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Visage 7
This software is CE-compliant and is defined as a class IIa medical device in accordance with Medical Devices
Directive 93/42/EEC.
All product and company names are trademarks or registered trademarks of the respective companies.
Some of the specifications described herein may not be currently available in all countries. Please contact your
local sales representative for the most current information.

Caution

US federal law restricts this device to sale by or on the order of a physician (or properly licensed practitioner).

Information in this manual may be subject to changes without prior announcement.

Manufacturer US Distributor Australian Sponsor

Visage Imaging GmbH Visage Imaging, Inc. Pro Medicus Limited

Lepsiusstraße 70 12625 High Bluff Drive Suite 205 450 Swan St
12163 Berlin, Germany San Diego, CA 92130, USA Richmond VIC 3121, Australia
Phone: +49 30 700968-0 Phone: +1 858 345-4410 Phone: +61 3 9429 8800
Email: [email protected] Toll-free: +1 888 998-4724

Support and Safety Contact

Phone: +49 30 700968-30

Email: [email protected]

For contact information and a list of our world-wide office locations visit www.visageimaging.com.
Visage Imaging is a wholly owned subsidiary of Pro Medicus Ltd. www.promedicus.com.

Copyright © Visage Imaging GmbH. All rights reserved.

Document Version 15.00
Table of contents

Intended use, data security, and system requirements ......9

Intended use ........................................................................................................... 9

Data protection and data security ......................................................................... 10

System requirements ............................................................................................ 10

Symbols on the packaging .................................................................................... 11

System and workflow overview ........................................13

Key features of Visage 7 ....................................................................................... 13

Workflow overview ................................................................................................ 14

Study Browser ..................................................................15

Query section ........................................................................................................ 16
Filter and search criteria ..................................................................................... 16
Starting, resetting, or repeating a query ............................................................. 18
Query presets ..................................................................................................... 19

Study list ................................................................................................................ 20

Information in the study list ................................................................................. 20
Preview section .................................................................................................. 21

Loading data from the study list ............................................................................ 22

Session management ........................................................................................... 23

Data management ................................................................................................. 25

Importing and exporting studies ......................................................................... 25
Retrieving and sending studies (DICOM network) .............................................. 27
Attaching documents to studies .......................................................................... 28
Attaching files to studies .................................................................................. 28
Scanning attachments ...................................................................................... 29
Managing access rights to data .......................................................................... 29
Delete-protecting studies .................................................................................... 30

Visage 7 3
 Table of contents

Anonymizing and marking cases for presentation .............................................. 30

Study labels ...................................................................................................... 30
Privacy mode ................................................................................................... 31
Creating anonymized teaching files ................................................................. 32
Anonymizing cases for other purposes ............................................................ 33

Patient Search ................................................................. 35

Query section ........................................................................................................ 35

Results list ............................................................................................................. 36

View windows .................................................................. 39

Protocols ............................................................................................................... 40

Viewers and viewer layouts ................................................................................... 41

Layouts toolbar .................................................................................................. 41
Thumbnail section ............................................................................................... 43
Viewer controls ................................................................................................... 48
Navigation and display options for volume datasets ........................................... 49
Image text and warning symbols ........................................................................ 52

Tools ...................................................................................................................... 54
Basic navigation and image display tools ........................................................... 55
Default Navigation ........................................................................................... 55
Zoom ............................................................................................................... 55
Pan .................................................................................................................. 56
Inverse (.) ......................................................................................................... 56
Edge enhancement .......................................................................................... 57
Window level tools .............................................................................................. 57
Window Level .................................................................................................. 57
Auto Window Level in ROI ............................................................................... 58
Show Window Level Presets ............................................................................ 58
Enlarge/Reduce Window Width ....................................................................... 59
Save Current W/L as Presentation State ......................................................... 59
Tools for adjusting the display size ..................................................................... 59
Fit Width/Height, Fit Width, Fit Height ............................................................. 59
Zoom 100% ...................................................................................................... 59
Magnifying Glass .............................................................................................. 60
Tools for rotating and flipping images ................................................................. 61
Rotate Clockwise, Rotate Counterclockwise .................................................... 61
Flip Horizontally, Flip Vertically ........................................................................ 61
Rotate in Plane ................................................................................................. 61
Save Flip/Rotate as Presentation State ........................................................... 62

4 Visage 7
Table of contents

Tools for scrolling in image stacks ...................................................................... 62

Browse Slices .................................................................................................. 62
Browse in All Priors .......................................................................................... 63
Skip Slices While Scrolling ............................................................................... 63
Browse Continuously ....................................................................................... 64
Scroll Page by Page (Mouse Wheel Mode) ..................................................... 64
First Slice (Home), Previous Slice (↑), Next Slice (↓), Last Slice (End) ............ 65
Previous Thick Slice (PgUp), Next Thick Slice (PgDn) .................................... 65
Play/Pause ...................................................................................................... 65
Show Multiframes in Single Tiles ..................................................................... 66
Tools for browsing datasets ................................................................................ 66
Previous Study, Next Study ............................................................................. 67
Previous Volume (Ctrl/Cmd ←), Next Volume (Ctrl/Cmd →) .......................... 67
Previous Image Set, Next Image Set ............................................................... 67
Previous Phase (←), Next Phase (→) ............................................................. 67
Previous Study from Study Browser, Next Study from Study Browser ............ 67
Workflow integration tools .................................................................................. 68
Study Navigator ................................................................................................ 68
Close Session .................................................................................................. 72
Start/Stop Dictation .......................................................................................... 72
Reset Dictation ................................................................................................. 72
Go To Next Study ............................................................................................. 72
Skip to Next Study ............................................................................................ 73
Reports and Scanned Documents .................................................................. 73
Show Worklist .................................................................................................. 73
Referrer Information ......................................................................................... 73
Tools for linking viewers ..................................................................................... 73
Toggle Linking .................................................................................................. 74
Link Current Position ........................................................................................ 74
Reset Viewer Linking ....................................................................................... 74
Automatically Link Viewers .............................................................................. 74
Automatic Viewer Registration,
Automatic Viewer Registration (Translation Only) ........................................... 75
Link Display Properties .................................................................................... 76
Link Scrolling .................................................................................................... 76
Save Registration ............................................................................................. 78
Edit Viewer Linking ........................................................................................... 78
Group Editing tools ........................................................................................... 80
Annotation and measurement tools .................................................................... 82
Arrow/Text Annotation (N), Arrow Annotation .................................................. 82
Circle Annotation .............................................................................................. 83
Distance (D) ..................................................................................................... 84
Perpendicular Distance .................................................................................... 85
Calibrate Image ................................................................................................ 86
Angle ................................................................................................................ 86
Angle (Two Lines) ............................................................................................ 87
Distance Ratio .................................................................................................. 88
Vertical Distance .............................................................................................. 89
Annotate Spine ................................................................................................. 90
Cobb's Angle .................................................................................................... 91
Elliptic ROI ....................................................................................................... 92
Circular ROI ..................................................................................................... 92
Spherical ROI ................................................................................................... 93

Visage 7 5
 Table of contents

Point-Sized ROI, Pixel Value ........................................................................... 94

Freehand 2D ROI ............................................................................................. 94
Freehand 3D ROI ............................................................................................. 96
Save Annotations as Presentation State .......................................................... 97
Save visible Annotations as Presentation State ............................................... 97
Delete All Measurements/Annotations ............................................................. 97
Screenshot tools ................................................................................................. 98
Screenshot (S) ................................................................................................. 98
Screenshot All (Shift + S) ................................................................................. 98
Combined Screenshot (Alt + S) ........................................................................ 98
Key views tools ................................................................................................... 99
Store Key View (K) ........................................................................................... 99
Delete Key View ............................................................................................... 99
Previous Key View, Next Key View ................................................................. 99
Tools for 3D navigation ..................................................................................... 100
3D Rotate ...................................................................................................... 100
Reset Slice Orientations ................................................................................ 101
Anterior (A), Posterior (P), Left (L), Right (R), Head (H), Foot (F) View ......... 101
Position Crosshair ......................................................................................... 101
Triangulation .................................................................................................. 102
Center View ................................................................................................... 102
Cropping tools ................................................................................................... 103
Crop Box ........................................................................................................ 103
Crop Slab ....................................................................................................... 104
Crop Plane ..................................................................................................... 104
Crop Corner ................................................................................................... 105
Fusion registration tools and tools for displaying primary and overlay data ..... 105
Manual Registration ....................................................................................... 105
Align Centers .................................................................................................. 106
Automatic Registration ................................................................................... 106
Reset Registration .......................................................................................... 107
Accept Registration ........................................................................................ 107
Viewer Objects (Primary), Viewer Objects (Overlay) ..................................... 107
Tools for time-series analysis ........................................................................... 107
Time-density analysis ..................................................................................... 107
Subtract Baseline Phase ................................................................................ 108
Tools for viewing mammography studies ......................................................... 108
Quadrant Navigation ...................................................................................... 108
Magnifying Glasses ........................................................................................ 109
Previous Prior Study (Mammo), Next Prior Study (Mammo) ......................... 110
Toggle MG/Tomo ........................................................................................... 110
Data handling tools ........................................................................................... 110
Study Info Dialog ............................................................................................ 110
View Structured Reports ................................................................................ 111
View Reports (RIS) ........................................................................................ 111
View Reports (PACS) ..................................................................................... 111
Best Image Quality ......................................................................................... 111
Assign and Manage Labels ............................................................................ 112
Tool for printing images (Ctrl/Cmd + P) ............................................................ 113
Tools for switching image text and graphics on and off .................................... 114
Tools for performing quality assurance on images ........................................... 117

6 Visage 7
Table of contents

Permanent Text Label .................................................................................... 117

Save Modified Image ..................................................................................... 118
Select for Quality Assurance .......................................................................... 118

Tool cards ........................................................................................................... 119

Templates ......................................................................................................... 120
3D Color Map ................................................................................................... 121
Display .............................................................................................................. 123
Cine .................................................................................................................. 124
Line Profile ........................................................................................................ 128

Complex tools and applications .......................................................................... 129

Batching tools and tool card ............................................................................. 129
Stacked batching ............................................................................................ 129
Rotational batching ....................................................................................... 131
Saving, sending, or exporting images ............................................................ 132
3D segmentation tools and tool cards .............................................................. 134
Tools for automatic removal of structures ...................................................... 134
Bone removal tool card .................................................................................. 135
Freehand cropping tool .................................................................................. 136
Edit tool card .................................................................................................. 137
Structures tool card ........................................................................................ 139
Statistics tool card .......................................................................................... 142
Vessel analysis tools and tool card .................................................................. 144
Curve definition and vessel tracing ................................................................ 144
Curved View ................................................................................................... 147
Lumen View and Cross-Section View ............................................................ 147
Cardiac analysis for CT studies ........................................................................ 149
LV Analysis tool card ...................................................................................... 149
LV Results tool card ....................................................................................... 150
Calcium tool card ........................................................................................... 151
Brain perfusion analysis tools and tool card ..................................................... 153
Perfusion toolbar ............................................................................................ 153
Brain Perfusion tool card ................................................................................ 155
Lesion tracking tools and SUV tool card ........................................................... 156
SUV tool card ................................................................................................. 156
Lesion tool and Lesions tool card ................................................................... 157

Export window ................................................................161

Screenshots ........................................................................................................ 161

Reports ................................................................................................................ 164

Basic reporting .................................................................................................. 164
Diagnostic reporting workflow ........................................................................... 165
Creating report templates ................................................................................. 167

Visage 7 7
 Table of contents

Quality Assurance .......................................................... 169

Query section ...................................................................................................... 170
Filter and search criteria ................................................................................... 170
Starting and resetting a search ......................................................................... 172
Query presets ................................................................................................... 173

Performed procedures and scheduled procedures lists ...................................... 174

Information in the performed procedures list .................................................... 174
Information in the scheduled procedures list .................................................... 175
Organizing and rearranging procedures lists .................................................... 176

Quality assurance tasks ...................................................................................... 177

Quality assurance with RIS ............................................................................... 177
Quality assurance without RIS .......................................................................... 178

Customizing Visage 7 Client .......................................... 181

Basic settings ...................................................................................................... 181
UI appearance and display size ........................................................................ 181
Change Password dialog box ........................................................................... 181
Reset all warnings ............................................................................................ 182
Streaming compression .................................................................................... 182
Monitor Configuration dialog box ...................................................................... 183
Render Settings dialog box ............................................................................... 185
Configure Window/Level Presets dialog box .................................................... 186
Configure Keyboard Shortcuts dialog box ........................................................ 187
Configure Tool Palette dialog box ..................................................................... 189

Properties and protocols ..................................................................................... 190

Properties dialog box ........................................................................................ 190
Automatic loading of prior studies ..................................................................... 192
Configuring automatic loading of prior studies ............................................... 192
Editing rules for automatic loading of prior studies ........................................ 192
Modifying and creating protocols ...................................................................... 194
Simple protocol editing ................................................................................... 194
Protocols dialog box ....................................................................................... 195
Advanced protocol editing .............................................................................. 197
Edit Layout dialog box .................................................................................... 198
Image Assignment dialog box ........................................................................ 200
Save Protocol dialog box ............................................................................... 201
Edit Conditions dialog box .............................................................................. 203

8 Visage 7
Intended use, data security, and
system requirements

Visage 7 is an imaging solution based entirely on efficient thin-client streaming tech-

nology. It scales easily from a single radiology practice to large distributed health-
care enterprises and allows efficient viewing, processing, and archiving of very large
numbers of images, including thin-slice volumetric data from CT, MR, PET-CT, and
other 3D modalities.

Intended use
Visage 7 is a system for distributing, viewing, processing, and archiving medical
images in healthcare environments. The Visage 7 server receives image data in
DICOM format via network. This provides flexible connections to archives, modali-
ties, and workstations. Modalities supported by Visage 7 are listed in the DICOM
Conformance Statement.
Aside from general image interpretation and processing tools, Visage 7 provides
specific tool sets for several clinical applications, including:
• CT/MR angiography, for example, for vascular analysis and stent planning
• Cardiac analysis, including calcium scoring and functional assessment of car-
diac CT data
• Neuroradiology, including CT and MR brain perfusion analysis
• Oncology, including SUV analysis and lesion marking and analysis
Visage is to be used only by trained and instructed healthcare professionals. It can
support physicians and/or their medical staff in providing their own diagnosis for
medical cases. The final decision regarding diagnoses, however, resides with the
doctors and/or their medical staff in their own area of responsibility. Although the
Web and thin-client technologies allow the software to be run on a variety of hard-
ware platforms, for diagnostic purposes the user must ensure that the display hard-
ware used for reading the images complies with state-of-the-art diagnostic
requirements and currently valid laws.
Only DICOM for presentation images can be used on an FDA approved monitor for
mammography for primary image diagnosis. Only uncompressed or nonlossy com-
pressed images must be used for primary image diagnosis in mammography.

Visage 7 9
Data protection and data security Intended use, data security, and system requirements

Data protection and data security

Patient data is subject to data protection. Therefore, users have to ensure compli-
ance with all applicable laws and regulations in their country. Visage 7 provides
extensive security mechanisms that help you assure data protection and data secu-
rity. On the administration platform, the system administrator can activate the audit
trail option to comply with the strict regulations regarding security and privacy of
health data (HIPAA) according to US law.

Caution

For data security reasons, it is not permitted to make changes to the Visage
product and its database. Contravention of this will lead to all guarantees being
revoked and under some circumstances may violate applicable laws.

System requirements
With Visage 7, all image data is stored on the server at all times. Users access the
data directly on the server from any number of radiology workstations, office PCs,
laptop computers, or other devices. Image data does not need to be sent to client
computers in the process. Instead, Visage 7 employs a technique that is called thin-
client streaming or thin-client computing. All image processing (2D, 3D, or 4D) is
performed on the server.
Server hardware consists of standard server platforms, but they must be qualified
by Visage Imaging. For a detailed server hardware and software specification, con-
tact customer support.
Client computers neither need to hold large volumes of data nor do they need to
perform any of the actual image processing. Therefore, system requirements for
Visage 7 Client computers are minimal as far as memory, graphics, or computing
power is concerned. As a result, the Visage 7 Client can be installed on virtually any
standard computer or standard laptop with a network connection. Visage 7 supports
all recent versions of Windows® and Mac OS. With Visage 7, Mac and Windows
users can work together in a fully integrated environment and workflow.
Detailed system requirements are documented in the release notes, which are
available on your Visage 7 server's download page.

10 Visage 7
Intended use, data security, and system requirements Symbols on the packaging

Symbols on the packaging

These symbols on the packaging convey information that is essential for the proper
use of the product.

Fragile

Keep dry

Protect from heat and radioactive sources

Temperature limitation

Consult operating instructions

Caution, consult accompanying documents

Date of manufacture (YYYY)

Manufacturer

CE-mark with reference number of VI’s Notified Body

(TÜV Rheinland LGA Products GmbH)

Serial number

Reference number

Visage 7 11
Symbols on the packaging Intended use, data security, and system requirements

12 Visage 7
System and workflow overview

Visage 7 delivers a fully scalable solution for primary interpretation, advanced visu-
alization, image distribution and archiving. All functionality is provided in a single cli-
ent software application with native thin-slice access and 3D and 4D
postprocessing. Visage 7 is entirely based on client-server streaming technology
with all functionality accessible from anywhere in the enterprise network or via the
Internet. With the Visage 7 thin-client solution, there is no waiting time for the data
to be copied onto your client computer, because all 3D processing and other calcu-
lations are performed on the server.

Key features of Visage 7

Visage 7 is an archive-neutral diagnostic and clinical viewing application that pro-
vides a comprehensive imaging workflow for all modalities.
• Universal viewing
One thin-client application for reading everything from plain film to cardiac CT.
• Native thin-slice and 3D processing
Seamlessly integrated multiplanar reformatting, volume rendering, and volumet-
ric analysis.
• Advanced clinical applications
Supporting a wide spectrum of modalities, including CT and MR angiography,
cardiac CT, neuroradiology, and oncology.
• Distributed workflow and archiving
Instant, unified remote access to multiple locations without replicating data.
• Native Windows and Mac Client OS
Windows and Mac users seamlessly integrated into a single workflow and IT
platform.
• Easy scalability
The fully scalable distributed thin-client architecture makes it easy to add more
modalities, users, and locations.
• Features and user levels
Most features and tools can be turned on or off for individual user levels. User
levels allow the definition of roles, such as the role referring physician, who will
be presented the Patient Search window rather than the Study Browser. On a
finer level, individual tools can also be enabled or disabled for each user level.

Visage 7 13
Workflow overview System and workflow overview

Workflow overview
Visage 7 offers all the benefits of a flexible state-of-the-art PACS with advanced 2D,
3D, and 4D visualization. Efficient image interpretation is central to this solution, in
which all data remain on the server at all times and client computers use thin-client
technology to access the data.

Image Interpretation
Efficient primary interpretation is facilitated by fast loading times,
flexible display protocols, and fully integrated 3D navigation.
Image Postprocessing Prior studies, postprocessing results, and interactive
Before or during primary interpretation, users can processing tools are instantly available, and the
perform advanced postprocessing tasks such radiologist can easily store and share key
as bone removal, volumetric analysis, or images and examination results.
perfusion analysis.

Second Opinion
Quality Assurance (QA) and Demonstrations
Authorized users (e.g. PACS Radiologists and clinicians
administrators) can verify or can easily access images
correct the assignment of and postprocessing results
images to accession numbers simultaneously or
and patient IDS, split and consecutively.
merge patients and studies,
Visage® 7
Server
and delete images.
Media, Paper, Film
Users can export original
images as well as key images
Importing Prior Studies from any client computer.
Users can import prior studies Images can be printed on
from any client computer and paper or film or they can be copied
assign them to the correct patient. to CD, DVD, or other electronic
Visage 7 can be configured either to media.
archive or to delete prior studies after a
period of time.
Web Access for
Referring Physicians
Receiving Image Data Referring physicians can be provided with instant
Visage 7 receives and stores image data from all modalities thin client access to reports and images via Internet, from
and can be configured to forward selected data to other destinations. any Windows or Mac OS computer as well as on mobile devices.
Visage 7 can serve as a full archive, or as a cache storage Display protocols, functionality levels, and access rights can be
for efficient access to large data volumes on top of an existing archive. configured individually per user or user type.

14 Visage 7
Study Browser

screen8studybrowser
In the Study Browser, you search for patient and study data. Here you select the
images that you want to read and load them into a View window.

Note

If your Visage 7 is integrated in other clinical software, such as a Pro Medicus

RIS, the Study Browser might not be shown. Instead, you use the worklist of the
RIS to select and load data directly into Visage 7.

If the Visage 7 Study Browser is shown, remember that the Study Browser is not
a worklist. A worklist would present and preselect cases and tasks that a user has
been scheduled to complete next. By contrast, the Study Browser gives an over-
view of all data that is stored on the Visage 7 server or on connected network
nodes. You search these lists for the study or studies that you want to read next.

Find out more about the Study Browser and about how to load data and perform
data management tasks in the following sections.
• Query section
• Study list
• Loading data from the study list
• Session management
• Data management

Visage 7 15
Query section Study Browser

Query section
Before you start defining search criteria for a database query, select the database
tab where you want to search. Queries apply only to the database whose tab card is
currently shown in the foreground.

Tip

If you do not know a complete name or number, you can use wildcards in your
search. For example, type Mil in the patient name box to find Miller, Milford, Milt-
ner, or *mil to find all the above and also Hamilton, or AB??34 in the patient ID
box to find AB1234, AB0034, and AB11345678.
However, even if you use wildcards, always specify your search criteria as pre-
cisely as possible. Rather general queries might yield a very long hit list, which
requires extensive scrolling.

Filter and search criteria

Use the filter and search criteria in this list to search for study data.

Patient Enter the name, date of birth, or ID of the patient that you are looking for. If you do
not remember the exact name, date, or number, use wildcards.
For names that occur frequently, you might want to include the first name or other
components of the patient’s name in your search. To define such a search, you
need to know how patient names are stored in the database.
FamilyName GivenName MiddleName Prefix Suffix
The following example shows a search for first name, last name. and title.
Doe John*Dr.
If you want to search for more than one patient, separate patient names with a
semicolon (;) or the pipe character (|). For example, Anderson|Alexander or
Miller;Milford.

Date Click the Date box and select if you want to search by Study Date or Insertion
Date. The Insertion Date is the date when the study was transferred to the server
from a modality or an archive.
From ... To specifies a search period. Type dates in the format YYYY-MMM-DD, or
click the button to the right of a date box and select a date in the calendar.
Use the buttons Today, Yesterday, 1 Week, 2 Weeks as a quick way to specify
frequently searched periods in the correct format.
You can configure these four search-period buttons. Right-click one of the four but-
tons and select Hours > 1 Hour, for example, if you are frequently looking for stud-
ies that were performed within the last 60 minutes.

16 Visage 7
Study Browser Query section

Modality Select the check boxes for all modalities for whose studies you want to search:
CT (computed tomography), MR (magnetic resonance tomography), PT (positron
emission tomography, PET), US (ultrasound), CR (computed radiography), DX
(digital radiography), MG (Mammography), XA (X-ray angiography).
-Or-
Enter a modality abbreviation in the Others box. Separate multiple modalities by a
space, for example, CT PT MR.

Fields Here you can specify additional search criteria.

Open the lists of available criteria with the double-arrow buttons and select a crite-
rion.

Specify your search string in the input box below the selected criterion. Remember
that you can use wildcards in your search.
If you want to search for more than one accession number, for example, separate
numbers with a semicolon (;) or the pipe character (|). For example, 12345|67890
or 09876;54321.
If the search strings themselves contain semicolons, pipe characters, or back-
slashes, as in Ward 4; Rm.6 or Ward 1\Rm.2, use the following notation:
Ward 4\; Rm.6;Ward 1\\Rm.2 or Ward 4\; Rm.6|Ward 1\\Rm.2
-Or-
Click the list button next to an input field.

Select an item.

Study Labels If you are using labels to organize your studies, you can use these flags to search
for data in the Study Browser.
Open the list of available labels and select one or several labels.
-Or-
Type the label that you are looking for, or define a combined search.
Label_A Label_B - this string searches for all studies with either Label_A or
Label_B.
Label_A +Label_B - this string searches for all studies that are marked with both
Label_A and Label_B.
Label_A -Label_B - this string searches for all studies that are marked with
Label_A but not with Label_B.
Note that in the Study Browser you can not only search for labels but also assign
labels to studies. Use Study Labels from the context menu of the study list to
assign labels. Proceed in the same way as when you assign labels while reading
images. See Assign and Manage Labels, page 112.

Visage 7 17
Query section Study Browser

Study States Click the Study States button and select study states in the Select State dialog
box.
Note that searching by study state Interpretation Status makes sense only if the
modalities that send the data to the Visage 7 server set this flag. In Visage 7 you
cannot set or edit the interpretation status of a study.
If study states have been defined in your search, the Study States button label is
shown italic and the Reset button next to it is available. Click this Reset button if
you want to reset only study states but none of the other search criteria.

Starting, resetting, or repeating a query

Use these buttons to start a database search, to reset search criteria, or to repeat a
recent query.

Starting a query Click Query to start a database search.

Remember that the system queries only the server whose tab card is currently
shown in the foreground.

Resetting search Click Reset to remove all search criteria from the query section.
criteria

Repeating a recent 1. Click Reset and hold the mouse button down to show a list of recent queries.
query

2. Click the query that you want to repeat.

The filter and search criteria of this query appear in the query section now.
3. Click Query to start the database search.

18 Visage 7
Study Browser Query section

Query presets
If you frequently use the same combinations of search criteria, you can save them in
a preset. Your presets are listed directly above the query section. Any presets that
you define are available for your own user account only. You cannot make presets
public.

Tip

A preset stores both search criteria and the arrangement of the study list and the
preview section.

Quick search with a 1. Click a preset button to retrieve its search criteria.
preset

2. Depending on how you defined the preset, you might have to click Query to start
the search.

Defining a preset 1. In the query section of the Study Browser, select and type search criteria.
2. Click New Preset.

3. In the Preset dialog box, enter a name for your new preset.
4. Select Default if you want to make this preset the default query preset.
The default preset is the query preset that is automatically applied when the
Visage 7 Client is started.
5. Check Auto Query if you want the system to reenter your search criteria and
then run the search immediately. You do not have to click Query again.
-Or-
Check Default plus Auto Query to have the system run this search every time
you call up the Visage 7 software.
6. Save the preset.
A new preset button appears above the query section.

Tip

Right-click presets that you have defined earlier. A context menu appears which
helps you to manage presets. For example, you can remove preset buttons that
you no longer need.

Visage 7 19
Study list Study Browser

Study list
screen8studybrowser8sourcetab
The study list may comprise two or more tab cards.
• The leftmost tab card is your Visage 7 server, which is also referred to as the pri-
mary server.
• The tab card next to the primary server tab lists the studies that you read
recently.
• Any tab cards further to the right represent more Visage 7 servers, connected
DICOM network nodes, or external drives.
1. Click the + tab to show a list of available servers, nodes and drives.

Servers with the Visage 7 logo are partner systems. You can load data from
partner systems in just the same way as from the primary server. List items with-
out Visage 7 logo are connected DICOM network nodes or external drives. You
need to retrieve data from these nodes or drives before you can load the data.
2. Select a server, network node, or drive to add this tab card.

Information in the study list

The study list is arranged in a hierarchical tree view. Use the +/- buttons in front of
the entries to expand or collapse this list.
For a better overview, you can sort the list by clicking a column header. Clicking a
second time reverses the search order.
If a study in the study list appears dimmed, the Visage 7 server has not or not yet
received all images and the study is considered incomplete. Whether you can nev-
ertheless load incomplete studies depends on your system configuration.

Patient The name of the patient.

Date of Birth The date of birth of the patient.

Issuer The institution that issued the patient ID.

20 Visage 7
Study Browser Study list

Patient ID Patient’s identification number.

Accession Number Job number of the study in the HIS/RIS (hospital or radiology information system).

Modality Modality or modalities where the patient was examined.

Images Number of images in a study or series.

3D This column shows a bullet when a series is a 3D series, which means that it con-
tains at least one continuous 3D volume.

A green bullet indicates that a volume dataset is available on the primary server or
on a partner server.

A yellow bullet indicates that the system is currently creating a volume dataset from
the original slice images.

Study/Series Description Study or series description.

