E-Com Droc User Manual

DROC Software
User Manual
Rev. 1.0
E-COM Technology Limited

©2018 All rights reserved
北京友通上昊科技有限公司第 1 页
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CETF-DROCS -B-03
This product complies with the following requirements:
Council Directive 93/42/EEC concerning medical devices when it bears the following CE marking of
conformity. The year of CE marking is 2018.
The location of the CE mark label is in the service manual.
EU Authorized Representative:
Villa Sistemi Medicali S.p.A.
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APPLICABLE STANDARDS
 EN 62304 Medical device software – Software life cycle processes

 EN 62366 Medical Devices-Application of usability engineering to medical devices
 EN 980 Graphical symbols for use in the labeling of medical devices
 EN 1041 Information supplied by the manufacturer with medical devices
 IEC 60601-1 Medical Electrical Equipment Part 1: General Requirements for Basic Safety and
Essential Performance
DOCUMENT PROPERTY
Function Name
Prepared by Application Specialist Moyu Yang
Reviewed by Product Technical Leader Kewei Wang
Reviewed by Regulation Engineer Lingling Zhang
Reviewed by Technical Support Manager Mingwei Wang
Reviewed by Marketing Manager Jizhou Xiao
Approved by Quality Manager Jianzhe Wang

NOTICE
The information contained in this manual is confidential and proprietary to E-COM Technology Limited. This
information is provided only to authorize representatives of E-COM's customers solely for the purpose of
facilitating the use of E-COM's products. No information contained herein may be disclosed to any
unauthorized person for any purpose whatsoever without the prior written consent of E-COM Technology
Limited.
The information in this document is subject to change without notice. Copyright ©2008 by E-COM
Technology Limited. All rights reserved.
The E-COM logo is a registered trademark of E-COM Technology Limited. Printed in P. R. CHINA
All trademarks, registered trademarks, and product names used within this document are the property of
their respective owners.
E-COM Technology Limited
1F Building 2, No.99 Kechuang 14th Street, BDA,

101111 Beijing, PEOPLE'S REPUBLIC OF CHINA
TEL: (+86) 10 5975 5367
FAX: (+86) 10 5975 5360
E-mail: [email protected]
Website: www.e-comtech.com
Revision History
Revision Date Change Description

1 2019-4-09 Initial release
Table of Contents Page vi
Table of Contents
TABLE OF CONTENTS ................................................................................. VI
ABOUT .......................................................................................................... IX
SAFETY AND REGULATORY ....................................................................... XI
1 INSTALLATION....................................................................................... 1
1.1 INSTALL PPACS..................................................................................................................................... 2
1.2 INSTALL DROC ...................................................................................................................................... 4
2 QUICK START ........................................................................................ 6

2.1 POWER ON AND LOGIN ........................................................................................................................... 7
2.2 START AND END EXANIMATIONS .............................................................................................................. 9
2.3 A BASIC IMAGE ACQUISITION W ORKFLOW ............................................................................................. 10
2.4 LOGOFF, EXIT OR SHUTDOWN .............................................................................................................. 12
3 WORKLIST MANAGEMENT ................................................................ 13

3.1 CREATING LOCAL STUDIES ................................................................................................................... 14
3.2 OBTAINING W ORKLIST FROM HIS/RIS ................................................................................................... 15
3.3 LOCAL STUDY MANAGEMENT ................................................................................................................ 16
3.4 EDITING STUDIES ................................................................................................................................. 18
3.5 SWAPPING IMAGES ............................................................................................................................... 19
3.6 EMERGENCY EXAMINATION ................................................................................................................... 20
3.7 QUERYING AND SORTING STUDIES ........................................................................................................ 20
3.8 SCREENING EXAMINATION .................................................................................................................... 21
3.9 USE OF BARCODE READER................................................................................................................... 22
4 IMAGE ACQUISITION .......................................................................... 23

4.1 PREPARATIONS BEFORE ACQUISITION ................................................................................................... 24
4.1.1 Selecting Workstation .................................................................................................................... 24
4.1.2 Adjusting Exposure Factors ........................................................................................................... 24
4.1.3 Selecting Focal Spot ...................................................................................................................... 25
4.1.4 Use of AEC .................................................................................................................................... 26
Software User Manual

Table of Contents Page vii
4.1.5 Other Technical Preparations ........................................................................................................ 27

4.1.6 Patient Preparations ...................................................................................................................... 28
4.2 ACQUIRING IMAGE ................................................................................................................................ 28
4.3 IMAGE QUALITY CONTROL .................................................................................................................... 31
5 IMAGE MANIPULATION ...................................................................... 34

5.1 BASIC IMAGE MANIPULATION................................................................................................................. 35
5.1.1 Common Manipulation Tools ......................................................................................................... 35
5.1.2 Select Image Layout ...................................................................................................................... 36
5.1.3 Rotating and Flipping ..................................................................................................................... 36
5.1.4 Operation of displaying scale......................................................................................................... 37
5.1.5 Brightness and Contrast Operations ............................................................................................. 38
5.1.6 Cropping and Masking ................................................................................................................... 39
5.2 RE-PROCESS IMAGES ........................................................................................................................... 40
5.2.1 Image Processing Styles ............................................................................................................... 40
5.2.2 Advanced Image Post-processing ................................................................................................. 41
5.3 MEASUREMENT AND ANNOTATION ......................................................................................................... 44
5.4 OTHER VIEWING TOOLS ....................................................................................................................... 46
6 IMAGE MANAGEMENT........................................................................ 47
6.1 ARCHIVE, IMPORT AND EXPORT............................................................................................................. 47
6.2 PRINT IMAGES...................................................................................................................................... 48
6.2.1 Create an empty film sheet ............................................................................................................ 50
6.2.2 Design Film Layout ........................................................................................................................ 51
6.2.3 Manipulate Images in Layout ......................................................................................................... 52
6.2.4 Add Annotations on Image............................................................................................................. 53
6.2.5 Printing ........................................................................................................................................... 54
6.3 QUEUE MANAGEMENT .......................................................................................................................... 54
6.4 VIEWING EXPORTED IMAGES ................................................................................................................ 55
6.5 DELETE AND PROTECT ......................................................................................................................... 56
7 ADVANCED APPLICATIONS ............................................................... 58

7.1 IMAGE STITCH ...................................................................................................................................... 58
7.1.1 New Study for Stitching ................................................................................................................. 59
7.1.2 Acquire Images for Stitching .......................................................................................................... 59
7.1.3 Auto Stitch...................................................................................................................................... 60
7.1.4 Manual Stitch ................................................................................................................................. 61
7.1.5 Close Stitching ............................................................................................................................... 66
7.1.6 Side-by-Side Stitch ........................................................................................................................ 67
7.2 DUAL ENERGY ..................................................................................................................................... 68
8 SYSTEM MANAGEMENT ..................................................................... 71

Table of Contents Page viii
8.1 CHECK SYSTEM STATUS IN THE STATUS BAR ........................................................................................... 71

8.2 CHECK SOFTWARE VERSION INFORMATION ............................................................................................ 72
8.3 MANAGE USER ACCOUNTS .................................................................................................................... 73
8.4 EMERGENCY SETTINGS ........................................................................................................................ 74
8.5 SYSTEM STATISTICS ............................................................................................................................. 75
APPENDIX: GLOSSARY .............................................................................. 77

About Page ix
About
Audience
This manual is intended for users of the Digital Radiography Operating Console (DROC) software.
The targeted clinical users include qualified trained doctors, radiographers, or radiologic technologists.
It is important for you to read and understand the contents of this manual before attempting to use
this software.
Prerequisites
The procedures in this manual assume that audiences have basic computer operation skills and know
how to do basic operations related to the computer’s graphical user interface.
It is essential for you to have necessary knowledge to capably perform the different diagnostic imaging
procedures within your modality. This knowledge is gained through a variety of educational methods
such as clinical working experience, hospital based programs, and as part of many college and
university Radiologic Technology programs.
Scope of This Manual

This manual contains information about the software and its operational features. It is not intended to
teach radiological science or make any type of clinical diagnosis.
Indications for Use

The software is intended to generate digital radiographic images of the skull, spinal column, chest,
abdomen, extremities, and other body parts in patients of all ages. Applications can be performed
with the patient sitting, standing, or lying in the prone or supine position and is intended for use in all
routine radiography exams.
The product is not intended for mammographic applications.
Contraindication

About Page x
None known.
Expected Service Life

The expected service life is 10 years after its release only when operators are qualified and have
received related training and follow instructions in this manual.
Storage and Transportation

This software product is stored in CD-ROM. It must be well protected against dampness, moisture,
and dust; and be able to stand shock, scratching, and pressure.
After packing, this product can be adapted to air, rail, shipping and road transport. There are no other
special requirements for transport.
Graphic Conventions
This manual uses four types of special messages to emphasize information or point out potential risks
to personnel or equipment.
NOTE: A Note provides additional information that is helpful to you. It may emphasize such
information as expanded explanations, hints, or reminders.
RECOMMEND: It provides best practices based on professional experiences in X-ray industry.
Cautions point out procedures that you must follow precisely to avoid damage
to equipment, loss of data, or corruption of files in software applications.
Warnings point out procedures that you must follow precisely to avoid injury to
yourself or others.

Safety and Regulatory Page xi
Safety and Regulatory

The operator must read this manual carefully before operating the system.
Please do not execute the DIGITAL RADIOGRAPHY OPERATING CONSOLE

SOFTWARE before you get the necessary training from the manufacturer.
The DIGITAL RADIOGRAPHY OPERATING CONSOLE SOFTWARE is

interfaced to medically approved x-ray generating equipment. Be certain
to follow the x-ray generator instructions and specification for wearing
proper lead shielding when in the presence of x-ray generating equipment.
All personnel must wear Dosimeters during all phases of installation,

operation and maintenance of the DIGITAL RADIOGRAPHY OPERATING
CONSOLE SOFTWARE and the equipment to which it is interfaced.
Do not attempt to alter DIGITAL RADIOGRAPHY OPERATING CONSOLE

SOFTWARE. Doing so could disrupt the functioning of the instrument and
result in loss of images. Use of any software not provided by Manufacture
is strictly prohibited!
Do not attempt any maintenance of DIGITAL RADIOGRAPHY OPERATING

CONSOLE SOFTWARE, including troubleshooting, in the presence of any
patients or non-authorized staff.
Do not attempt any repairs if the DIGITAL RADIOGRAPHY OPERATING

CONSOLE SOFTWARE fails to operate correctly. Only the specified engineer
authorized by the manufacturer has the rights to do this.
It is the User’s responsibility to provide the means for audio and visual
communication between the Operator and the patient.
Keep the patient in full view at all times and never leave the patient
unattended when using the software to acquire images.
Do not load other software or incompatible versions of the software

onto the system computer.

Safety and Regulatory Page xii
Radiation Safety
Always use the optimal technical factors for each procedure to minimize X-ray exposure and to
produce the best diagnostic results. In particular, you must be thoroughly familiar with the safety
precautions before operating this system.
When using the software to acquire an x-ray image, there should be no

other people other than the patient in the exam room during x-ray exposure.
If another person is required to enter the room while x-ray exposures are
possible, that person should wear a lead apron.
Radiation Protection
You should know that exposure to X-ray radiation may be damaging to health, use great care to
provide protection against exposure to the primary beam. Some of the effects of X-ray radiation are
cumulative and may extend over a period of months or years. The best safety rule for X-ray operator
is “Avoid exposure to the primary beam at all times”. Any object in the path of the primary beam
produces secondary (scattered) radiation. The intensity of the secondary radiation is dependent on
the energy and intensity of the primary beam and the atomic number for the object material struck by
the primary beam. Secondary radiation may be of greater intensity than that of the radiation reaching
the film. Take protective measures to safeguard against it. An effective protective measure is the use
of lead shielding. To minimize dangerous exposure, use such items as lead screens, lead
impregnated gloves, aprons, thyroid collars, etc. The lead screen should contain a minimum of 2.0
mm of lead or equivalent and personal protective devices (aprons, gloves, etc.) must contain a
minimum of 0.25 mm of lead or equivalent.
When using the software to acquire an x-ray image, it is better for operators
to keep a distance no less than 2 meters from the focal spot and X-ray beam,
protect body and do not expose hands, wrists, arms or other parts of the
body to the primary beam.
Personal Radiation Dosimeters

A common method of determining whether personnel have been exposed to excessive radiation is
the use of personal radiation dosimeters. Even though this device only measures the radiation which
reaches the area of the body on which they are worn, they do provide a reasonable indication of the
amount of radiation received.
Privacy and Data Security

Safety and Regulatory Page xiii
To protect patient privacy, HIPAA security measures are required when using this software. Any
personal data including patient and patient’s relative data, operator and physician data etc. in this
software must meet GDPR requirements.
Access control for patient data is provided in this software. Any operator needs authorization before
this software access. Different operators may have different roles and permissions, and all user
account information are encrypted. All operator activities as logon, collecting, transferring, or
exporting patient data etc. are recorded. Only authorized personals can check audition records.
This software only collect minimum patient data for examination and provides interfaces to change
inaccurate patient data and examination information. Please retrieve patient date only from authorized
sources such as hospital HIS/RIS servers. It is operator’s responsibility to delete personal’s data if it
is not needed in this software anymore. It is recommended to erase patient data only after it is
transferred. Erasure operations should be controlled by higher privilege operators.
Pseudonymisation or anonymization technologies are widely used when transferring personal data in
this software. Only necessary personal data is collected in the software statistics, and only
pseudonymized and encrypt patient information are logged in the software. Patient information will be
removed when screenshot is take for any purpose.
Each operator can access the software only when correct passwords are
filled in. It is each operator’s responsibility to make sure his/her
passwords are enough complex and keep it confidential.
It is operator’s responsibility to delete a patient’s study when it is

useless anymore or required to be deleted by the information owner.
Whenever an operator doesn’t need to access this software anymore,

please remove all his/her account information.
It is operator’s responsibility to decide whether the “Anonymous” option

is selected or not when exporting patient’s images.
NOTE: All names including patient names, technician names, physician names, and etc.
appearing in example screens in this manual are factious. Any sameness to real people is purely
coincidental.

