Confidential patient information is hidden by default.
To remove a participant from the session
1. Swipe horizontally across the participant’s name in the Collaboration panel.

2. Tap Remove.
Joining Sessions
IMPORTANT: In a collaboration session, only the host’s view is of diagnostic quality.
To join a collaboration session
1. Click or tap the link in the invitation email or otherwise provided by the session’s host.
2. Enter your name and email address to identify yourself to the host.
If the host has already loaded images, participants will see the image view and the host’s mouse
cursor. If the host is in the search interface, participants will see an empty image view and a message
that the host is not currently viewing images. Participants can interact with the view if the host grants
them the ability.
The aspect ratio seen by participants is determined by the host’s own display.
Collaborating with Audio/Video

While collaborating, it is possible to communicate with a participant in a real-time audio/video (A/V)
session.
To initiate an A/V session

l From the collaboration panel, tap the Audio/Video tool to request an A/V session. Once the
session is initiated, participants may click or tap the audio/video button to broadcast from their
device.
To resize an A/V window
l Tap the Resize button to toggle between window sizes.
You can adjust the opacity of obtrusive or distracting A/V windows.
To adjust the opacity of an A/V window
l Drag along the bottom edge of the window.

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Synapse® Mobility 7.1.

Synapse Mobility V. 7.1.3 User Guide

Confidential and Proprietary Information

FUJIFILM Medical Systems U.S.A., Inc.

Confidential and Proprietary 1

Synapse® Mobility User Guide 6

Software User Profile 6

About this Release 7

About this User Guide 7

Fujifilm Disclaimer Statement 8

Indications for Use and Regulatory Status 11

Indications for Use 11

Manufacturer, Distributor, and EU Importer 11

Important Safety and Security Considerations 13

Risk of Potential Errors 15

Your Reading Environment 16

Training & User Familiarization 18

Confidential and Proprietary 2

Installing the App 20

Exploring the Interface 20

Ending a Viewing Session 21

Supported Mobile Devices and Operating Systems 22

Configuring the Server 22

Configuring the App 24

About the Search Interface 27

Browsing Search Results 29

Drilling Down the Results of a Search 29

Selecting recently loaded studies 33

Returning to the Search Interface 33

Using the Study Tray 33

Confidential and Proprietary 3

About the Viewer 34

GSPS and CSPS 34

Source Image Compression 35

Key Image Series 35

Overview of the Viewer's Features 35

Configuring Metadata Display 36

Displaying Related Studies 37

Working with Measurements 37

Adjusting Image Quality 43

Confidential and Proprietary 4

About 2D View Mode 45

Scrolling Through Images 46

About the 3D View 49

Magnifying Part of a Volume 49

About MIP/MPR View Mode 51

Scrolling Through Images 52

Collaborating with Audio/Video 54

Confidential and Proprietary 5

Synapse® Mobility User Guide

Software User Profile

Confidential and Proprietary 6

About this Release

About this User Guide

Screenshots are for visual reference only.

Confidential and Proprietary 7

Fujifilm Disclaimer Statement

Confidential and Proprietary 8

Synapse is a registered trademark of FUJIFILM Medical Systems U.S.A., Inc.

Confidential and Proprietary 9

l iPhone 5S, iPhone 6, iPhone 6 Plus*, iPhone 6S, iPhone 7, iPhone 7 Plus, iPhone 8, iPhone X