Study/Series Date Date and time when the study or series was performed. The format is YYYY-MMM-
DD and HH:MM:SS (24 hour clock).

Institution/Station Name Name of the institution or department or name of the device where the study was
performed.

Insertion Date Date and time when the study or series was sent to this database. The format is
YYYY-MMM-DD and HH:MM:SS (24 hour clock).

Interpretation This column indicates whether a report exists for a study and shows the report sta-
tus (new, in progress, draft, preliminary, or final).

Preview section
When you select a series or volume dataset on the primary server (leftmost tab
card), a preview image is shown below the study list.
The preview image is the first image of a series, or the central slice of a volume
dataset. If you select multiple series, one preview image is shown for each of these
series.

Windowing preview For a better overview, you can window preview images.
images
1. Click a preview image.
2. Hold the mouse button down.
3. Drag the mouse up or down or right or left to change brightness or contrast.

Resizing the preview You can change the size of the preview section and the study list.
section
Drag the split bar that separates these screen areas up or down.
You cannot resize individual preview images.

Visage 7 21
Loading data from the study list Study Browser

Loading data from the study list

Choose one of the following methods to load data from the study list.

Loading with double- To load a single study, series, or volume dataset, double-click it in the study list.
click
However, be aware that when you double-click a study for which session informa-
tion exists, the system loads the session and not the original images. See also Ses-
sion management, page 23.

Loading more than one 1. Select the studies, series, or volume datasets that you want to load.
study, series, or dataset
Use the Shift key or the Ctrl (Windows) or Cmd (Mac) key for multiselection.
into one tab card
2. Click the View button or select View from the context menu.
-Or-
Use Add to View if you do not want to replace the currently loaded data but load
additional data.

Tip

Right-click a patient name and select Find All Studies For This Patient as a
quick way to find and load prior studies of a patient.

Loading studies into If you are currently reading images and are interrupted by a request for your opinion
separate tab cards on a different case, you can load this new study in a separate tab card.
1. Select the new case in the study list and click the View In New Tab button or
select View In New Tab from the context menu.
In the title bar, a new tab card appears. The tab of the active tab card is high-
lighted with a bullet.

2. Use these tabs to switch between cases.

Loading studies into a 1. Right-click a study in the study list and select Load in separate window.
separate Visage 7
A new Visage 7 Client opens containing only this case and the Export window. A
Client
colored bar below the title bar reminds you that this is not the case you worked
on originally.
2. Return to your original case with Alt + Tab (Windows) or Cmd + Tab (Mac), this
leaves the second case open.
-Or-
Close the new case with the Close Window button in the colored bar.

22 Visage 7
Study Browser Session management

Special loading options Instead of having the system select a protocol best suited for the selected data, you
can preselect data display options when loading the data. You can choose to show
all series of a study side by side or, for time series, to show all phases side by side.
1. Select the study you want to load.
2. Right-click and select View All Series Side-By-Side or View All Phases Side-
By-Side.

Viewing reports If a preliminary or final report exists for a study, you can preview it in Study
Browser.
Right-click a study for which a preliminary or final report exists and select View
Reports from the context menu.

Loading data for quality If your user rights permit you to perform quality assurance tasks, you can load data
assurance directly from the study list onto the Quality Assurance platform.
1. Select one or several studies, series, or volume datasets.
2. Right-click and select Quality Assurance from the context menu.

Session management
Visage 7 supports session management. Session management means that you can
save image processing and evaluation results when you have to interrupt your work.
When you return later, you can load the session again and resume your work or
present your results to colleagues.

Note

Session management requires that your user account is assigned to an appropri-

ate user level. Talk to your system administrator to find out about your user level
settings.

Saving a session Use File > Save Session or File > Save Session As to save a session. For one
study you can save more than one session if you want to document stages or dis-
cuss different aspects.

AutoLogoff session If the system logs you off automatically after an extended period of no user interac-
tion, it saves any changes in an AutoLogoff session.

Tip

Open the AutoLogoff session immediately after you have logged on again and
decide whether to save it in a user-created session. When the system logs you
off automatically a second time, a new AutoLogoff session is created, which
overwrites the previous one.

Visage 7 23
Session management Study Browser

Session list If session management has been enabled for your user account, the lower right cor-
ner of the Study Browser displays a session list.
When no study is selected in the study list, all your recent sessions are shown in the
session list.

When a study is selected in the study list, the session list displays only sessions of
this particular study. An AutoLogoff session is shown in red and in the topmost
position of this list.

Loading a session Double-click a session in the session list.

-Or-
Double-click a study in the study list.
Depending on the configuration of this feature, a double-click either loads the most
recent session or starts a new session. See Properties dialog box, page 190.

Ignoring session infor- You might choose to ignore session information explicitly when you load a study.
mation
1. In the study list of the Study Browser, select the study.
2. Then double-click <New Session> in the session management box.
The system loads the original data as they were sent from the modality and ignores
any intermediate evaluation results.

Sharing sessions Sessions are usually available only for the user account that created the session.
However, you can choose to share sessions with colleagues.
When you save a session, indicate whether you want to make this session available
for all users or only for your own user account. Sessions that you made available for
all users are marked with the word (shared) in the session management box.

Sending session links You can send shared sessions as session links to colleagues.
or study links
1. Double-click a session in the session list.
2. Select File > Copy Session Link.
3. Open your email program and send the session link in an email.
When your colleagues receive such emails, all they need to do is to click the
attached link. Visage 7 loads the session, provided, of course, Visage 7 is installed
on your colleagues’ computers.

24 Visage 7
Study Browser Data management

If you did not share a session or if you are not working with sessions, you can copy
and send study links instead of session links. A study link will help the recipient of
the email to find and open a study quickly. A study link will not communicate ses-
sion-specific information, however.
1. Double-click the study in the study list.
2. Select File > Copy Study Link.
3. Open your email program and send the study link in an email.

More information about A session saves the following information and image processing results:
sessions
• How many and which datasets were loaded at the time the session was saved
• Protocol and display settings
• Key views and screenshots with or without annotations and measurements
• Segmentation results, such as 3D ROIs or vessel segmentation results
• Structures and contours
• Cardiac analysis results
Session information is temporary data. Sessions are stored on the Visage 7 server
for as long as the studies they refer to are stored on the server. When a study is
deleted from the database, session information is lost. Deletion of study data can be
triggered manually or automatically, that is when the hard disk is full. Automatic
deletion of study data affects the oldest studies on the server.
To avoid losing sessions that you want to preserve over a longer time, delete-pro-
tect these studies. See Delete-protecting studies, page 30.

Data management
Aside from the daily tasks of searching and loading study data, you also use the
Study Browser for less frequent data management tasks.

Importing and exporting studies

You use these functions when you receive image data on a patient CD or DVD or
when you want to create a patient medium.

Note

You need appropriate user rights to be able to import and export studies.

Importing a study from 1. Insert a patient CD, DVD, or connect a USB stick.
CD, DVD, or USB stick
If Visage 7 finds DICOM data on this medium, the DICOM data detected dialog
box opens.

Visage 7 25
Data management Study Browser

2. Click Import.
In the study list of the Study Browser, a new tab card appears.
3. On this new tab card, select the study or studies that you want to import.
4. Click Import.

The Import DICOM Data dialog box opens. In this dialog box you can modify
certain attributes of the data to be imported.
For example, if you are importing a study from another institution, you might
have to update the patient ID so that it matches the ID used in your own practice.
Identical patient IDs is a prerequisite for Visage 7 to identify the imported study
as a prior study for a patient who already exists in your system.
5. Select Create new UIDs and modify the Patient ID, for example.
Other import presets might also be available in your Visage 7 Client. These pre-
sets were configured to meet the requirements for patient data import in your
particular institution.
6. Also select Don't archive data (for Visage 7 installations with archive option) if
you want to import the data only temporarily and plan to delete it again later.
7. Select Prevent autorouting to ensure that your data is not forwarded to other
servers, independent of the autorouting rules that are configured in your system.
8. Click Import Data.

Tip

If your forgot to select the Don’t archive data option during data import, you can
select this flag later in the study list. Right-click a study that has not yet been
archived and select Don’t archive data. Be aware that you cannot reset this flag.

Exporting studies You can export studies either from Study Browser or from the View or Export win-
dows. In Study Browser, you explicitly select studies from the study list of your
Visage 7 server (primary server). You cannot export data from partner systems or
connected DICOM nodes. In order to export studies from a View window, you load
the relevant studies first. All the loaded studies will be exported. You cannot exclude
loaded studies from data export.
1. In Study Browser, select the study or studies that you want to export, right-click
and select Media Export.
-Or-
In a View window or the Export window, select File > Media Export.
2. Select a Destination
Export files to local client folder - select this option to download data onto
your local computer or onto a USB stick at your local computer. Also select the
drive and folder to where you want to export the data.

26 Visage 7
Study Browser Data management

Burn Patient CD/DVD - select this option to create a CD or DVD on a CD/DVD

writer on your local computer.
Export files on server - select this option to export data to a predefined folder
on the Visage 7 server. From there, the data can be picked up by a CD/DVD pro-
ducer station, for example.
CD Producer Station - select this option to create a CD or DVD on a CD/DVD
producer station that is connected to the Visage 7 server. Also select the storage
capacity of your medium. This option is only available if a CD producer station is
connected to the Visage 7 server.
CD producer station or stations configured as DICOM nodes - if configured, one
or more additional CD producer stations in your hospital might be available here.
Send to ... - select a DICOM node that has been configured to receive studies
from Visage 7.
3. Select export options.
Include Media Viewer allows the recipient of the CD, DVD, or USB stick to read
the study data directly from this medium. No other software is required. Also
select Autorun Media Viewer if you want Media Viewer to be started automati-
cally when the CD or DVD is inserted in the CD/DVD drive or when a USB stick
is connected to a computer.
Uncompressed only exports data according to the IHE standard.
De-Identify exports an anonymized copy of the selected data.
4. Click Export.
Exporting includes sending the images and creating a DICOM directory. Depending
on the data volume that you are exporting, this process might take a while.

Retrieving and sending studies (DICOM network)

You use these functions if you want to fetch a study from a connected DICOM net-
work node or send a study to another DICOM node.

Note

You need appropriate user rights to be able to retrieve and send studies.

Retrieving a study from You need to retrieve studies from a connected DICOM node before you can load
a DICOM node the data. You do not need to retrieve data from partner systems. Partner systems
are servers whose tab cards are marked with a Visage 7 logo.
1. Select the tab card of a connected DICOM node.
2. Define search criteria in the query section and click Query.

3. In the study list, select the study that you want to retrieve.

Visage 7 27
Data management Study Browser

4. Click Retrieve.

5. Return to the leftmost tab card. That is the tab card of the Visage 7 server.
6. Search for the study that you just retrieved.

Sending data across You can send data either from the primary server, that is your own Visage 7 server,
the network or from partner systems. The tab cards of partner systems are marked with a
Visage 7 logo. You cannot send data directly from connected DICOM nodes or
external media. If you want to send data from such a node or medium, retrieve the
data first.
1. Select the study that you want to send in the study list of the Visage 7 server.
2. Right-click and select DICOM Send and select the server or servers that you
want to send the data to.
-Or-
Select DICOM Quick Send to send the selected data off to preconfigured desti-
nations immediately.

Attaching documents to studies

You can attach reports, scanned documents, or notes from the referring physician,
or other files to a case.
Attachments are appended to a study as a separate series each. The program sug-
gestion for the series number ensures that the attached series will be added to the
end of the study.
In a View window, the attached files will appear as additional thumbnails in the
thumbnail section. Here you can double-click an attachment and show the data in a
separate window.

Attaching files to studies

Only pdf files and image files can be imported from the file system and attached to a
study.
1. In the study list, right-click a study and select Add Attachment.
2. In the Add Attachments To Study dialog box, click Browse and select one or
several files in your file system.
3. Modify series information, if necessary.
4. Select Don’t archive data and Prevent autorouting to prevent the attachments
from being archived or sent to other network nodes for archiving.
These settings will affect only attachments and not the study as such.
5. Click Import.

28 Visage 7
Study Browser Data management

Scanning attachments
1. In the study list, right-click a study and select Add Document Scan.
2. In the Add Document Scan to Study dialog box, select your scanner and scan
settings.
Note that the highest resolution you can select here might be lower than the
maximum resolution of your scanner.
3. Click Scan to scan one or several pages.
4. Use these buttons to review the scanned pages.

5. Modify series information, if necessary.

6. Select Don’t archive data and Prevent autorouting to prevent the attachments
from being archived or sent to other network nodes for archiving.
These settings will affect only attachments and not the study as such.
7. Click Import.

Managing access rights to data

When you import a study from an external medium, the study is automatically
assigned to your own user account and the user group Standard. Change the study
assignment to user or user group to make the data available for other users as well.

Note

You need appropriate user rights to be able to grant access rights to individual
users or entire user groups.

1. On the primary server (leftmost tab), select one or several studies.

2. Right-click and select Assign study to groups or Assign study to users.
3. In the Study Assignment dialog box, select the user groups or users who will
have access to these studies.

Note

In the Study Assignment dialog box, you can also revoke access rights to study
data. Do not revoke access rights to a study for your own user account or for a
user group that you are a member of. If you do, you no longer have access to this
study either. You cannot restore your own access rights to study data after you
have closed the dialog box. As soon as the study list is updated, the study is no
longer listed. You or your user group can only be granted access rights to this
study again by another user with appropriate user rights, or by the system admin-
istrator.

Visage 7 29
Data management Study Browser

Delete-protecting studies
Users with advanced user rights can delete studies that are not delete-protected
from the Visage 7 server in the Quality Assurance window. Manual deletion of
studies might become necessary when patient data have been corrected and dupli-
cates of a study exist on the server. Automatic deletion of old data that has already
been archived can be configured by the system administrator to free disk space.
When a study is deleted from the server either automatically or manually, session
information is irretrievably lost. Therefore, you might want to delete-protect cases
whose sessions contain information that you want to preserve over an extended
period of time. For example, you might want to save cases that you have marked
with labels and that you want to keep for research purposes.
1. Select the study that you want to delete-protect.
2. Right-click and select Delete Protection.

Note

You need appropriate user rights to be able to delete-protect studies.

Anonymizing and marking cases for presentation

Visage 7 provides mechanisms for marking studies for presentation or other pur-
poses and for anonymized display of data.

Study labels
You use study labels to mark studies for various purposes.
Three types of study labels exist:
• Public labels for marking teaching files
You use these labels to mark anonymized cases that you want to discuss with
your students. Students who open the Visage 7 Client will see only those studies
that have been marked with a teaching file label.
Teaching file labels start with a configurable prefix, for example, the word
teach. If teach is the configured label prefix, teach_class2 or teaching-
course2 are considered teaching file labels. However, a public label with the
name class1 or course2-teaching would not be identified as a teaching file
label but as a public label for other purposes.
• Public labels for other purposes
You use a label of this type, for example, to mark studies that you want to dis-
cuss with your colleagues in your department’s weekly meeting.
• Private labels
Private labels are only visible in your own user account. You use labels of this
type, for example, to collect cases for research purposes or simply to find a
study again quickly.

30 Visage 7
Study Browser Data management

Creating and assigning 1. In the study list, right-click a study and select Study Labels.
study labels
2. Type the new label name.
Visage 7 now offers you two versions of the new label, new label (private) and
new label (public).
3. Select the check box in front of the public or private version and click Apply.
Visage 7 creates the new label and assigns the selected study to it.
4. Assign a second label to the study, if required.

Deleting a study label 1. In the study list, right-click a study and select Study Labels.
2. Start typing the name of the label that you want to delete.
3. In the list, right-click the study label and select Delete.
When you delete a study label you remove the marker from all studies that it had
been assigned to. You do not delete the studies.

Tip

If you use labels to collect cases for teaching or research purposes, you will prob-
ably want to keep these cases in your database for some time. Therefore, con-
sider delete-protecting such cases to avoid that labels and session information
being lost when the data is moved to the archive and deleted from the server.
See Delete-protecting studies page 30.

Privacy mode
In privacy mode, any information that would identify a case is temporarily hidden.

You can switch to privacy mode either from the Study Browser or from a View win-
dow.
Select File > Privacy Mode > Study Browser and View Screen or View Screen
Only.
Privacy mode will remain turned on until you end it again (File > Privacy Mode >
Off).

Visage 7 31
Data management Study Browser

Creating anonymized teaching files

While privacy mode is a display mode only, de-identification or anonymization of
case data means removing any information that would identify the patient from a
copy of a case permanently.
You can anonymize a study and assign the anonymized copy to a predefined teach-
ing file label in one step.
1. In the study list, right-click a study and select De-identification and Teaching
Files.
In the de-identification dialog box, the Create De-identified Copy check box is
selected. Do not clear this box.
Moreover, the system suggests that you replace the patient name with a case
description and the prefix TF_ (for teaching file). The system has also replaced
the patient ID, study ID, and accession number with random codes. The date of
birth is replaced by January 1st of the patient’s actual year of birth.
2. Click an item in the New Value column and change this random data if you want.
3. Select the following options for anonymization:
Remove other demographic tags and Remove private tags: Aside from the
data shown in this dialog box, other information might be stored in the DICOM
data of this study that also helps to identify the patient. Selecting these two
options removes all DICOM tags that might contain information about the
patient.
Don’t archive and Prevent autorouting: Selecting these options prevents the
anonymized study from being archived or sent to another network node for
archiving.
4. Select a teaching label for the anonymized copy.
You can only select predefined teaching labels here. You cannot create a new
teaching file label in this dialog box.
5. Click Apply.
When copying is complete, the anonymized study does not appear in the study
list immediately.
6. Check your query settings and click Query to update the study list.

Tip

Do not forget to delete-protect the anonymized study, particularly if you selected

the options that prevent archiving and autorouting. See Delete-protecting studies
page 30.

32 Visage 7
Study Browser Data management

Anonymizing cases for other purposes

If you want to create an anonymized copy of a study in order to present it at a con-
ference or to include it in a research project, you proceed in two steps.

Creating an ano- 1. In the study list, right-click a study and select De-identification and Teaching
nymized copy of a case Files.
2. Proceed as described in Creating anonymized teaching files, page 32. However,
do not assign a teaching file label.

Marking the ano- 1. In the study list, search for the anonymized case.
nymized case with a
2. Right-click the anonymized case and select Study Label.
private label
3. Assign a public or private label as described in Creating and assigning study
labels, page 31.

Visage 7 33
Data management Study Browser

34 Visage 7
Patient Search

screen8patientsearch
Patient Search is targeted at referring physicians. Here, referring physicians can
search for patients and open reports and images of patients whom they have
referred. The list of patients and studies in this window is populated from the RIS
(radiology information system) and depends on your access rights that have been
defined by your RIS administrator.
Patient Search is subdivided into two sections:
• Query section
• Results list

Query section
tool8patientsearch8search
In the query section you can configure your search of accessible studies by select-
ing one or several of the following criteria.

First Name, Last Name The patient’s last name and first name.

Date of Birth The patient’s date of birth.

tool8patientsearch8birth-
date
The date of birth box allows free text entry in most date formats. For example, for
June 3rd, 2009, the system accepts any of the following date entries: 03062009,
3.6.2009, 3.JUN 2009, 3/6/2009, 3/JUN/2009.
The default date format is defined by the property settings of the user interface
(date widget, date local settings). For example, the default for the region Germany,
Austria, Switzerland, Australia and UK is DD.MM.YYYY.

Patient ID The patient’s identification number.

Location Name of the location where the study was performed.

Accession Number Job number of the study in the RIS (radiology information system).

Study Date Date when the study was performed.

From ... To Here you can specify a search period. Enter dates in the format YYYY-MMM-DD, or
click the button to the right of a date box and select a date in the calendar.

Today, Yesterday, Use the buttons Today, Yesterday, 1 Week, 2 Weeks as a quick way to specify
1 Week, 2 Weeks frequently searched periods in the correct format.

Visage 7 35
Results list Patient Search

Modality Select the check boxes of all modalities whose studies you want to search:
CT (computed tomography), MR (magnetic resonance tomography), PT (positron
emission tomography, PET), US (ultrasound), CR (computed radiography), DX
(digital radiography), MG (Mammography), XA (X-ray angiography).
-Or-
Type the abbreviation of the modality in the text box.
-Or-
Select All to search for all studies irrespective of the modality where they were per-
formed.

Only My Patients Depending on your access rights in the RIS, you can to search for and open studies
of only your own patients, only patients from your practice, or all patients.
Only Patients from my
Practice If you have access rights to all patients, you have to provide the exact Patient ID,
Date of Birth or Accession Number for identification
All Patients

Only Signed Reports Limits your search to reports that are finalized, that is signed.

Click this button to start the search.

Results list
In the search results list, you find images and reports for patients that you referred
for radiologic examination.

Viewing images You can open images directly from the results list, where they are shown with the
patient name, date of study, examination type, and modality.
Double-click the image symbol to open the images.

Opening reports When reports are available, a report button is shown next to the images in the
results list.
Double-click this button to open the report from the RIS (radiology information sys-
tem).

-Or-
Double-click this button to open a signed report.

36 Visage 7
Patient Search Results list

Tip

In the report window, you can view and print reports.

Visage 7 37
Results list Patient Search

38 Visage 7
View windows

screen8view
Once you have loaded images, these are shown in one or several View windows
which appear as tab cards in the title bar. Tab cards show the name of the patient
whose data they contain. The active tab card is highlighted with a bullet.

Use tab cards to switch between cases.

Depending on your selection of data, a View window is shown with a specific screen
layout. This screen layout is defined in a protocol.
The system preselects a different protocol for data of different modalities and ana-
tomical regions, and depending on the monitor configuration and the number of
loaded series. If you prefer a different screen layout, you can select a different pro-
tocol, show a different arrangement of viewers, or show and hide toolbars and tool
cards.
Find out more about these options and the tools available for reading images in the
following sections:
• Protocols
• Viewers and viewer layouts
• Tools
• Tool cards
For more information about how to perform complex tasks that combine various
tools and tool cards, refer to this section:
• Complex tools and applications

Visage 7 39
Protocols View windows

Protocols
Protocols define the screen layout and the display parameters for the loaded
images.

Protocol assignment When a user loads one or several studies, series, or volume datasets, the system
automatically selects a suitable protocol for the data. The system uses the following
matching criteria to make this selection.
• Monitor configuration
Different protocols exist for different combinations of monitors and for different
screen resolutions.
• Study and series criteria
Protocol matching criteria usually include the modality or a combination of
modalities that acquired the data.
For example, a CT series might be shown with a different screen layout than an
MR series or a combination of CT and PET series. Other study and series crite-
ria include the study description, the part of the body, or whether current and
prior studies are displayed.
• Protocol availability and protocol ranking
Protocols might have been defined in such a way that they are available for indi-
vidual users or individual user levels only. Moreover, users can assign priority
ratings to protocols. A protocol with a high priority rating is more likely to be auto-
matically selected than a protocol with a low priority rating.

Protocol definition Your system comes with a number of predefined protocols. Users with advanced
user rights can adapt these protocols and their matching criteria or create protocols
of their own.
See Properties and protocols, page 190.
A protocol typically defines the following layout and display aspects:
• The number and arrangement of image segments (viewers)
• The initial rendering parameters for each viewer
• The linking of viewers for synchronized navigation in multiple viewers
• The availability and location of toolbars
• The availability and location of tool cards

40 Visage 7
View windows Viewers and viewer layouts

Selecting a different 1. Drop down the protocol menu and select a different protocol.
protocol

Further up in the Protocol menu, you find alternative system suggestions for the
current dataset. Further down in the list, you find all protocols that exist in your
system. These protocols are grouped by monitor configuration and by modality
or modalities.
2. Select one of these protocols to change the screen layout.

Viewers and viewer layouts

After you have loaded one or several studies, series, or volume datasets, Visage 7
displays the images in one or several viewers.
Use the following controls and the various tools from the toolbars to optimize and
read image data. See also Tools, page 54.
Use the mouse if you want to rearrange datasets in viewers: Click any of the four
corners of a viewer where the image text is shown. Drag the thumbnail that rep-
resents the data in this viewer to another viewer.

Layouts toolbar
tool8protocol8layouts tool8viewing8togglefullscreen

With the buttons of this toolbar you can switch between various viewer layouts that
are suitable for the loaded data. These layouts have been defined in the active pro-
tocol. Different protocols offer different sets of layouts.

Selecting a layout Click one of the buttons on this toolbar.

Tip

Double-click a viewer in any of the available layouts to show this viewer

fullscreen. Double-click again to return to the original layout.

Visage 7 41
Viewers and viewer layouts View windows

If the layout you are looking for is not shown on the Layouts toolbar, add it to this
toolbar.
1. Right-click the toolbar and select Show Layout from the context menu.
2. Select the layout.
3. Now click the new layout button that has appeared on the toolbar.

Rearranging the Lay- You can rearrange the Layouts toolbar for frequently used protocols.
outs toolbar
1. Drag a layout along the toolbar to show it in a more prominent place.
-Or-
Right-click a layout and select Make default from the context menu to show this
layout right after loading a study.
-Or-
Add or remove layout buttons on the toolbar with Show Layout or Hide Layout
from the context menu.
2. Select Save Layout Preferences from the context menu to save these changes
for your user account.

Creating a new layout By creating a new layout you can arrange images in a way suitable for reading a
particular case.
1. Right-click the Layouts toolbar and select New Layout.
2. Move the cursor across the matrix of available viewers.
Selected viewers appear black.
3. Click to complete viewer selection.
4. From the thumbnail section, drag images into the viewers.
5. Click the Save Sort Order button to save the new layout and image arrange-
ment in a DICOM presentation state.
tool8presentationstate8savesortorder

In Study Browser, the presentation state appears as a new series with modality
PR. The next time you load this study, images will be displayed in the new layout
automatically.

42 Visage 7
View windows Viewers and viewer layouts

Thumbnail section
toolcard8imagesets
At the bottom of the screen the thumbnail section might be shown. If the thumbnail
section is currently not shown, click the small arrow that points up at the bottom of
the screen.

Initially, the thumbnail section shows the study (or studies) that you have loaded into
the View window as well as any prior studies that were identified by the system as
potentially relevant for a case.

A green border around a thumbnail indicates that this image set is currently shown
in the active viewer. Click a thumbnail with a green border to highlight the active
viewer briefly.

A green triangle in the lower right corner of a thumbnail indicates that this image
set is shown in one of the other viewers on the screen.

A gray triangle in the lower right corner of a thumbnail indicates that this image set
had been displayed in a viewer at some time during the current session but has
been unloaded in the meantime.

A cube symbol indicates that a thumbnail represents a volume.

In this case, this would be a volume that contains 69 images.

A folder symbol indicates that a thumbnail represents subsets of images.

In this case, this would be 20 time series containing 32 images each.

A thumbnail with background hatching represents a prior study that has not been
loaded or expanded yet.

Visage 7 43
Viewers and viewer layouts View windows

Study dates are color-coded:

• Typically, the study date of the current study, that is the study that you have
loaded from Study Browser, is shown white with a black background.
• The study dates of prior studies are shown red with a white background.
• The study dates of additional and more recent studies are shown green with a
black background.

Tip

You can modify this color coding for your user account.

Showing DICOM series Right after you have loaded a study, image sets are arranged in the thumbnail sec-
tion as defined by the active protocol.
Right-click the thumbnail section of a study and select Show DICOM Series from
the context menu.

All series of this study are now displayed in their DICOM hierarchy.

Sorting thumbnails by Right after you have loaded a study, image sets are arranged in the thumbnail sec-
time tion as defined by the active protocol, which is by relevance rather than in chrono-
logical order.
Right-click the thumbnail section and select Sort by time from the context menu.

Thumbnails are now sorted by acquisition time.

Showing images or 1. Right-click a thumbnail with a folder symbol and select Show Images from the
subsets of data context menu.
The thumbnail folds out and shows the image sets it contains.

44 Visage 7
View windows Viewers and viewer layouts

2. Click the Close button to close the foldout again.

Viewing reports If a preliminary or final report exists for a study, you can preview it in the thumbnail
section.
Right-click a study for which a preliminary or final report exists and select Show
Reports from the context menu.

Scrolling in the thumb- If more studies or image sets have been loaded than can be shown in the thumbnail
nail section section at a time, a white triangle is shown at the right edge of the thumbnail sec-
tion. This triangle indicates that there are more thumbnails further to the right.
Drag any of the shown thumbnails to the left to scroll in the thumbnail section.