Installation Page 1
1 Installation
1
Installation
The Digital Radiography Operating Console (DROC) software product consists two components: a
software CD-ROM and a dongle. The CD-ROM stores the software installer and user manual. The
dongle is used to control the software license.
Figure 1-1: Software CD-ROM and Dongle
This chapter provides detailed instructions for the software package installation and uninstallation.
The software package includes two parts, PPACS and DROC. During DROC installation, it will check
whether PPACS is installed or not; if not, it will kick off PPACS installation first. You also can manually
install PPACS first.
DROC is responsible for synchronizing of all imaging hardware components and the whole acquisition
workflow of the graphic user interface. The relationship of DROC and PPACS could be shown in the
below figure.

Installation Page 2
DICOM
DROC PPACS
Networ
PACS
Host Computer
HIS/RIS Printer
Figure 1-2: Relationship of DROC and PPACS
During installing the software package, monitor each step and answer
questions in time of other applications, especially Windows Firewall and 3rd-
party anti-virus software.
Make sure that the super dongle of this system is inserted to the USB slot
correctly before any related operation. This USB dongle is driverless.
1.1 Install PPACS
The Personal PACS (PPACS) is responsible for managing local images and communicating with other
DICOM network nodes, including HIS/RIS, PACS, and Printers.
Different PPACS versions are not compatible with each other. Thus, if the
system has been installed with a previous version, please remove it prior to
this installation.
In software CD-ROM, open the PPACS folder and start the program “PPACSSetup”. Then select a
language for installation. Note, the language selected here is just for installation only; it is not the software
user interface language.
Figure 1-3: Select a language for PPACS installation

Installation Page 3
After selecting the installation language, the welcome message appears. Then, the next step is to choose
the installation location.
Figure 1-4: Select PPACS installation location
Don’t use non-single byte characters as Chinese, Japanese, and Korea

(CJK) and blank space for PPACS installation folder name.
The next step is to input the Application Entity (AE) Title and TCP Port of the PPACS service. The
default AE Title is the computer name and the default TCP Port is 104. Normally, they are not needed
to be changed since each computer in the hospital network has a unique name.

Installation Page 4
Figure 1-5: Configure AE Title and TCP Port for PPACS
Don’t type an existing name in the AE Title field. Don’t type a used TCP Port for
PPACS. Please consulate the network administrator of this site if needed.
Then, click “Next” button and follow installation wizard to complete PPACS installation. This process will
take about several minutes. After its installation, please restart computer.
1.2 Install DROC
Before the DROC Software installation, please ensure PPACS has been installed successfully.
In the software CD-ROM, find the DROC software installer program and start it. The installation wizard
will ask for its installation location as shown in the below figure.

Installation Page 5
Figure 1-6: Select a folder for DROC installation
To change the default installation folder, you can manually fill in a new folder name or click Browse
button and choose an existing folder as the target installation directory. Then click Next button. This
process will last for several minutes.

Quick Start Page 6
2 Quick Start
2
Quick Start
Welcome to the world of digital X-ray diagnostic images. Digital Radiography Operating Console
(DROC) software is one of the finest intelligent radiography operator console based on Microsoft
Windows operating system. This user manual will provide detailed instructions for its operation.
The software is a PC-based operator console, works as the integrated controlling subsystem of digital
radiography equipment. It is a digital x-ray image acquisition workstation software and provides the
control functions for synchronizing the flat panel Detector (FPD) and the X-ray generating equipment.
It is also an image review workstation with many image manipulation tools.
In the software, X-ray images are stored in a database and are made available to picture archiving
and communication systems (PACS). The option of communicating with patient management
systems (HIS, RIS, etc.) to exchange patient data is also integrated. This software is compliant with
DICOM 3.0.
This Chapter provides overview of the software functions and describes a basic procedure from the
system starting up to its shutting down including a basic workflow of using the software to acquire
images and send them to output devices. A basic procedure includes below steps:
1 Power on and login the system

2 Create a new patient and select a protocol for examination
3 Acquire x-ray images one by one. Reject an image if its quality is not good and then repeat
acquisition until its image quality meet expectation.
4 After finishing all image acquisition of this patient, sent them to PACS archive server(s) or
DICOM printer if possible.
5 Logoff , exit or shutdown the system

Quick Start Page 7
2.1 Power On and Login
The below steps give a brief description on how to start the x-ray system and the console software.
1. Start high voltage generator, image detectors, and other hardware components.
2. Check whether all imaging related hardware of the X-ray system operates smoothly.
3. Start the console computer and log in the computer operation system.
4. Start the software and log in it.
NOTE: Refer to the relevant manual for detailed operation instructions of the hardware
components as the high voltage generator, flat panel detector and other X-ray imaging
components in the system.
In the login window, please select your own user name in the user name list and input your own
password correctly. Then, click the button “Login” or click the “Enter” keyboard.
Figure 2-1: The Software Login Screen
NOTE: When entering passwords, the software will not display the relevant character information
for the security purpose. Passwords are case sensitive.
For GDPR applicable countries, an operator has to change his/her default password for the first login.
To meet GDPR, the console software requires more complex password rules. The change Password
window is shown as the below picture.
The console software will check whether new passwords can meet its password rules or not. It will
indicate which password rules are not met by new passwords.

Quick Start Page 8
Figure 2-2: The Change Password Window
After login the software, the “NEW” patient screen or the “WORKLIST” screen displays. It depends
on the hospital network configuration and operator’s preferences. If no HIS/RIS is connected with the
software, the “NEW” patient screen will be the default screen after login.
The Navigation Pane is on the right side of the software screen, which includes multiple main menus,
which are explained in the below table. Each different menu accomplishes a specific group of
functions. Depending on permissions of your dongle, your software may display different menus.
Symbol Name Description
Patient management related functions, such as new patient, work list from
PATIENT HIS/RIS, and local exam history, etc. For details please refer to Chapter 3
“Worklist Management” and Chapter 6 “Image Management”.
A software console for controlling x-ray imaging components and acquiring

EXAM
images. For details please refer to Chapter 4 “Image Acquisition”.
Rich of tools for image post-processing, viewing, annotation, measurement, etc.

VIEW
For details please refer to Chapter 5 “Image Manipulation”.
A powerful “WYSWYG” film composer. For details please refer to Chapter 6

PRINT
“Image Management”.
Image stitching function. It is an optional pluggable module. For details please

STITCH
refer to the part “Image Stitch” in Chapter 7 “Advanced Applications”.
REPORT Diagnostic report function. It is an optional pluggable module.
User management, detector calibration, preference settings, statistics, etc. For

SYSTEM
details please refer to Chapter 8 “System Management”.
EXIT Exit or logoff the software, or power off the host computer.

Quick Start Page 9
2.2 Start and End Exanimations
An examination have different states from start to end. At different stages, an exam can be started
in different ways.
State Operation Description
For local created exams or obtained from HIS/RIS, double-click one

Scheduled Start Exam exam, or select multiple exams of one same patient and click "EXAM"
in the navigation bar to enter the EXAM screen.
For an ongoing exam, its protocols can be modified temporally. For

example, remove some views, add new views, and copy an existing
In Progress Modify Exam
view, and so on. To add a new protocol, click [+] at the end of the left
index pane.
In the "LOCAL" page of the navigation bar [PATIENT], double click a

Resume
Suspended suspended exam, or select it and click the "EXAM" in the navigation
Exam
bar to enter the EXAM screen to continue this exam.
For completed exams in the “LOCAL” page, select one exam and
Append click the “EXAM” in the navigation bar to enter the EXAM screen,
Completed
Exam where operators can click [+] at the end of the left index pane to
append new protocols for examination.
In addition to the basic workflow described above, multiple studies of one patient can be performed
together.
Patient
Procedure Procedure Procedure

(Study/Serials) (Study/Serials) (Study/Serials)
Image Image Image
Figure 2-3: Hierarchy of Patients, Procedures, and Images
When the same patient has multiple different procedures, each procedure has an accession number.
In the process of examination, each procedure of the patient can be carried out separately or
combined through below two buttons in the "EXAM" screen. This feature needs to be turned on in
SYSTEM > PREFERENCES. When a stitching study or a dual energy study exist in selected multiple
studies, each study is forced to be displayed separately.

Quick Start Page 10
One Multiple procedures of one same patient are performed separately. Each
Procedure procedure is an individual page, which only contain its own views in the View
One Study Index pane on the EXAM screen.
Multi- Multiple procedures of one patient are combined without distinguishing

Procedure between them, and views of all these procedures are listed together in the
One Study View Index pane.
For an ongoing examination, its procedures and views can also be modified temporally.
Add Protocol To add protocols, click the [+] at the end of the View Index pane.
Delete To remove a view from the View Index pane, select it and then click the
Protocol/Reject button. If the selected is an image but not a view, clicking this button will reject
Image this image.
To copy a view, select it and then click the button. If the selected is an image
Copy Protocol
but not a view, clicking this button will copy this image’s view.
When leaving the "EXAM" screen and returning to the "PATIENT" screen or exiting the software, if all
views of the study are completed, this study is completed; if any view is still remaining in the Index
List pane, the software asks whether to complete or suspend this study.
2.3 A Basic Image Acquisition Workflow
As the most basic workflow of image acquisition, the first step is to create a new patient and select
protocols for examination.
When filling in the basic information of patients, the field marked with “*” is compulsory.
NOTE: Make sure the patient's name and ID number are input correctly. The patient ID number
is unique and different patients have different ID numbers.
Then select procedures for examination. In the upper right area of the screen, the often used protocols
are listed as default for quick selection. By clicking each body part of the virtual person, protocols of
the corresponding part are displayed. When a protocol is selected, its views are added in the lower
right area of the screen.
After adding protocols, click the "EXAM" button in the navigation bar, the new patient window will
close and enter the "EXAM" screen.
In the EXAM screen, the left side of the Index List pane lists views that needs to be exposed. If a view
has been exposed, it will be replaced by the thumbnail of the corresponding acquired image. By

Quick Start Page 11
default, images are acquired in the top-to-bottom order of the index list. To acquire the image for a
view which is not the current one, click on the view in the index list pane, and it becomes the current
view for acquisition. After the image is acquired, the exposure sequence will be carried out from top
to bottom by default again.
New Patient
Acquire Image
Manipulate Image
Print Image
Figure 2-4: A Basic Image Acquisition Workflow
If no proper protective measures are taken or operating rules are not

strictly followed, the X-ray system could cause harm to patients and
operators.
When imaging components are ready for exposure, press and hold the exposure hand switch for a
few seconds (normally 0.5-3 seconds, depending on the type of flat panel detector), and the exposure
will begin. Generally, the generator will give a sound of "di", indicating the exposure ray. Then, release
the hand switch.
After the exposure, the preview image is usually displayed first and then the final full size image is
displayed a few seconds later. In the image viewer screen, a lot of image manipulation tools are
provided for different applications. Please refer to the following chapters for details.
Usually, after an image is acquired successfully, the brightness and contrast of the image can be
adjusted by pressing the right mouse button. Slide up and down to change the window level, while
slide left and right to change the window width of the image.

Quick Start Page 12
Acquired images can be sent to the archive server or printed. If the default image storage node is
configured, when an exam is completed, acquired images in this exam will be automatically sent to
the default node.
2.4 Logoff, Exit or Shutdown
On the navigation bar, click Exit button. Then the exit window will pop up as the following figure.
Figure 2-5: Exit the Software
To exit the software, click the “Exit” button.
To logoff the software so that other users can log in, click the “Logoff” button.
To shut down the computer, click the “Shutdown” button.
RECOMMEND: It is recommended to shut down the host computer running the software every
day to avoid potential system performance degradation.
Please shut down the computer in accordance with this manual. Do not shut
down the computer power directly when the software is running normally.
Incorrect shutdown may cause data loss!
If the power supply of the host computer is likely to be suddenly cut off, please
use UPS. When the software is running, sudden power failure may result in
data loss!

Worklist Management Page 13
3 Worklist Management
3
Worklist
Management
This chapter focuses on various operations related to worklist. For example, create new patients and
studies locally, query and retrieve worklist from Hospital Information System or Radiological
Information System (HIS/RIS), import of a list of patient information from an Excel file for screening
examination purposes, etc.
In the navigation bar [PATIENT] screen, there are mainly three pages related to worklist. This chapter
describes each in detail.
 NEW. Create a new study locally, create a new patient, and select protocols.
 WORKLIST. Query and retrieve remote HIS/RIS scheduled worklist.
 LOCAL. Manage local new studies, and ongoing or completed studies including remotely retrieved
studies.
A study has multiple states from its creation to completion that is indicated in the Status column of the
LOCAL worklist.
Symbol Status Description
Scheduled Local new studies, or studies that have not yet started.
Local newly created studies or those retrieved from HIS/RIS that have
Suspended
started and exited but are not finished.
Completed locally created studies and those retrieved from HIS/RIS. This
Completed
also includes studies that completed partial exams but abandoned.

3.1 Creating Local Studies
In the PATIENT screen, you can create local patients and examination tasks. When you enter basic
patient information, you can use the Tab key to switch fields to fill in.
Please ensure that the patient name and patient ID are entered correctly. Incorrect input can result in
duplicate records for a patient, making it difficult to query the patient in the future.
NOTE: Fields marked with “*” are compulsory. If a required field is not filled in, the exam cannot
begin.
The Software Predefined Protocol List
Selected Protocols
Figure 3-1: New Patient Screen
After the date of birth is filled in, the software automatically calculate and display the age; conversely,
after the patient's age can be entered, the software calculates the year of birth.
Then, specify the patient's body size, gender, and pregnancy status. It is very important to select the
patient's body size correctly, which will affect the selection of exposure parameters and thus affect
the image quality at the end.

Male Natural male
Sex Female Natural female
Gender unknown, transgender, bisexual, neutral, etc. Default

Unknown/Other
gender.
Not Pregnant Not pregnant female
Possibly
Possibly pregnant but no proof female
Pregnant
Pregnancy
Status Definitely
Pregnant female
Pregnant
Female without a pregnancy status check. Default pregnancy

Unknown
status.
After filling in the patient information on the left side of the “NEW” patient screen, the next step is to
select protocols for exam. In the upper right of the protocol list, the default is often used protocols. By
clicking one body part of the virtual patient, protocols of the corresponding body part is listed for
selection. When an exam protocol is selected, it is added to the below selected protocol area.
The software supports selecting multiple studies of one patient at the same time to start examination.
One study has one accession number.
To save the being created study locally and continue to create another one, click the "Save to Local"
button, and the newly created examination information will be saved in the LOCAL study list. Its status
is scheduled.
To start the being created study, click the "EXAM" button in the navigation bar. This study will be
saved in the LOCAL study list after suspend or complete it.
3.2 Obtaining Worklist from HIS/RIS
If the software is connected to RIS/HIS system, in the "WORKLIST" page, click the “Refresh” button
to load scheduled studies from RIS/HIS system.
To obtain studies with some specific criteria from HIS/RIS system, input query criteria in the query
panel and then click the Query button. Then, select one from the queried results to start examination.
The connection between the host computer and the hospital network (including RIS/HIS/PACS/
printer, etc.) may be wired or wireless, or both. In the status bar at the bottom of the software screen,
relevant network status are indicated.

Symbol Name Decryption
The tethered Ethernet to the hospital network (including

Network connected
RIS/HIS/PACS/ printer, etc.) is connected.
Wired
Network The tethered Ethernet to the hospital network (including
No network access RIS/HIS/PACS/ printer, etc.) is disconnected. Click on the
Symbol to see details.
Wireless network
The wireless network works fine and in the best condition.
signal best
Wireless network
The wireless network works fine.
signal good
The wireless network signal is weak, and the data
Wireless Wireless network
transmission speed is very slow. It is suggested to improve
Nework signal weak
the quality of wireless signal.
The wireless network is connected, but the signal is so weak
Wireless network
that it is barely usable. Please contact IT admin to improve
signal too weak to use
the quality of the wireless signal.
Wireless network The wireless network connection is broken. Please contact
broken IT admin to restore it.
NOTE: After obtaining worklist from HIS/RIS, if the network is interrupted intentionally or
unintentionally, the software will not refresh worklist anymore and will retain the latest refresh
results until the network is recovered.
When a scheduled study in WORKLIST is started, if some or all of required images of this study have
been acquired, these images will be saved in the local database, and this study can be seen in the
[LOCAL] study list.
3.3 Local Study Management
In the "PATIENT > LOCAL” screen, with the help of the query panel, operators can start one
scheduled study, resume one suspended study, or perform some other study management activities.

Figure 3-2: LOCAL Study List Screen
For all LOCAL studies, operators can edit, delete, and protect one or multiple studies. The following
table briefly describes related operations.
Any study has errors can be corrected, such as patient information error, or
Edit Study
protocol information error.
 Delete one or multiple studies, which acquired images will also be deleted
Delete together.
Study  If a study obtained from HIS/RIS is deleted, it may be retrieved again.
 Refer to Chapter 6 “Image Management” for more descriptions.
To protect one or multiple studies from being deleted, especially for studies
Protect
containing acquired images. Refer to Chapter 6 “Image Management” for more
Study
descriptions.
If two patients' information or studies are confused, they can be easily corrected
Swap Image
by this function, including scheduled, suspended, and completed studies.
Operators can import patient information list in batches from Excel files. It is
Import Study
often used for screening.
For a study that has not been completed, it can be selected again to start or resume examination.
For details, please refer to Chapter 4"Image Acquisition".
For completed studies, they can be exported, sent to PACS server, and shared to cloud etc. Please
refer to Chapter 6 “Image Management” for details.

3.4 Editing Studies
A patient’s information and/or examination information may have errors or incomplete, so it is

necessary to edit, correct or complete these information, including but not limited to:
 Information of locally created patients is incorrect or incomplete

 Information of studies obtained from HIS/RIS has some errors or incomplete
 Emergency examinations
 Information of patients imported from Excel files is incorrect or incomplete
Figure 3-3: Edit Patient and Examination Information
After modifying the patient information on the left side, click the button "Save" and the relevant DICOM
header information of each image of this patient will be updated.
If the examination protocol of two images are confused, please drag and drop one image thumbnail
onto the other. It will take effect immediately.
If the examination protocol of one image is wrong, please drag and drop this image thumbnail onto
the correct view picture (if not exist please create it first). It will take effect immediately.
NOTE: The editing operations for all patients and their examinations are only valid in the local
database. For the patients and examination information obtained from HIS/RIS, please notify
HIS/RIS to make corresponding modifications manually.

NOTE: All correction operations for patient information and study information will be recorded for
audition by this software.
3.5 Swapping Images
When studies of two patients are confused, for example, it should be Murray’s turn to start
examination but Mary went to the x-ray room and started examination, images acquired need to be
swapped. This operation is also valid for a local study and a study obtained from HIS/RIS.
Figure 3-4: Swap Image Screen
Drag and drop operations with mouse are supported. Also, the software provides below buttons for
related operations.

 Select an image of the left patient, select an image of the right patient, and
click the button to exchange the two images to each other. It is similar to
the drag-and-drop operation.
 Operators can drag and drop an image of one patient onto an image of the
Swap Image
other patient. Then, these two images are exchanged.
 An image of one patient can also be dragged and dropped onto a view of
the other patient. Then, the patient information and view name of this image
will be changed.

Move Image Select an image of the left patient and click the button to move it to the right
to Right patient. This operation is equivalent to dragging this image from the left patient
Patient to the blank area of the right patient.
Move Image
to Left It is the opposite operation of “Move Image to Right Patient”.
Patient
Delete
Select a view and click the button to delete it. To add a protocol, click [+].
Protocol
Copy To copy a view, select it and click the button. To copy the view of an image,
Protocol select this image and click the button.
If rejected images of two patients are also confused, it should also be corrected.
NOTE: All modification operations for patients and their examinations are only valid in the local
database and will not change images that have been sent to PACS node. To update PACS nodes
for these local modification, please manually resend these images.
3.6 Emergency Examination
To start an emergency examination without the registration process, click the Emergency button.
Then software loads the EXAM window directly for technicians in order to acquire images of this
emergency patient.
Immediate X-ray examination is required or no patient information is available

Emergency
temporarily. For example, a patient is unconscious and unidentified.
After clicking Emergency button, the software will register an emergency patient automatically with
the name composed of prefix, current date and sequence number. The sequence number increases
1 by each patient.
NOTE: The prefix of the emergency patient name, the default exam procedure and other factors
can be modified in the system settings. Please refer to “Emergency Settings” in Chapter 8.
After an emergency examination is completed, it will be saved in the “LOCAL” study list. Whenever
an emergency patient information is clarified, his/her identification information and examination
information should be corrected and completed with the study editing function.
3.7 Querying and Sorting Studies

Querying and sorting operations can be used when the worklist is too long and a specific study needs
to be looked up quickly. Studies can be queried by multiple query criteria in the query panel, which is
part of the operation panel in the "LOCAL" page and the "WORKLIST" page.
 Studies can be queried based on the patient name, ID, and/or

accession number.
 The input focus jumps sequentially among the query fields by

clicking the Tab key.
 Queries are case-insensitive and Chinese-English-insensitive.
 Support fuzzy query character "*", such as "George *". Here, "*"
may represent one or more words or letters.
 Support partial matching queries, for example, with part of a

name.
Figure 3-5: Query Panel
After specifying the query condition, press the [Query] button, and the matching studies will be listed.
Click on one column heading in the study list, and the list will be reordered accordingly. It is either
ascending or descending alphabetically; by default, descending after odd number of clicking, while
ascending after even number of clicking.
3.8 Screening Examination
For large throughput of patients, centralized and similar examinations, such as physical screening
examination, patient information is required to be input quickly. The software provide an Excel
template for this special application.
Patients' information can be filled in the Excel template file in advance, and then imported into the
software. Then, the software automatically generates accession numbers for patients.
The following figure is an example of patient information template. An editable Excel template file,
"Import Template_en_v2.xls", is saved in the software installation directory. To modify this file, please
follow below rules:
 Lines in this Excel file should coherent no empty line.

 Before importing this excel file, please try to empty old data to avoid duplicated exams.
 PID, Patient Name, Age and Sex are all required. Otherwise, information in this line is
uncompleted and it is an illegal line and thus will not be imported.

 The length of PID or Patient Name should not exceed 64 characters. Otherwise, this line will not
be imported.
 The Sex field is only one character, F/M/O, abbreviation of female/male/other respectively.
Otherwise, this line will not be imported.
Figure 3-6: Patient Information Template
3.9 Use of Barcode Reader
If the barcode reader is connected with the software, the workflow efficiency will be improved.
Barcode reader is a second-class laser device. Its laser beams are emitted from
its scanning hole. To avoid being irradiated by the laser beam, do not look at
the scanning hole.
The content reading from the barcode is usually configured as the Patient ID or Accession Number.
This software can search this content in worklist. For example, if the barcode content is mapped to
the accession number, the software will find this content in the worklist and the corresponding study
will be selected for further operation.
When a barcode reader is used, the input focus is automatically placed on the configured text field of
Patient ID or Accession Number. If the input focus is elsewhere, put it to the configured text field with
the mouse.
When scanning the patient's barcode, if the hospital information system (HIS) or radiation information
system (RIS) is connected, the software will find the corresponding patient and examination
information from the worklist based on the barcode input. If no HIS/RIS, the software will query local
database according to the barcode input.
After finding the corresponding study of this barcode, the software will automatically start its
examination. If the scanned barcode cannot be found, the corresponding information needs to be
added manually.
NOTE: For further and detailed information on the barcode reader usage, please refer to its
manufacturer's user manual.

Image Acquisition Page 23
4 Image Acquisition
4
Image
Acquisition
This chapter describes the complete image acquisition process from preparations before acquisition
to image quality control. The software supports not only digital detectors, but also conventional
cassettes. The image acquisition screen is shown in the below figure. Its left side is the View/Image
Index pane, the middle area is the information area/image preview area, and the right side is the
operation panel. The top right of the screen is the exposure status area.
Index
Pane
Operation
Panel
Figure 4-1: Image Acquisition Screen

In the Index pane, operators can select any view for exposure; if no selection, the exposure order will
start from the top view to the bottom one.
4.1 Preparations before Acquisition
4.1.1 Selecting Workstation
The software supports several workstations, each of which corresponds to a detector or Bucky. In a
specific system, depending on the hardware configuration, different combinations of these
workstations can be supported, up to three digital acquisition modes (i.e., non-conventional mode).

The most basic mode of examinations. The digital detector is placed inside
Table Mode the Bucky under the table. The patient can be supine, decubitus, and prone
on the table.
Wall Stand A common mode. The digital detector is placed inside the Bucky of the Wall
Mode Stand, and the patient can be standing, sitting, and leaning etc. in front of it.
The digital detector can be placed on the table surface or placed freely in any
Free Mode
position, making it easy to acquire images for special views.
The second free mode digital detector, depending on the hardware

Free Mode 2
configuration, does not exist in every system.
It is for conventional X-ray exposures on CR plates or cassette films to

Conventional
produce CR images or film images. Since there is no digital detector in this
Mode
mode, there is no digital images displaying in the software.
4.1.2 Adjusting Exposure Factors
In general, the default settings of exposure factors are enough. Operators can also manually adjust
them as needed. Exposure conditions are closely related to the patient's body size. By choosing
different body sizes, the pre-defined exposure conditions can be switched quickly. Then, according
to the patient's specific conditions, do some fine-tuning. The figure below illustrates the relationship
between patient's body size and exposure factors.