Collapsing or expand- 1. Click a study date to collapse the study.

ing studies

2. Click the study date a second time to collapse the study even further.

3. Click the study date a third time to expand the study again.

Showing all studies of a Move the slider to the left of the thumbnail section all the way up to show all studies
patient that exist for this patient on the Visage 7 server.

Visage 7 45
Viewers and viewer layouts View windows

Selecting more prior If you find more prior studies that you consider relevant for your case, select them.
studies
Click the pin symbol in front of the study date to select a study.

Controlling display of If a large number of studies exist for a patient on the Visage 7 server, use the slider
prior studies to the left of the thumbnail section for a better overview.
Slider position bottom: shows only loaded studies and studies you selected with a
pin symbol.
Slider position center: shows all the above studies plus studies preselected as rele-
vant prior studies by the system as a result of auto-prior loading settings.
Slider position top: shows all studies of this patient on the Visage 7 server.

Popup viewer Double-click a thumbnail to show this image set in a separate floating window.

For example, you can use this window to show a scout image, which can remain
open while you read images in the various viewers.

Updating the thumb- If images are still being uploaded to the Visage 7 server when you open a case,
nail section update the displayed data at intervals.
1. Open the Study Navigator,
See Study Navigator, page 68.
2. Click Refresh to refresh both the Study Navigator and the thumbnail section.

46 Visage 7
View windows Viewers and viewer layouts

Loading image sets Drag a thumbnail from the thumbnail section into a viewer to load this image set.

Note

Not all image sets can be displayed in all viewers. For example, an MPR viewer
or a 3D viewer accepts only 3D volumes, but no 2D images. If you cannot show
2D images in a viewer, select a different layout and try again.

Tip

With large monitors or multiple monitors, dragging thumbnails into viewers might
mean that you have to drag thumbnails a long way.
Select Show Mini Drop Zone for your user account in such a case (File > Pref-
erences > Properties > User Interface).
When you now start dragging a thumbnail, a small image appears in the thumb-
nail section. This image represents the monitor layout. Dragging a thumbnail into
a viewer in the Mini Drop Zone has the same effect as dragging it all the way
across the monitor to the target viewer.

Unloading image sets Click viewer text in any of the four corners of a viewer and drag the thumbnail back
to the thumbnail section to clear a viewer.
-Or-
Right-click and drag the thumbnail back to the thumbnail section to remove only the
overlay dataset from the viewer but not the primary dataset.
-Or-
Select Show Mini Drop Zone for your user account and drag the thumbnail onto
the small red x in the Mini Drop Zone to clear a viewer or to remove the overlay
dataset.

Visage 7 47
Viewers and viewer layouts View windows

Loading an entire study Drag a study date from the thumbnail section into a viewer to load the entire study.

Viewer controls
tool8viewercontrols
Below each viewer, a bar with controls can be shown. These controls are within
easy reach of each viewer and help to optimize image display. For example, you
can use the viewer controls to change the zoom factor or window level for your
images.
From the viewer controls, you can select which type of image you want to display in
a viewer. The viewer controls bar offers different display options for different image
types. For example, if you are currently showing thick slices, you can change the
compositing mode here. See also Compositing modes for thick slices, page 50.
1. From the viewer context menu or tool palette, select Viewer Controls to show
this bar.

2. Click the arrow button next to a control to drop down a list of options.

-Or-
Click to select window level, slice thickness, or zoom factor and overwrite these
settings.

48 Visage 7
View windows Viewers and viewer layouts

Navigation and display options for volume datasets

These options are available only if you have loaded volume datasets. This means
that these options are available in MPR viewers or 3D viewers but not in 2D view-
ers.

Crosshair navigation in In MPR viewers, scoutline crosshairs indicate the orientation and position of the
MPR viewers slices that are currently shown in other MPR viewers.
• A blue line represents the image in the MPR segment with the blue viewer
frame.
• A green line represents the image in the MPR segment with the green viewer
frame.
• A red line represents the image in the MPR segment with the red viewer frame.

Note

The scoutline crosshair is shown only in viewers that show orthogonal views of
the same volume dataset. Crosshair lines are not shown in viewers that display
2D data, or in isolated MPR viewers.

Small arrows that point to the crosshair indicate the viewing direction in the other
two MPR viewers.

When you move the cursor over the center of the crosshair, the cursor changes its
shape. Use the crosshair center to drag the entire crosshair. This moves two view
planes simultaneously and shows new slice images in the other two MPR viewers.
The move cursor is not available for partial crosshair display.

When you move the cursor over a crosshair line, the cursor changes its shape.
Drag this line up or down to move through the volume along one of the other two
standard axes. Dragging a crosshair line updates one of the other two MPR view-
ers.

Visage 7 49
Viewers and viewer layouts View windows

When you move the cursor over the rotation handles (small dots), the cursor
changes its shape. Drag the cursor up or down to rotate the crosshair. Crosshair
rotation updates the two other MPR viewers and generates images with nonstan-
dard views.

When you click one of the small triangles on the crosshair lines along the edges of
the image the crosshair lines appear dotted.
You can now change the slice thickness in the MPR viewers by dragging the han-
dles up or down. When you release the mouse button, the slice thickness indicator
and the selected thick slice compositing mode in the viewer controls are updated.

Compositing modes for The default slice thickness for reconstructed images in MPR viewers is specified in
thick slices the active protocol. The default slice thickness is usually the slice thickness of the
original scans.
You can change the slice thickness for your loaded images and then choose a dif-
ferent compositing mode for thick slices from the viewer controls.
• Thin MPR
In this mode, slices are shown in their original slice thickness.
• Maximum intensity (MIP)
In this mode, data values are computed as the maximum of the values of the
original slices.
• Minimum intensity (MinIP)
In this mode, data values are computed as the minimum of the values of the orig-
inal slices.
• Average intensity (AvIP)
In this mode, data values are computed as the average of the values of the orig-
inal slices.
-Or-
Use this tool or keyboard shortcut T to switch from display of thin slices to display of
thick slices and vice versa.

Use this tool or keyboard shortcut Shift + T to toggle compositing modes (MIP,
MiniIP, AVIP).

50 Visage 7
View windows Viewers and viewer layouts

Display options in 3D The 3D viewer displays a 2D projection of a volume. In this viewer, you can choose
viewers between several volume rendering techniques and volume display modes.
• 3D MIP (maximum intensity projection)
Visage 7 calculates the maximum of all the voxel values that lie on the virtual
viewing ray behind this pixel. 3D MIP requires a grayscale color map.
• VRT (volume rendering technique, also called emission-absorption model)
This technique maps data values to colors and transparencies defined in a 3D
color map. The voxels are interpreted as small diffuse light sources that emit and
absorb light in the direction of the viewer. Each voxel is interpreted as a local dif-
fuse light source, without additional shading.
• VRT (diffuse)
This rendering technique is similar to VRT. However, an additional virtual light
source and a diffuse lighting model adds shades to the surfaces of the volume.
For example, curved surfaces become darker toward the edges, which results in
a more natural appearance.
• VRT (specular)
In addition to diffuse shading, specular shading uses a lighting model that
reflects light dependent on the angle between the incoming and reflected light.
This means that on smooth surfaces users see highlights, and that shading
becomes even more expressive than with diffuse shading. Specular shading is
especially good for large surfaces with fine detail.
• Perspective projection
This projection mode gives a more natural impression. Perspective projection
corresponds with the everyday experience of perspective distortion. Objects that
are far away appear smaller than objects close by.
If perspective projection is not selected, orthographic projection is active.
Orthographic viewing is like viewing an object through a lens with a very long
focal distance, a telelens. The viewing rays are almost parallel to each other and
no perspective distortion occurs. In orthographic mode, you can perform mea-
surements in the image plane, for example distance measurements and angle
measurements. With perspective projection turned on, measurements are not
possible.
The Perspective Projection toggle is available only from the 3D viewer context
menu (Properties > Perspective Projection) but not from the viewer controls.
• Smart sampling
This option reduces artifacts in the volume display.
The Smart Sampling toggle is available only from the 3D viewer context menu
(Properties > Smart Sampling) but not from the viewer controls.

Visage 7 51
Viewers and viewer layouts View windows

Image text and warning symbols

Aside from image information, viewers contain information about the loaded data in
the form of image text and symbols.

Warning symbols These symbols alert you to the fact that an image is shown with reduced image
quality or that warnings exist concerning the displayed images.

Low resolution warning

A red bullet in the lower right corner of a viewer indicates reduced image quality.
The low-resolution warning appears while the dataset is still being loaded and the
system generates full image quality. The low-resolution warning also appears if a
low streaming compression level is selected.
See Best Image Quality, page 111, for information on how to load individual images
in best image quality but with slower download time.

Image synchronization in progress

A yellow bullet indicates that the image has not yet been updated with your latest
image processing step. The previous image is still displayed while image process-
ing is performed in the background. When image processing is complete, the yel-
low bullet disappears.

Miscellaneous warnings
A yellow warning triangle in the upper left corner of the images indicates that warn-
ings exist for this dataset.

Note

Do not use images that show a red or yellow bullet for primary diagnosis.
Find out more about warnings by clicking the yellow warning triangle if you see it
in your viewers.

Scale In calibrated image types, for example, CT images, a scale can be shown on the
right edge of the viewers. The scale looks like a small ruler and indicates centime-
ters. When you zoom in on an image the scale switches to millimeters.

Showing or hiding If the image text is in your way during image processing, you can hide it.
image text
Use View > Show in Viewer to hide or redisplay image information.
-Or-
Use tools from the tool palette to show or hide image information. See Tools for
switching image text and graphics on and off, page 114.

52 Visage 7
View windows Viewers and viewer layouts

Tip

When you are working with a small window size and low screen resolution, it is
not always possible to show image texts and symbols correctly. Texts are trun-
cated, and symbols, the scale, or a color bar might be shown on top of each
other. Maximize the program window and then switch to fullscreen mode for dis-
play of all image information.

Showing image text Position the cursor over image text, hold the Ctrl key down, and rotate the mouse
larger or smaller wheel to show the image text in all viewers larger or smaller.

Privacy mode Switch to privacy mode if you want to hide any information that would identify a
patient temporarily. You would use this mode for presentation purposes, for exam-
ple.
Select File > Privacy Mode > View Screen Only.
See also Privacy mode, page 31.

Visage 7 53
Tools View windows

Tools
A number of buttons are shown along the edges of your screen after you have
loaded data. These buttons represent tools with which you can start functions or
select options with a single mouse click. The tools are grouped in toolbars. Which
toolbars are shown when you first load data, the position of toolbars, and the
assignment of tools to toolbars depends on the selected protocol.

Arrangement of tool- Select View > Show Toolbars to show more toolbars or to hide toolbars.
bars
-Or-
1. Click the toolbar handle to the left or above a toolbar.
2. Drag the toolbar across the screen and drop it wherever you prefer it to be
shown.
When you drag a toolbar to the left, right, or bottom edge of the screen, a new tool-
bar section appears there. When you drag a toolbar anywhere else on the screen, it
turns into a floating window.
If you are working with more than one monitor, use View > Show Toolbars > Syn-
chronize with other monitors to synchronize your arrangement of toolbars on all
monitors.
tool8viewing8contextmenu
Tool palette and viewer A selection of the most frequently used toolbar buttons is also available from right
context menu within a viewer.
1. Right-click a viewer to show the tool palette, viewer context menu, or both.
In your user profile, you can define whether tool palette, viewer context menu, or
both are shown. See Configure Tool Palette dialog box, page 189.
2. Click the Show Context Menu button on the tool palette to show this menu if it is
not displayed when you right-click a viewer.

Keyboard shortcuts Some of the functions and options that are represented by toolbar buttons can also
be selected with keyboard shortcuts. These keyboard shortcuts are active even if a
toolbar or button is currently not displayed on the screen.
A number of keyboard shortcuts have been predefined for your system. These
shortcuts are indicated in brackets after the tool name in this document.

Tip

Select Help > Keyboard Shortcuts in the main menu to show the list of factory-
default shortcuts. From this dialog box, you can copy the shortcuts list and print it
out with another software program.
On your keyboard, press Ctrl + A (Windows) or Cmd + A (Mac) to select all
shortcuts and then Ctrl/Cmd + C (copy).
Open your word-processing program.
Paste the shortcuts list (Ctrl/Cmd + V) and then print it (Ctrl/Cmd + P).

54 Visage 7
View windows Tools

Note

Users with appropriate user rights can change the assignment of keyboard short-
cuts for their own user account or for other users as well. See Configure Key-
board Shortcuts dialog box, page 187.
Therefore, the keyboard shortcuts indicated in this document might no longer be
correct for your system.

Basic navigation and image display tools

This set of tools is available in almost all protocols. Typically, these tools are part of
the Standard Tools toolbar.

Default Navigation
tool8navigation8default

This tool is assigned to the function that is most frequently used in the context of an
image type and viewer type.
1. Click the Default Navigation button to select this tool.
2. Use the left mouse button to perform the function that is assigned to the default
navigation tool.

Zoom
tool8zoom

With this tool, you can enlarge or reduce images interactively.

1. Click the Zoom button to select this tool.
2. Click a viewer and hold the mouse button down.
3. Drag the cursor up to zoom in.
-Or-
Drag the cursor down to zoom out.

Visage 7 55
Tools View windows

Tip

Use the middle mouse button (or wheel button) to zoom images without selecting
the Zoom button on the toolbar first.

-Or-
Use the percentage box in the viewer controls to change the image display size.

Pan
tool8navigation8pan

With this tool, you can move an image within a viewer.

1. Click the Pan button to select this tool.
2. Drag the mouse across a viewer to move the image within the viewer.
You typically use this tool after you have zoomed an image and relevant image
information has moved out of the viewer.

Tip

Use the right mouse button to pan images without selecting the Pan button on
the toolbar first.

Inverse (.)
tool8rendermode8inverse

This tool inverts the image in the active viewer. Inversion means that light areas are
displayed dark and dark areas are displayed light.
Inversion is not possible for the 3D viewer.

Tip

The factory-defined keyboard shortcut for the inversion tool is the period key.

56 Visage 7
View windows Tools

Edge enhancement
tool8rendermode8edgeenhancement

Use this tool to optimize image quality and to increase contrast between structures
in slice images.
1. Click the Edge Enhancement button to select this tool.
2. Drag the mouse up or down to adjust image sharpness.
-Or-
Use the edge enhancement slider on the Display tool card to adjust image
sharpness.

Tip

The edge enhancement filter is particularly useful for improving the sharpness or
definition of XA images.

Window level tools

With this set of tools, you can change contrast and brightness in images.

Window Level
tool8windowlevel

With this tool, you can change the contrast and brightness in images interactively.
1. Click the Window Level button to select this tool.
-Or-
Use the left and right mouse button to window images without selecting the Win-
dow Level button on the toolbar first.

2. Click a viewer and hold the mouse button or mouse buttons down.
3. Drag left or right to change the window width (contrast).
-Or-
Drag up or down to change the window center (brightness).

Visage 7 57
Tools View windows

Histogram While the Window Level tool is active, a histogram of grayscale values or HU val-
ues is shown in the lower left corner of the viewer. In the histogram, a small white
bar shows window settings graphically. The bar moves when you move the window
center and expands or shrinks when you change the window width.
If the histogram is in your way, you can hide it. See Toggle Histogram, page 115.

Windowing in fusion When you window an image in fusion mode, this affects the window level of the pri-
mode mary dataset. To window the image of the overlay dataset, press and hold the Shift
key while you window the image.

Auto Window Level in ROI

tool8windowlevel8roi

With this tool, you can optimize contrast and brightness in images by focusing on a
specific region of interest.
1. Click the Auto Window Level in ROI button to select this tool.
2. Click and draw an ellipse around your region of interest.
When you release the mouse button, the system identifies the minimum and maxi-
mum pixel intensities in this ROI. The system then applies these window levels to all
images in this viewer and in all linked viewers.

Tip

This tool is particularly useful with image data that is not calibrated. For example,
use Auto Window Level in ROI in MR images in which the local receive coil
sensitivity varies considerably and with it the voxel intensity.

Show Window Level Presets

tool8windowlevelpreset8menu

Use this tool to show a list of all window level presets that exist for an image type.
1. Click the Show Window Level Presets button to open a menu.

2. Select a window level preset from the list.

-Or-
Select Window/Level Presets to define new window level presets. See Config-
ure Window/Level Presets dialog box, page 186.

58 Visage 7
View windows Tools

Enlarge/Reduce Window Width

tool8windowlevel8width8decrease tool8windowlevel8width8increase

Use these tools to enlarge or reduce the window width step by step.
The adaptation factor and fix point can be configured in the property settings for
these tools. See Properties dialog box, page 190.
The factory default settings are enlargement or reduction of the window width by a
factor of 2 while the window center remains unchanged.

Save Current W/L as Presentation State

tool8presentationstate8savewindowlevel

Use this tool to save window level adjustments permanently.

Clicking this tool saves window level adjustments in a DICOM presentation state. In
Study Browser, the presentation state appears as a new series with modality PR.
The next time you load this study, images will be displayed with the saved window
levels automatically.

Tools for adjusting the display size

In addition to interactive zooming (see Zoom, page 55), Visage 7 offers several
other tools for optimizing image display size quickly.

Fit Width/Height, Fit Width, Fit Height

tool8zoom8fitwidth tool8zoom8fitall tool8zoom8fitheight

Fit Width/Height fits images optimally in their viewers. Fit Width makes optimum
use of the viewer width, and Fit Height makes optimum use of the viewer height.
If an MPR viewer is active when you click one of these buttons, the images in the
active viewer and in all linked viewers are resized. If the 3D viewer is currently
active, only the volume display is resized, other viewers are not affected.

Zoom 100%
tool8zoom8factorone

This tool shows images in their original size. This means that one pixel from the
image file corresponds to exactly one pixel on the monitor.

Visage 7 59
Tools View windows

If an MPR viewer is active when you click this button, the images in the active
viewer and in all linked viewers are resized. If the 3D viewer is currently active, only
the volume display is resized, other viewers are not affected.

Tip

Clicking the Zoom 100% tool has the same effect as selecting zoom level 100%
(1:1) from the viewer controls.

Magnifying Glass
tool8viewing8magnifyingglass

Use this tool to be able to see details without having to zoom the entire image.
1. Click the Magnifying Glass button to select this tool.
2. Click an image and hold the mouse button down.
A rectangular area appears, which is magnified by a configurable factor (typically
factor 2).
3. Drag to move the rectangle across the image.
This movement gives you the impression of holding a magnifying glass in your
hand.
4. Rotate the mouse wheel while you still hold the left mouse button down to
increase or decrease the zoom factor of the magnifying glass.
5. Release the mouse button to turn the magnifying glass off.
The tool is still selected and you can click again in another viewer and use the
magnifying glass there.
6. Click the tool on the toolbar a second time.
Only now is the Magnifying Glass tool turned off again.

Tip

Choose multiple Magnifying Glasses rather than a single Magnifying Glass

whenever you want to inspect and compare magnified sections in more than one
viewer. See also Magnifying Glasses, page 109.

60 Visage 7
View windows Tools

Tools for rotating and flipping images

With the tools in this section you can rotate or flip images.
Be sure to show the orientation cube or orientation labels in the viewers before you
use these tools. Select View > Show in Viewer > Orientation Cube, or View >
Show in Viewer > Orientation Labels to show these orientation aids.

Rotate Clockwise, Rotate Counterclockwise

tool8viewing8rotateclockwise tool8viewing8rotatecounterclockwise

These tools rotate the image in the active viewer by 90° clockwise or counterclock-
wise.
Rotation affects only the viewer in which you clicked. Images in linked viewers are
not affected.

Flip Horizontally, Flip Vertically

tool8viewing8fliphorizontal tool8viewing8flipvertical

These tools rotate the image in the active viewer around its vertical or horizontal
axis. Rotation affects only the viewer in which you clicked. Images in linked viewers
are not affected.
Note that you cannot flip the volume in the 3D viewer.

Rotate in Plane
tool8navigation8rotateinplane

Use this tool to rotate an image with the mouse.

1. Click the Rotate in Plane button to select this tool.
2. Click an image and hold the mouse button down.
3. Drag to rotate the image.
Rotation affects only the viewer in which you drag. Images in linked viewers are not
affected.

Tip

Use this tool, for example, to straighten up images that were acquired tilted.

Visage 7 61
Tools View windows

Save Flip/Rotate as Presentation State

tool8presentationstate8savefliprotate

Use this tool to save flipped or rotated images permanently.

Clicking this tool saves flipped or rotated images in a DICOM presentation state. In
Study Browser, the presentation state appears as a new series with modality PR.
The next time you load this study, affected images will be displayed flipped or
rotated automatically.

Tools for scrolling in image stacks

The tools in this section help you to scroll through the images in image stacks.

Browse Slices
tool8browsing8slices

With this tool, you can use the left mouse button or the mouse wheel to move
through an image stack in a 2D viewer or MPR viewer.
Browse Slices is the standard navigation tool in 2D viewers and MPR viewers.
1. Click the Browse Slices button to select this tool.
-Or-
Click the Default Navigation button or hold the Ctrl or Cmd key down.
2. Drag up or down or use the mouse wheel to scroll forward or backward through
the image stack.
When you drag quickly, Browse Slices skips slices so that you reach your desti-
nation as quickly as possible. If you use the mouse wheel for scrolling, whether
or not slices will be skipped depends on whether the tool Skip Slices While
Scrolling is also selected. See also Skip Slices While Scrolling, page 63.

Note

When scrolling in an MPR viewer in thick-slice mode, you can define the scrolling
increment, that is the overlap between thick slices, with the property Tools, Slice
Browsing, Overlap of Thick Slices. Refer to section Properties dialog box,
page 190, to learn how to change properties for your user profile.
Overlap 0 means that each click of the mouse wheel scrolls the distance of the
slice thickness of a thick slice. With overlap 1, scrolling is very smooth because
one click of the mouse wheel scrolls the distance of an original thin slice. Any
value in between 0 and 1 defines an overlap. For example, 0.2 means that when
you scroll to the next thick slice, this slice overlaps approximately 20% with the
previous slice.

62 Visage 7
View windows Tools

Tip

When you browse slices in MPR viewers, scrolling up with the mouse wheel,
arrow keys, or by dragging with the left mouse button scrolls deeper into the
respective viewer. By contrast, scrolling down scrolls further out.
Referring to standard orientations, this means that scrolling down results in the
following browsing behavior.
• In axial slices and view F (feet), you move toward the patient's feet.
• In coronal slices and view A (anterior), you move toward the patient's front.
• In sagittal slices and view L (left), you move toward the left side of the patient.

Browse in All Priors

tool8browsing8toggleinallpriors

Use this tool to change the behavior of the Browse Slices tool.
 A current study and more than one prior studies have been loaded.
 A layout is selected that shows current and prior study side by side.
1. Click Browse in All Priors to select this tool.
2. Click Browse Slices.
3. Point to a viewer that shows an image of the prior study.
4. Turn the mouse wheel.
You now scroll images in all viewers that show prior studies. Scrolling is synchro-
nized so that you can compare the images from the current study with those of the
various prior studies.

Skip Slices While Scrolling

tool8browsing8toggleskipslices

This tool affects the behavior of the arrow keys and the mouse wheel when you use
the tool Browse Slices.
If the Skip Slices While Scrolling tool is selected, scrolling quickly with the mouse
wheel or arrow keys results in slices being skipped. Canceling the selection of this
tool ensures that you will not skip images when browsing slices with the mouse
wheel or arrow keys. Scrolling might become slower if the tool is turned off.

Visage 7 63
Tools View windows

Note

Skip Slices While Scrolling is selected by default.

You need to clear it explicitly if you want to see every single image in an image
stack when you browse slices.
-Or-
Use the tool Browse Continuously instead of the tool Browse Slices when
scrolling through an image stack to be sure you see all slices.

Browse Continuously
tool8browsing8continously

This tool is an alternative to Browse Slices. Browse Continuously has a cine-like

effect with a steady browsing speed. This tool shows all the images in an image
stack, it does not skip slices even if you move the mouse fast.
1. Click the Browse Continuously button to select this tool.
2. Start dragging up or down to start scrolling forward or backward through the
image stack.
After an initial mouse movement you no longer need to move the mouse. Hold the
mouse steady and the left mouse button down. Scrolling continues at a steady
speed showing one image in the image stack after the other until you reach the last
image in the stack.

Note

When you scroll in an MPR viewer in thick-slice mode, you can control the slice
overlap for scrolling with properties settings. See Browse Slices, page 62, and
Properties dialog box, page 190.

Scroll Page by Page (Mouse Wheel Mode)

tool8browsing8togglepagebypage

Some protocols, typically those for ultrasound and plain-film images, present
images as so-called tiles rather than in image stacks. Tiled presentation arranges
images next to each other, and scrolling causes all viewers in this presentation
mode to be updated synchronously.
Two modes exist for scrolling in tiled presentation mode:
• The Scroll Page by Page tool is selected.
Use Browse Slices or scroll with the mouse wheel to replace the contents of all
viewers with the next page of new images.

64 Visage 7
View windows Tools

• The Scroll Page by Page tool is not selected.

Browse Slices or the mouse wheel causes each viewer to advance by just one
image at a time. This gives you the impression of images flowing through your
viewers, for example, from the lower right to the upper left.

First Slice (Home), Previous Slice (↑), Next Slice (↓), Last Slice
(End)
tool8browsing8firstslice
tool8browsing8lastslicetool8browsing8previousslice
tool8datanavigation8previousslice
tool8browsing8nextslice
tool8datanaviga-
tion8nextslice

Use these tools to scroll slices in viewers that show image stacks of either scans or
reformats.

Tip

The factory-defined keyboard shortcuts for browsing to the previous or next slice
are the up and down arrow keys.

Previous Thick Slice (PgUp), Next Thick Slice (PgDn)

tool8browsing8previousthickslice tool8browsing8nextthickslice

If you have switched to thick-slice display in a volume dataset, use these tools to
browse slices.

Play/Pause
tool8cine8play

With this tool, you can play back images in a stack or time series, or you can rotate
around a volume in a 3D viewer. The tool gives you the impression of a movie being
played back.
Use the Cine tool card to define playback parameters such as playback type, play-
back range, frame rate and playback speed. See Cine, page 124, for details.

Tip

While the movie is being played back, the toolbar button changes its shape. Use
the Pause button to interrupt or stop the playback.

Visage 7 65
Tools View windows

Synchronized display If you have loaded appropriate data, Visage 7 synchronizes cine display in two or
of pre- and post-stress more viewers based on ECG information embedded in the images.
cardiac echo
A typical application for synchronized cine display is a comparison of cardiac ultra-
sound (cardiac echo) sequences before and after physical exercise (pre- and post-
stress). After stress, the heart rate is higher. To allow comparison of the pre-stress
and post-stress sequence, the system slows down playback of the post-stress
sequence (or speeds up playback of the pre-stress sequence). As a result, images
of corresponding heart phases are shown side by side at any time during playback.
Synchronization of cine display based on ECG data is defined in the active protocol.

Show Multiframes in Single Tiles

tool8browsing8togglecollapsedmultiframe

With this tool, you can switch display of multiframe images:

• Collapsed
The multiframe objects are shown in single viewers as an image stack.
tool8browsing8firstframe tool8browsing8previousframe tool8browsing8nextframe
tool8browsing8lastframe
Use the tools Next Frame (Ctrl/Cmd ↑), Previous Frame (Ctrl/Cmd ↓), First
Frame (Ctrl/Cmd Home), Last Frame (Ctrl/Cmd End) to scroll through the
image stack of a collapsed multiframe.
-Or-
Click a viewer and drag up or down or hold the Ctrl/Cmd key down while you
turn the mouse wheel to scroll frame by frame.
-Or-
Click a viewer and simply turn the mouse wheel (Ctrl/Cmd key not held down)
to scroll on to the next multiframe object.
• Expanded
Each of the individual images of a multiframe object occupies a separate viewer.

Tools for browsing datasets

The tools in this section help you to browse datasets without having to return to the
Study Browser.
Choose which of these tools you use or combine tools according to your preferred
mode of working.
• Select and load multiple datasets in the Study Browser.
Use the following tools to scroll through the loaded data: Previous Study, Next
Study, Previous Volume (Ctrl/Cmd ←), Next Volume (Ctrl/Cmd →), Previous
Image Set, Next Image Set, Previous Phase (←), Next Phase (→).
• Filter and sort the list in the Study Browser so that it shows the studies you
want to read next. Load the first of these studies.

66 Visage 7
View windows Tools

Use the following tools to move on to the next study: Previous Study from Study
Browser, Next Study from Study Browser.

Previous Study, Next Study

tool8datanavigation8previousstudy tool8datanavigation8nextstudy

These tools expect you to have loaded more than one study.
Use Previous Study/Next Study to scroll through the loaded studies.

Previous Volume (Ctrl/Cmd ←), Next Volume (Ctrl/Cmd →)

tool8datanavigation8previousvolume tool8datanavigation8nextvolume

These tools expect you to have loaded more than one volume dataset.
Use Previous Volume/Next Volume to scroll through the loaded datasets.

Previous Image Set, Next Image Set

tool8datanavigation8previousimageset tool8datanavigation8nextimageset

These tools expect you to have loaded more than one image set.
Use Previous Image Set/Next Image Set to scroll through the loaded series.

Previous Phase (←), Next Phase (→)

tool8datanavigation8previousphase tool8datanavigation8nextphase

If you have loaded a time series, use Previous Phase/Next Phase to scroll through
the phase images.

Previous Study from Study Browser, Next Study from Study

Browser
tool8datanavigation8nextstudyfrombrowser tool8datanavigation8previousstudy-
frombrowser

Use these tools to load the study right above or below the one currently selected in
the Study Browser.

Visage 7 67
Tools View windows

Workflow integration tools

Visage 7 can be integrated in a variety of clinical workflow programs, such as radiol-
ogy information systems (RIS), hospital information systems (HIS), or picture
archiving and communications systems (PACS). The level of workflow integration
depends on the particular setup and configuration of systems in your organization.
Therefore, some functions described here might not be available in your installation
or might be configured to behave slightly differently than described here.

Study Navigator
tool8general8studynavigator

This tool opens the Study Navigator dialog box, from where you can select and
load more studies of the current patient. The tool appears gray if the current study is
the only study that is stored on the Visage 7 server for the current patient.
When you open the Study Navigator for the first time, all studies that are stored on
the server for the current patient are shown.

The studies that have already been loaded are marked with a green box along the
right edge of the dialog box. Prior studies that are potentially relevant for a case are
shown in standard display. Any other studies are slightly grayed out.

Selecting more rele- You might consider more prior studies relevant for the case than the ones sug-
vant prior studies gested by the system.
Click the pin symbol of such a prior study.

68 Visage 7
View windows Tools

Controlling display of If a large number of studies exist for a patient on the Visage 7 server, use the slider
prior studies for a better overview.

Slider position left: Shows only loaded studies and studies you selected with a pin
symbol.
Slider position center: Shows all the above studies plus studies preselected as rele-
vant prior studies by the system as a result of auto-prior loading settings.
Slider position right: Shows all studies of this patient on the Visage 7 server.

Filtering the study list Type a search string in the Filter box.
The study list is updated showing loaded studies, studies you marked with the pin
symbol, and studies whose study description or study date/time fields contain this
string.

Expanding and collaps- 1. Click a study to show thumbnails of the images, series, and volume datasets the
ing studies study contains.
2. Click the study again to hide thumbnails again.
-Or-
Click Collapse to hide thumbnails of all studies.

Relative study date Use the menu in the upper right corner of the dialog box to toggle study date display
modes.

Visage 7 69
Tools View windows

Updating Study Naviga- If images are still being uploaded to the Visage 7 server when you open a case,
tor and thumbnail sec- update the displayed data at intervals.
tion
Click Refresh in the Study Navigator dialog box to refresh both the Study Naviga-
tor and the thumbnail section.

Loading studies from 1. Select the box all the way to the right of a study.
Study Navigator
The box turns green.
2. Click Load.

Loading individual 1. Click a study to show thumbnails of the images, series, and volume datasets it
image sets contains.
2. Drag a thumbnail from the Study Navigator into a viewer.

Tip

With large monitors or multiple monitors, dragging thumbnails into viewers might
mean that you have to drag thumbnails a long way.
Select Show Mini Drop Zone for your user account in such a case (File > Pref-
erences > Properties > User Interface).
When you now start dragging a thumbnail, a small image appears in the thumb-
nail section. This image represents the monitor layout. Dragging a thumbnail into
a viewer in the Mini Drop Zone has the same effect as dragging it all the way
across the monitor to the target viewer.

70 Visage 7
View windows Tools

Multiple Protocols If you are using more than one monitor for reading images with Visage 7 Client, you
can define which study or studies you want to show on which monitor.
1. Select the check box Multiple Protocols.
2. Select a monitor column for each study.

3. Click Load.

Viewing a report If a report exists for a study, a report icon is shown which also indicates the report
status.
Click a report icon to show a preliminary or final report.

Visage 7 71
Tools View windows

Close Session
tool8general8closesession

This tool unloads all data from a View window. The tool also closes all viewers, tool-
bars, and tool cards and leaves the View window entirely blank.
Switch to the Study Browser to select and load new data after you have clicked
Close Session.

Start/Stop Dictation
tool8integration8toggledictation

Use this tool to start or end dictating a report.

1. Click Start/Stop Dictation after you have loaded a study.
If you have loaded more than one current study, the system will ask you which
study the report refers to.
2. Start dictating your report.
3. Click the button again when you have finished the report.
This marks this study as reported on (dictation status completed).
Depending on your system configuration, ending dictation might load the next case
automatically.

Reset Dictation
tool8integration8resetdictation

You cannot create a second report for a study for which a report has already been
dictated.
If you want to delete a report and create a new one instead, use this tool to reset the
dictation status of the currently loaded study. Start/Stop Dictation is available
again and you can dictate a new report now.

Go To Next Study
tool8integration8gotonextstudy

If you have selected more than one study for report dictation in your radiology work-
list, use this tool to move on to the next study.
If the Start/Stop Dictation tool is still turned on when you click Go To Next Study,
you are prompted to confirm that the first report is finished.

72 Visage 7
View windows Tools

Skip to Next Study

tool8integration8skiptonextstudy

If your worklist supports skipping, use this button to mark the current study as to be
skipped in the worklist. You proceed to the next study or item in the worklist.

Reports and Scanned Documents

tool8general8reportsviewer tool8integration8showscanneddocuments
tion8showpreviousreports
tool8integra-

Click this button to open the reports window of your RIS.

Show Worklist
tool8integration8showworklist

Click this button to open the worklist window of your RIS (radiology information sys-
tem), HIS (hospital information system), or PACS (picture archiving and communi-
cations system).

Referrer Information
tool8integration8showreferrerinformation

Click this button to open the referrer details window of your RIS (radiology informa-
tion system), HIS (hospital information system), or PACS (picture archiving and
communications system).

Tools for linking viewers

In Visage 7, many image navigation and image processing tasks can be synchro-
nized across viewers, which helps to compare images. For example, synchronized
scrolling means that when you scroll an image stack in a viewer, image stacks in
linked viewers scroll too. For example, synchronized zooming means that not only
the image in the active viewer is enlarged but all images in all linked viewers are.
Viewer linking is defined in the active protocol. After loading image data, the proto-
col decides which viewers are linked and with respect to which activities. Viewer
linking can be modified interactively. You use the tools described in this section to
redefine how activities are synchronized across viewers.
When you close a study or load new data, modifications to viewer linking are dis-
carded. To preserve your modifications, save your session or save the protocol.
See also Session management, page 23, and Properties and protocols, page 190.

Visage 7 73
Tools View windows

Toggle Linking
tool8linking8toggle

Use this tool to turn viewer linking on or off. Toggle Linking affects all viewers that
are assigned to any of the linking groups that are defined in the protocol.

Link Current Position

tool8linking8registration8fromcursorposition

Use this tool to align two 3D datasets based on a common reference point, which
are shown in side-by-side MPR viewers. The tool requires that appropriate linking
groups are defined in the active protocol.
1. Scroll to corresponding images in viewers that are currently not linked.
This means, cancel the selection of the tools Toggle Linking or Link Current
Position first.
2. Select the tool Position Crosshair and click to position the crosshair in the
same reference point in both datasets.
-Or-
Press and hold the Alt key, and click to position the crosshair.
Use a landmark that can be identified easily, such as the bifurcation of the tra-
chea or a large calcification.
3. Select Link Current Position.
The viewers are now linked for synchronized scrolling. Visage 7 calculates a true
3D registration for the two datasets using the 3D position of the reference point and
the orientation of your MPR viewers. You can now scroll in any direction or rotate
MPR planes and the two datasets remain linked.

Reset Viewer Linking

tool8linking8registration8reset

Use this tool to reset any dataset alignment made with the Link Current Position
tool.

Automatically Link Viewers

tool8linking8definegroups8automatic

Use this tool to link scrolling in all corresponding 2D viewers in basic CT or MR pro-
tocols. Visage 7 will try to link all currently displayed image stacks that show the
same part of the body and that use the same spatial orientation.

74 Visage 7
View windows Tools

For example, select Automatically Link Viewers in a layout that shows five axial
stacks and three sagittal stacks. Visage 7 links all axial stacks that show the same
part of the body, and also all sagittal stacks that show the same part of the body.
This creates two linking groups for synchronized scrolling.
Automatically Link Viewers reads DICOM information to identify corresponding
images.

Tip

Simply clicking Automatically Link Viewers links viewers in one study only.

Pressing and holding the Shift key down and then clicking Automatically Link
Viewers links viewers in all the loaded current and prior studies.

Shift +

Automatic Viewer Registration, Automatic Viewer Registration

(Translation Only)
tool8linking8registration8automatic tool8linking8registration8automatic8translation

Use one of these tools to link scrolling in viewers that show corresponding images.

Caution

Be aware that automatic registration does not always align images correctly.
Please verify registration results and correct registration manually, if necessary.

Technically speaking, Automatic Viewer Registration compares grayscale values

of pixels to identify corresponding structures and to align images. Therefore, Auto-
matic Viewer Registration can even link viewers that show images from a current
study and one or several prior studies.
The tools Automatic Viewer Registration and Automatic Viewer Registration
(Translation Only) use a similar algorithm, however, while Automatic Viewer Reg-
istration considers 3D translation and rotation, Automatic Viewer Registration
(Translation Only) only considers a 3D translation but no rotation.

Visage 7 75
Tools View windows

Link Display Properties

tool8linking8toggledisplayproperties

Use this tool to synchronize changes to certain display properties such as modifica-
tion of the slice thickness to all linked viewers.

Link Scrolling
tool8linking8editgroup8scrolling

Use this tool as a shortcut to Edit Viewer Linking (see below). Link Scrolling syn-
chronizes various activities across viewers.
Clicking this tool has a different effect on different viewer types.

Only two viewers Select the Link Scrolling tool.

shown
Scrolling, panning, rotating, flipping images and, for MPR groups, also zooming and
3D rotation is now synchronized.

More than two viewers: 1. Select the Link Scrolling tool.

2D viewers
2. Select all viewers that show series with a similar orientation and that you want to
include in synchronized scrolling.
Selected viewers are highlighted with a red border.
3. Click Accept and Exit in the lower right corner of the last selected viewer.
In a layout with more than two viewers that show 2D images, for example, X-ray
images, scrolling, panning, rotating, and flipping images is now synchronized.

More than two viewers: An MPR group is a set of three MPR viewers that show MPR reformats from a 3D
MPR groups dataset side by side, initially in axial, sagittal, and coronal orientation. These three
MPR viewers are linked automatically, that is by the protocol.
With the Link Scrolling tool you can link several such MPR groups, for example
one in a current examination and one in a prior examination. Linking MPR groups in
this way will synchronize the following activities in the current and prior examination:
scrolling, panning, rotating, flipping, zooming, and 3D rotation.
1. Select the Link Scrolling tool.
2. Click an MPR viewer in one MPR group.
This viewer and the other two MPR viewers in the group are highlighted with a
red border.
3. Click an MPR viewer in a second MPR group.
All six MPR viewers are highlighted now.
4. Click Accept and Exit in the lower right corner of the last selected viewer.

76 Visage 7
View windows Tools

-Or-
1. Position the crosshair on the same reference point in both datasets.
2. Select the Link Scrolling tool.
3. Click an MPR viewer in one MPR group.
This viewer and the other two MPR viewers in the group are highlighted with a
red border.
4. Click an MPR viewer in a second MPR group.
All six MPR viewers are highlighted now.
5. Click Link with Current Position and Exit in the lower right corner of the last
selected viewer.
Visage 7 calculates 3D registration for the two datasets using the 3D position of the
reference point rather than DICOM frame of reference information stored in the
datasets.

Linking individual MPR In viewers that show individual MPR or MIP slices, Link Scrolling synchronizes
viewers or MIP viewers scrolling but no other activities.
1. Select the Link Scrolling tool.
2. Select all viewers in which you want to synchronize scrolling.
Selected viewers are highlighted with a red border.
3. Click Accept and Exit in the lower right corner of the last selected viewer.

Unlinking viewers 1. Select the Link Scrolling tool a second time.

2. Click a viewer.
All viewers that you linked with the Link Scrolling tool earlier are now high-
lighted with a red border.
3. Click linked viewers to remove the red border and to remove them from the link-
ing group.
4. Click Accept and Exit in the lower right corner of the last viewer that you
remove from the linking group.

Correcting viewer link- If synchronized scrolling does not show corresponding images in the linked viewers,
ing you can correct this interactively.
1. Scroll until one of the linked viewers shows an image with a clearly recognizable
landmark.
2. Click to select one of the other linked viewers.
This is a viewer that does not show a corresponding image.
3. Press and hold the Shift key down.
Scrolling will only affect the second viewer now.
4. Scroll to an image that corresponds to the image in the first viewer (image show-
ing the same landmark).
5. Release the Shift key.
Scrolling will be synchronized across all linked viewers again now.

Visage 7 77
Tools View windows

Save Registration
tool8registration8save

Use this tool to save the registration (spatial alignment) of series for linked scrolling
in current and prior studies permanently.
Clicking this tool saves the registration of series in current and prior studies in a
DICOM object. In Study Browser, this DICOM object appears as a new series with
modality REG in the current (most recent) study.

Edit Viewer Linking

tool8linking8editgroups

With this tool, you can edit the assignment of viewers to linking groups for synchro-
nized image navigation and image processing.

Editing viewer linking 1. Click the Edit Viewer Linking button to select this tool.
In this mode, graphical buttons appear in all viewers. These buttons represent
types of activities that can be synchronized across viewers.
2. Point to one of these buttons in a viewer.
The button is highlighted in this viewer and all other viewers that belong to a
group in which this activity is synchronized.

3. Click this button in more viewers to add them to this group.

All viewers that belong to this group are now highlighted with a red border.
4. Click a second activity button to synchronize this activity across the viewers of
this group, too.
5. Click Apply to confirm linking group definition.

Continue and define more groups now.

-Or-

78 Visage 7
View windows Tools

Click Delete All Viewer Groups to reset viewer linking and start defining groups
again from scratch.

-Or-
Click Accept and Exit to end linking group definition.

The group concept The idea of viewer linking is to synchronize certain activities in multiple viewers.
Synchronized activities help you to compare images and to optimize image display
across linked viewers with a minimum of mouse clicks.
Several linking groups can coexist. For example, if you have loaded CT or MR
series and have a screen layout with eight viewers, two groups might exist. Group 1
might comprise the upper left two viewers and group 2 might combine the lower
right two viewers.
In group 1, only scrolling is synchronized. This means that when you scroll the
image stack in the upper left viewer, images also scroll in the viewer next to it. When
you zoom the image in the upper left viewer, only this image is enlarged but the
image in the viewer next to it is not.
In group 2, zooming and panning is synchronized but scrolling is not. When you
zoom in on the image in the lower right viewer, the image in the viewer next to it is
also enlarged. However, when you start scrolling in one of these lower right image
stacks, only the active viewer is affected.
However, viewers can only belong to one linking group of a specific type.

Activities that can be The following activities can be linked across viewers.
linked

Cursor Position/Navigation Synchronization

Linking viewers with this button synchronizes scrolling in these viewers.

3D Rotation Synchronization
Linking viewers with this button synchronizes 3D rotation in these viewers.

Zoom Synchronization
Linking viewers with this button synchronizes zooming in these viewers.

Pan/Rotate Synchronization
Linking viewers with this button synchronizes the following activities: rotation
clockwise and counterclockwise, flipping horizontally and vertically, and pan-
ning

Tiled Navigation
Linking viewers with this button creates a group of viewers for tiled image display.
See also Scroll Page by Page (Mouse Wheel Mode), page 64.

Visage 7 79
Tools View windows

Window/Level Synchronization
Linking viewers with this button synchronizes windowing in these viewers.

Time Synchronization
Linking viewers with this button synchronizes playback of time series and browsing
in time series.

Dataset Synchronization
Linking viewers with this button synchronizes loading of data in these viewers, for
example, from the thumbnail section.

Detaching viewers from If viewers are linked but you want to apply a particular processing step to one
groups temporarily viewer only, you can detach this viewer from its group.
1. Click the lock in the viewer controls.

>
2. Click the lock again later on to reattach the viewer to its linking groups.
-Or-
1. Right-click the lock and cancel the selection for an activity to detach the viewer
from this group.

>

Right-click the lock again and reattach the viewer to its group later.

Group Editing tools

tool8linking8editgroups8quick
Use these tools instead of the Edit Viewer Linking tool as a quick way of linking
viewers with respect to one activity only.
In most protocols you find these tools on a separate toolbar, which is called Viewer
Linking (Group Editing).

Quick linking of view- 1. Select one of these tools, for example, Modify Window Level Group.
ers

2. Click all viewers in which you want to synchronize windowing.

Selected viewers are highlighted with a red border.

80 Visage 7
View windows Tools

3. Click Accept and Exit in the lower right corner of the last viewer to confirm.

Overview of group edit- The following tools are available for quick and easy group definition:
ing tools
Modify Translation Navigation Group
Assign viewers to a translation navigation group for synchronized scrolling.
Datasets in a translation navigation group share the same reference point.

Modify Rotation Navigation Group

Assign viewers to a rotation navigation group for synchronized 3D rotation.
Datasets in a rotation navigation group share the same reference point and orienta-
tion.

Modify Zoom Group

Assign viewers to a rotation navigation group for synchronized zooming.
Synchronized zooming shows structures of the same size in the same size in all
linked viewers. This does not necessarily mean that the zoom factor in all linked
viewers is identical when you zoom in or out.

Modify Pan/Rotate Group

Assign viewers to a pan/rotate group for synchronization of the following activi-
ties: rotation clockwise and counterclockwise, flipping horizontally and verti-
cally, and panning.

Modify Tile Group

Assign viewers to a group for tiled image display. See also Scroll Page by Page
(Mouse Wheel Mode), page 64.

Modify Window Level Group

Assign viewers to a window level group for synchronized windowing.

Modify Time Phase Group

Assign viewers to a time phase group for synchronized playback of time series
and synchronized browsing in time series.

Modify Dataset Group

Assign viewers to a dataset group to ensure that several viewers show the same
dataset. For example, if you load data in one viewer from the thumbnail section, all
viewers in a dataset group are updated.

Visage 7 81
Tools View windows

Annotation and measurement tools

With this set of tools you can annotate and evaluate image information

Note

In the 3D viewer, measurements are only possible in orthographic but not in per-
spective projection. See also Perspective projection, page 51.

Every time you add an annotation to an image or perform a measurement, the pro-
gram creates a screenshot and sends it to the Export window. From there you can
insert these screenshots in your report.
If annotations or ROI statistics make it hard to read image information that lies
underneath, you can hide annotations and measurements. See Toggle Annotations
and Toggle Annotation Statistics, page 115.

Arrow/Text Annotation (N), Arrow Annotation

tool8annotation8textarrow tool8annotation8arrow

Use one of these tools to add annotation text or draw arrows to point to observa-
tions.

Creating a text annota- 1. Click the Arrow/Text Annotation button to select this tool.
tion
2. Click a point in an image.
3. In the Edit Annotation dialog box, type your annotation text.

Creating an arrow plus 1. Click the Arrow/Text Annotation button to select this tool.
text annotation
2. Click where you want to point to.
3. Hold the mouse button down, and drag across the image to create an arrow.
4. Release the mouse button.
5. In the Edit Annotation dialog box, type your annotation text.

Drawing only an arrow 1. Click the Arrow Annotation button to select this tool.
(no text)
2. Click where you want to point to.
3. Hold the mouse button down, and drag across the image to create an arrow.
4. Release the mouse button.

Moving or editing an 1. Click an annotation text to select it.

annotation
2. Drag the text to move it.
-Or-
1. Click the arrow head.
2. Drag to move this end of the line until it points to a different observation.

82 Visage 7
View windows Tools

-Or-
1. Right-click an annotation text or an arrow and select Properties.
2. In the Edit Annotation dialog box, change the way the annotation is displayed.

Showing text at a fixed 1. Right-click a text annotation.

viewer position
Do not right-click an arrow plus text annotation.
2. Select Fixed Position in Viewer.
3. Start scrolling slices.
The annotation text remains static. This means the text appears in each slice image
and at the same window position.

Copying an annotation 1. Right-click an annotation and select Copy Object from the context menu.
-Or-
Select the annotation and press Ctrl + C (Windows) or Cmd + C (Mac).
2. Scroll to the slice in which you want to paste the annotation.
-Or-
Click the viewer in which you want to paste the annotation.
3. Right-click and select Paste Object from the context menu.
-Or-
Press Ctrl + V (Windows) or Cmd + V (Mac).

Circle Annotation
tool8annotation8circle

Use this tool to draw a circle around an area of interest and to add annotation text
that comments your observation.
Do not confuse the Circle Annotation tool with the Circular ROI tool. Annotation
tools merely highlight an area of interest but do not evaluate image information. See
also Circular ROI, page 92.

Creating a circle anno- 1. Click the Circle Annotation button to select this tool.
tation
2. Click a point in an image to create a circle around this point.
3. Drag in or out to make the circle smaller or larger.
4. Release the mouse button.
5. In the Edit Annotation dialog box, type your annotation text.

Moving or editing a cir- 1. Click the annotation graphic or the text to select it.
cle annotation
Four dots appear around the circle and one dot in the middle of the circle.
2. Drag the dots around the circle in or out to resize the circle.
-Or-

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Tools View windows

Drag the dot in the middle to move the entire annotation graphic plus text.
-Or-
If the Move text freely option in the Edit Annotation dialog box is selected, you
can select and move the text only.

Distance (D)
tool8measurement8distance

Use this tool to measure distances. Distances are indicated in millimeters.

Caution

The accuracy of distance measurements is ± 2 pixels. Larger errors can occur if

the image is displayed with reduced matrix size, that is, if not every original pixel
is shown on the screen due to zoom-out. For optimum accuracy, we recommend
zooming into the structure of interest as much as possible. The accuracy is fur-
ther limited by the physical resolution of the acquisition itself. If the monitor used
for display does not permit exact pixel selection, the inaccuracy can be still
greater.

Measuring a distance 1. Click the Distance button to select this tool.

2. Click where you want to start your distance measurement.
3. Hold the mouse button down, and drag across the image.
4. Release the mouse button at the endpoint of your distance line.

Showing the measure- 1. Right-click the distance line.

ment in all slices
2. Select Show on all Slices.
3. Start scrolling slices.
The measurement graphics and results are shown in all slices.

84 Visage 7
View windows Tools

Perpendicular Distance
tool8measurement8perpendiculardistance

Use this tool to perform two distance measurements that are exactly perpendicular.
For example, use this tool to measure the dimensions of a lesion.

Caution

The accuracy of distance measurements is ± 2 pixels. Larger errors can occur if

the image is displayed with reduced matrix size, that is, if not every original pixel
is shown on the screen due to zoom-out. For optimum accuracy, we recommend
zooming into the structure of interest as much as possible. The accuracy is fur-
ther limited by the physical resolution of the acquisition itself. If the monitor used
for display does not permit exact pixel selection, the inaccuracy can be still
greater.

Measuring a perpendic- 1. Click the Perpendicular Distance button to select this tool.
ular distance
2. Click where you want to start your distance measurement.
3. Hold the mouse button down, and drag the mouse across the image.
4. Release the mouse button at the endpoint of your distance line.
5. Draw the second distance line in the same way.
If the lines are exactly perpendicular, the right angle symbol is shown where the
lines intersect.

Tip

Be sure to draw the second line immediately after you have finished the first. If
you click elsewhere in the meantime, the system interprets both lines as separate
distance measurements.

Showing the measure- 1. Right-click the measurement.

ment in all slices
2. Select Show on all Slices.
3. Start scrolling slices.
The measurement graphics and results are shown in all slices.

Visage 7 85
Tools View windows

Calibrate Image
tool8measurement8calibration2d

Use the calibration tool if a distance measurement yields only an estimate, which is
indicated by an asterisk, or if the measurement yields pixel values.

Caution

The accuracy of distance measurements is ± 2 pixels. Larger errors can occur if

the image is displayed with reduced matrix size, that is, if not every original pixel
is shown on the screen due to zoom-out. For optimum accuracy, we recommend
zooming into the structure of interest as much as possible. The accuracy is fur-
ther limited by the physical resolution of the acquisition itself. If the monitor used
for display does not permit exact pixel selection, the inaccuracy can be still
greater.

1. Click the Calibrate Image button to select this tool.

2. Measure an object with known dimensions.
3. In the Calibrate dialog box, enter the known length.
4. Click OK.
The program recalculates any previously measured distances. In the upper right
corner of the image the words manual calibration indicate that manual calibration
has been performed on this image.

Angle
tool8measurement8angle

Use this method of measuring angles if the legs of your angle intersect within the
image area.

Caution

The accuracy of all angle measurements (2D, Cobb's angle) depends on the
length of the shorter of the two angle legs. The longer the angle legs are, the bet-
ter the accuracy.
For example:
Length of shorter angle leg (measurement error): 10 pixels (± 12°),
20 pixels (± 6°), 50 pixels (± 2.5°), 100 pixels (± 1.1°)
Larger errors can occur if the image is displayed with reduced matrix size, that is,
if not every original pixel is shown on the screen due to zoom-out. For optimum
accuracy, we recommend that you zoom into the structure of interest as much as
possible. The accuracy is further limited by the physical resolution of the acquisi-
tion itself. If the monitor used for display does not permit exact pixel selection, the
inaccuracy can be still greater.

86 Visage 7
View windows Tools

Measuring an angle 1. Click the Angle button to select this tool.

2. Click and drag to draw the first leg of your angle.
3. Release the mouse button at the vertex.
4. Drag to draw the second leg.
5. Click to end drawing the second leg.

Showing the measure- 1. Right-click the angle.

ment in all slices
2. Select Show on all Slices.
3. Start scrolling slices.
The measurement graphics and results are shown in all slices.

Angle (Two Lines)

tool8measurement8angletwolines

Use this method of measuring angles, for example, if the legs of the angle intersect
outside the image area.

Caution

The accuracy of all angle measurements (2D, Cobb's angle) depends on the
length of the shorter of the two angle legs. The longer the angle legs are, the bet-
ter the accuracy.
For example:
Length of shorter angle leg (measurement error): 10 pixels (± 12°),
20 pixels (± 6°), 50 pixels (± 2.5°), 100 pixels (± 1.1°)
Larger errors can occur if the image is displayed with reduced matrix size, that is,
if not every original pixel is shown on the screen due to zoom-out. For optimum
accuracy, we recommend that you zoom into the structure of interest as much as
possible. The accuracy is further limited by the physical resolution of the acquisi-
tion itself. If the monitor used for display does not permit exact pixel selection, the
inaccuracy can be still greater.

Measuring an angle 1. Click the Angle (Two Lines) button to select this tool.
2. Click and drag to draw the first line.
3. Release the mouse button to finish the first line.
4. Click and drag to draw the second line.
5. Release the mouse button to finish the second line.
Of course, you can also use Angle (Two Lines) if the lines intersect. For intersect-
ing lines the system calculates both the acute angle and the obtuse angle.

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Tools View windows

Showing the measure- 1. Right-click the angle.

ment in all slices
2. Select Show on all Slices.
3. Start scrolling slices.
The measurement graphics and results are shown in all slices.

Distance Ratio
tool8measurement8distanceratio

Use this tool to measure two distance lines and to have the system calculate the
ratio between both measurements.

Caution

The accuracy of distance measurements is ± 2 pixels. Larger errors can occur if

the image is displayed with reduced matrix size, that is, if not every original pixel
is shown on the screen due to zoom-out. For optimum accuracy, we recommend
zooming into the structure of interest as much as possible. The accuracy is fur-
ther limited by the physical resolution of the acquisition itself. If the monitor used
for display does not permit exact pixel selection, the inaccuracy can be still
greater.