Figure 4-2: Body Size vs. Exposure Factors
The following table gives some brief descriptions of exposure factors.
Factor Name Description
 The tube voltage determines the quality of X-rays, reflecting the ability of X-rays
to penetrate objects, primarily affecting the contrast of raw images and also
affecting the brightness of raw images. The higher the tube voltage, the wider
Tube the gray level of the acquired image.
kV 儿童/瘦小成人正常成人体型肥胖或肌肉型成人
Voltage  Click on [+]/[-] in the display area of the kV to change the value of tube voltage.
If the maximum or minimum value is reached, the tube voltage will not change.
 The range of tube voltage varies with the type of high voltage generator.
 Empirical formula: mAs × 2 ≈ kV × 115%
Tube
mA It is the tube exposure current. It influences the brightness of raw images.
Current
 The exposure time can be adjusted manually only when the time mode is
selected.
 The time mode is usually used in cases where there are special requirements
Exposure for exposure time. For example, chest radiography requires short exposure time
mS
Time to reduce motion artifacts.
 In the time mode, the mAs value cannot be adjusted manually, but it will be
changed by adjusting mA and mS values respectively.
 Note: the minimum exposure time is 50 mS for some dynamic girds.
 It is the product of exposure current and exposure time. It affects the brightness
of raw images.
Current
 Only when the mAs mode is selected, it can be adjusted manually.
mAs Time
Product  In mAs mode, the values of mA and mS cannot be adjusted. When changing
the mAs value, the generator will automatically select the corresponding mA
and mS values. At this time, the exposure time may be less than 50 ms.
In AEC mode, it is used to adjust the x-ray density, which influences the brightness
Density Density
of raw images.
When manually adjusting the exposure parameters, clicking on the [+] button can increase the value;
conversely, clicking on [-] can reduce the value; holding down can make the value change quickly
until it is released.
4.1.3 Selecting Focal Spot

The focal spot selection is related to the exposure current and the exposure time. It affects the
sharpness of object edge in image.

 Identifies controls or indicators associated with the selection of a small
focal spot.
 Mainly used for small and thin body parts such as limbs and skulls, as well
Small Focal as for children and small size adults.
Spot  Imaging with the small focal spot can improve the edge sharpness of
objects in image and reduce the blurring of edges.
 However, for large body parts, it will take longer exposure time when using
small focus, and thus shorten the service life of tubes.
 Identifies controls or indicators associated with the selection of a large
focal spot.
Large Focal
 In order to reduce the exposure time and reduce the influence of patient
Spot
and organ movement on image quality, it is often used for thick body parts
as spine, chest, abdomen, hips and so on.
NOTE: The exposure current (mA) of tube is normally limited by its focal spot sizes. The focus
can be automatically switched depending on the current level for some tubes.
4.1.4 Use of AEC
Automatic exposure control (AEC) acquisition mode is different from manual acquisition mode (mAs
mode and time mode). The exposure time is automatically truncated by monitoring whether the X-ray
dose received by the ionization chamber reaches the preset radiation dose. AEC can automatically
compensate for the differences caused by the thickness, density and technical parameters (such as
mA, kVp and SID) for different body parts, and finally produce best images with uniform quality.
Click on the “AEC” button to select the automatic exposure control mode; then, click on different ion
chamber symbols to use any combination of them. Whether to use AEC or not depends on the
exposed body part. Usually, the software's protocol has default settings for each view, and thus it
needs to be changed only in some special cases, for example, one side of the patient's lung is cut off.
Right Ion The left and right ion chambers should be selected to expose symmetrical
Chamber body parts, such as lungs or kidneys.
The middle ion chamber is located at the center of the X-ray field of view.
Middle Ion Therefore, the exposed body part should be located in the center of the X-ray
Chamber field of vision. For small body parts as neck, only the middle ion chamber
should be selected.
Left Ion The left and right ion chambers should be selected to expose symmetrical
Chamber body parts, such as lungs or kidneys.

It is very important to positioning patients correctly. For example, when an arm is exposed, if it cannot
cover the selected ion chamber, it will result in an early end of the exposure and thus cause insufficient
exposure.
NOTE: In AEC mode, the exposed body part should cover selected ion chambers. If the FOV
cannot cover selected ion chambers due to hardware limitation, please choose manual exposure
mode.
The sensitivity of AEC can be changed by adjusting the optical density. The range of optical density
is related to the high voltage generator. Default density (0) is set for normal contrast and density
requirement. For patients with large muscles, increase density appropriately; conversely, for patients
with small muscles, reduce density appropriately. If an image shows obvious particle noise, the
density can be increased. If an image is too black or too bright, adjust the LUT curve instead of the
density value.
The exposure time and mAs in AEC mode are not adjustable. After exposure, the real exposure time
and mAs value will be automatically displayed. The backup time of AEC may be displayed in the time
field according to different generators. If the maximum exposure time of tube is reached, it could lead
to inadequate exposure; and thus please increase mA to avoid this case.
NOTE: The AEC is related to the high voltage generator. If there are frequent errors of AEC, or if
the AEC backup time is reached frequently, it indicates the system may have some problem.
Please contact service engineers of the system vendor.
4.1.5 Other Technical Preparations
Some other technical preparations maybe needed based on different hardware configurations. For
example, it may be necessary to select a proper copper filter according to different anatomies. In
addition, pay attention to the following technical conditions.
 Identifies controls for opening the collimator blades, or indicates partially or

fully open state.
 Adjust collimator and make sure the X-ray field of view (FOV) covers exactly
Collimation
the exposed body part.
 A lager FOV not only lets patients absorb more doses, but also affects the
image quality.

 It is X-ray source to imager distance.

 The larger the SID, the sharper the object edge in the image.
 Due to the attenuation rule of the distance square ratio of X-ray energy, the
SID
tube needs to work with higher loads for a larger SID; and thus it may affect
the tube life.
 Usually for small body parts, SID is about 120 centimeters.
 Some systems may be equipped with high or low density grids.

 In order to improve the image quality for body parts thicker than 10 cm, it is
usually necessary to select an appropriate grid and ensure it is correctly
inserted.
Grid
 Grids not only absorb a large amount of scattered x-rays, but also a small
amount of effective x-rays. Therefore, the effective radiation absorbed by
grids needs to be compensated by increasing the voltage according to the
density of grid.
4.1.6 Patient Preparations
Patients should also take some preparations before exposure. First of all, ensure the current patient
information and examination information are correct. Secondly, patients should take off unnecessary
clothing and jewelries, which may impact image quality, to avoid re-exposures. Thirdly, patients
should take necessary X-ray protection. Finally, guide patients to take the correct positioning. In
addition, patients should adopt the appropriate breathing mode to cooperate with the acquisition.
Breathing Mode Anatomy
1 Breathe naturally Extremities
2 Breathe naturally and then hold Skull, Neck, and Heart
3 Inhalation deeply and then hold Lung, Upper Ribs
4 Exhalation deeply and then hold Abdomen, Lower Ribs
5 Breathe quietly and shallow Chest
If no proper protective measures are taken for patients, the X-ray system
could do harm to them.
NOTE: If there are errors in patient information or examination information, please correct them
in PATIENT > LOCAL screen.
4.2 Acquiring Image
Once the acquisition conditions are ready, press the hand switch to shot X-ray. Usually, after pressing
the 1st-level switch, each imaging component starts to prepare. After holding the 1st-level switch for a

little stay, i.e., 1-2 seconds, the 2nd-level switch is pressed and hold for about 1-4 seconds. Generally,
the generator itself will give a "beep" sound to indicate exposure. Then, release the switch after a
short stay. Finally, the preview image will display and then the full size image in a few seconds.
Premature release of hand switch may cause exposure failure.
In the EXAM screen, the software displays the states of the hand switch, the high voltage generator
and the digital detector as described in the below table.
Device Symbol Status Description
The 1st-level/2nd-level hand switch is pressed down. The 1st-level

Pressed
switch issues the preparation signal, while the 2 nd-level switch issues
Down
the X-ray trigger single to generator.
X-ray
Switch Released The hand switch is in the released state.
Warming
Tube is warming up.
up
Generator is idle and will enter the preparation stage after pressing
Idle
down the 1-st level switch.
X-ray The tube is emitting x-rays after the 2nd-level switch is pressed
Generator Busy
down, while it means initializing if the switch is not pressed down.
Unit
Inhibit
X-ray exposure is not allowed.
Exposure
Idle The FPD is idle.
Flat Panel
FPD is busy (including preparing, acquiring image, transferring
Detector Busy
image etc.) It takes about several seconds.
(FPD)
Error FPD error or lost connection.
There are many reasons of inhibiting the generator exposure. For example,
 The x-ray room door is open.

 The remaining power of detector battery is below the required threshold (valid only for battery-
driven detectors).

 Lost communication with the current detector.

 The temperature of the current detector is too low.
 The temperature of the current detector is too high.
 The current detector is sleeping.
 The Wi-Fi signal strength of the current detector is lower than the required threshold (only valid
for wireless detectors).
 For detectors with electronic collision sensors, exposure will be inhibited if a serious collision is
detected.
 Lost communication with generator (valid only for systems with generator communication ability).
 The remaining heat unit (HU) of tube does not meet the exposure conditions. At this time, a
message will prompt; moreover, generator reset or restart cannot clear the inhabitation.
 Synchronization box failure (valid only for systems with synchronization boxes)
 Any software failures affecting exposure, for example, PPACS service is not running.
 Other hardware failures or not ready, such as positioning devices.
If an error occurs during exposure, the system status symbol on the status bar will prompt a warning
or error message, which will disappear in seconds.
When the generator has some errors and cannot be self-corrected, please
Reset
click the reset button. If it still cannot restore to the normal status after reset,
Generator
please restart it manually.
NOTE: In the EXAM screen, some model of detectors may enter the "sleeping" mode after a
certain period of time to save energy according to different configurations. Most of them are
battery-driven portable detectors. It normally takes about several seconds to “wake up” a detector
to the working state.
When an image is being uploaded from the detector to the host running the software, if the network
suddenly disconnected, it will be indicated in the corresponding detector network symbol on the status
bar, and an error message box will be prompted. Please recover the network failure as soon as
possible. When the network is restored, its symbol on the status bar will become normal. At this time,
the software will re-upload this image.
When failed to upload the acquired image from the detector due to the
network problem, please do not restart the detector to avoid the loss of
image.
When failed to upload the acquired image from the detector due to the
network problem, please do not restart the software, and do not exit the
current exam, to avoid the failure of restoring the current image.

4.3 Image Quality Control
The exposure dose will affect the image quality. Reasonable exposure dose will get the best image
quality. Overexposure or underexposure will result in loss of image quality; if the degree of
overexposure or underexposure is serious, it will affect the diagnosis and need re-exposure, thus
increasing the patient's radiation dose.
EXI is the abbreviation of Exposure Index, which reflects the exposure dose. It represents the dose
level that reaches the detector surface after passing through the object in the irradiated area. The
larger it is, the higher the incident dose to the detector surface after passing through the object in the
irradiated area.
Exposure index includes relative EXI and standard EXI, which have a definite conversion coefficient.
Relative EXI is the calculation of the average gray level of the exposed part on the image. Standard
EXI is also called EXI as short. The DI (Deviation Index) reflects the deviation level between the
standard EXI of the current image and the expected target EXI.
EXI values are stored in the header of DICOM image and can be seen in the four corners of the image.
Image acquisition technicians can judge whether the exposure dose is appropriate according to EXI,
DI and Relative EXI in the information displayed in the four corners of the image.
The relationship of DI and image quality is described in the table below.
DI Exposure Level Image Quality

The image noise is serious. Thicker body parts may not get
≤ -0.5 Under Exposure enough radiation dose. It may cause the lack of image
information and affect clinical diagnosis.
Appropriate quality of images can be obtained for clinical
(-0.5, +0.5) Normal Exposure
diagnosis.
When overexposure is within the linear interval of a detector,
the image quality will not be affected and even be improved,
but patients received more radiation dose. If the degree of
≥ +0.5 Overexposure overexposure exceeds the linear range of detector, the
image quality will be reduced, and even the phenomenon of
"burnout" will occur, which will lead to the loss of image
information and affect clinical diagnosis.
Relative EXI is related with the detector A/D. At present, there are mainly 14-bit and 16-bit digital
detectors on the market. The table below gives the general reference range of relative EXI for different
body parts.
Body Part 14-bit Detector 16-bit Detector
1 Extremities 450-750 1200-1500
2 Skull & Neck 750-1200 1500-2500

3 Thorax 800-1200 1500-2500
4 Abdomen & Hip 1200-1500 2500-3500
5 Lumber Spine AP/PA 1200-1500 2500-3500
6 Lumber Spine Lateral 1500-2000 3000-4500
When the relative EXI is too large, patients has absorbed more doses. When it is too low, image noise
is more serious, and even influence clinical diagnosis. Therefore, X-ray examination should follow the
principle of "as low as reasonably achievable" (ALARA), to ensure that the diagnosis is not affected,
as far as possible to reduce the radiation dose of all patients, especially children and small patients.
In order to balance the image quality and the patient's absorbed dose, the following factors should be
carefully considered before each exposure:
 Field of Vision (FOV) is very important for specific anatomical areas. If FOV is too large, it will
bring more soft x-rays and thus cause the image become foggy and difficult for diagnosis.
Moreover, because of the poor penetrability of soft x-rays, patients will absorb more doses.
Therefore, careful consideration should be given to the anatomical area covered by the
collimation.
 Make sure the patient, primarily the body part being exposed, is positioned correctly in the x-
ray beam center especially when using the automatic exposure control (AEC). If the exposed
body part dose not properly cover ion chambers, the actual dose maybe larger than or less
than the required dose, and thus leading to overexposure or re-exposure.
 Try to use pediatric assisted positioning devices. These devices are often helpful for certain
patients and examinations by reducing patient movement that might lead to repeated
exposures.
 Protective clothing/lead baffle/shielding. Please take proper protective measures, including

shielding the non-exposed body parts of patients.
If the image quality is too low to satisfy clinical diagnosis because of various reasons, for example,
the patient moved during the exposure process and thus resulting in unclear image, operators can
click the "Reject" button and select a rejection reason. Operators can choose the main reason for
rejection or enter a reason in the custom textbox. If reject an image in the “EXAM” screen, the view
of the rejected image will be automatically copied. By default all images are auto accepted after
acquisition.