Calculating the dis- 1. Click the Distance Ratio button to select this tool.
tance ratio
2. Measure the first distance line.
Click, drag, and release the mouse button at the endpoint.
3. Measure a second distance line.

Tip

You can use this tool to calculate the cardiothoracic ratio in X-ray images, for
example.

Showing the measure- 1. Right-click the measurement.

ment in all slices
2. Select Show on all Slices.
3. Start scrolling slices.
The measurement graphics and results are shown in all slices.

88 Visage 7
View windows Tools

Vertical Distance
tool8measurement8verticaldistance

Use this tool to measure the vertical distance between points in your images.

Caution

The accuracy of distance measurements is ± 2 pixels. Larger errors can occur if

the image is displayed with reduced matrix size, that is, if not every original pixel
is shown on the screen due to zoom-out. For optimum accuracy, we recommend
zooming into the structure of interest as much as possible. The accuracy is fur-
ther limited by the physical resolution of the acquisition itself. If the monitor used
for display does not permit exact pixel selection, the inaccuracy can be still
greater.

Measuring a vertical 1. Click the Vertical Distance button to select this tool.
distance
2. Click a point in your image.
3. Click a second point in your image.
The system draws two horizontal lines through both image points and calculates the
vertical distance between the two lines.

Tip

You can use this tool to measure the pelvic tilt in an X-ray image of the hip of a
standing patient, for example.

Showing the measure- 1. Right-click the measurement.

ment in all slices
2. Select Show on all Slices.
3. Start scrolling slices.
The measurement graphics and results are shown in all slices.

Visage 7 89
Tools View windows

Annotate Spine
tool8annotation8spinelabeling toolcard8spinelabeling

Use this tool to label vertebrae and intervertebral disks in images of the spine.
When you click the tool, a new toolbar appears in the lower right corner of the active
viewer and the Spine Labeling tool card opens.

Labeling vertebrae or 1. Select whether you want to label vertebrae or intervertebral disks.
intervertebral disks

2. Select the direction in which you want to proceed.

3. Select if you want to label vertebrae or intervertebral disk consecutively or if you

want to label only every second or third vertebra or intervertebral disk.

4. On the Spine Labeling tool card, select the vertebra or intervertebral disk label
with which you will begin.
5. Click this vertebra or intervertebral disk in the image to label it.
-Or-
Click and drag away from the vertebra or intervertebral disk to create an arrow.
On the Spine Labeling tool card, the next vertebra or intervertebral disk label is
selected now.
6. Click the next vertebra or intervertebral disk in the image and continue until you
have labeled all vertebrae or intervertebral disks.
7. Right-click a label in the image and select Properties to change font settings or
graphical display settings for a label.

Showing labels in all 1. Right-click the label of a vertebra or an intervertebral disk.

slices
2. Select Show on all Slices.
3. Start scrolling slices.
The label is shown in all slices.

90 Visage 7
View windows Tools

Cobb's Angle
tool8measurement8cobbangle

Use this tool to measure Cobb’s angles in images of the spine.

Caution

The accuracy of all angle measurements (2D, Cobb's angle) depends on the
length of the shorter of the two angle legs. The longer the angle legs are, the bet-
ter the accuracy.
For example:
Length of shorter angle leg (measurement error): 10 pixels (± 12°),
20 pixels (± 6°), 50 pixels (± 2.5°), 100 pixels (± 1.1°)
Larger errors can occur if the image is displayed with reduced matrix size, that is,
if not every original pixel is shown on the screen due to zoom-out. For optimum
accuracy, we recommend that you zoom into the structure of interest as much as
possible. The accuracy is further limited by the physical resolution of the acquisi-
tion itself. If the monitor used for display does not permit exact pixel selection, the
inaccuracy can be still greater.

Measuring Cobb’s 1. Click the Cobb’s Angle button to select this tool.
angles
2. Click and draw a first line.
3. Draw a second line. The lines do not have to intersect.
The acute angle between the two lines is shown.
4. Draw a third line.
The acute angle between the second and third line is shown.
5. Continue in this way to measure more Cobb’s angles.

Showing the measure- 1. Right-click the measurement.

ment in all slices
2. Select Show on all Slices.
3. Start scrolling slices.
The measurement graphics and results shown in all slices.

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Tools View windows

Elliptic ROI
tool8measurement8ellipticalroi

A 2D ROI evaluates image information in the currently displayed image or slice.

Caution

The relative error of an elliptical ROI measurement is ± 2 pixels/(shorter radius).

For example:
Shorter radius (measurement error): 10 pixels (± 20%), 20 pixels (± 10%),
50 pixels (± 4%), 100 pixels (± 2%).
Larger errors can occur if the image is displayed with reduced matrix size, that is,
if not every original pixel is shown on the screen due to zoom-out. For optimum
accuracy, we recommend that you zoom into the structure of interest as much as
possible. The accuracy is further limited by the physical resolution of the acquisi-
tion itself. If the monitor used for display does not permit exact pixel selection, the
inaccuracy can be still greater.

1. Click the Elliptic ROI button to select this tool.

2. Click the center of your region of interest and drag the mouse out.
3. Release the mouse button when the ellipse is large enough.

Copying a ROI 1. Right-click a ROI and select Copy Object from the context menu.
-Or-
Select the ROI and press Ctrl + C (Windows) or Cmd + C (Mac).
2. Scroll to the slice in which you want to paste the ROI.
-Or-
Click the viewer in which you want to paste the ROI.
3. Right-click and select Paste Object from the context menu.
-Or-
Press Ctrl + V (Windows) or Cmd + V (Mac).

Circular ROI
tool8measurement8circularroi

Use this tool to evaluate a 2D region of interest that is exactly circular.

Do not confuse the Circular ROI tool with the Circle Annotation tool. Annotation
tools merely highlight an area of interest but do not evaluate image information. See
also Circle Annotation, page 83.

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View windows Tools

Drawing a circular ROI 1. Click the Circular ROI button to select this tool.
2. Click the center of your region of interest and drag the mouse out.
3. Release the mouse button when the circle is large enough.

Comparing circular If you want to compare regions of interest, you can predefine the size of your next
regions of interest ROI.
1. Right-click your first circular ROI.
2. Select Set Size as Default.
3. Select the Circular ROI tool again.
4. Click to create a second circular ROI.
The new ROI has exactly the same size as the first ROI.

Copying a ROI 1. Right-click a ROI and select Copy Object from the context menu.
-Or-
Select the ROI and press Ctrl + C (Windows) or Cmd + C (Mac).
2. Scroll to the slice in which you want to paste the ROI.
-Or-
Click the viewer in which you want to paste the ROI.
3. Right-click and select Paste Object from the context menu.
-Or-
Press Ctrl + V (Windows) or Cmd + V (Mac).

Spherical ROI
tool8measurement8sphericalroi

Use this tool to evaluate 3D ROIs that are exactly spherical.

1. Click the Spherical ROI button to select this tool.
2. Draw a circle in a slice image.
The program calculates the statistics of a volume of interest (3D ROI) with the
size of the circle in all dimensions.
3. Scroll through the image stack to see 2D representations of the selected spheri-
cal volume in various slices.

Tip

A 3D ROI evaluates volume information and therefore only makes sense in data
of modalities that allow generation of volume datasets.
3D ROIs are also called VOIs (volumes of interest).

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Tools View windows

Copying a ROI 1. Right-click a ROI and select Copy Object from the context menu.
-Or-
Select the ROI and press Ctrl + C (Windows) or Cmd + C (Mac).
2. Scroll to the slice in which you want to paste the ROI.
-Or-
Click the viewer in which you want to paste the ROI.
3. Right-click and select Paste Object from the context menu.
-Or-
Press Ctrl + V (Windows) or Cmd + V (Mac).

Point-Sized ROI, Pixel Value

tool8measurement8pointsizedroi tool8measurement8pixelprobing

If you want to evaluate a point rather than an area or volume, use the Point-Sized
ROI or the Pixel Value tool.

Point-sized ROIs 1. Click the Point-Sized ROI button to select this tool.
2. Click a pixel in an image.
The grayscale or density value of this pixel is shown and the program creates both a
screenshot and a key view.

Pixel Value 1. Click the Pixel Value button to select this tool.
2. Move the cursor across an image.
The intensity value of the current cursor position is shown in the lower left corner of
the viewer, below the series and image number. The program does not create a
screenshot.

Freehand 2D ROI
tool8measurement8freehandroi2d

Use this tool to draw a freehand shape and evaluate image information in this
region of interest (ROI).

Freehand 2D ROI tools When you click the Freehand 2D ROI tool, a new toolbar appears in the lower right
corner of the active viewer. Here you find the following tools for drawing and refining
freehand shapes in 2D.

New Elliptical Contour

Use this button to circle the area of interest with an ellipse or a circle. Click a start
point, and drag the mouse out.

94 Visage 7
View windows Tools

New Freehand Contour

Use this button to draw a freehand shape. Click a start point on the contour. Hold
the mouse button down, and draw a contour line.

New Balloon Contour

Use this tool to draw a border around a structure or area of interest of a specific
brightness. Click in the structure and drag out.

Append mode
With any of the contour tools, use the Shift key to start Append mode (the cursor
turns into an arrow with a plus sign).
Draw a contour or select a contour you have drawn earlier.
Press and hold the Shift key down and then draw a second contour.
If the contours overlap, the system merges them into a single ROI. If the contours
do not overlap, the system nevertheless interprets them as parts of a single region
of interest. Add a third contour to this ROI, if necessary.
Release the Shift key to turn Append mode off again.

Refine Contour
Use this tool to correct or refine contour lines.
Click anywhere in the image and drag the mouse to show a circle with which you
can correct the ROI graphic. The further away from the contour line you click, the
larger the circle will be.
Click inside the ROI graphic to enlarge the ROI graphic by pushing the contour out.
Click outside the ROI graphic to use the circle to push the contour line in.

Undo
Use Undo to retrace your steps.

OK
Click OK when you have finished drawing and refining 2D ROIs to close the tool.

Copying a ROI 1. Right-click a ROI and select Copy Object from the context menu.
-Or-
Select the ROI and press Ctrl + C (Windows) or Cmd + C (Mac).
2. Scroll to the slice in which you want to paste the ROI.
-Or-
Click the viewer in which you want to paste the ROI.
3. Right-click and select Paste Object from the context menu.
-Or-
Press Ctrl + V (Windows) or Cmd + V (Mac).

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Tools View windows

Freehand 3D ROI
tool8measurement8freehandroi3d

Use this tool to define a freehand 3D ROI by drawing ROI graphics in various slices
of a volume dataset.

Freehand 3D ROI tools When you click the Freehand 3D ROI tool, a new toolbar appears in the lower right
corner of the active viewer. Here you find the following tools for drawing and refining
freehand shapes in 3D.

New Elliptical Contour

Use this button to enclose the area of interest with an ellipse. Click a start point,
and drag the mouse out to draw a circle or ellipse.

New Freehand Contour

Use this button to draw a freehand shape. Click a start point on the contour. Hold
the mouse button down, and draw a contour line.

New Balloon Contour

Use this tool to draw a border around a structure or area of interest of a specific
brightness. Click in the structure and drag out.

Append mode
With any of the contour tools, use the Shift key to start Append mode (the cursor
turns into an arrow with a plus sign).
Draw a contour or select a contour you have drawn earlier.
Press and hold the Shift key down and then draw a second contour.
If the contours overlap, the system merges them into a single ROI. If the contours
do not overlap, the system nevertheless interprets them as parts of a single region
of interest. Add a third contour to this ROI, if necessary.
Release the Shift key to turn Append mode off again.

Refine Contour
Use this tool to correct or refine contour lines.
Click anywhere in the image and drag the mouse to show a circle with which you
can correct the ROI graphic. The further away from the contour line you click, the
larger the circle will be.
Click inside the ROI graphic to enlarge the ROI graphic by pushing the contour out.
Click outside the ROI graphic to use the circle to push the contour line in.
When you have finished drawing and refining a ROI graphic in one slice, scroll on to
the next slice and also draw a ROI there.
Continue in this way through all slices that show the volume of interest.

Undo
Use Undo to retrace your steps.

96 Visage 7
View windows Tools

OK
Click OK when you have finished drawing and refining ROI graphics in all slices.
The system calculates ROI statistics and closes the freehand 3D ROI tool

Copying a ROI 1. Right-click a ROI and select Copy Object from the context menu.
-Or-
Select the ROI and press Ctrl + C (Windows) or Cmd + C (Mac).
2. Scroll to the slice in which you want to paste the ROI.
-Or-
Click the viewer in which you want to paste the ROI.
3. Right-click and select Paste Object from the context menu.
-Or-
Press Ctrl + V (Windows) or Cmd + V (Mac).

Save Annotations as Presentation State

tool8presentationstate8saveallannotationmeasurement

Use this tool to save all annotations and measurements in the currently loaded
dataset permanently.
Clicking this tool saves annotations and measurements in a DICOM presentation
state. In Study Browser, the presentation state appears as a new series with
modality PR. The next time you load this study, your annotations are shown in the
images.

Save visible Annotations as Presentation State

tool8presentationstate8saveannotationmeasurement

Use this tool to save annotations and measurements that you currently see on
the screen in a DICOM presentation state.
In Study Browser, the presentation state appears as a new series with modality
PR. The next time you load this study, your annotations are shown in the images.

Delete All Measurements/Annotations

tool8measurement8deleteall

Use this tool to delete all measurements and annotations in your dataset.

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Tools View windows

Note

Clicking this tool removes all measurements and annotations in all the images of
all the loaded studies. Moreover, key views and screenshots, which the program
created automatically for each measurement or annotation, are also deleted.

Screenshot tools
Screenshots serve the purpose of documenting observations. For example, you
create a screenshot to show it in your report.
Every time you add a text or graphical annotation or perform a measurement, the
program takes a screenshot. Screenshots are hard copies of the image in the cur-
rently selected viewer, complete with annotations, measurements, and image text, if
shown. If you want to preserve an image without annotating it, you create a screen-
shot with one of the screenshot tools. Visage 7 collects all screenshots that you cre-
ate during a session in the Export window. From the Export window, you can save
these screenshots, send or print them, or include them in your report.

Screenshot (S)
tool8snapshot8activeviewer

Use this tool to create a screenshot of the currently selected viewer. The screenshot
is sent to the Export window.

Screenshot All (Shift + S)

tool8snapshot8allviewers

Use this tool to create screenshots of all viewers that are currently shown on the
screen. Several screenshots are sent to the Export window.

Combined Screenshot (Alt + S)

tool8snapshot8allviewersinone

Use this tool to create a combined screenshot that shows all viewers that are cur-
rently displayed on the screen in one image. One screenshot is sent to the Export
window.

98 Visage 7
View windows Tools

Key views tools

When you read images, you make observations that you want to highlight and also
save to be able to come back to them later. For cross-sectional images, that is CT,
MR, and PET images, Visage 7 offers the concept of key views for this purpose.
Key views help you to come back to an observation in a later session and also to
repeat or refine measurements, for example.
A key view is created every time you annotate an image or perform a measurement.
In addition to this, you can create a key view for every other slice to which you want
to return later.

Note

Key views exist for the duration of the current session. To preserve key views,
save your session. See also Session management, page 23.

Store Key View (K)

tool8keyview8store

Use this tool to save what is currently shown in the active viewer in a key view.
When you save a key view this way, the program also creates a screenshot and
sends it to the Export window.

Delete Key View

tool8keyview8delete

Use this tool to delete a key view. This button is available only if a key view is shown
in the active viewer.
When you delete a key view, the corresponding screenshot in the Export window is
also deleted.

Previous Key View, Next Key View

tool8keyview8previous tool8keyview8next

Use these tools to browse through the key views that are stored in your session.

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Tools View windows

Tools for 3D navigation

In 3D datasets, you use the tools in this section or the scoutline crosshair to move
through the volume. See also Crosshair navigation in MPR viewers, page 49.

Tip

For a better overview, show orientation labels and the orientation cube before
you start navigating through the volume. Use View > Show in Viewer on the
menu to display the orientation cube and orientation labels.

3D Rotate
tool8navigation8rotate3d

With this tool, you can rotate around the volume in the 3D viewer or in the MPR
viewers.
3D Rotate is the standard navigation tool in the 3D viewer and in curved view.

3D rotation in the 3D 1. Click the 3D Rotate button to select this tool.

viewer
-Or-
Click the Default Navigation button or hold the Ctrl or Cmd key down.
2. Click anywhere in the 3D viewer.
3. Hold the mouse button down and drag to rotate the volume in the direction of the
mouse movement.

Tip

Use any of the standard orientation buttons or keyboard shortcuts to reset rota-
tion. See Anterior (A), Posterior (P), Left (L), Right (R), Head (H), Foot (F) View,
page 101.

3D rotation in MPR 1. Click the 3D Rotate button to select this tool.

viewers
2. Click the point in an image that is to be the center of rotation.
3. Hold the mouse button down and drag to rotate the image plane.
New slice images in nonstandard orientations are created in the process. The orien-
tation labels and orientation cube indicate the new image orientation.

Tip

Use Reset Slice Orientations to return to the original image orientation

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View windows Tools

2D rotation 1. Click the 3D Rotate button to select this tool.

2. Hold the V key down while you drag to rotate a single image or 3D volume.
V + 3D Rotate has the same effect as choosing the tool Rotate in Plane. See
Rotate in Plane, page 61.

Reset Slice Orientations

tool8orientation8resetmpr

Use this tool to reset the orientation in all linked MPR viewers to their original orien-
tation. Images are now shown in the orientation in which they were displayed right
after loading.

Anterior (A), Posterior (P), Left (L), Right (R), Head (H), Foot (F)
View
tool8orientations

Use these tools to display the image in the currently active viewer in one of the stan-
dard anatomical views.
For example, if you click H or F in an MPR viewer that shows axial slices, this
reverses the viewing direction in this viewer. If you click H or F in an MPR viewer
that shows sagittal or coronal slices, this rearranges viewers.
Clicking a standard orientation button in the 3D viewer affects the 3D viewer only.

Position Crosshair
tool8navigation8target

Use this tool to focus on a particular point in the volume in linked viewers.

Note

Position Crosshair affects linked viewers only.

1. Click the Position Crosshair button to select this tool.

2. Click a visible (opaque) structure in the 3D viewer.
-Or-
Click any point in one of the images in the MPR viewers.
Clicking sets the crosshair of the MPR viewers to this 3D position and updates all
MPR viewers that show this dataset.

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Tools View windows

Tip

Show the 3D crosshair in the 3D viewer before you click Position Crosshair.

Triangulation
tool8navigation8triangulation

Use this tool to focus on a particular point in the volume in all viewers that show
images or volume datasets that contain this point.

Note

Triangulation affects image display in all viewers and not only in linked viewers.

1. Click the Triangulation button to select this tool.

2. Click a point in any of the viewers.

Tip

The Triangulation tool is particularly useful when you are reading multiseries
MR datasets.

Center View
tool8viewing8centerview

Use this tool to move images in linked viewers in such a way that the scoutline
crosshair is in the viewer center.
For example, use this tool after you have moved the crosshair. See also Crosshair
navigation in MPR viewers, page 49.

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View windows Tools

Cropping tools
Use the cropping tools to cut away portions of the volume that hide more important
information that lies underneath.

Tip

Show the bounding box in the 3D viewer before you select one of these tools.
The bounding box helps you to identify the portions of the volume that you want
to cut away.

Crop Box
tool8clipping8box

Use this tool to cut away the outer parts of the volume.
1. Click the Crop Box button to select this tool.
This tool removes the outer volume parts, a smaller volume box in the center of
the volume dataset remains.
2. Click inside the box to move it.
-Or-
Drag a border line to resize the box.
-Or-
Click a corner of the box and drag to rotate the crop box.
3. Click the Crop Box button a second time to show the entire volume again.

Tip

When you click a cropping tool, the Lock Crop Region button appears in the
lower right corner of the active viewer.

Clicking this button locks the crop region. You can now move or rotate the vol-
ume within the crop box.

Visage 7 103
Tools View windows

Crop Slab
tool8clipping8slab

Use this tool to cut away portions of the volume so that only a slab remains. A slab
is a section of the volume between any two parallel planes with oblique orientation.
1. Click the Crop Slab button to select this tool.
-Or-
In the 3D viewer use the keyboard shortcut T to turn slab display on or off.
2. Drag slab boundaries out or in to change the slab thickness.
3. Click the Crop Slab button a second time to show the entire volume again.

Tip

When you click a cropping tool, the Lock Crop Region button appears in the
lower right corner of the active viewer.

Clicking this button locks the crop region. You can now move or rotate the vol-
ume within the slab.

Crop Plane
tool8clipping8plane

Use this tool to cut away a corner of the volume along an oblique cutting plane.
1. Click the Crop Plane button to select this tool.
2. Drag the orange line, which defines what will be cut away, to move this plane in
or out.
3. Click the Crop Plane button a second time to show the entire volume again.

Tip

When you click a cropping tool, the Lock Crop Region button appears in the
lower right corner of the active viewer.

Clicking this button locks the crop region. You can now move or rotate the vol-
ume within the remaining volume box.

104 Visage 7
View windows Tools

Crop Corner
tool8clipping8corner

Use this tool to cut away a box from the corner of the volume.
1. Click the Crop Corner button to select this tool.
A box is removed from the corner that is pointing toward you in the 3D viewer.
2. In the MPR viewers, drag the orange lines, which define the corner to be cut
away, to increase or decrease the box.
3. Click the Crop Corner button a second time to show the entire volume again.

Tip

When you click a cropping tool, the Lock Crop Region button appears in the
lower right corner of the active viewer.

Clicking this button locks the crop region. You can now move or rotate the vol-
ume within the remaining volume box.

Fusion registration tools and tools for displaying primary and overlay data
With Visage 7 you can display suitable datasets in fusion mode. Fusion display
overlays datasets, for example, a CT and a PET series of the same study.
Fusion display requires that datasets are registered, which means that they are
aligned spatially. Even though Visage 7 usually aligns datasets automatically when
you load suitable data, always check and confirm alignment manually.

Manual Registration
tool8registration8manual

Use this tool to start manual alignment mode. In this mode, the two datasets are
overlaid. The primary dataset is shown pink, and the overlay dataset is shown green
in the active viewer. An outlined cross also appears in the viewer.
1. Click the center of the cross.
2. Hold the mouse button down, and drag the green layer.
3. When corresponding structures in the green and pink layer are exactly overlaid,
release the mouse button.

Visage 7 105
Tools View windows

-Or-
1. Click one of the ends of the cross.
The cursor changes its shape and indicates rotation.
2. Hold the mouse button down and drag to rotate the green overlay layer.

Tip

Before you align datasets manually, window the two datasets in such a way that
prominent structures, such as bones, are clearly visible. This helps you to overlay
the two corresponding images correctly.

Align Centers
tool8registration8aligncentersofgravity

Use this button to have Visage 7 align the centers of the bounding boxes of the two
datasets.

Automatic Registration
tool8registration8automatic

Use this button to have Visage 7 identify and align corresponding structures by
comparing pixel intensities.

Caution

Be aware that automatic registration does not always align images correctly.
Please verify registration results and correct registration manually, if necessary.

Tip

Automatic Registration of primary and overlay datasets and Automatic Viewer

Registration for linked scrolling use the same principle of comparing grayscale
information in images.
See also Automatic Viewer Registration, Automatic Viewer Registration (Transla-
tion Only), page 75.

106 Visage 7
View windows Tools

Reset Registration
tool8registration8reset

Click this tool to undo manual alignment, center alignment, or automatic registra-
tion. The two datasets are now registered in the same way as they were right after
loading.

Accept Registration
tool8registration8accept

Click this tool after you have finished aligning your datasets manually.

Viewer Objects (Primary), Viewer Objects (Overlay)

tool8multivolume8primary tool8multivolume8overlay

Multimodality studies can contain more than one series per modality. Multiple series
are indicated by these buttons in the MPR viewers and the 3D viewer.
Use these tools to open a menu from which you can select a different primary or
overlay dataset.

Tools for time-series analysis

When you load time series, the system selects a protocol that has been optimized
for comparison and analysis of images at various phases.

Time-density analysis
Time-density analysis plots the density progression in one or several regions of
interest over time in time-resolved 3D datasets.
1. Select the viewer that shows the baseline phase. Typically this is the upper left
viewer.
2. Draw a circular, elliptical, freehand, or point-sized ROI.

3. Right-click and select Time-Density Analysis.

The program evaluates the density of the ROI in the various time steps of the
series and plots this information in a graph.
4. Draw a second ROI.

Visage 7 107
Tools View windows

5. Right-click and select Add to Time-Density Analysis.

The graph of the second ROI is added to the plot. ROIs are numbered both in the
plot and in the image.

Subtract Baseline Phase

tool8timeseries8baselinesubtraction

Use this tool to subtract the baseline phase from the other images of a time series.
As a result you see only those structures in which changes occurred over time. In a
time-series with contrast medium, subtraction helps to focus on the flow of contrast
medium.

Tip

Click Subtract Baseline Phase a second time to reset subtraction and show all
image information again.

Tools for viewing mammography studies

Protocols for mammography studies feature a specific arrangement of images,
which is particularly well-suited for a comparison of the left and right breast.
Moreover, these protocols offer tools for synchronized image navigation in high-res-
olution images and for comparing magnified sections in corresponding images.

Quadrant Navigation
tool8mammography8quadrantnavigation tool8mammography8quadrantnaviga-
tion8overview

Use this tool to enlarge the displayed images and to read them quadrant by quad-
rant.
1. Click the Quadrant Navigation button to select this tool.
2. Press the right arrow key to show the upper right quadrant of images of the right
breast and the upper left quadrant of images of the left breast enlarged and side
by side.
3. Press the right arrow key a second time to move on to the lower right quadrant
(right breast) and lower left quadrant (left breast).
4. Press the right arrow key a third time to move on to the lower left quadrant (right
breast) and lower right quadrant (left breast).
5. Press the right arrow key a fourth time to move on to the upper left quadrant
(right breast) and upper right quadrant (left breast).
6. Press the right arrow key a fifth time to show the entire images again.
7. Continue pressing the right arrow key to return to quadrant display.

108 Visage 7
View windows Tools

Tip

When the entire images are shown, you can choose whether to show complete
overview images or whether to cut away background information and show the
overview image enlarged.

Quadrant Overview Enlarged shows the overview image enlarged and cuts
away background pixels, burnt-in text, and markers.

Quadrant Overview shows either the full image or cuts away only background
pixels, depending on the property settings for this tool.
Choose this tool if you suspect that Quadrant Overview Enlarged might not dis-
play all diagnostically relevant information.

Magnifying Glasses
tool8viewing8magnifyingglasses

Use this tool rather than Magnifying Glass to be able to compare enlarged sec-
tions of the left and right breast.
1. Click the Magnifying Glasses button to select this tool.
2. Click the image of the left breast and hold the mouse button down.
A rectangular area appears which shows this section of the image in its original
size (100%).
3. Drag to move the rectangle across the image.
4. Release the mouse button and move on to the image that shows the right breast.
5. Also click here and move the magnifier to the area of interest.
The magnifiers remain visible in both viewers for as long as the Magnifying
Glasses tool is selected.
6. For layouts that show images in more than one orientation, you can continue
applying magnifying glasses to these other viewers as well.
7. Click the tool on the toolbar a second time or click another tool to remove the
magnified sections from all viewers.

Visage 7 109
Tools View windows

Tip

The tool Magnifying Glasses is not reserved for mammography studies but also
available in other protocols, image types and viewers.
Choose multiple Magnifying Glasses rather than a single Magnifying Glass
whenever you want to inspect and compare magnified sections in more than one
viewer. See also Magnifying Glass, page 60.

Previous Prior Study (Mammo), Next Prior Study (Mammo)

tool8datanavigation8nextprior tool8datanavigation8previousprior

Use these tools to scroll through corresponding images in prior studies.

-Or-
Use Browse in All Priors for a similar effect. See Browse in All Priors, page 63.

Toggle MG/Tomo
tool8mammography8togglemgtomo

Use this tool to switch between 2D and 3D series display in the current viewer. The
tool is only available in DBT (digital breast tomosynthesis) studies.

Data handling tools

These tools help you with various data handling tasks.