If the current image is accepted, click the Reject button to reject it. When an
image is rejected, a symbol "X" will be added on its thumbnail in the image
Reject Image index. Rejected images will still be saved in the local database, and can be
/Delete View re-accepted for other further operations as re-process, send and export etc.
If the current one is not an image but a view, click this button to delete it from
the image index.
For a rejected image, click the Accept button to accept it again if its quality is
Accept Image satisfactory. In the image index, there will be a symbol "√" on each accepted
image.

Image Manipulation Page 34
5 Image Manipulation
5
Image
Manipulation
This chapter focuses on various image manipulations including topics as basic and advanced image
processing, image measurements and annotations, and image crop and mask etc. Two methods are
normally used to start image manipulations, one is after image acquisition in an ongoing exam; the
other is selecting a completed study and then click “VIEW” in the navigation bar, or double-clicking a
completed study directly. The following picture is an Image Viewer screen copy.
Image Manipulation
and Preview Area
Image
Index
Operation
Panel
Figure 5-1: Image Viewer

The left pane is the image thumbnail list, the middle area is the image preview pane, and the right
pane next to the navigation bar is the operation panel. In the operation panel, users can customize
the tool list by hiding/showing some tools in SYSTEM > Preferences. In this chapter, all manipulation
tools will be described.
There are also 4 sub-panels in the operation panel, which are described in the following table.
Clicking this button will open the image processing sub-panel, where several
Image
predefined image processing styles are provided for user’s selection, and
Processing
advanced image processing tools are also available for image processing
Sub-Panel
experts.
Crop & Mask Clicking this button will open the image cropping and masking sub-panel, where
Sub-Panel some often used film sizes are also listed for quick cropping.
Annotation Clicking this button will open the image annotation sub-panel, where L/R mark
Sub-Panel and often used text annotations are ready for easily adding an annotations.
Measurement
Clicking this button will open the image measurement sub-panel.
Sub-Panel
5.1 Basic Image Manipulation
5.1.1 Common Manipulation Tools
For any image, its window level and window width could be adjusted with a mouse. After pressing the
right mouse button, move the mouse in the image display area, slide up and down to change the
window width, and slide left and right to change the window level. In addition, the software also defines
the following general operation buttons.
Resetting the mouse cursor. Change the mouse cursor to Arrow. The state of
Reset the mouse will be changed by some operations, such as magnifying glass,
Cursor zooming operation, roaming operation, etc. To restore the mouse's normal
state (arrow), click the button. The shortcut is the ESC key.
As default, manipulations on an image will be saved to the same one

Save As
automatically. To save the current image as a new one or copy it, click Save
New/Copy
As New button and then one of its copy will be created.
After a series of operations are applied on the current image, such as zooming,
panning, flipping, rotation, and inverting. To cancel all the changes to the image
Reset Image
and restore it to how it was when it was loaded in the VIEWER window, please
click the Reset Image button.

5.1.2 Select Image Layout
There are 4 layouts are ready for selection. Click the corresponding button to select an image layout.
1×1 Layout Only one image will be displayed in the preview pane.
2×1 Layout 2 images will be displayed in the preview pane.
Double-click on an image in a multi-grid to display the image in a 1x1 layout.
To select several discontinuous images, hold down the Ctrl key of the keyboard when selecting
them; click on the selected image again, that is, cancel the selection of the image.
To select multiple consecutive images, after selecting the first image, hold down the Shift key on
the keyboard, then click on another image, and all images in the middle are also selected.
All images selected will be marked with a small box. There can only be one active image with a dashed
border.
5.1.3 Rotating and Flipping
With regard to the direction of image viewing, the software provides the following five ways to rotate
and flip images.
Horizontal
The image can be horizontally mirrored by clicking the Horizontal Flip button.
Flip

Vertical Flip The image can be vertically mirrored by clicking the Vertical Flip button.
Anti-
Clockwise The image can be rotated 90°anti-clockwise as required.
Rotation
Clockwise
The image can be rotated 90°clockwise as required.
Rotation
After clicking the button, you can rotate the image at any angle with the mouse.
Free
Press the left mouse button at a certain position of image, then drag and rotate,
Rotation
release the mouse and finish the rotation operation.
5.1.4 Operation of displaying scale
An image can be enlarged to view an area which is of special interesting. There are multiple tools could
be used for image displaying ratio related operations.
Fit-to-
Click Fit-to-Window button to display the current selected image in the full size
Window
mode.
Display
Click the 1:1 button, the image can be viewed in the Pixel to Pixel mode. One
Pixel-to- monitor pixel is on behalf of one image pixel. To view the interested area of an
Pixel image, if this area is in the outside of the display area, hold the left mouse key and
Display move mouse to a desired direction. In the pixel-to-pixel mode, it is easier to view
more details of an image.
True Size After clicking the True Size Display button, the image will be zoomed to its true
Display size.
Click the Zoom button, then press and drag the left mouse button up or down on
an image to zoom in or zoom out it. Dragging up increases the image zooms while
Zoom
dragging down decreases it. Click the arrow button in the operation panel to
restore the mouse status.
When you zoom in image, it may become larger than the image area. Panning
(moving the image within the image area) then becomes important. Click the Pan
Pan
button, then click and drag the left mouse button within the image area to move
the image. Release the mouse button to drop the image in its new position.
Press the Magnifier button and then click on the interested region which you want
Magnifier
to magnify, the magnifying window will appear on the interested region.

5.1.5 Brightness and Contrast Operations
The brightness and contrast of image can be adjusted by the right mouse button. After pressing the
right mouse button, move the mouse on the current image in the displaying area to adjust its WW/L.
Slide up and down to change the window width, while slide left and right to change the window level.
At the same time, the information of window width and window level can also be updated dynamically
at the 4-courner of the current image in the displaying area.
The following figure is an example of image contrast. The contrast of the left image is larger than that
of the right one.
Figure 5-2: Image Contrast Example
In addition, the software also provides the following tools to observe the image more easily.
Increase
Click on the button, and the image brightness increases.
Brightness
Decrease
Click this button to decrease the brightness of the Image.
Brightness
Increase
To increase the image contrast. The image latitude will be decreased.
Contrast
Decrease
To decrease the image contrast. The image latitude will be increased.
Contrast
Auto When the Auto Windowing button is clicked, the image will automatically adjust
Windowing its window width and window level.

After the button is clicked, use the mouse to select a Region of Interest (ROI)
ROI
on the image, then its window width and window level are applied to the whole
Windowing
image.
After the Manual Windowing button is clicked, the mouse pointer will be
changed to . When the mouse is in this status, moving the mouse
horizontally can adjust the image contrast (WW). Moving leftward can decrease
Manual WW value, while moving rightward can increase WW value. The smaller the
Windowing WW value, the sharper the image is. Similarly, moving the mouse vertically can
adjust the brightness (WL). Moving upward can increase WL value, while
moving downward can decrease WL value. The larger the WL value, the
brighter the image. This tool is useful for touch-screen operation because an
user can use his/her finger to adjust WW/L.
To display the current selected in its inverse statue, click the Invert button.
Invert
Click this button again to revoke the last invert operation.
The following figure shows an invert operation example.
Figure 5-3: Image Invert Example
5.1.6 Cropping and Masking
If necessary, users can crop or use a mask to select a part of the image to save or print. After acquiring
an image, its original size and shutter information are saved locally. Images can be manually cropped
again, and cropped images can be sent to printers or image archiving servers. The software provides
the following tools for image cropping and masking.
Crop and Click this button to enter the crop and mask sub-panel, which also includes a
Maks Panel variety of common film sizes for easy image cropping

When you crop a rectangle in an image, you can adjust the size and position of
the area you want to crop. If the trimming box is not displayed, click this button,
and the rectangle enclosed by the four lines will appear on the image, and the
corresponding content is the clipped image. When the mouse moves to a line,
the mouse changes to a horizontal or vertical arrow shape, then press the left
Ranctangualr
mouse button and move to drag the crop line to the appropriate position. When
Cropping
you move the mouse over the four corners of the trimming frame, the mouse
changes to a diagonal arrow shape, and then press the left mouse button and
move to drag the two lines that make up the corner. When the mouse is placed
inside the trimming box, the mouse becomes the shape of the hand, and then
the left mouse button is pressed and moved to drag the entire trimming frame.
Cancel When the button is clicked, the cropping frame is removed and the cropping
Cropping operation is cancelled.
Polygon After clicking this button, use the mouse to draw an arbitrary polygon mask. The
Masking area outside the shutter is not visible.
Cancel
Click this button to cancel the result of the shutter.
Masking
When annotations or measurements are outside of the cropping or masking area, they will also be
cut off. To re-crop an image which display size is smaller than the expected cropping size, please
zoom it out first by clicking the Zoom button.
5.2 Re-process Images
5.2.1 Image Processing Styles
The software provides 5 common image post-processing styles and one user-defined image post-
processing style. An operator can choose one appropriate style according to the doctor’s preference
or the actual clinical diagnosis needs, and obtain different image post-processing effects. The
following table gives a brief description of each style.
Style Description
The default style of the factory. It tends to balance the density contrast and detail
1 Balanced enhancement of each tissue in the image to obtain a more balanced display of each
tissue.
High The density contrast between different tissues is improved, and the degree of detail
2
Contrast enhancement is appropriately enhanced to better highlight tissue information.
It tends to reduce the contrast between tissues with different thickness and X-ray
attenuation, and to highlight the soft tissue display. At this time, the density contrast
3 Soft between skeleton and soft tissue is weakened, and the tissues with different thickness
and X-ray attenuation can be displayed together. All tissues can be observed without
adjusting the window width and window level.

It tends to highlight bone tissue information. It is in order to improve tissue contrast and
4 Hard detail enhancement, so as to show the whole bone tissue and fine texture more clearly
and prominently.
It tends to weaken the contrast of tissue density and the enhancement of detail to
simulate the effect of CR or conventional film. It is worth noting that although the image
LUT
5 style processed by this style is close to CR or film effect, advanced post-processing is
still used here. If advanced image post-processing is strictly prohibited in some specific
scenarios, please turn off the advanced post-image processing.
Users can customize a set of image post-processing parameters according to their
6 Customized
actual requirements.
Usually, the balanced style can achieve a better display effect. To meet special requirements or for a
particular patient, users may need to choose a different post-processing style. The following is screen
shots of the image processing sub-panel and the advanced adjustment sub-panel.
5.2.2 Advanced Image Post-processing
Figure 5-4: Image Processing Style and Advanced Adjustment Panel
Using the histogram curve, the brightness and contrast of images can be adjusted, and the
organizational structure in a specific gray scale can be easily observed. Window Width is the width of

the curve (the gray range mapped). Window Level is the gray value corresponding to the center point
of the curve. Drag the square handle on the curve until the image is satisfactory: Drag the top square
handle to change the maximum density of the image, drag the bottom one to change the minimum
density of the image, and drag the middle one to change the center of the curve. At the same time,
the image in the image area updates with the modified curve in real time.
When adjusted with the right mouse button, moving the mouse in the image display area will also
change the curve, sliding up and down to change the window level of the curve, sliding left and right
to change the window width of the curve, and the curve will be updated at the same time.
If the default style cannot meet clinical needs, operators can click on the [Advanced] button to open
the Advanced Adjustment panel and adjust parameters to meet their own needs. Symphony
integrates a variety of advanced image processing functions, and provides an optimized combination
of parameters for different examinations to improve the quality of image diagnosis. Symphony
processing mainly includes the following four parameters.
Factor Description
It can improve the density contrast between different tissues in the image. If the
settings are too large, the too thick parts in the image will be too bright, while thinner
parts will be too dark. Excessively amplifying an image will cause its details to be over-
amplified, and thus mislead clinicians. For example, for Chest PA/AP, a smaller
Amplifier/ amplifier value is preferred because excessive enhancement of the lung texture is
1
Gain likely to cause a misdiagnosis similar to the thickening of the lung texture; for skull and
extremities, a smaller amplifier value is also preferred because the over-enhancement
of the trabecular bone is easily misdiagnosed as osteoporosis; while for the lumber
lateral view, its thickness is larger than other parts and thus larger amplifier value is
preferred. The weaker enhancement is similar to traditional film.
Used to control the clarity of the display of various structures. The larger the dynamic
range, the more structures are clearly displayed. By increasing this parameter, the
dynamic range of image can be enlarged, so that tissues with different thickness can
Latitude/
be displayed at the same window width and window level at the same time. Observers
2 Dynamic
can observe more information at the same time. For example, Chest PA/AP, its
Range
thickness is almost constant, i.e., no very thick parts while no very thin parts, and thus
its factor value is relative smaller; while for the lumber, a larger value is preferred;
otherwise, the information of the sacrum part is not enough.
Used to adjust the level of detail of images. The bigger the value, the sharper the
image, and the clearer the details, but the stronger the noise. It is more conducive to
Detail displaying small texture and density changes in the image. However, while enhancing
3
Enhancement the details, the noise granularity of image will also increase. Operators should take
into account the level of image noise while enhancing details. It is not recommended
to enhance details too much.
This parameter can get better noise reduction effect. The bigger the parameter is, the
greater the suppression of image noise and the smoother the image effect is. But at
the same time, it also weakens the image detail display. Operators need to take into
Noise
4 account the level of detail display while suppressing noise. It is not recommended to
Suppression
increase the parameter excessively. For the lumber lateral view, its thickness is larger
than other body parts and thus often has larger noises; therefore, a larger noise
suppression is normally required.