Study Info Dialog

tool8general8studyinfo

Use this tool to show the study information dialog box. The information in this dialog
box is read-only, except for the Comment box.
In the Comment box you can add or edit study comments. Any changes are saved
on the Visage 7 server automatically. No further user interaction is required to save
comments.

110 Visage 7
View windows Tools

View Structured Reports

tool8reporting8showreports8sr

Use this tool to show any DICOM structured reports that exist for the currently
loaded study, as well as for associated prior studies.

View Reports (RIS)

tool8reporting8showreports8ris

Use this tool to show reports that exist for the currently loaded studies in the RIS.
The reports are shown in a separate report window.
The tool icon indicates the report status (unsigned report, signed report, report for
prior study only, no report at all).

Tip

In the report window, you can view and print reports.

View Reports (PACS)

tool8reporting8showreports8pacs

Use this tool to view PACS reports or HL7 reports for the currently loaded studies.
This tool opens the Export window and displays the reports there.
The tool icon indicates the report status.

Best Image Quality

tool8viewing8bestimagequality

For users who access the Visage 7 server over the Internet, a red bullet might be
permanently shown in the lower right corner of all images. The red bullet indicates
low image resolution as a result of high compression rates, which were selected to
improve download speed.
Use the Best Image Quality tool and select individual images only. These images
are downloaded with best image quality but potentially slow download times.

Visage 7 111
Tools View windows

Assign and Manage Labels

toolbar8labels

Use this tool to open the Study Labels dialog box.

Assigning a label to a 1. Select one or several of the existing labels that you want to assign this study to.
study
-Or-
Type the name of a new label and select either the public or private version of
the new label.

2. Click Apply.

Creating a label button For even easier label assignment in future, you can create label buttons on the
Labels toolbar.
1. Right-click a label and assign it to a button placeholder.

2. Next time you want to assign this label, click the button on the Labels toolbar.

112 Visage 7
View windows Tools

Tip

For more information about study labels, see Anonymizing cases for other pur-
poses, page 33.

Tool for printing images (Ctrl/Cmd + P)

With this tool, you can print out images on a DICOM printer, or on a Windows
printer, or save one or several images as a pdf file.
1. Right-click a viewer and select Print from the context menu.
2. Select a printer and printer settings in the Print dialog box.
3. Click Print to start the printout or to create a pdf file.

Printer settings

Device In the upper part of the dialog box, select DICOM printers and one of the DICOM
printers connected to your Visage 7 server.
-Or-
Select Other Destinations and select a Windows printer or Save as PDF.
Also select the number of copies.

Images Select which image or images you will print out:

Active Image prints the image in the active viewer. Image orientation, zoom and
window settings in the printout are the same as in the active viewer. If image texts
are currently shown in the image, these texts are printed as well. Measurements or
annotations are not printed.
Active Image Set prints all images of the image set currently shown in the active
viewer. All images are printed in their original orientation and together with any
image texts that are currently displayed on the screen. Measurements or annota-
tions are not printed.
Visible Images prints all images that are currently shown on the screen. Image ori-
entation, zoom and window settings in the printout are the same as on the screen
when you click the tool. This option is available only if all viewers show original
images.
Visible Image Sets prints the images of all image sets that are currently displayed
in the various viewers of the selected layout. If one image set is shown in more than
one viewer, it is printed only once. All images are printed in their original orientation.

Visage 7 113
Tools View windows

Layout Select how many images you want to print on one page or film sheet by specifying
the number of Rows and Columns.
Selecting 1 for rows and also 1 for columns prints exactly one image per page or
film sheet. Selecting 2 for rows and also 2 for columns prints exactly four images
per page or film sheet.
Also specify the Fit Mode:
Image fits the image into the image box on the page or film.
Viewer prints images as shown in the viewer. This option is available only for the
tools Active Image and Visible Images.
True Size scales the image up or down so that one centimeter on the printout cor-
responds to one centimeter in reality. This mode takes image calibration into
account. If you select this option for uncalibrated images, a warning appears. True
Size is only available for DICOM printers.

Media Properties In this section of the dialog box, select medium type, size, orientation, and color
mode. Which options are available in this section depends on the selected device.

Tools for switching image text and graphics on and off

With the tools in this section, you can show or hide texts or graphics that overlay the
actual images. Some of these tools show or hide all text or groups of text or graph-
ics, whereas other tools toggle only specific information.
Toggle tools affect all viewers or all viewers of a specific viewer type. For example,
you cannot show patient and study data in one viewer but hide this information in all
other viewers.

Toggle tools on the tool The toggle tools can be configured to be shown in toolbars or on the tool palette.
palette Show the tool palette by right-clicking a viewer. However, remember that it depends
on your system configuration whether right-clicking shows the tool palette, or the
viewer context menu, or both (see also Configure Tool Palette dialog box, page
189).

Toggle All
tool8showinviewer8toggleallviewertexts
Use this tool to show or hide any texts or graphics that are currently selected for
display in the View > Show in Viewer menu.
Alternatively, use the Space key on your keyboard to show or hide text and graph-
ics.

Toggle Patient/Study Data

tool8showinviewer8togglepatientdata
Use this tool to show or hide patient or study information in all viewers.

Toggle Viewer Text Categories

tool8viewertext8cyclecategories
Use this tool to show patient and study information at different levels of detail.

114 Visage 7
View windows Tools

Toggle Orientation Labels

tool8showinviewer8toggleorientationlabels
Use this tool to show or hide orientation labels in viewers.
Orientation labels indicate the viewing direction: A for anterior, P for posterior, L for
left, R for right, H for head, and F for feet.

Toggle Orientation Cube

tool8showinviewer8toggleorientationcube
Use this tool to show or hide the orientation cube in the lower left corner of the view-
ers.
For DBT (digital breast tomosynthesis) volumes, a slice-position reference graphic
is shown instead of the orientation cube.

Toggle Histogram
tool8windowlevel8togglehistogram
While the Window Level tool is active, a histogram of grayscale values or HU val-
ues is shown in the lower left corner of the viewer.
Use this tool to hide or redisplay the window level histogram.

Toggle Scale
tool8showinviewer8togglescale
In calibrated image types, for example, CT images, a scale can be shown on the
right edge of the viewers. The scale looks like a small ruler and indicates centime-
ters or millimeters when you zoom in.
Use this tool to hide or redisplay the scale.

Toggle Color Scale

tool8showinviewer8togglecolorscale
In viewers that show color images, a scale that indicates the value range can be
shown. For example, in PET (positron emission tomography) images the value
range indicates standard uptake values (SUV) and the colors they correspond to.
Use this tool to show or hide the color-map value-range indicator.

Toggle Annotations
tool8showinviewer8toggleannotations
Use this tool to show or hide annotation text, annotation arrows, and measurement
graphics and results.
-Or-

Toggle Annotation Statistics

tool8showinviewer8toggleannotationstatistics
Use this tool to hide or redisplay the results of measurements only. With Toggle
Annotation Statistics turned off, measurement graphics are still visible, only the
results of measurements are hidden.
This tool is particularly useful in the context of ROI statistics, which might hide
underlying image information.
Note that instead of showing or hiding all ROI statistics you can also hide the
results of individual ROI measurements only. Select a ROI measurement and use
the context menu and not the Toggle Annotation Statistics tool to show or hide
this information.

Visage 7 115
Tools View windows

Toggle Viewer Controls

tool8viewercontrols8toggle
Use this tool to show or hide the viewer control bar at the bottom edge of the view-
ers. Toggle Viewer Controls affects all viewers of the same viewer type.

Toggle 2D Bounding Box, Toggle 3D Bounding Box

tool8showinviewer8toggleboundingbox2d tool8showinviewer8togglebounding- box3d
Use these tools to show or hide a box or cube that indicates volume borders in
MPR viewers or 3D viewers.

Toggle 2D Crosshair, Toggle 3D Crosshair

tool8showinviewer8togglecrosshair2d tool8showinviewer8togglecrosshair3d
Use these tools to show or hide scoutline crosshairs in MPR viewers or the 3D
crosshair in 3D viewers.

Toggle Partial Crosshair

tool8showinviewer8togglepartialcrosshair
When the full 2D crosshair is shown the crosshair center becomes a move handle,
irrespectively of the tool that is currently selected.
Switch to partial crosshair display to turn the move function off. For example, switch
to partial crosshair display before you perform any measurements that start at or
near the crosshair center.

Toggle Scoutlines
tool8showinviewer8togglescoutlines
Use this tool to show or hide scoutlines. Scoutlines are dashed lines in 2D viewers
or MPR viewers that indicate the location of a slice shown in one of the other view-
ers.

Toggle Slice Boundaries

tool8showinviewer8togglethicksliceboundaries
In thick-slice display use this tool to show slice boundaries in MPR viewers of the
same dataset.

Toggle Centerline
tool8vessel8togglecenterline
Use this tool to show or hide the curve definition or vessel centerline during vessel
analysis or curved planar reformatting.
Note that in curved view centerline display must be turned on in the context menu.
Only then can you use the Toggle Centerline button on the toolbar to hide or redis-
play the centerline.

Toggle DICOM Overlays, Toggle DICOM Annotations

Toggle DICOM Shutters, Toggle ECG curve
cannotations
tool8showinviewer8toggledicomoverlays
tool8showinviewer8toggledicomshutters
tool8showinviewer8toggledicomgraphi-
tool8showinviewer8toggledi-
comecgcurve
Use these tools to show or hide DICOM overlays, DICOM annotations, DICOM
shutters, or the ECG curve.
These tools are available only if images contain this information.

Toggle Localizer Image

tool8showinviewer8togglescoutimage
Use this tool to hide or redisplay the embedded scout or localizer image in
fullscreen mode.
Note that this is possible only if display of the embedded scout or localizer has been
defined in the property settings of a viewer type.

116 Visage 7
View windows Tools

Tools for performing quality assurance on images

On some occasions it is necessary to correct images so that these corrections apply
even if the images are viewed with a viewer software other than Visage 7 Client.
Such corrections include the following cases:
• Patient information or orientation labels that are burnt into the images need to be
replaced.
• 2D images need to be rotated or flipped.
• Window level settings need to be changed in individual 2D images or in a 3D vol-
ume dataset.
• The assignment of images to series or studies needs to be corrected.

Note

Visage 7 Client provides two tools to make and save permanent changes to
image content. However, these tools are available only if your user account has
appropriate user rights.

Permanent Text Label

tool8imagecontentqa8permanenttextlabel

Use this tool to overwrite patient or study data or orientation labels that are burnt
into the images.
1. Click the Permanent Text Label button to select this tool.
The Edit Permanent Labels dialog box opens. Text label creation and editing
mode is active as long as this dialog box remains open.
2. In the image, click the patient information or orientation label that you want to
overwrite.
A black box appears. The box more or less covers the existing patient informa-
tion or orientation label.
3. Drag to move the box or use the sizing handles (orange dots) so that the box
covers the text that you want to overwrite completely.
4. Type the correct information in the Label properties box of the Edit Permanent
Labels dialog box.
5. Use the Font size slider to resize the text.
6. Under Image selection, select whether to apply the new label to the current
image only or to all images in the image set.
7. Save your changes and close the dialog box.
Closing the dialog box ends label creation and editing mode.

Visage 7 117
Tools View windows

Tip

To change a text label that you just entered, or to delete one of your labels, reen-
ter label editing mode.
Click the Permanent Text Label button again and click a label that you entered
earlier to select it. You can now change the label text, move or resize the label, or
delete it with the Del key on the keyboard.

Save Modified Image

tool8imagecontentqa8savemodifiedimage

Use this tool to save changes to image content permanently.

1. Click Save Modified Image.
2. Select which changes you want to save.
You can only save changes to window level settings, flip or rotate operations,
annotations, layout changes and changes to text labels but no other modifica-
tions to image content.
Save Modified Image combines the tools Save Current W/L as Presentation
State, Save Flip/Rotate as Presentation State, Save Annotations as Presen-
tation State, and Save Sort Order with saving permanent text label changes.

Select for Quality Assurance

tool8qualityassurance8selectfromactiveviewer

Use this tool to load a case onto the Quality Assurance platform.
1. Select an image.
2. Click Select for Quality Assurance.
Here you will find the selected case in the Performed Procedures list.

118 Visage 7
View windows Tool cards

Tool cards
Tool cards can be arranged in one or several stacks, usually along the right edge of
the program window. Alternatively, tool cards can be displayed as floating windows.
Your currently active protocol defines how and how many tool cards are shown right
after you have loaded data.

Showing or hiding tool 1. Click the arrow button on the right edge of the screen to show tool cards, if these
cards are currently hidden.

2. Select the tool card you need from the drop-down list.

-Or-
Select a tool card from the Tools menu.

When you select a tool card from the Tools menu, it is shown as a floating window.

Tips for arranging tool Some tool cards require more space than others. You can therefore resize tool card
cards stacks or the width of the entire tool card area.
1. Point to the line that divides two stacks of tool cards.
The cursor changes its shape.
2. Drag the line up or down to resize the tool card above and below.

If the tool card area is temporarily in your way, you can hide it.
Clear View > Show Tool Cards in the main menu to hide the tool card section.

Visage 7 119
Tool cards View windows

Floating windows are usually displayed in a size that ensures that they are not in
your way while you are reading images. You can enlarge these windows, if neces-
sary.
Click the lower left or lower right corner of the window and drag it out to show the
tool card larger.

Templates
toolcard8colortemplates3d
Templates offer a quick way to optimize the volume display in the 3D viewer for spe-
cific tasks.
A template defines volume rendering and display parameters for volume datasets of
a particular modality or a combination of modalities.
A template stores the following information:
• The modality of the primary and overlay dataset
• A color map for the primary and overlay dataset
See also 3D Color Map, page 121.
• Rendering and display settings for the volume display in the 3D viewer

User-defined templates A number of predefined templates came with the system. Advanced users can
adjust these to their own requirements or define their own set of 3D templates.
When you save a new or adapted template, you can make it available for all users
or for your own user account only.

Note

When you edit and save one of the All users templates, you change this tem-
plate permanently and for all Visage 7 users in your network. The factory-defined
template version is lost this way.

Controls on this tool Use the following buttons and tools to select a template or to manage templates:
card

Click a template thumbnail on the tool card to select it.

The tool card lists only templates that were defined for the modality or modalities of
the data that is currently loaded.

Click Reset to return to the original volume display and to revoke your changes.

120 Visage 7
View windows Tool cards

Click Save to save the 3D rendering and display settings currently applied to the
volume in the active 3D viewer. A dialog box opens. Enter a template name and
decide whether the new template will be available for all users or for your user
account only.

Select a thumbnail and click Delete to remove it from the list of available templates.

3D Color Map
toolcard8colormap3d
On the 3D Color Map tool card, you can select and edit the color map that is used
for VRT rendering in the 3D viewer.
A color map assigns colors and transparencies to different tissue types as defined
by their window level. By selecting and adjusting a color map, you focus on struc-
tures and tissue types that are of particular interest to you. With a suitable color map
you can display these structures particularly clearly and hide what would only dis-
tract you from the question at hand.

User-defined color A number of predefined color maps came with your system. Advanced users can
maps adjust these or define their own set of 3D color maps. When you save a new or
adapted color map, you can make it available for all users or for your own user
account only.

Note

Some of the available color maps, for example, gray ramp and temperature, can
only be edited to a limited extent. In these color maps you can adjust only the
data windows of the tissue types but no color and transparency settings. You
cannot save changes to these color maps either.

Controls on this tool Use the following controls to select the dataset and color map that you want to
card change, and to manage color maps.

Primary Dataset, Overlay Fusion mode only.

Dataset
Select which of the two color maps you want to edit, the color map of the primary
dataset or the overlay dataset.

Color map selection Click the arrow button next to the currently selected color map label to drop down a
list of all color maps available in your system

Click Reset to return to the original 3D color map and to revoke your changes.

Click Save to save changes or to create a new color map. A dialog box opens.
Enter a color map name and decide whether the new color map will be available for
all users or for your user account only.

Click Delete to remove the selected color map from the list.

Visage 7 121
Tool cards View windows

Color map editor The color map editor shows the histogram of grayscale values or HU values of the
selected dataset as a background image. The graphs that overlay the grayscale his-
togram represent the tissue types and their color and transparency settings for VRT
rendering.
You can edit these graphs to change the color map.
• You can change the data window for a tissue type.
See Moving or resizing the histogram
• You can select different colors for each graph or you can change the transpar-
ency settings for a tissue type.
See Editing a graph
• You can change the tissue type description.
See Editing a graph
• You can add or delete tissue type graphs.
See Adding or removing a graph

Moving or resizing the 1. Click the black area above or below the grayscale histogram, and hold the
histogram mouse button down.
The cursor changes its shape: it turns into a double-arrow.
2. Drag the mouse to the right or left to move the histogram and to show areas to
the right or left that were previously hidden.
-Or-
Drag the cursor up or down to condense or expand the histogram.

Editing a graph 1. Click a graph to select it.

2. Drag the boxes along the bottom line of the histogram to change the window
center and window width of this tissue type.
-Or-
Double-click the boxes along the bottom line or at the apex or apices to change
the color definition of the graph.
-Or-
Drag these boxes up or down to change transparency settings.
-Or-
Click the tissue description text above the histogram and edit this text.

122 Visage 7
View windows Tool cards

Renaming a graph 1. Select a tissue graph.

The name of the selected tissue type appears above the graph section.
2. Select this text to overwrite it.

Adding or removing a 1. Right-click next to a graph to open a menu.

graph
2. Select New Tissue to add a new graph.
-Or-
Select Delete Tissue to delete the selected graph.
-Or-
Select one of the listed tissue types for editing.

Display
toolcard8display
On this tool card you can adapt display settings in the selected viewer. The Display
tool card offers slightly different controls depending on the selected viewer and
whether fusion mode is active or not.

Display tool card in When you have loaded suitable data, you use this tool card to turn fusion mode on
fusion mode and off and to adjust display settings.

Primary Dataset, Overlay Use these check boxes to turn fusion mode on and off.
Dataset
Select which dataset to display on top of the other from the drop-down lists below
the Primary Dataset and Overlay Dataset check boxes.
Fusion display is particularly suitable for studies from combined multimodality scan-
ners, such as CT-PET and CT-SPECT. However, you can also use this feature to
overlay two CT series, for example.

Histogram and color Use the slider below a histogram to adjust the window settings for this dataset. Or
map drop down a list of color maps with the arrow button to the right of the histogram
and select a suitable color map.

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Fusion slider Use this slider to fade between the primary and the overlay datasets. If you move
the slider all the way to the left, only the primary dataset is visible. If you move it all
the way to the right, only the overlay dataset is visible.
If Smart Fusion Slider is configured in the tool properties for fusion mode, image
display switches to grayscale inverse for a 100% PET image. See Properties dialog
box, page 190, for information about how to configure tool properties.

Edge enhancement Use this slider to adjust the sharpness of images.

slider
This slider is available only when the Edge Enhancement tool is selected.

Display tool card in When you have loaded data that is not suitable for fusion display, you use this tool
nonfusion mode card to adjust window level and image resolution.

Dataset selection If you have loaded more than one dataset, use the drop-down list of the Display
tool card to select which dataset to display.

Histogram and color Use the slider below the histogram to adjust window settings. Alternatively, drop
map down a list with the arrow button to the right of the histogram and select a color
map.

Always Highest Resolu- This check box is available only if the active viewer is an MPR viewer, the CPR
tion viewer, or the lumen viewer.
Select this box to show full resolution images even during image processing. This
might slow down system performance. To show a downsampled image during pro-
gram interaction, clear this check box.

Cine
toolcard8cine
With the controls on the Cine tool card you can animate image display in a viewer.
For example, you can scroll through images in an image stack, or play back a time
series or a video. In the 3D viewer, you can rotate the volume or move the crop
plane through the volume.
You can record these animations for presentation purposes, for example. You can
save the resulting images as a new DICOM series (.dcm) on the primary server or
send them to another DICOM server. Or save images on your computer as an
MPEG movie (.mpg), or as JPEG (.jpg), PNG (.png), or DICOM (.dcm) images.
The Cine tool card looks slightly different depending on the loaded data and the
selected viewer.

Cine tool card for MPR The following options are available for MPR viewers with image stacks or time
viewers series.

Batching Select whether you want to scroll through the slice images (Stack) or whether you
want to show a time series over the acquired time (Time).

Position Select the first and last image of your movie.

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Increment Select an increment for scrolling. The increment can either be the Same as Slice
Thickness or any other value in millimeters (Custom).

Frame Rate Select Frame Time, Frame Time Vector, or Recommended Display Frame Rate
to play back the movie with the frame rate defined in the DICOM data.
-Or-
Select User-Defined to define the frame rate in frames per second (FPS) here on
the Cine tool card.
-Or-
Select Default Cine Rate (User Property) to play back the movie with a preferred
frame rate, which you have defined in your user profile.

Play Speed Use this slider to slow down or speed up playback interactively.

Update All Viewers Only active for time series.

With this check box you decide whether to apply cine mode to all viewers or to play
the film in the selected viewer only.

Cine tool card for 3D The following options are available for 3D viewers.
viewers

Batching Select an animation mode here:

Rotate - this rotates the entire volume.
Crop - this has a crop plane move through the volume. This option is shown only if
the Crop Plane tool is currently turned on.
Time - this plays the volume back over time. This option is available only if the
loaded dataset is a time series.

Parameters Select the rotation Angle (360° is full rotation) and Increment.

Axis Select a rotation axis and decide whether this axis refers to the patient coordinate
system (Object Coordinates) or to Screen Coordinates.

Frame Rate Select Frame Time, Frame Time Vector, or Recommended Display Frame Rate
to play back the movie with the frame rate defined in the DICOM data.
-Or-
Select User-Defined to define the frame rate in frames per second (FPS) here on
the Cine tool card.
-Or-
Select Default Cine Rate (User Property) to play back the movie with a preferred
frame rate, which you have defined in your user profile.

Play Speed Use this slider to slow down or speed up playback interactively.

Best 3D Quality Select this box for slow playback in best 3D quality.

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Tool cards View windows

Update All Viewers Only active for time series.

With this check box you decide whether to apply cine mode to all viewers or to play
the film in the selected viewer only.

Cine tool card for CPR The following options are available if the active viewer is the CPR viewer or lumen
or lumen viewer viewer.

Batching Select whether you want to scroll slice by slice (Stack) or whether you want to
rotate around the segmented structure or vessel (Rotation).

Position, Increment Only active if you have selected Stack.

Select the first and last image of your movie.
Select an increment for scrolling. The increment can either be the Same as Slice
Thickness or any other value in millimeters (Custom).

Parameters, Axis Only active if you have selected Rotation.

Select the rotation Angle (360° is full rotation) and Increment.
Select a rotation axis and decide whether this axis refers to the patient coordinate
system (Object Coordinates) or to Screen Coordinates.

Frame Rate Select Frame Time, Frame Time Vector, or Recommended Display Frame Rate
to play back the movie with the frame rate defined in the DICOM data.
-Or-
Select User-Defined to define the frame rate in frames per second (FPS) here on
the Cine tool card.
-Or-
Select Default Cine Rate (User Property) to play back the movie with a preferred
frame rate, which you have defined in your user profile.

Play Speed Use this slider to slow down or speed up playback interactively.

Best 3D Quality Select this box for slow playback in best 3D quality.

Update All Viewers Only active for time series.

With this check box you decide whether to apply cine mode to all viewers or to play
the film in the selected viewer only.

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Cine tool card for The following options are available if the active viewer shows a video.
videos

Batching Indicates that the active viewer displays a video file (MPEG or H264)

Frame Rate Select Frame Time to play back the movie with the frame rate defined in the video.
-Or-
Select User-Defined to define the frame rate in frames per second (FPS) here on
the Cine tool card.
-Or-
Select Default Cine Rate (User Property) to play back the movie with a preferred
frame rate, which you have defined in your user profile.

Play Speed Use this slider to slow down or speed up playback interactively.

Playback tools Use the following tools on the Cine tool card to start or halt cine display:

Click Play or use the keyboard shortcut C to play your film back once.

Click Pause or use the keyboard shortcut C again to pause the playback.

Select Loop to play the film in an endless loop.

Select Swing to play the film in a bouncing loop: When the playback reaches the
last image, the movie is played backward to the first image, then forward again, and
so on.

Click Record to open the Cine Options dialog box.

(Not possible if a video is displayed.)
Choose whether to save your film as an MPEG movie or as a slide show. Alterna-
tively, you can save the film as a new DICOM series on your local computer or on a
connected DICOM server.

Progress bar slider Use this slider to fast-forward or rewind the video.

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Line Profile
toolcard8lineprofile
The Line Profile tool card shows the grayscale or HU value profile of a selected
distance line. If there is only one line in the image, the profile of this line is shown
even if you have not selected it.
If you have moved a distance line that was in your way no line profile can be shown.
Move the distance line back to its original position to redisplay the line profile.

Controls on this tool Use the controls on this tool card to save line profile data or to create a screenshot.
card

Linear/Log Select linear or logarithmic scale.

x/y- axis The x-axis shows the length of the line or lines, the y-axis represents grayscale val-
ues, HU (Hounsfield units), or SUV (standard uptake values).
In fusion mode, two profiles are shown, one for the primary image and one for the
overlay image. The colors of the lines correspond to the colors of the units shown
on the two y-axes.

Click this button to create a screenshot of your line profile or profiles. The screen-
shot is sent to the Export window. From the Export window, you can save it to hard
disk, or drag it into your report.

Click this button to save the data of your line profile onto your hard disk as a
comma-separated list (*.csv file).

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Complex tools and applications

This section describes complex tasks and applications that involve more than one
tool or a combination of tools from toolbars and tool cards.

Batching tools and tool card

toolcard8batching
Batching is a process that generates new slice images (reformats) from a volume
dataset and saves them on the server or on your local computer.
Two types of batching are possible with Visage 7:
• Stacked batching
• Rotational batching

Stacked batching
tool8batching8stacked

Stacked batching is a process in which a new stack of coplanar reformats is cre-

ated.

Stacked batching tools When you click the Stacked Batching tool, a new toolbar appears in the lower right
corner of the active viewer. Here you find tools for creating a new image series.

Toggle Direction
This button reverses the direction in which you will walk through the volume.

Toggle Aspect Ratio

This button plans new images either in the resolution of the viewer or in a standard
512x512 pixel resolution. 512x512 is available for grayscale images only.

Toggle RGB/Grayscale
With this button you select the color scheme for the reformats: grayscale or RGB.
Grayscale creates a new series of medical images. These images can be win-
dowed, resized, or evaluated in future postprocessing sessions, just like any other
DICOM series.
RGB images are screenshots and any information that they contain is burnt into the
images. This means that you cannot change any of their display parameters or per-
form measurements in these images in future postprocessing sessions.

Save/Send
With this button you start the batching process and save your new series on the
server or on a DICOM node. See Saving, sending, or exporting images.

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Export
With this button, you start the batching process and export the new images to your
local computer or to a folder in your network. See Saving, sending, or exporting
images.

Open Tool Card

With this button, you open the Batching tool card in stacked batching mode. On
the tool card, you can specify the number of images to be created, their slice thick-
ness, overlap, and slice distance.

Cancel
With this button, you exit stacked batching mode without creating a new series.

Batching tool card in On the Batching tool card, you define slice parameters and you lock or unlock
stacked batching mode parameters.

Unlocking a parameter means that this slice parameter changes when you adjust
the range of the new image stack graphically in the scout images.
Locking or unlocking of slice parameters affects only graphical processing steps.
You can overwrite slice parameters on the Batching tool card irrespectively of
whether they are locked or not.

Number of images This parameter defines how many new reformats will be created.

Image thickness This parameter defines the slice thickness of the new reformats.

Overlap This parameter indicates whether and how much images overlap. A positive value
creates overlapping slices, a negative value creates gaps between slices.

Direction With these buttons, you define the direction in which you will walk through the vol-
ume.

Distance This parameter defines the distance between corresponding slice boundaries.

Properties With this button, you can open the configuration dialog box for stacked batching.
See also Properties dialog box, page 190.

Save/Send
With this button, you start the batching process and save your new series on the
server or on a DICOM node. See Saving, sending, or exporting images.

Export
With this button, you start the batching process and export the new images to your
local computer or to a folder in your network. See Saving, sending, or exporting
images.