To achieve a natural effect, a smaller gain and a smaller dynamic range are preferred; otherwise, for
enhanced effects, a larger gain and a larger dynamic range are preferred.
Figure 5-5: Enhanced Effect (Left) vs. Natural Effect (Right)
Noise and detail are a contradictory unity. Excessive noise reduction will also result in loss of detail;
on the contrary, excessive detail enhancement will lead to greater noises.
Figure 5-6: Excessive Noise Reduction (Left) vs. Excessive Detail Enhancement (Right)
Different types of histogram curves have different effects. The often used one is sigmoid curve.

1 2
Figure 5-7: Different Effects with Different Histogram Curves

(1-Linear, 2-Log, 3-Exponential, 4-Sigmoid)
5.3 Measurement and Annotation
The software provides some common measurement tools described in the below table. For some
measurements, the length calibration is required before measurements.

Click the button and enter the measurement panel, which includes not only
Measurement
some common measuring tools, but also many drawing tools to identify
Panel
regions of interest.
For each image, measurement calibration can improve measurement accuracy.

To start calibration, click the length calibration button and then follow online tips.
Length On an image draw a line and input its real length into the text field of calibration.
Calibration A size-known object can be used as the reference during taking an exposure.
Note: a size-known ball is better than a ruler since it can decrease the deviation
caused by the x-ray angle.
It is to measure the distance between two points by selecting on an image. The
Line measurement result can be moved. To change a finished measurement, click
Measurement this line again to select it. Then moving one of the two points, the measurement
result will be updated at the same time.
To measure the angle between two lines. Firstly, select a point as the vertex, and
then select two points separately to create two crossing lines with the 1st point as
Angle
the crossing point. When moving anyone of these 3 points, the measurement
Measurement
result will be updated accordingly at the same time. The measurement result
texts can also be moved.
Delete
Click on a measurement or drawing result to select it, and then click the
Measurement
button to delete it. It is equivalent to the Del key on keyboard.
Result
Along with the measurement function, there are some common graphical annotation tools that can be used to
identify regions of interest in an image. See the table below for details.
Draw Click the button to draw a square on an image. After drawing, you can adjust its
Square size and position.
Draw Click the button to draw a circle/ellipse on an image. After drawing, you can adjust
Ellipse its size and position.
You can also add “L”/ “R” marker and comment text to an image and display them on the image. Each
mark/comment can only be added once on an image. This mark and comments will be sent or printed
with the image.
The added L/R marker and comments can be dragged and dropped anywhere within the image with
the mouse. Annotations cannot be dragged outside of the image's cropping box or the display area.
In addition to selecting system-predefined text annotations, users can add custom texts online. The
user's customized text, if used frequently, can also be saved to the system for easy addition later.

Annotation Click this button to go to the Add Comment sub-panel, which contains predefined
Panel L/R markers, as well as various common comments.
By clicking this button, the L marker can be added to the image, and its position
Left Marker
on the image can be changed by dragging the marker.
Right By clicking this button, the R marker can be added to the image, and its position
Marker on the image can be changed by dragging the marker.
To delete a marker or comment on the image, select it with mouse and then click
Delete
the [Del] key on the keyboard. Click this button and all added annotations on the
Annotations
image will be deleted.
5.4 Other Viewing Tools
On each image, its four corners show the patient's basic information, exposure dose, image
parameters and other related information. The content and location of 4-corner information can be
configured. The software also provides some other viewing tools as listed in the below table.
Reference The reference grid lines can be displayed as dashed lines on an image. Click the
Grid Lines button again to hide the reference grid lines.
DICOM To check the DICOM header information of the current active image, click the
Header DICOM Header Information button. To search a DICOM tag in the DICOM
Information header information window, click ‘Ctrl+F’ to start searching.
Display the radiation dose structured report (RDSR) of the current study. It is also
RDSR
a DICOM format image and can be sent or printed.
Show 4-
Displays the four-corner inforamtion on images. Click to change to the "Hide Four
Corner
Corners Info" button.
Information
Hide 4-
Hide the 4-corner information on images. Click and change to the "Show Four
Corner
Corner Information" button.
Information

Image Management Page 47
6 Image Management
6
Image
Management
This chapter mainly talks about the management of images. It includes the management of local
images, such as export, archiving, and printing operations; how to protect the patient-related images
from being automatically deleted by the system, local disk space management, etc. In addition, when
viewing images, you can select some images of one study and send them to the designated DICOM
node or different nodes.
6.1 Archive, Import and Export
The software provides the following main ways to send, export, and import image to meet different
clinical usage scenarios. This chapter will provide detailed instructions on the main ways in which
they are used.
Users can select one or multiple DICOM images and send them to one or
more specified archive nodes.
Send Image
After clicking the Send button, all selected images will be put in the
sending queue and handled at background by PPACS services.
The selected image(s) can be exported from the database to an external

directory or USB disk which is not manageable by the software. It can be
Export Image
DICOM format or computer compatible format, such as BMP, JPG, TIFF,
etc.

The selected image(s) can be recorded onto DVD/CD disks. It can be a

Burn Image patient's image for the patient's own archive, or it can be an image of
multiple patients for the purpose of hospital backup.
The selected image(s) can be uploaded to dedicated cloud space for
Share Image sharing. This is an optional advanced function. It is not included in this
chapter.
External DICOM images can be imported into the image database
Import Image managed by the software. You can import a single image file or all Image
files in a directory.
For completed studies the LOCAL page, you can select images of one study or multiple studies to
archive, export, print, share, burn to DVDs etc. External images can also be imported.
To select all images of multiple discontinuous studies, press the CTRL key of the keyboard when
selecting them. To unselect a study, click this selected study again.
To select multiple consecutive studies, select the first study, hold down the SHIFT key on the
keyboard and click on the last study. Then, all images of studies in the middle will be selected.
In the image viewer screen, you can also initiate an image export operation. The difference is that not
all images but selective images of one study can be selected for archiving, exporting, recording, cloud
sharing and so on.
To select several discontinuous images of one study, hold down the CTRL key of the keyboard when
you select them. To unselect an image, click this selected image again.
NOTE: Rejected Images cannot be selected for archiving or printing.
NOTE: All un-rejected images of a study could be automatically sent to the predefined default
archive node, if configured, whenever this study is finished.
NOTE: When performing the image export operation, according to the purpose of the export,
decide whether to carry out "anonymization" processing in export options, so as to protect the
patient's personal information.
6.2 Print Images

The software offers a flexible and versatile film composer for printing image on film or paper. It supply
us with what you see is what you get (WYSWYG). Users can select a predefined layout or design a
new layout. Printing jobs are executed at background and thus users can continue to use the software.
To open the film composer, normally, there are 3 cases:
 For an ongoing study, click “Print” in the navigation bar directly.

 In the local worklist, click “Print” in the navigation bar after selecting a study. Then, all accepted
images of this study will be loaded into the image index pane.
 In the image viewer, uses can only select one or multiple images and then click “Print”; then, only
selected images will be loaded into the image index.
NOTE: Images of multiple studies and of different patients could be loaded into the image index
for printing. Also, they could be printed on one film.
Figure 6-1: Film Composer Screen
In the film composer as shown in the above figure, the left pane of image thumbnail list is the image
index, the middle area is the current film sheet, and the right pane next to the navigation bar is the
operation panel.
Users could create multiple virtual film sheets and each is represented by a film tab in the top of
sheets. With these film tabs, users can easily page through from one film sheet to another.

In the image list pane, image thumbnails of the current study are listed. When the image index pane
cannot display all image thumbnails, users could use the up-down scroll bar in this pane or the scroll
button of a mouse. Users could drag one image from the image index into one viewpoint of the current
film sheet.
With the film composer, a normal print workflow roughly includes following steps:
 Step 1: New films
 Step 2: Designing the layout of films
 Step 3: Manipulating images in the layout
 Step 4: Add annotations to images
 Step 5: Select a printer and print films
6.2.1 Create an empty film sheet
Film sheet related operation are defined in the below table.
A new (empty) film sheet will be appended to the end of the film sheet list
Add Film Sheet
and it will become the current active one. Its layout will reuse the last one.
Click the Delete Film button to delete current film sheet from the film sheet
Delete Film
list. When there is only one film sheet in the list, this operation will only empty
Sheet
this film sheet and keep its layout design.
The orientation of the current film sheet can be switched between portrait
and landscape.
Portrait /
Landscape
Portrait Landscape
If the film size of the current film sheet need to be changed, please select the expected film size
from the film size dropdown list in the operation panel.

6.2.2 Design Film Layout
By setting the layout of the film sheet, users can define how many images per film sheet. The software
not only predefines some often used film layouts, but also provides free layout design tools. The film
layout design related tools are described in the below table.

After clicking the Define Film Layout button, a visual layout window appears for
selection. Then, move the mouse cursor to the desired position, and the
viewports will be highlighted by changing its color to indicate the layout
selected.
Define Film
Layout
Click the left mouse button again; the selected layout will apply to all sheets of
current job. If the cursor is moved outside the layout window, it will disappear
and the layout of all sheets will keep unchanged.
Select
The software predefined some layouts. To select one, click this button and
Predefined
all predefined layouts will be listed for selection.
Layout
To divide one cell to 1-16 smaller ones, click the Add Child Layout button. A
Add Child
child cell can also be divided again. With this function, a special layout could
Layout
be designed according to user’s requirements.
Delete Child
To delete all child layouts, click the Delete Child Layout button.
Layout
When some film sheets contain empty viewports, users could reorganize
Repack Images images within sheets to make better use of the film material. Click the repack
image button to repack all sheets, empty sheets are removed if necessary.
After clicking the Move Image button, the left button of mouse will change its
Move Image function for moving an image. Then, users can drag and drop one image
among different viewpoints of the current sheet.
 To remove an image from the current sheet, select this image and
then click the Delete Image button.
Delete Image  The Del key on the keyboard is the same as this button.
 To delete multiple images, use the Ctrl key when selecting
images.
The following figure shows an example of multi-level child layout.

Figure 6-2: Example of child layout
6.2.3 Manipulate Images in Layout
After the layout of films is designed, the WYSIWYG editing of images can be carried out.
To print an image in the full size mode, select this image and then click the
Full Size Full Size button. When multiple images are selected, they all will be printed
in the full size mode.
To print an image in the true size mode, select this image and then click
True Size the True Size button. When multiple images are selected, they all will be
printed in the true size mode.
After clicking the Zooming button, the left button of mouse will change its
function for zooming images. Then, press and drag the left mouse button up
Zooming or down to zoom in or zoom out an image. Dragging up increases the image
zooms while dragging down decreases it. When multiple images are
selected, they could be zoomed together with the same manner.
When zooming in an image, which may become larger than the viewing
area, panning (moving the image within the viewing area) becomes
necessary. After clicking the Panning button, drag some part of an image
Panning
and move it, then release the mouse button to drop the image in its new
position. When multiple images are selected, they could be panning together
with the same manner.
Click the Same Zoom Ratio button, then all images in the current sheet will
Same Zoom be magnified to same factor as the current focus. For example, when a left
Ratio leg image and a right leg image will be printed in the same sheet but exposed
separately, this tool is helpful.
Images can be mirrored by clicking the Flip Horizontally button. When

Horizontal Flip
multiple images are selected, they could be flipped horizontally together.

Images can be mirrored vertically by clicking the Vertical Flip button. When
Vertical Flip
multiple images are selected, they could be flipped vertically together.
Rotate Image An image can be rotated 90° anti-clockwise by clicking this button. When
Anti-Clockwise multiple images are selected, they could be rotated anti-clockwise together.
Rotate Image An image can be rotated 90°clockwise by clicking this button. When multiple
Clockwise images are selected, they could be rotated clockwise together.
To invert an image, select this image and then click the Invert Image button.
Invert Image When multiple images are selected, they could be inverted clockwise
together.
To select multiple images in the layout for manipulating, press the Ctrl key of the keyboard when
selecting.
In the film composer, the contrast and brightness of images could also be adjusted before printing
and only for printing. To adjust WW/L of an image, hold the mouse right button on an image and then
move upside/downside or leftward/rightward as in the image Viewer. When multiple images are
selected, their WW/L could be adjusted together.
6.2.4 Add Annotations on Image
As the last step in film composing, you can add annotations to image. The related operations are
described in the table below.
To show annotations on the current film, click the Show Annotation button.
Show
Note: the 4-corner label can be shown on film is predefined according to
Annotation
user’s preference.
To hide annotations on the current film, click the Hide Annotation button.
Hide Annotation
All 4-corner labels and manually added text annotations will be hidden.
To add a text annotation on film, click the Add Text button and then select a
predefined text(s) or input free texts. To move its location on film, please
Add Text
select it and then drag & drop to a new location on film.
Note: all text annotations added here are just for printing only.
Delete Text To delete a text annotation on film, select it and click the Delete Text button.

NOTE: The L/R mark is always printed out on film. Only annotation can be hidden.
6.2.5 Printing
After film editing, DICOM printing or ordinary printing can be carried out. Send edited films to the
selected printer and finish printing. Refer to the table below for related operations.
Click the DICOM Print button, then all designed virtual films will be transmitted
DICOM Print to the selected DICOM printer node. The real film size is the same as that of
the designed virtual film.
Click the Windows Print button, then all designed virtual films will be
Windows Print
transmitted to the selected normal printer node, which is paper-oriented.
When multiple DICOM printers are connected, users can select a printer in the DICOM printer list.
All DICOM print jobs are executed at background and managed by PPACS print service. Thus, during
printing films, users can continue other operations.
6.3 Queue Management
After selected images are started to be sent (archived or printed), all sending jobs are executed in the
background, and the user can continue to perform other operations. In the background, the PPACS
services can establish a connection with the remote image archive server or DICOM printer, and then
start to transmit images in the sending queue one by one.
When a remote DICOM node is not online or the network is failure, after attempting to send an image
multiple times unsuccessfully, this sending job will fail. The sent image is left in the sending queue
and can be sent again when the network is restored or the DICOM node is online. The sending states
include the following ones:
 SENDING. One connection for this job is being established with a remote DICOM node, or it is
being sent. The job being sent cannot be deleted.

 COMPLETED. This image has been successfully sent to the specified DICOM node.
 FAILED. This image was not successfully sent to the specified DICOM node. Check the network
status or whether the remote DICOM node is configured correctly.
In PATIENT > QUEUE page, users can check status of all send/print jobs within a specified date range
as shown in the below figure.
Figure 6-3: Check Image Transmission States
For jobs in sending queues, users can delete a job or manually send a failed job.
Deletes selected jobs in queue. The Ctrl key and Shift key can be used
Delete Job
for multiple selections.
Resend Job Manually send an image again, primarily for failed jobs.
6.4 Viewing Exported Images
If the file format of exported images is the computer-compatible format as BMP, TIFF, or JPEG,
images can be viewed in any image viewer. If the file format is DICOM, any 3rd-party DICOM image
viewer can be used.

To view exported DICOM images, the "Mini Viewer" application exported with images together can
also be used. This is an unlicensed Windows operating system-based portable DICOM image viewing
application.
The MiniViewer supports the DCOM directory structure (DCOM DIR) and also contains some basic
viewing and measuring tools.
Figure 6-4: MiniViewer Tool
6.5 Delete and Protect
As an image acquisition software, the image storage space of the host running the software is typically
smaller than a dedicated image storage server. To check the free disk space of the local image
storage, you can move the mouse on the disk space symbol in the status bar at any time. Depending
on the size of free disk space, administrators can manually export or delete some images.

Disk space is nearly
The disk space that stores images is empty or almost unused.
empty
Small usage of disk
A small amount of disk space is used to store images.
space
More disk space for storing image is used. Please pay attention to
More disk space is used
recent disk space usage.
There is almost no disk space left to store many images, so it needs
Disk space is nearly full to be cleaned up; otherwise, it may influence image acquisition and
even cause image lost.

Depending on the system configuration, when the available storage space drops to a predetermined
value, patient's examinations and their images will be deleted according to the first-in-first-out principle;
earliest images may be automatically deleted to release storage space for new images. When this
software starts to clean up disk space depends on the settings. Administrators can set a threshold for
local disk space. When the disk space of the image storage directory is lower than the critical value,
the software starts to clean up the disk space. It is recommended that the threshold be set to the
maximum image taken in one day for all patients. For example, the maximum number of patients in a
day is 100. Each patient acquires two images on average. Assuming the size of each image is 16M
according to the type of detector and the body part of image, the critical value can be set to
16*2*100=3.2G or more.
It is recommended not to delete images that are not archived, printed or exported.
NOTE: To avoid deleting important images by mistake, these images can be protected.
When a patient's images are protected, these images will not be deleted. In the “LOCAL” study list,
there are some tools related with image deletion and protection operations as described in the below
table.

 The image deletion is study-based.
 When deleting images of selected studies, there will be a confirmation
Delete window.
Study  Multiple studies can be selected (with the CTRL key or Shift key) to delete
together.
 The image being sent is in the background, whose study cannot be deleted.
 Protected studies cannot be deleted.
 Multiple studies can be selected (with the CTRL key or Shift key) and then
Protect
protected together.
Study
 A protected study is indicated by a small lock in the Status column.
 If a selected study has been protected, click this button again to unprotect it.
NOTE: To delete images manually, as default, users with administrator privileges are required.

Advanced Applications Page 58
7 Advanced Applications
7
Advanced
Applications
This chapter describes advanced applications of the software in detail, including image stitching, dual-
energy and so on. Advanced applications are optional functions. Thus, not all advanced functions are
included in your software.
7.1 Image Stitch
The image stitching function is to make up for the limitation of imaging size of existing detectors.
Technicians cannot obtain such larger images as whole body image, whole spine image, etc. at one
x-ray acquisition.
Stitching methods include automatic stitching and manual stitching. Automatic stitching usually
requires working with the automatic positioning device to achieve a high success rate of stitching
effect. If the effect of automatic stitching is not good, manual stitching can be used. If there is no
automatic positioning devices, the effect of automatic stitching is often not ideal; therefore, manual
stitching is often used to achieve better stitching effect.
A common image stitching workflow is described as follows:
 Step 1: create a patient and select “Advanced->Image Stitch” during selecting a protocol,
which normally including 2~8 views.
 Positioning device and preparing patient for exposure.
 Step 2: image acquisition one by one for these 2~8 views. Before each view is exposed, the

detector and the tube need to move to the designated position "automatically" or "manually".
 Step 3: Stitching images automatically or manually.
 Step 4: Completing. To perform image cropping and saving operations.
If images have been generated previously, including the DCM format image imported from other
system, users can skip the first and second steps and directly select the study to enter the "STITCH"
screen, or select two or more images in the "VIEW" screen to enter the "STITCH" screen.
7.1.1 New Study for Stitching
In the "NEW" page of the "PATIENT" menu of the navigation bar, fill in the patient information for
registration, and then select a stitching protocol by clicking the "Advanced" button below the dummy
patient and select the "Stitch" menu. Then, select the required stitching protocol in the stitching
protocol list as shown in the below figure.
Figure 7-1: Create a Stitching Procedure
7.1.2 Acquire Images for Stitching
After completing the new stitching procedure registration for a patient, click the “EXAM” button in the
navigation bar and the software will enter the image acquisition screen.
In the process of acquiring images, in order to improve the quality of stitching, no matter the
positioning device is automatic or manual, please pay attention to the following:

 All images for stitching must be acquired with the same SID.
 For better image stitching effect, it is recommended to use the maximum SID allowed by the
hardware; for stitching images containing “Thorax”, it is recommended that the SID should NOT
be less than 150 cm.
 Do not rotate the detector between exposures.
 Two images for stitching need at least 1/8 of the overlapping area for a better stitching success
rate.
 To avoid separating the chest into two images, acquiring chest image is always done in one
exposure.
 Try to ensure that the anatomy is at the center of image. For example, to get a long arm image
with multiple exposures, make sure the arm is perpendicular to the center of detector.
NOTE: When acquiring images for stitching, try to avoid patient movement; otherwise it may
affect the stitching effect.
NOTE: Exposure parameters may need to be adjusted for different body parts.
During the image acquisition process, all views in the stitching procedure will be exposed in turn. For
each exposure, the positioning device, the detector and the x-ray tube move to the corresponding
position, and complete the image acquisition.
7.1.3 Auto Stitch
After acquiring all images of a stitch procedure, the stitching can be started immediately. The
previously acquired images can also be stitched. Also, several DCM format images imported from
outside can be stitched. For a completed study, you can select images that need to be stitched in the
“VIEW” screen, and then click the “STITCH” button in the navigation bar to start automatic stitching
or manual stitching. No matter images that need stitching comes from the cooperation of automatic
positioning device or not, the software can be used to stitch them automatically.
When all images of a stich procedure is acquired, the software will enter the "STITCH" screen. By
default, the software will start automatic stitching. Each stitching of two images takes about 10
seconds. Please do not do any operation until the stitching is completed.

Figure 7-2: An Example of Image Stitching
NOTE: Evaluate the image quality after automatic stitching and start manual stitching when
necessary.
7.1.4 Manual Stitch
No matter image acquisition is supported by the automatic positioning device or not, as long as there
are more than two DCM format images, they can be stitched.
If there are more than two images, the software will stitch them one by one. Firstly, the first and second
images are stitched together. After the stitching preview is accepted, it will continue to stitch the third
image together, and so on. Until the last image is stitched together, the whole stitched image can be
obtained.
The left side of the stitching screen is the image index pane. Before starting stitching, please select
several images in the image index pane, where the symbol is shown in the lower right corner of
a selected image. At the same time, the image index can be reordered by dragging the mouse.
Furthermore, images can be rotated and flipped by using buttons in the operation panel. The middle
area is the image preview are.

NOTE: When the stitching begins, the order and direction of stitched images cannot be adjusted.
Figure 7-3: Preparations before Manual Stitching
After adjusting the order and direction of images before stitching, click the "Start" button to enter the
manual stitching mode. The order of image stitching is pair-wise according to the order of images in
the image index. When stitching any two images in a stitching process, click the “Next” button for
automatic stitching, or use one of the three auxiliary stitching tools provided by the software to improve
the success rate of manual stitching.
Cross-shaped
Click the button, and then place the cross as the stitching benchmark in
Reference Point
the "close" positions of the two stitching images.
Tool
Click the button, and then place the rectangular box at a similar position on
Rectangular the two stitching images to select the matching area. The rectangular area
Reference Zone on the upper image is the feature area (FA), while the rectangular area on
Tool the lower image is the being searched area (SA), where is required to
contain the feature area.

Crosshair Click the button, and then place the crosshair to select the reference point
Absolute Point at the position of the two switching images. These two points should be
Tool "the identical" pixel absolutely.
The following figure shows an example of the cross-shaped reference point tool. The position of the
reference point is placed not only in the overlapping area of the two images, but also in the body part
with obvious anatomical features to improve the success rate of stitching.
Figure 7-4: An Example of Cross-Shaped Reference Point
The following figure shows an example of the Rectangular Reference Zone tool. In the case of spine
images, the upper feature area (FA) preferably contains a complete, clear vertebra and a small portion
of two adjacent vertebras, without ribs; while the lower search area (SA) may also contain more
portion of two adjacent vertebras.

Figure 7-5: An Example of Rectangular Reference Zone
NOTE: The success rate of the zone matching is much higher than that of the point matching.
After each two images are stitched, the overlapping zone can be checked in the transparent mode or
in the fusion mode.
Show The preview of a completed stitching image will be displayed in

Overlapping transparent mode by default. In this mode, the overlapping zone of the
(Transparent two images are transparent, which can clearly show whether the two
Mode) images coincide accurately.

Hide
Click this button, the overlapping area in transparent mode will be
Overlapping
displayed in the fusion mode.
(Fusion Mode)
In the transparent mode, the seam of the stitched image can be adjusted. A seam is indicated by a
dashed line. Carefully observe the image seam during adjusting the overlapping area with the four
direction buttons. Accuracy can reach one pixel per step. Each time the direction button is clicked,
the lower image will move a few pixels, and the moving pixel value of one step can be adjusted
manually. By default, each step represents 5 pixels. To change the pace, please drag the step slider.
Figure 7-6: Image Preview during Stitching
NOTE: The software will automatically adjust the window width and the window level of the image
after stitching. The WW/L can also be adjusted manually by dragging the right mouse button.

NOTE: In the image display area, the user can scroll the mouse wheel to zoom in or out to view
the image.
7.1.5 Close Stitching
After multiple images are stitched into one image, its WW/L will be automatically balanced; users can
also use the right mouse button to make some adjustments as needed. There are also some follow-
up works that need to be done, mainly including cropping and saving. The following table describes
related buttons that will be used at this stage.
Click this button to add a crop box to the image, indicated by a yellow
Show/Hide rectangle, which border and its four corners can be dragged by the mouse
Crop Box to change its size. Inside the crop box, press the left mouse button to drag
its position.
Perform
Click this button to perform the cropping operation. The software will crop
Cropping
the stitched image according to the crop box.
Operation
Click this button, the stitched image will be saved and the software will return
Save Stitched
to the “EXAM” screen, and its thumbnail will be automatically created in the
Image
image index.
If the stitched image is not satisfactory or the quality of stitching images is

Abandon
not good due to patient’s movement, you can click this button to abandon
Stitched Image
this stitching operation.
One of the main operations in the closing stage is to crop the stitched image. Then, save the cropped
image. If the image quality of the stitched image is not satisfactory, you can give it up or restart
stitching if necessary.

Figure 7-7: Cropping Stitched Image
7.1.6 Side-by-Side Stitch
In the "STITCH" screen, in addition to the normal manual stitching by clicking the "Start" button, for
images of bilateral limbs, in order to improve the quality of stitching, click the "Start Slit Split” button
and the software will start manual stitching for single lateral limb. The side-by-side stitching method
for one side is the same as that of common manual stitching. With this stitching method, the stitching
of both sides will be performed respectively, and then stich the left side and the right side into one
image.
1 2

3 4
Figure 7-8: Example of Side-by-Side Stitch
7.2 Dual Energy
Dual Energy (DE) needs acquiring a low kVp image and a high kVp image in rapid succession. The
acquired images are processed to create a soft-tissue image and a bone image, which eliminates
obstruction from overlying bones and provides more information on calcification content.
Dual Energy application is often used for Chest and Abdomen AP and PA anatomical views. DE has
significant potential for improving the conspicuity of chest pathology by removing the bone structures
and for improving specificity by providing calcification information in the bone image, which greatly
aids in characterizing pulmonary nodules. Dual-energy subtraction images are also helpful in the
recognition of hilar and meditational masses; the detection of tracheal narrowing and vascular disease;
the identiﬁcation of bone, pleural, and chest wall abnormalities.
Figure 7-9: Clinical Application Example of DE

In the DE applications, it is compulsory to use Automatic Exposure Control (AEC). Therefore, even
the kV is different (high and low), the image EXIs of these two images are similar.
NOTE: The Dual Energy function requires related imaging components supporting it including the
x-ray generator and the flat panel detector.
The DE acquisition workflow is described as below:
1. To start a dual-energy exam, select “Advanced->Dual Energy” during selecting a protocol for
a patient.
2. Positioning device and patient preparation.
3. After entering the exam screen, pressing down and holding the hand switch until these two
exposures, one is the low dose and the other is the high dose, are completed.
4. Next, the software will automatically process these two images and created two new
processed Dual Energy images, one is about bones, and the other is about soft tissues.
5. Click “Close” button to exit the dual energy image procedure.
Figure 7-10: Image Processing with Dual Energy (DE) Acquisition

NOTE: It is particularly important for the patient not to move or breathe during the DE exposure.
Excessive whole-body patient motion can result in residual rib contrast in the soft-tissue image.
The Dual Energy (DE) module is an advanced option, which maybe not exist in your software.