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Rotational batching
tool8batching8rotationalhorizontal tool8batching8rotationalvertical

Rotational batching is a process that creates new reformats from a volume dataset
by rotating around a center point. In 3D this gives you the impression of walking
around the volume. Rotational batching can be started from MPR viewers or from
CPR viewers.

Rotational batching When you click Rotational Batching (Vertical) or Rotational Batching (Horizon-
tools tal), a new toolbar appears in the lower right corner of the viewer. Here you will find
tools for creating a new image series.

Toggle Direction
This button reverses the direction in which you will walk around the volume.

Center Rotation Axis

This button moves the rotation axis to the center of the preview image. This func-
tion is useful if you have panned the image in the viewer that is to become the pre-
view before you started rotational batching.

Toggle Aspect Ratio

This button plans new images either in the resolution of the viewer or in a standard
512x512 pixel resolution. 512x512 is available for grayscale images only.

Toggle RGB/Grayscale
With this button, you select the color scheme for the reformats: grayscale or RGB
Grayscale creates a new series of medical images. These images can be win-
dowed, resized, or evaluated in future postprocessing sessions, just like any other
DICOM series.
RGB images are screenshots and any information that they contain is frozen into
the images. This means that you cannot change any of their display parameters or
perform measurements in these images in future postprocessing sessions.

Save/Send
With this button, you start the batching process and save your new series on the
server or to a DICOM node. See Saving, sending, or exporting images.

Export
With this button, you start the batching process and export the new images to your
local computer or to a folder in your network. See Saving, sending, or exporting
images.

Open Tool Card

With this button, you open the Batching tool card in rotational batching mode. On
the tool card, you can specify the number of images to be created, their slice thick-
ness, overlap, and slice distance.

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Complex tools and applications View windows

Cancel
With this button, you exit rotational batching mode without creating a new series.

Batching tool card in On the Batching tool card, you define slice parameters and you lock or unlock
rotational batching parameters.
mode
Unlocking a parameter means that this slice parameter changes when you adjust
the range of the new image stack graphically in the scout images.
Locking or unlocking of slice parameters affects only graphical processing steps.
You can overwrite slice parameters on the Batching tool card irrespectively of
whether they are locked or not.

Number of images This parameter defines how many new reformats will be created.

Angular increment This parameter indicates the increments between slices.

Image thickness This parameter defines the slice thickness of the new reformats.

Direction With these buttons, you define the direction in which you will walk around the vol-
ume.

Properties With this button, you can open the configuration dialog box for rotational batching.
See also Properties dialog box, page 190.

Save/Send
With this button, you start the batching process and save your new series on the
server or on a DICOM node. See Saving, sending, or exporting images.

Export
With this button, you start the batching process and export the new images to your
local computer or to a folder in your network. See Saving, sending, or exporting
images.

Saving, sending, or exporting images

You can save, send, or export images from all the toolbars of all three batching
modes and from the Batching tool card.
Save/Send or Export starts the actual batching process. It is not until you click one
of these buttons that new images are actually created.

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Tip

In Visage 7 we make a distinction between the concepts of saving, sending, and

exporting data. Saving data means storing data on the Visage 7 server in
DICOM format. Sending data means transferring data to a connected DICOM
node. Exporting data means downloading data to the file system of your local
computer, or to a network drive and folder.

Save/Send
With this button, you save the new series on the server or on a DICOM node. Click-
ing Save/Send opens the DICOM Send dialog box. Here you select send options:
Destination - select one or several servers where you want to save the new series.
Scout Images - select whether you want to include the scout images in the series.
If you also select Show Measurements and Annotations and Show Orientation
Cube under Scout Images, this refers to scout images but not to new reformats.
Series Number and Series Description - enter a series number and series
description. For example, enter a high number to append the series to the end of
the study.
Make Default - this button saves your settings as program suggestions for subse-
quent batching jobs.
Save - this button starts the batching process and sends the new series to the
selected server or servers.

Export
With this button, you export the new images to your local computer or to any folder
in your network. Depending on the color scheme that you selected earlier, clicking
Export opens the Export Grayscale dialog box or the Export RGB dialog box.
Export as - select the file format of the new images. Note that the file formats *.jpg,
*.mpg, and *.png are available only for RGB images but not for grayscale images.
Note also that when you select DICOM for RGB images this creates screenshot
images only. Windowing and measurements are only possible in new reformats of
the type grayscale plus DICOM format.
Destination - click Browse to select a destination folder.
Scout Images - select whether you want to include the scout images in the series.
If you also select Show Measurements and Annotations and Show Orientation
Cube under Scout Images, this refers to scout images but not to new reformats.
Options - for grayscale DICOM images enter a series number and series descrip-
tion. For RGB images of any file format, select whether patient information and ori-
entation labels are to be shown permanently in the images.
Export - this button starts the batching process and saves the images on your local
computer or in a folder of your network.

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Complex tools and applications View windows

3D segmentation tools and tool cards

Visage 7 provides various tools and techniques for 3D segmentation. 3D segmenta-
tion is the process of identifying objects in 3D and defining their contours. As a
result of 3D segmentation, the system has assigned each voxel in the volume either
to this object or to surrounding structures.
3D segmentation is relevant in a variety of contexts and for a variety of objects or
structures. In all applications, 3D segmentation is the first step before objects can
be removed or before structures can be analyzed in greater detail. Visage 7 pro-
vides tools for automatic, semiautomatic, or manual 3D segmentation and also per-
mits a combined approach.

Tools for automatic removal of structures

These tools segment and remove specific structures automatically. Both tools are
available for CT datasets only.

Caution

Automatic segmentation tools (remove table, remove leg bones, remove chest
wall) support the physician by hiding structures that occlude important informa-
tion in the images.
However, the software cannot guarantee that the detected pixels correspond to
the actual anatomical structures for each individual patient and scan. It is the
responsibility of the user to check whether any relevant structure has been acci-
dentally removed. In that case, simply click the respective tool again to bring the
removed structures back.

Remove Patient Table

tool8segmentation8removepatienttable
Use this tool to remove the patient table from a CT dataset with a single click. Click
the button a second time to redisplay the patient table.

Remove Chest Wall

tool8segmentation8removechestwall
Use this tool to remove the chest wall or rib cage from a CT thorax dataset with a
single click. Click a second time to redisplay the chest wall.

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Bone removal tool card

toolcard8boneremoval
For CT angiography datasets, Visage 7 provides a tool for semiautomatic segmen-
tation of the bones of the legs, or of pelvis and spine.

Caution

The Bone tool card supports the physician in finding bone structures in the image
data.
However, the software cannot guarantee that the detected and displayed struc-
tures actually correspond to the bones of the pelvis, spine, and the bones of the
legs. It is the responsibility of the user to check the plausibility and accuracy of
the presented data.

Bone segmentation The Bone tool card guides you through the segmentation process step by step.
tools

Run Segmentation Algo- Select Run Segmentation Algorithm and also which bones you want to remove.
rithm

Next, click Find Aorta.

The system attempts to find the aorta and asks you to verify the aorta position
before you continue.
If the system cannot identify the aorta, you are prompted to identify it manually. In
an MPR viewer, scroll to a slice in which the aorta is clearly visible. Move the scout-
line crosshair so that its center points to the aorta.

Next, click Compute.

Use these buttons to switch between display of vessels only, bones only, or display
of both bones and vessels.

Click Reset, if bone segmentation did not yield correct results. Run the algorithm
again. However, pay closer attention to the aorta verification step this time.

Load Pre-Computed Bone segmentation with the Bone tool card is automatically stored by the system.
Segmentation
The next time you load the same dataset, you do not have to perform bone removal
again. Instead, load the results from the last segmentation run.
Select Load Pre-Computed Segmentation and click Load.
-Or-

Remove Leg Bones

tool8segmentation8removelegbones
Use this tool on the toolbar to reload bone segmentation.
If no segmentation information exists for this dataset, a message requests you to
run the segmentation algorithm on the Bone tool card first.

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Freehand cropping tool

tool8segmentation8freehandcropping

Use this tool to segment structures manually.

1. Click the Freehand Crop button on the toolbar to select this tool.
2. Select the viewer that shows the structure that you want to crop particularly
clearly.
3. Drag the mouse around the structure.
When you release the mouse button the system closes the shape.

Freehand cropping After you have drawn a freehand shape, a new toolbar appears in the lower right
tools corner of the active viewer. Use the tools on this toolbar to remove the volume
inside or outside the freehand shape.

Remove Inside
Use this button to remove all that lies inside the shape that you have just drawn.
-Or-

Remove Outside
Use this button to remove all that lies outside the shape that you have just drawn.
The system determines what to remove from the volume by extruding the shape
through all slices in the direction orthogonal to the current image plane. These vox-
els are removed from the volume in the 3D viewer.

Remove Last Contour

Use this button to delete the last shape that you drew in this viewer.

Reset Remove
Use this tool to reset freehand cropping. The complete volume is shown again.

Accept and Exit

Click Accept and Exit to accept cropping and to close the Freehand Crop tool.

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Edit tool card

toolcard8edit
The Edit tool card offers tools for threshold-based segmentation or contour-based
segmentation and also for managing segmentation results.

Segmentation princi- Two basic principles exist for identifying a structure within a volume dataset:
ples
• Threshold-based segmentation
Threshold-based segmentation combines graphical identification of what to seg-
ment and definition of a range of grayscale or HU values.
• Contour-based segmentation
Contour-based segmentation expects you to draw a contour around the struc-
ture that you want to segment in two or more slices. The system then connects
the contours throughout the volume and identifies all voxels that lie within the 3D
contour as belonging to the selection.

Key terms for manag- To be able to manage 3D segmentation results efficiently, you need to be familiar
ing 3D segmentation with the following key terms:
• Selection
When you identify a structure with threshold-based segmentation tools or con-
tour-based segmentation tools, you create a selection. A selection is shown red
until you add it to an object, remove it from an object, or clear the selection.
• Object
An object is a named 3D segmentation result. You can add selections to an
object, remove selections from an object, and show, hide, and fade objects that
you have segmented in your volume.

Tools on the Edit tool Use these tools on the Edit tool card to segment portions of the volume and man-
card age objects.

Connected Voxels in Value Range (3D)

When you select this tool, the system highlights certain structures in the MPR view-
ers. These structures have a grayscale or HU value that lies within the range that is
defined by the Data Range slider on the Edit tool card. In the 3D viewer, only struc-
tures of this data range are visible now.
Now click the structure of interest. This is either a visible structure in the 3D viewer,
or a yellow area in an MPR viewer. The system creates a selection now. The selec-
tion is shown red.

Encircle Voxels in Value Range (3D)

When you select this tool, the system highlights structures of the range defined by
the Data Range slider in the same way as for the tool above.
Now draw a freehand shape around the structure of interest. Circle either a yellow
structure in an MPR viewer or a visible structure in a 3D viewer. The system creates
a selection now. The selection is shown red.

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Encircle Voxels in Value Range (2D)

When you select this tool, the system highlights structures of the range defined by
the Data Range slider, in the same way as for the tools above.
Now draw a freehand shape around a yellow structure of interest in an MPR viewer.
This selects all voxels within the freehand shape that lie within the specified data
range but only in one slice. If you zoom in on the volume in the 3D viewer you see
that only a small ribbon is shown red.

Data Range Use the data range slider or Min. and Max. boxes to define or fine-tune the data
range of the structure that you want to segment.

Define Contour in 3D
This tool starts contour-based segmentation, which is independent of the data
range that is defined by the Data Range slider.
When you select this tool, a new toolbar appears in the lower right corner of the
active viewer.
Select New Elliptical Contour or New Freehand Contour and roughly circle the
area of interest, or select New Balloon Contour, click, and drag out. (See also
Freehand 3D ROI, page 96)
Use the Refine Contour tool to correct and refine contour lines.
Click anywhere in the image and drag the mouse to show a circle with which you
can correct the ROI graphic. The further away from the contour line you click, the
larger the circle will be.
Click inside the ROI graphic to enlarge the ROI graphic by pushing the contour out.
Click outside the ROI graphic to use the circle to push the contour line in.
The precision required in contour definition depends on the clinical task at hand.
Use your clinical judgement to determine the required accuracy for this contour
definition task.
Scroll to the next slice, and repeat contour definition and refining. You do not have
to use the same contour definition tool in all slices. Choose whichever tool is most
appropriate from slice to slice. Moreover, you do not have to define a contour in all
slices. If the contour of the structure does not change significantly for a few slices
you can skip contour definition in these slices.
Proceed in the same way in several slices until you reach the last slice in the image
stack that shows the structure.
Click OK when you have finished drawing and refining the contour in the last slice.
OK ends contour-based segmentation. The system interpolates your contours and
creates a selection, which is shown red.

Use the Grow and Grow 2x buttons to expand the selection by a few pixels.
-Or-
Use the Shrink and Shrink 2x buttons to reduce your selection.

Use Clear to undo a selection that you have not yet assigned to an object, and to
start again from scratch.

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Objects list By default, this list contains the objects Exterior and Cropped.
Consider Cropped a generic container for any portions of the volume that you want
to remove but not name. Exterior is a container for all portions of the volume that
are not assigned to Cropped or any other object.
If you have already performed segmentation with another segmentation tool, such
as the Remove Patient Table tool, these objects are also listed here.
Right-click the list to create a new object or to manage existing objects in the list.

Click the plus button to the right of an object to add a selection to an object.
-Or-
Click the minus button to the left of an object to remove a selection from this object.
Use the lock button to the right to allow modification of an object (green and open
lock) or to protect an object from accidental modification (red and closed lock).

Save Segmentations as Presentation State

tool8presentationstate8savesegmentation
With this tool you can save segmentation results in a DICOM presentation state.
In Study Browser, the presentation state appears as a new series with modality
PR. The next time you load this study, segmentation results from a previous ses-
sion will be available again.

Structures tool card

toolcard8structures
You use the Structures tool card to perform contour-based segmentation of a com-
plex structure, for example, a tumor or an entire organ. You can then evaluate the
structure, calculate its area or volume, and move on to the Statistics tool card.

Contour-based seg- Contour-based 3D segmentation expects you to draw a contour around the struc-
mentation ture that you want to segment in several slices. The system connects the contours
throughout the volume and identifies all voxels that lie within the 3D contour as
belonging to the selection.

2D and 3D structures On the Structures tool card, you can segment both 2D structures and 3D struc-
tures.
2D and 3D structures are the same as freehand 2D or 3D ROIs that you draw with
the corresponding tools from the toolbar. See also Freehand 2D ROI, page 94, and
Freehand 3D ROI, page 96.

Freehand 2D structure Click the New 2D button on the tool card. A new toolbar appears in the lower right
corner of the active viewer.

New Elliptical Contour

Use this button to enclose the area of interest with an ellipse. Click a start point,
and drag the mouse out to draw a circle or ellipse.

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New Freehand Contour

Use this button to draw a freehand shape. Click a start point on the contour. Hold
the mouse button down and draw a contour line.

New Balloon Contour

Use this tool to draw a border around a structure or area of interest of a specific
brightness. Click in the structure and drag out.

Append mode
With any of the contour tools, use the Shift key to start Append mode (the cursor
turns into an arrow with a plus sign).
Draw a contour or select a contour you have drawn earlier.
Press and hold the Shift key down and then draw a second contour.
If the contours overlap, the system merges them into a single ROI. If the contours
do not overlap, the system nevertheless interprets them as parts of a single region
of interest. Add a third contour to this ROI, if necessary.
Release the Shift key to turn Append mode off again.

Refine Contour
Use this tool to correct or refine contour lines.
Click anywhere in the image and drag the mouse to show a circle with which you
can correct the ROI graphic. The further away from the contour line you click, the
larger the circle will be.
Click inside the ROI graphic to enlarge the ROI graphic by pushing the contour out.
Click outside the ROI graphic to use the circle to push the contour line in.

Undo
Use Undo to retrace your steps.

OK
Click OK when you have finished drawing and refining 2D ROIs to close the tool.

Freehand 3D structure Click the New 3D button on the tool card.

A new tool card appears in the lower right corner of the active viewer.

New Elliptical Contour

Use this button to circle the area of interest with an ellipse. Click a start point, and
drag the mouse out to draw a circle or ellipse.

New Freehand Contour

Use this button to draw a freehand shape. Click a start point on the contour. Hold
the mouse button down and draw a contour line.

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New Balloon Contour

Use this tool to draw a border around a structure or area of interest of a specific
brightness. Click in the structure and drag out.

Append mode
With any of the contour tools, use the Shift key to start Append mode (the cursor
turns into an arrow with a plus sign).
Draw a contour or select a contour you have drawn earlier.
Press and hold the Shift key down and then draw a second contour.
If the contours overlap, the system merges them into a single ROI. If the contours
do not overlap, the system nevertheless interprets them as parts of a single region
of interest. Add a third contour to this ROI, if necessary.
Release the Shift key to turn Append mode off again.

Refine Contour
Use this tool to correct or refine contour lines.
Click anywhere in the image and drag the mouse to show a circle with which you
can correct the ROI graphic. The further away from the contour line you click, the
larger the circle will be.
Click inside the ROI graphic to enlarge the ROI graphic by pushing the contour out.
Click outside the ROI graphic to use the circle to push the contour line in.
When you have finished drawing and refining a ROI graphic in one slice, scroll on to
the next slice and also draw a ROI there.

Undo
Use Undo to retrace your steps.

OK
Click OK when you have finished drawing and refining ROI graphics in all slices.
The system calculates ROI statistics and closes the freehand 3D ROI tool.

Editing structures Use the structures list on this tool card to select ROIs or contours for editing.
Click a ROI or a contour to show the slice that contains the ROI graphic.
The freehand ROI toolbar opens in the lower right corner of the viewer. You can
now refine the ROI or add more contours to a 3D structure.
-Or-
Right-click a ROI or a contour to rename it.
-Or-
Use the Delete Structure button or the context menu of the structures list to delete
a ROI.
Use the button to delete an entire ROI.

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Use the context menu if you want to delete only a single contour in a 3D ROI.

Tip

If ROI graphics are in your way in further image evaluation steps, clear the MPR
check box in the structures list. This hides ROI graphics in MPR viewers.
ROIs are usually not shown in the 3D viewer. Select the 3D box for a ROI in the
structures list to ensure that this ROI is visible in the 3D viewer.

Converting a ROI into When you create a 3D structure or freehand 3D ROI, the program assumes that you
an object want to perform statistical evaluation of this volume of interest. The program does
not automatically assume that you want to turn it into an object too.
To turn a 3D structure or freehand 3D ROI into an object, proceed as follows:
1. Select the 3D ROI on the Structures tool card.
2. Right-click and select Create Selection.
3. Go to the Edit tool card.
4. Create a new object and add the selection to the new object.
See also Objects list, page 139.

Statistics tool card

toolcard8statistics
The Statistics tool card performs statistical analysis of all ROIs and structures that
you have defined in your dataset:
• Volumes of interest that you have cropped with the Freehand Crop tools
• The table, if you removed it with the Remove Patient Table tool
• Bones that you have segmented with the Bone tool card
• The chest wall, if you removed it with the Remove Chest Wall tool
• Vessels that you have analyzed with the Vessel tool card
• Structures that you have defined on the Structures tool card
• Objects that you have segmented and named on the Edit tool card
• Lesions that you have segmented with the Segment Lesion tool on the Lesion
toolbar

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Tip

For a better overview, show the Statistics tool card as a floating window.
Double-click the Statistics tab in the tool card section.

Statistics for the report 1. Click Compute to update the results table on the Statistics tool card.

2. Click the Screenshot Statistics button in the upper left corner of the Statistics
tool card.

This button creates a screenshot of the entire results table and sends it to the
Export window. You can drag the screenshot into your report from there.
-Or-
Select one or several rows in the results table and click the Screenshot
Selected Statistics button if only selected measurements are relevant for the
report.

Exporting results If you want to evaluate statistics any further, export the entire results table or only
individual lines as comma-separated lists (*.csv). Comma-separated lists can be
imported in spreadsheet programs, such as Excel.
Click Export CSV.

-Or-
Select one or several rows in the results table and click Export CSV Selected.

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Vessel analysis tools and tool card

toolcard8vessel
Visage 7 provides tools specifically for the segmentation and analysis of vessels in
3D datasets of CT and MR angiography studies.
These tools are available from the Vessel tool card and from toolbar buttons. If you
plan to trace more than one vessel in a dataset, start from the Vessel tool card.

Caution

Vessel tracing supports physicians in finding vessel-like structures in the image

data and in navigating quickly along these structures for efficient review.
However, the software cannot guarantee that the detected and displayed struc-
tures correspond to an actual vessel fragment. It is the responsibility of the user
to check the plausibility and accuracy of the presented data.

1. Select and name the vessel you are about to trace.

-Or-
Right-click the vessels list and insert a new vessel.
2. Define and edit a curve and start vessel tracing.
See Curve definition and vessel tracing.
3. Switch to one of the overview and analysis views for further vessel evaluation.
See Curved View, page 147, or Lumen View and Cross-Section View, page 147.

Curve definition and vessel tracing

tool8vessel8editpoints

You use the Define/Edit Curve tool on the toolbar or on the Vessel tool card to
start curve definition.

Defining a new curve 1. Click Define/Edit Curve to start curve definition mode.
2. Now click control points along the vessel, either in the 3D viewer, or in MPR
viewers, or in a combination of both.
3. End curve definition and have the system trace the vessel.

Semiautomatic versus When you define a curve and trace a vessel be aware that two vessel tracing
manual vessel tracing modes exist, semiautomatic vessel tracing and manual vessel tracing.
• In semiautomatic vessel tracing a user clicks control points and the software
searches for the vessel segments between these points. Semiautomatic vessel
tracing uses a tracing algorithm that uses information such as pixel value thresh-
olds and gradients to identify vessel segments.
Click points between which you want the system to trace the vessel. This creates
green dots in the images.

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• In manual vessel tracing the program assumes that the user-defined control
points lie on the centerline of the vessel. The software then connects these
points by straight lines instead of performing a search.
To define manual control points, press and hold the Shift key while you click.
This creates blue dots in the images.

Tip

You can even combine the two methods to connect critical points where auto-
matic, that is voxel-density-based tracing, would fail.

Image navigation Even while you are defining or editing points, you can return to standard image nav-
during curve definition igation functions by holding the Ctrl (Windows) or Cmd (Mac) key down. For exam-
ple, press and hold the Ctrl or Cmd key and drag in an MPR viewer to scroll
through the stack, or drag in a 3D viewer to rotate the volume.

Switching endpoints When you define a new control point for a vessel, the software automatically con-
nects it to the closest endpoint of the vessel. This point is shown as a pink box.
In very curved vessels, both endpoints might lie close to the new point and the soft-
ware might pick the wrong endpoint. If this happens, switch to the correct endpoint
manually. Press and hold both the Shift and Ctrl (Windows) or Cmd (Mac) keys
when you define a new point.

Editing existing curves If you have already defined a curve or vessel, use the Define/Edit Curve tool to edit
or vessels control points and points inserted by the software.
1. On the Vessel tool card, select the curve or vessel that you want to modify.
2. Click Define/Edit Curve to start curve-editing mode.
Now you can see points along the curve in your MPR and 3D viewers.
3. Click a point to position the MPR crosshair exactly on this point.
-Or-
Click a point and drag the mouse to change its 3D position but without position-
ing the MPR crosshair on this point. After you have moved a point, the software
retraces the segments adjacent to this point and adjusts the curve accordingly.
4. To delete a point, briefly rest the cursor on the point to select it, then press the
Del or Backspace key. Surrounding curve segments are retraced.
-Or-
To define new points, position the mouse away from an existing point and click,
or press and hold the Shift key and click. New points are connected to the clos-
est endpoint of the curve.
-Or-
Position the cursor between two existing points to highlight a curve segment.
Click the segment and drag the mouse to define an additional control point
between two existing points.

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Tools in the curve edit- When you select the Define/Edit Curve tool, a new toolbar appears in the lower
ing toolbar right corner of the active viewer.

Large Vessel Tracing

Click this button when you have finished clicking points along the length of the rele-
vant vessel section and when you are analyzing a large vessel.
-Or-

Small Vessel Tracing

Click this button if you are analyzing a small vessel, and in particular a coronary
vessel.
To start large or small vessel tracing you can use either a tool on the toolbar or a
tool card button. Both the tools and buttons start the same function. Both the large
and small vessel tracing tools also end curve-editing mode.
-Or-

Trace Aorta
Click this button if you are analyzing the aorta.

Show All Vertices

tool8vessel8toggleallvertices
This button is particularly useful if you are using MPR viewers and not the 3D
viewer to define a curve along a vessel.
Show All Vertices projects the curve that you have defined so far onto the cur-
rently shown slice. If you switch Show All Vertices off, only those points that lie in
the currently displayed slice are visible.

Undo
Click this button to undo the last curve editing step.
-Or-

Clear Points
Use the Clear Points button on the Vessel tool card to delete all points and start
curve definition again from scratch.

Accept and Exit

Click Accept and Exit to end curve definition without actually tracing a vessel but
to create a curved view only.

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Curved View
tool8vessel8togglecurvedview

Use this tool to open curved view, which is an additional viewer.

If you have not yet defined a curve, this viewer is empty. After you have defined a
curve this viewer shows a projection image of a curved plane defined by the vertices
of your curve definition.
See also Curve definition and vessel tracing, page 144.

Navigating in curved 1. If you have traced more than one vessel, use the context menu of the CPR
view viewer to select which vessel you want to display.
2. Click Toggle Centerline for better orientation.

See also Toggle Centerline, page 116.

3. Rotate around the centerline in curved view. Rotation is the standard navigation
tool in the CPR viewer.

4. Press and hold the Alt key, and click a point on the vessel in the CPR viewer.
The crosshair moves to exactly this point in all MPR viewers.

Curved view other than You can use curved view not only in the context of vessel analysis but also to ana-
in vessel analysis lyze curved structures.
1. For example, use the Define/Edit Curve tool to define a curve along the spine.
2. End curve definition with OK.
See also Curve definition and vessel tracing, page 144.
3. Open curved view.

Lumen View and Cross-Section View

tool8vessel8togglelumenview tool8vessel8togglecrosssectionview

Lumen view and cross-section view are two views particularly for the analysis of
vessels. Both views are not available in any other context. Both views are available
only if you have defined a curve and then clicked either the Large Vessel Tracing
or the Small Vessel Tracing tool.
See also Curve definition and vessel tracing,page 144.

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Navigating along the 1. If you have traced more than one vessel, use the context menu of the lumen
vessel in lumen view viewer to select which vessel you want to display.
2. Rotate around the vessel.
The rotation tool is selected automatically in this viewer. Therefore, you can
rotate by dragging the left mouse button.

3. Drag one of the vessel sliders to a point of interest.

The active vessel slider is highlighted with an orange triangle at its bottom.
4. Click Switch Active Vessel Slider to switch between vessel sliders.

Alternatively, use the keyboard shortcut E to switch vessel sliders.

Navigation in cross- Clicking and dragging a vessel slider in lumen view turns cross-section view on in
section view the upper left viewer.

Scrolling in cross-section view means navigating along the vessel slice by slice.
While you scroll, the slice orientation changes so that you always see an exact
cross-section of the vessel.

Measuring stenoses Stenosis calculation can either use line measurements or area measurements.
1. Use lumen view, or cross-section view, or a combination of both views to move
to points of interest along the vessel.
2. In cross-section view, use the Distance tool to measure vessel cross-sections.

-Or-
Use one of these area measurement tools.

In lumen view, measurement results are shown next to the vessel sliders.
3. Right-click a measurement text and classify the measurement. For example,
select Stenosis n%.

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If Stenosis n% is not available, you might have right-clicked the vessel slider
and not the text. Or you have clicked the text of the reference point, which is the
higher value.

Measuring vessel seg- In lumen view, use the Distance tool to measure the length of a vessel segment.
ment length

The segment length is shown in millimeters in lumen view and the endpoints of the
measurements are indicated in curved view. Measurements are color-coded in both
views.

Cardiac analysis for CT studies

Cardiac analysis options require that the cardiology option is installed and that your
user account has been granted the right to work with this option.

LV Analysis tool card

toolcard8leftventricleanalysis
The LV Analysis tool card provides tools for LV segmentation and LV analysis. The
tool card also guides you through LV analysis step by step.

Caution

The LV tools support the physician in finding the left ventricle in the image data.
However, the software cannot guarantee that the detected and displayed struc-
tures correspond to the left ventricle. It is the responsibility of the user to check
the plausibility and accuracy of the presented data.