System Management Page 71
8 System Management
8
System
Management
This chapter focuses on system management. From SYSTEM menu in the navigation bar, users can
perform following management tasks:
 Check software version information

 User account management
 Emergency settings
 Statistic, and
8.1 Check system status in the status bar
During the system usage, please pay attention to the system status in the status bar, which is located
on the bottom of the software screen. It can be configured according to your system hardware
configurations. Thus, some icons may not be displayed on your software.
System No It means no hardware or software error happened.

Error Note: system warning message(s) maybe exist.
When the background color of “X” become red, it means some hardware or
software error happened and the software has some important functions cannot
System Error work. Clicking this icon can see its detailed error information. Under most cases,
the software and related hardware need to be restarted in order to clear the error
message.

System No It means no any hardware or software warning message. Normally, the software
Warning system can work in this status.
When the background color of “!” become yellow, it means some hardware or
System software warning happened. The software may work in a degraded mode and
Warning some functions may not work. Clicking this icon can see its detailed warning
information.
Shows the percentage of the tube heat unit (HU). When there is no enough
Tube Heat Unit
remaining HU, the x-ray exposure will be inhibited.
 For a digital flat panel detector, its temperature information can be provided.
 At most 3 digital FPDs can be supported in one system. The number of FPD
FPD
is labeled on icon. To see the detailed temperature information of a FPD,
Temperature
please move the mouse on the corresponding icon.
Status
 If the FPD temperature is out of its recommended working temperature
range, its image quality may not be guaranteed.
 If a flat panel detector (FPD) supports the wireless mode, its wireless signal
status could be provided with multiple levels.
 At most 3 wireless FPDs can be supported in one system. The number of
FPD is labeled on icon. To see its detailed information, please move the
FPD Wi-Fi
mouse on the corresponding icon.
Status
 Make sure the FPD Wi-Fi signal strength is good enough. Otherwise, the
image transfer time may become longer or even fail. If an image is lost due
to its FPD Wi-Fi signal is very low, please try to recover this image after its
Wi-Fi status become good.
 If a flat panel detector (FPD) is chargeable, the remaining power of its

battery could be provided with multiple levels.
 At most 3 FPDs can be supported in one system. The number of FPD is
FPD Battery
labeled on icon. To see the detailed battery information of a FPD, please
Status
move the mouse on the corresponding icon.
 Please check each FPD battery frequently. Recharge it or replace it if
necessary.
Host Battery
If the software host is a laptop or tablet, its battery status could be provided.
Status
If the software host has Ethernet connection with the hospital network, it
Host Network provides the network connection status to PACS nodes and to DICOM printers.
Status It can also provide its Wi-Fi signal status if have. To see its detailed information,
please click on this icon.
Disk Space Status contains 5 levels. To see its detailed information, please
move the mouse on this icon. When there is no more disk space available for
Disk Space the current system usage, this icon color will become red. At this moment, it is
Status strongly recommended to free some disk space by transferring images to a
dedicated PACS or exporting images to USB disks or DVDs and then delete
local copies.
8.2 Check software version information
To check the software manufacturer information and its version number, please go to the “About”
tab in the SYSTEM Menu of the navigation bar.

8.3 Manage user accounts
Different roles has different privilege to manage this system. The Manager role could perform most
management functions. The software pre-defines 3 type of roles as shown in the below table.
Role Name Description
The Manager role focuses on system management, software settings, user account
Manager management, network configuration, and hardware configurations, etc. A normal clinical
workflow as for the Technician role is not designed as this role’s main task.
Including all privileges for the Technician role, the application role can also manage
Application protocols, such as create new views and procedures, change the x-ray exposure
technique settings and image post-processing settings in the system database.
Standard and limited role, only allow to go through the whole image acquisition workflow
Technician
including new patient registration, taking exams and managing images.
The length requirements of user accounts in this software is described as below.
 User Name: minimum length is one character and maximum length is 64 characters;
 User ID: minimum length is one character and maximum length is 10 characters;
 User Password: minimum length is 8 characters and maximum length is 64 characters.
From SYSTEM menu in the Navigation Bar, click User Accounts tab to open the User Management
window as shown in the below figure. When a user login with the manager privilege account, all user
accounts are listed; otherwise, each user can only see his/her own account information. In this window,
you can create a new account, edit an existing user, or delete an existing user.

Figure 8-1: User Account Management Window
To start creating a new user account, click the “New” Button in the bottom of the User Account
management window.
NOTE: Passwords are case sensitive. The asterisk (*) character displays for each entered
character to protect the privacy of the password.
NOTE: Only the Manager role can create new user accounts, edit and delete existing user
accounts. Users of other roles can only change his/her password.
To edit an existing user account, select this account in the user account list and then click the “Edit”
Button in the bottom of the User Account management window.
To delete an existing user account, select this account in the user account list and then click the
“Delete” Button in the bottom of the User Account management window.
8.4 Emergency Settings
For an Emergency examination, to speed up its workflow, the software can automatically create the
emergency patient information and the examination information. The default settings for emergency
can be modified according to user’s preference.
To modify the emergency settings, go to the SYSTEM > Emergency Setting. The Emergency
Setting window is showed as the below figure.

Figure 8-2: Emergency setting window
For emergency registration, the patient’s default name is PID Prefix + date + sequence number. You
can choose, add or delete a PID Prefix.
To add a PID prefix, input texts in the field of PID Prefix and click “New” button; then this prefix will be
added to the Patient ID Prefix list.
To delete a prefix, select one item from Patient ID Prefix list and then click the “Delete” button.
To specify the default procedure for emergency examinations, click the “Add Procedure” button.
8.5 System Statistics
In the Statistics function of the SYSTEM menu, users can take statistics for workloads, work quality,
and patient dose information.
In the workload statistics, the total number of acquired images by each user during a specified period
of date could be summarized.
In the Reject Detail statistics, the reject reason of each rejected image during a specified period of
date could be listed. Also, the number of rejected images and the rejected ratios for different body
parts are calculated.
In the X-Ray Book page, the dose related information for each exposure will be listed

For each statistics, specify the query criteria, such as the date range, and then click Query button.
The queried results will be summarized and listed.
Figure 8-3: System Statistics Screen
To export a statistic result, click Export button to save the statistic information as an Excel file.

Appendix: Glossary Page 77
Appendix: Glossary
Accession Number: In DICOM, a term to uniquely identify a visit to a site by a patient. The meaning
and use of accession numbers is not consistent in medical information. The
Digital Radiography System uses the DICOM definition of the term.
Anti-scatter Grid: Device used to prevent the radiation scattered within the patient from reaching
the Digital Radiography Detector and fogging it.
AEC: Automatic Exposure Control.
AP: Anterior/Posterior view position for X-ray exposure.
Artifact: Changes to an image due to outside influences such as defective pixels or
Digital Radiography Detector scan lines.
Automatic Exposure Ion chamber within the Bucky. Used to terminate X-ray when image density is
Control(AEC): achieved by measuring the amount of dosage occurring at the Digital
Radiography Detector and providing feedback to the X-ray Generator to stop
the exposure.
Bucky: The component that houses the Digital Radiography Detector, AEC, moving
grid, and related components. In the Digital Radiography System, the Bucky
contains the Digital Radiography Detector instead of the conventional film
cassette.
Collimator: The Collimator regulates the size and shape of the X-ray beam to accurately
localize the area of interest on the patient, while reducing overall patient
irradiation exposure.
CPU: Central Processing Unit of the Digital Radiography Operating Console
Software.
Diagnostic X-ray An X-ray system designed for irradiation of any part of the patient body for the
System: purpose of diagnosis or visualization.
DICOM: Digital Imaging and Communications in Medicine (DICOM). An industry
standard specification for interconnection of medical imaging equipment.
Digital Radiography Operating Console Software.
DROC: The Digital Radiography Operating Console Software, the user-interface for
the digital radiography system.
Detector: A flat panel that receives the X-ray image and converts it to digital information.
The Digital Radiography Detector replaces conventional X-ray film and
cassettes.
Direct Radiography A term used to distinguish the use of a photoconductor-based method as
(DR): opposed to the X-ray capture and conversion method used in a scintillator or
phosphor-based detector.
DR: Direct Radiography or Digital Radiography

ESA: Exam Specific Algorithm, which is used to optimize raw image data for a
particular type of exam.
Focal Distance: The distance from the source of the X-ray to the patient.
Generator: Device that supplies power to and controls the X-ray tube.
HIS: Hospital Information System

Appendix: Glossary Page 78
In a hospital, the computer system that tracks patient demographic

Hospital Information information, visit information, and other patient records.
System(HIS):
Image Artifact: Non-desirable qualities on an image.
KVp: Peak kilo-volts. The highest energy of X-rays emitted by an X-ray tube (equal
to the peak applied tube voltage).
Lateral: Possible view position for X-ray exposure.
Look-Up Table(LUT): A table of values used to convert raw image data to output data for a specific
ESA setting.
LUT: Look-Up Table.
mA: Milliamperes.
mAs: Milliampere-seconds. Combined with kVp, it indicates the dose of X-rays.
Oblique: Possible view position for X-ray exposure.
Operating The basic software control system of the PC.
System(OS):
PA: Posterior/Anterior view position for X-ray exposure.
Procedure: A predefined collection of images (views) for X-ray exposure.
RIS: Radiology Information System.
SID: Source to Image Distance.
Source to Image The distance from the source of the X-rays to the detector.
Distance(SID):
Study: A specific instance of a procedure consisting of a set of X-ray images.
Technique Factor: Any of the parameters describing the properties of an X-ray beam, including
the beam energy(kVp), the beam intensity(mA), the duration(seconds), and
their exposure product(mAs), and the Source to Image Distance (SID) etc.
View: Prescription for the technique factors and geometric arrangement of the X-ray
source, patient, and image sensor that yields and image of organs of interest
seen on a specific orientation.
Visit: A set of studies identified in a locally unique manner and performed on a
particular patient at a particular site for a particular reason. A visit is normally
identified by an accession number or a Visit ID and is associated with a
diagnosis.

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DROC Software

E-COM Technology Limited

This product complies with the following requirements:

The location of the CE mark label is in the service manual.

 EN 62304 Medical device software – Software life cycle processes

Reviewed by Product Technical Leader Kewei Wang

Reviewed by Regulation Engineer Lingling Zhang

Reviewed by Technical Support Manager Mingwei Wang

Reviewed by Marketing Manager Jizhou Xiao

Approved by Quality Manager Jianzhe Wang

E-COM Technology Limited

1F Building 2, No.99 Kechuang 14th Street, BDA,

Revision Date Change Description

SAFETY AND REGULATORY ....................................................................... XI

2 QUICK START ........................................................................................ 6

3 WORKLIST MANAGEMENT ................................................................ 13

4 IMAGE ACQUISITION .......................................................................... 23

Software User Manual

4.1.5 Other Technical Preparations ........................................................................................................ 27

5 IMAGE MANIPULATION ...................................................................... 34

7 ADVANCED APPLICATIONS ............................................................... 58

8 SYSTEM MANAGEMENT ..................................................................... 71

Software User Manual

8.1 CHECK SYSTEM STATUS IN THE STATUS BAR ........................................................................................... 71

APPENDIX: GLOSSARY .............................................................................. 77

Software User Manual

Scope of This Manual

Indications for Use

The product is not intended for mammographic applications.

Software User Manual

Expected Service Life

Storage and Transportation

RECOMMEND: It provides best practices based on professional experiences in X-ray industry.

Software User Manual

Safety and Regulatory

Please do not execute the DIGITAL RADIOGRAPHY OPERATING CONSOLE

The DIGITAL RADIOGRAPHY OPERATING CONSOLE SOFTWARE is

All personnel must wear Dosimeters during all phases of installation,

Do not attempt to alter DIGITAL RADIOGRAPHY OPERATING CONSOLE

Do not attempt any maintenance of DIGITAL RADIOGRAPHY OPERATING

Do not attempt any repairs if the DIGITAL RADIOGRAPHY OPERATING

Do not load other software or incompatible versions of the software

Software User Manual

When using the software to acquire an x-ray image, there should be no

Personal Radiation Dosimeters

Privacy and Data Security

Software User Manual

It is operator’s responsibility to delete a patient’s study when it is

Whenever an operator doesn’t need to access this software anymore,

It is operator’s responsibility to decide whether the “Anonymous” option

Software User Manual

Figure 1-1: Software CD-ROM and Dongle

Software User Manual

Figure 1-2: Relationship of DROC and PPACS

1.1 Install PPACS

Figure 1-3: Select a language for PPACS installation

Software User Manual

Figure 1-4: Select PPACS installation location

Don’t use non-single byte characters as Chinese, Japanese, and Korea