Step 1: finding and cor- 1. Move the scoutline crosshair to the left ventricle in one MPR viewer.
recting axes
2. Click Find Axes on the LV Analysis tool card.

The system identifies the long and short axes of the left ventricle and selects
Edit Axes mode. The short and long axes are now shown as orange lines in the
MPR viewers.

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3. Correct axes by moving or rotating the orange lines in the MPR viewers, if nec-
essary.
4. Next, correct the valve level in one of the long-axis views (pink line).
The endpoints of the valve line serve as rotation handles.
5. When you have positioned axes correctly, click Apply.

Step 2: segmenting the 1. Click Find LV (All Phases).

left ventricle

When segmentation is complete, the left ventricle is shown as a yellow shaded

area in the MPR viewers.
2. Browse phase images, and check segmentation results in all phases.

If you do not agree with segmentation results in one or several images, click
Clear LV. Adjust the valve level and the axes as described above.
Click the Find LV button again when you have finished your adjustments.
-Or-
Proceed slice by slice and use the Clear LV (Current Slice) and Find LV (Cur-
rent Slice) buttons.
When segmentation has been performed correctly, proceed with LV analysis
step 3.

Step 3: time-volume Click Results to start time-volume analysis of the left ventricle.
analysis

LV Results tool card

toolcard8leftventricleresults
The LV Results tool card or floating window appears after you have clicked Results
on the LV Analysis tool card.

LV analysis results When the LV Results is a floating window, it consists of three segments:
• Summary section
• Curve display section
• AHA (American Heart Association) bull’s-eye view

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When you display the LV Results card in one of the tool card stacks, only one of
these segments can be shown at a time.

Use the drop-down selection box in the lower left corner of the tool card to select a
different view of your LV analysis results.

Summary Enter the heart rate of your patient here. The cardiac output value is updated auto-
matically.
Also adjust the system’s selection of the end-diastolic (ED) and end-systolic (ES)
phases with the sliders, if necessary.

Global volume Here you find a graph of the total LV volume over one heart cycle.

Bull’s-eye view View the results of the calculation of regional ejection fractions (%) in a bull’s-eye
view. The segments in this bull’s-eye display correspond to the AHA classification.
Move the cursor over a segment to show the segment designation as a tooltip. Or
right-click anywhere in the bull’s-eye view for a context menu with commands for
switching between results view and segment ID view.

Regional volume, endo- In this segment you find the stroke volume curves of the LV regions.
cardial distance
Initially the curves of all regions are shown. If you find this view hard to read, right-
click anywhere in this section. Select individual region curves.
When you create a report, only those curves that are currently shown will be
included.

Wall motion, bull’s-eye This segment shows the accumulated wall motion in a bull’s eye view.
motion

Click Report in the lower right corner of the LV Results window to send screen-
shots of all graphs and analysis results to the Export window.

Calcium tool card

toolcard8calciumscoring
Visage 7 provides a tool card for identifying the extent of calcified plaque in coro-
nary arteries. The Calcium tool card is shown when you load a suitable CT study.

Tools for identifying Use the following tools on the Calcium tool card to identify plaque in your images.
plaque
Click the Calcium Scoring button.
All areas with an intensity of more than 130 HU are highlighted (yellow).
Now start scrolling through the image stack slowly.

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When you observe plaque in an image, first select the vessel in which the plaque is
observed. Next, either click into the plaque or click and drag the mouse to draw a
line around the plaque. This assigns the plaque to the selected vessel.
To select a vessel, click one of the following buttons on the tool card: LM (left main
artery), LAD (left anterior descending artery), CX (left circumflex artery), RCA (right
coronary artery), PDA (posterior descending artery), A1, A2, A3 (placeholders for
any other arteries).
Right-click one of the A1 to A3 artery buttons and select Properties. Enter a label
and select a color for this artery.

In multislice mode, both voxels in the slice in which you click and adjacent voxels of
the same density in adjacent slices are assigned to plaque.
With multislice mode turned off, only voxels of the currently displayed slice are
assigned to plaque.

Reporting tools At the bottom of the Calcium tool card, you find tools and input boxes that help you
to prepare your report.

Coronary Artery Age The system calculates this information based on the amount of plaque that you
have identified in the images. You cannot overwrite this information.

Sex, Patient Age Correct this information, if necessary.

Ethnicity The information that you select here refers to the study that you want to refer to in
your report:
Select Undefined, if you want to refer to Hoff, 2001.
(Hoff, Julie Anne et al. Age and Gender Distributions of Coronary Artery Calcium
Detected by Electron Beam Tomography in 35,246 Adults. J. Am. Coll. Cardiology
2001, Vol. 87:1335-1339)
Select White, Black, Chinese, Hispanic, if you want to refer to MESA, 2006.
(McClelland, Robyn L. et al. Distribution of Coronary Artery Calcium by Race, Gen-
der, and Age: Results from the Multi-Ethnic Study of Atherosclerosis (MESA). Cir-
culation 2006, 113:30-37).

Click Report to send your findings to the Export window.

-Or-

Click Export CVS, to save your results as a comma-separated list on your com-
puter. *.cvs files can be read by spreadsheet programs, such as Excel.

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Brain perfusion analysis tools and tool card

Brain perfusion analysis requires that the neurology option is installed and that your
user account has been granted the right to work with this option.

Perfusion toolbar
toolbar8brainperfusion
This toolbar comprises all the tools that you need to perform brain perfusion analy-
sis.

Caution

The brain perfusion tool provides calculated results for neurologic diagnosis and
supports the physician in correcting patient movement in images.
However, the software cannot guarantee that the identified arterial and venous
points are correct and that the data set is suitable for the calculations. It is the
responsibility of the user to check the plausibility and accuracy of the result.

The tools are arranged left to right in the order in which you will need them.

Exclude current Phase from Perfusion Calculation

Browse the time series and decide whether all images can be included in the analy-
sis. If individual images show motion artifacts, for example, you can exclude them
from the analysis with this tool.

Display tMIP
Click this tool to calculate a tMIP image.
In a temporal MIP of a CT dataset, the brightness of each pixel indicates the maxi-
mum pixel value in any of the time steps. In MR datasets, tMIP shows the minimum
pixel value. tMIP helps to show contrast-filled vessels particularly clearly.

Define Artery
Next, click this button and then the main artery of the brain in the tMIP image.
The point where you clicked is marked as a ROI and an uptake curve for this ROI
appears in the viewer. The update curve for the artery is displayed red.

Define Vein
Next, click this button and then the main vein of the brain in the tMIP image.
The uptake curve of the vein is added to the graph. The uptake curve for the vein is
displayed blue.
Identification of the vein is necessary in CT datasets, but usually not in MR data-
sets.

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Calculate Perfusion
Next, click Calculate Perfusion.
This calculates the following functional maps: mean transit time (MTT), time to peak
(TTP), cerebral blood flow (CBF), cerebral blood volume (CBV).

Mirror Mode
Select the tMIP image (large viewer) and click Mirror Mode.
Drag the orange line so that it separates the left and right half of the brain. By click-
ing and dragging the endpoints you can rotate the line. You might have to move the
plot if it is in your way.

Define ROI
Select one of the functional maps, and click Define ROI.
A new toolbar appears in the lower right corner of the active viewer. The tools on
this toolbar are the same as when you evaluate freehand 2D ROIs in any other type
of image. Therefore, refer to this section for details on how to work with these tools:
Freehand 2D ROI, page 94.
Use this toolbar to draw an elliptical ROI or a freehand ROI around an area of inter-
est and to refine the contour.

Toggle Mirror Line

If the mirror line is in your way while you are analyzing functional images, use this
tool to hide and later redisplay it. Hiding the mirror line does not turn mirror mode
off, however.

Save/Send Perfusion Result

With this button, you save the new series on the server or on a DICOM node. Click-
ing the button opens the Send perfusion results dialog box. Here you select send
options:
Destination - select one or several servers where you want to save the new series.
Save Options - select how you want to save the maps that were calculated during
perfusion analysis and which maps you want to save. Each map will be saved as a
separate series. The images will have the same slice thickness as shown on
screen.
Original Maps - select this option if you want to save perfusion maps as grayscale
images. This creates new series of medical images. These images can be win-
dowed, resized, or evaluated in future postprocessing sessions, just like any other
DICOM series.
Colorized Maps - select this option if you want to save perfusion maps as color
images (RGB). RGB images are screenshots and any information that they contain
is frozen into the images. This means that you cannot change any of their display
parameters or perform measurements in these images in future postprocessing
sessions.
Mosaic - select this option if you want to create and send an overview image show-
ing the tMIP image plus the calculated maps side by side.

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Artery and Vein Positions - select this option if you want to save the coordinates
of the artery and vein position that you identified before you had the system calcu-
late perfusion in a DICOM presentation state. In Study Browser, the presentation
state appears as a new series with modality PR. The next time you load this study,
you can resume perfusion calculation or recalculate.
Screenshots - select this option to save or send all screenshots that were created
during perfusion analysis. If you want to save or send only selected screenshots,
use the Export window to do so.
Perfusion results - specify a series number and series description. The various
perfusion result series that will be created when you click Send will count up from
the series number you specify here. The series description text you enter here will
be used as a prefix for the perfusion result series.
Make Default - this button saves your settings as program suggestions for subse-
quent send jobs.

Brain Perfusion tool card

toolcard8brainperfusion
In standard brain perfusion analysis, you might not need to adjust parameter set-
tings on the Brain Perfusion tool card.
Adjust these settings only if default settings do not yield good results.

Presets Brain perfusion presets are parameter sets optimized for specific data acquisition
protocols.
If no presets have been configured for your system, a default parameter set is auto-
matically selected for CT or MR images respectively.

Brain Tissue To speed up calculation and to make interpretation of computed maps easier, only
brain tissue voxels are processed in brain perfusion analysis. Therefore, a mask is
computed from the first phase of the perfusion image series. The mask includes
only voxels with values between the Min and Max values that are defined here. All
other voxels are not analyzed during computation.
Default values 0 (Min) and 120 HU (Max) for CT images and 20% and 100% of the
grayscale value range in an MR dataset (indicated as US for “unspecified”).

Remove CSF To speed up the calculation and for ease of interpretation of the computed maps,
voxels that contain cerebro-spinal fluid (CSF) will not be processed.

Remove Vessels For ease of interpretation of the computed maps, voxels that contain larger vessels
will not be processed.

Smoothing To improve the signal-to-noise ratio (SNR), a Gaussian image filter can be applied
to all images before the computation. This parameter turns the smoothing filter on
or off and also allows the adjustment of the kernel width of the filter. Larger values
improve the SNR at the expense of a diminished spatial resolution.

Pre-contrast Images This parameter indicates the number of phases acquired before the contrast
medium reaches the brain. The baseline signal is computed by averaging these
images. After definition of the artery, the number of baseline images is determined
automatically.

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Last image Defines the last phase of the perfusion images series that is considered in the per-
fusion calculation.

Regularization Param. This parameter is used to suppress noise in the source data. Lower values provide
more accurate computation results but are more sensitive to noise.

Auto-Registration If this option is selected, an automatic motion registration is performed on the perfu-
sion time series when the user clicks one of the buttons Display tMIP, Define
Artery or Define Vein for the first time and no registration has been performed yet.
If the number of slices in the 3D volume is greater or equal to the number of slices
configured in the user interface, a 3D rigid body motion registration is performed,
otherwise only in-plane shifts and rotations are registered.

If you observe motion artifacts in the tMIP image, register your data before you con-
tinue.
Use the 2D Registration and 3D Registration buttons on the tool card to align
images and to recalculate the tMIP image.

Use the Default (adult) and Default (small children) buttons to switch hematocrit
values between program suggestions for adults and small children. You can fine-
tune these values with the slider further up on this tool card.

Use the Calculate Perfusion button at the bottom of the tool card or toolbar button
if you want to recalculate functional maps after parameter adjustments.

Lesion tracking tools and SUV tool card

Lesion tracking requires that the oncology option is installed and that your user
account has been granted the right to work with the oncology option.

SUV tool card

toolcard8standarduptakevalues
Use the SUV tool card to check patient data and SUV settings.

Settings on the SUV Check these settings after you have loaded a CT+PET study and before you start
tool card lesion tracking.

Patient’s weight, height, Check this information and add missing information. This information is relevant for
and sex the calculation of SUV for lean body mass and SUV for body surface area.

Radionuclide half-life, Check this information and add missing information, if necessary.
total dose, tracer injec-
tion, scan time

If you have changed patient or radionuclide information, you can use this button to
redisplay the data stored in the DICOM header of the dataset.

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View windows Complex tools and applications

Measured Activity, SUV, With these buttons you can select the units for radionuclide activity in the patient’s
Counts body. Choose between becquerel or standardized uptake values (SUV), or select
Counts for data acquired with Philips scanners.

This button stores the values for the initial data windows and for the preferred SUV
type in the global settings for your user account.

Lesion tool and Lesions tool card

tool8lesion toolcard8lesions
Use the Lesion tool and toolbar to mark and measure lesions.

Use the Lesions tool card for an overview of all the lesions that you have identified
in the loaded datasets.

Lesion tool Click the Lesion Tool button to show a new toolbar in the lower right corner of the
active viewer.

This toolbar comprises all the tools that you need for lesion tracking.

Segment Lesion
Click the lesion in the current study and also in the prior study, if the lesion is visible
in both studies.
If you have identified the lesion in both studies, the system creates a lesion pair,
labels it, and calculates activity.

Measure Lesion, Measure Lesion (2 Diameters)

If automatic lesion segmentation is not possible because of poor image quality or
because of artefacts in the images, resort to manual evaluation tools.
Select either the Measure Lesion or Measure Lesion (2 Diameters) tool, depend-
ing on which standard you follow. Drag the mouse across the lesion to measure its
diameter. Also measure the second diameter, if you work with the Measure Lesion
(2 Diameters) tool. Measure lesion dimensions in the prior study as well.

Visage 7 157
Complex tools and applications View windows

Caution

The accuracy of distance measurements is ± 2 pixels. Larger errors can occur if

the image is displayed with reduced matrix size, that is, if not every original pixel
is shown on the screen due to zoom-out. For optimum accuracy, we recommend
zooming into the structure of interest as much as possible. The accuracy is fur-
ther limited by the physical resolution of the acquisition itself. If the monitor used
for display does not permit exact pixel selection, the inaccuracy can be still
greater.

Mark Lesion
If a lesion does not exist in both datasets, use this tool to mark the spot where a
lesion exists in the other dataset.

Delete Lesion
Select a lesion by clicking on the lesion text and then use this tool to remove the
marker from the dataset.

Classify Lesion
Use this tool or the keyboard shortcuts to classify a lesion or lesion pair.
A Target Lesion (TL, F1) or a Target Lymph Node (LN-TL, F4) exists in both the
current and prior study and is relevant in both studies.
A Non-Target Lesion (NTL, F2) or a Non-Target Lymph Node (LN-NTL, F5)
exists in both studies but is of no relevance in the prior study.
A New Lesion (NL, F3) or a New Lymph Node (LN-NL, F6) exists in the current
study only.
An Unspecified Lesion (F10) is not considered in the report. Therefore, do not
leave lesions unspecified, unless you explicitly want to exclude them from the
report.

Previous Lesion, Next Lesion

Use these tools to browse through your lesion segmentations and to review your
findings.

Accept and Exit

Click this tool when you have identified and classified all lesions in your current and
prior study. This tool closes the lesion tool and creates a report in the Export win-
dow.

158 Visage 7
View windows Complex tools and applications

Lesions tool card Click the Open Lesion Toolcard button to show this tool card.

The Lesions tool card displays an overview of the lesions that you identified in the
loaded studies.

Tip

If lesions were identified during an earlier session, the system checks whether all
the relevant prior studies have been loaded before moving on to the Lesions tool
card.

Name The Name column lists all lesions and a summary of lesion diameters in target
lesions.
Click Add Lesion and measure a lesion in an image to identify a new lesion.
Double-click a lesion name in this column to edit the lesion name.
Right-click a lesion in this column or any of the other columns and select Delete to
remove a lesion from the list.
Click a lesion row, hold the mouse button down, and drag this line up or down to
change the order in which lesions are presented in the table.

Type Double-click the Type column of a lesion and select a different lesion type from the
list. See also Classify Lesion, page 158.
Double-click the Type column of a lesion type summary and select your mode of
working. The DICOM structured report will consider the selected mode.
In the Non-Target Lesions summary row, double-click the cell of the current study
and assess the overall response of non-target lesions: CR (complete response),
PD (progressive disease), Non-CR/Non-PD (neither of the above). Repeat this
step for prior studies if appropriate.

Current and prior stud- The columns of the current and prior studies show the diameters of the lesions that
ies you identified in the images.
Click the column header of the current study or a prior study and drag it into a
viewer to show this study in this viewer.
Use the context menu in these columns to split or merge lesions.
Splitting lesions: You have identified areas of activity in corresponding images of
the current and prior study and the system has assigned them to one lesion. In ret-
rospect, you realize that both areas of activity belong to different tumors.
Right-click the current or prior study column of this lesion and select Split into New
Lesion.
Merging lesions: You have identified two areas of activity in the current and prior
study and marked them as two separate lesions. In retrospect, you realize that both
areas of activity belong to the same tumor.

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Complex tools and applications View windows

Select (left-click) the table row of one lesion, and then right-click the table row of the
second lesion. Select Merge With Selected Lesion from the context menu.

Last edited This table row shows the name of the last user who edited lesions in a study.
Point to the table cell of each study to show the complete editing history in a tooltip.

Previous Lesion, Next Lesion

Use these tools to browse through your lesion segmentations and to review your
findings.

Select the Follow button to browse lesions in the current and prior studies simulta-
neously, even if viewers are not linked.
Clear the selection of the Follow button to browse lesions in one study only.
Selecting or clearing Follow makes sense only if viewers are not linked. If corre-
sponding viewers are linked in the current and prior studies, selecting or clearing
Follow has no effect on browsing.

If the system detects inconsistencies in the segmentation and identification of

lesions, a warning symbol appears on the Lesions tool card.
Point to this symbol to show a tooltip that explains the problem or inconsistency.

Click Report to send lesion statistics to the Export window as screenshots.

-Or-
Click Save to create a DICOM structured report of your findings and append it to
the current study as a new series (modality SR).

160 Visage 7
Export window

screen8export
You use the Export window to create reports or to save, send, or print screenshots.
The Export window is subdivided into two sections:
• Screenshots
In this section you find screenshots from the session in the active View window.
This is the tab card that is highlighted with a bullet.

• Reports
This section presents you with a template for quick and easy report creation.
Relevant patient and study information from the case in the active View window
has already been entered.

Screenshots
Screenshots are bitmap images that you have created or that were created auto-
matically to document observations or evaluation results. Because screenshots are
bitmaps, you cannot edit them, even if you send them as a DICOM series, or save
them in DICOM format.

Screenshot list In this list, you find the following types of screenshots:
• Screenshots that were created by the software when you stored a key view.
These screenshots are labeled Auto in the lower right corner. See Annotation
and measurement tools, page 82, and Key views tools, page 99.
• Screenshots that you have created with one of the screenshot tools.
Screenshots are numbered. All screenshots that you have created with Screen-
shot All have the same number. See Screenshot tools, page 98.
• Line profiles, which you have sent to the Export window with the screenshot tool
of the Line Profile tool card. See Line Profile, page 128.
• ROI statistics, which you have sent to the Export window with the screenshot
tool of the Statistics tool card. See Statistics tool card, page 142.
• Tables and graphs that result from an LV analysis or a calcium scoring analysis.
You have sent these analysis results to the Export window with the Report but-
ton on the corresponding tool card. See LV Results tool card, page 150, and Cal-
cium tool card, page 151.

Visage 7 161
Screenshots Export window

Displaying screenshots Double-click a screenshot to show it in a floating window.

If the screenshot list contains more than one screenshot, use the Previous Screen-
shot/Next Screenshot buttons in this floating window to browse screenshots.

Deleting screenshots Click a screenshot to select it and click Delete to remove screenshots that you do
not want to save.

Saving screenshots Saving or sending screenshots means saving them on the Visage 7 server, on a
partner system, or on a connected DICOM node.
1. Select the screenshots that you want to save.
-Or-
Press Ctrl + A (Windows) or Cmd + A (Mac) to select all screenshots in the
Export window.
2. Click Save/Send.

3. In the DICOM Send dialog box, select one or several DICOM servers.
If the list of servers is very long, type the name or part of the name of the server
in the Filter box above the list of destinations.
4. Enter a Series Number and Series Description.
The program suggests 1000 as a series number. This adds the screenshot
series to the end of the study.
5. Click Send.
-Or-
To have the system save your screenshots automatically next time, select Save
Automatically and Make Default before you click Send.
The next time you close a study for which screenshots exist, Visage 7 creates a
screenshot series and sends it to the server. If you have selected automatic data
transfer with confirmation, a message appears when you exit the program or try to
load a new study.

Exporting screenshots Exporting screenshots means storing them on your local computer or in your net-
work.
1. Select the screenshots that you want to export.
-Or-
Press Ctrl + A (Windows) or Cmd + A (Mac) to select all screenshots in the
Export window.
2. Click Export.

162 Visage 7
Export window Screenshots

3. Select the drive and folder where you want to save the images.
4. Enter a file name and select a file format.
Remember that if you select *.dcm the images are saved in DICOM format. You
need a DICOM viewer or a graphics program that can read DICOM data to be
able to view these images.
5. Click Save.

Printing screenshots If a DICOM printer is connected to your Visage 7 server, use Print below the
screenshots list to print images on paper or on film.
1. Select the screenshots that you want to print.
-Or-
Press Ctrl + A (Windows) or Cmd + A (Mac) to select all screenshots in the
Export window.
2. Click Print.

3. In the Print dialog box, select the printer and change printer settings, if neces-
sary.
See Printer settings, page 113.

Copying screenshots to If you want to show a screenshot in a presentation or in a text file, the easiest way is
the clipboard to copy it to the clipboard and paste it into your document from there.
1. Select the screenshot that you want to copy.
2. Right-click and select Copy, or use the keyboard shortcut Ctrl + C (Windows) or
Cmd + C (Mac).

Tip

You can only copy one screenshot at a time.

Visage 7 163
Reports Export window

Reports
Depending on the overall organization of reporting in your hospital you will proceed
in a different manner.

Basic reporting
In this mode of working, you use the Visage 7 Client Export window to summarize
your findings on a study and save it on your computer or in your network. However,
the final report on the case will be created in a different system, for example, the
reporting platform of the RIS (radiology information system).
To create a summary of findings in the Visage 7 Client Export window, you fill out a
report template and then save your report.

Filling out a report tem- A standard report template is already selected in the Export window and basic
plate patient data and study information has been entered in the report header.
1. If necessary, select a different report template.

2. Use the Insert Placeholders command on the Edit menu to add more study
data to the header or to the report text.
3. Add findings or comments by typing them into the report.
4. Use the buttons on the Text Formatting and Paragraph Formatting toolbars to
highlight or align your findings or comments text.
5. Drag screenshots into the report where you want to show them.

Saving a report Visage 7 offers various alternatives for saving reports, either in your network, on a
connected DICOM network node, or in the RIS (radiology information system).
Click Export Word or Export PDF to save your report as a Word file or pdf file on
your local computer or in the network.

Note

Export Word is available only on Windows PCs and only if Word for Windows is
installed on your client PC.

-Or-
1. Create a screenshot of your report pages.

164 Visage 7
Export window Reports

Creation of a screenshot of your report requires that a printer is installed at your

client PC.
2. Select all report pages in the Screenshots section.
3. Send these report pages as a screenshot series to the Visage 7 database or to a
connected DICOM network node.

-Or-
Use the Send to RIS button if your Visage 7 is connected to a radiology information
system, such as a ProMedicus RIS.

Diagnostic reporting workflow

In this mode of working your Visage 7 has been configured for creation and storage
of reports. Visage 7 records a history of changes by creating a new version of the
report every time a user edits and saves it again. Draft and preliminary reports are
expected to be signed off. Final reports can no longer be edited. Reports are stored
on the Visage 7 server and are eventually archived together with the image data of
a study.
In a diagnostic reporting workflow users are assigned specific rights regarding cre-
ation and review of draft, preliminary and final reports. This means, that your user
account might not be permitted to perform all the steps described below. For exam-
ple, you might have the right to create preliminary reports but not to sign off reports.

Tip

If you have any questions about your role in the diagnostic reporting workflow,
talk to your system administrator.

Creating a report A standard report template is already selected in the Export window and basic
patient data and study information has been entered in the report header.
1. If necessary, select a different report template.

2. Click Start Reporting above the report template.

3. Fill out the report template.

Use the Insert Placeholders command on the Edit menu to add more study
data to the header or to the report text.

Visage 7 165
Reports Export window

Add findings or comments by typing them into the report.

Use the buttons on the Text Formatting and Paragraph Formatting toolbars to
highlight or align your findings or comments.
Drag screenshots into the report where you want to show them.
4. Save the report.

Editing a report You can edit a draft or preliminary report either you or a colleague created for a
study. However, only one user can edit or create reports for a study at any one time.
When you load a study from Study Browser and move on to the Export window,
the most recent version of the study report is shown here.
1. Click Start Reporting.
If you try to edit or create a report another user has worked on since you have
loaded the study, a message will ask you to update the report first.
Click Options > Refresh near the right edge of the Export window.

Click Start Reporting again.

2. Add or correct findings and comments.
3. Save the report again.

Viewing previous report Every time you or another user edits a report and saves it again, a new report ver-
versions sion is created.
Click Options > Previous Versions and an earlier version of this report.

Visage 7 Client opens this earlier version of the report in a separate tab card. You
can read but not edit or sign off this report version.

Signing off a report With appropriate user rights you can sign off a report. Signing off means saving the
most recent report version as the final report.
Click Save as Final.

166 Visage 7
Export window Reports

A report with report status final can no longer be edited.

Resetting the report If your user account has the right to sign off reports, you can also reset the report
status status of final reports. Resetting the status of a final report to preliminary becomes
necessary when you need to add findings to an already signed off report.
Click Options > Reset Status.
The report status is reset to preliminary. You can now open it (Start Reporting) and
add any new findings, comments, or images and save it again.

Creating report templates

Templates contain patient and study data as placeholders and standard text. The
software comes with a few sample templates, which help you to understand the
basic concept and to create templates of your own. You can base a new template
either on a system template or on a typical report that you have just created.
1. Select Edit > Edit Template.
2. Add all the required placeholders and standard texts.
3. Format placeholders and standard texts.
4. Click Save next to the template selection list.

5. In the Save dialog box, enter a template name.

6. Also decide whether you want to make this template available for all users or
only for your own user account.

Visage 7 167
Reports Export window

168 Visage 7
Quality Assurance

screen8qualityassurance
Visage 7 provides a platform for performing quality assurance. Quality assurance
here means checking the assignment of studies to orders from the RIS (radiology
information system) and correcting patient, study, and series information.
The quality assurance workflow may differ from organization to organization. For
example, in many cases Patient Edits (name change) may be performed in the RIS
or the HIS (hospital information system), and the respective functions may even be
disabled in Visage 7. Please check with your PACS Administrator for site-specific
details.
Refer to Tools for performing quality assurance on images, page 117, for quality
assurance regarding image content.

Find out more about the Quality Assurance window and how to perform quality
assurance in the following sections.
• Query section
• Performed procedures and scheduled procedures lists
• Quality assurance tasks

Note

Only users with appropriate user rights are permitted to perform quality assur-
ance. For users without these user rights, the Quality Assurance window is not
available in their Visage 7 Client installation.
The right to perform quality assurance is independent of any other user rights.
This means that a user whose task it is to perform quality assurance might not
have access to any other program windows. Talk to your system administrator to
find out how these tasks are assigned in your institution.

Visage 7 169
Query section Quality Assurance

Query section
The query section of the Quality Assurance window comprises two tab cards.
• Study tab card
Data that you find as a result of a search on the Study tab card is listed in the
Performed Procedures list.
• Order tab card
Data that you find as a result of a search on the Order tab card is listed in the
Scheduled Procedures list.

Tip

If you do not know a complete name or number, you can use wildcards in your
search. For example, type Mil in the patient name box to find Miller, Milford, Milt-
ner, or *mil to find all the above and also Hamilton, or AB??34 in the patient ID
box to find AB1234, AB0034, and AB11345678.
However, even if you use wildcards, always specify your search criteria as pre-
cisely as possible. Rather general queries might yield a very long hit list, which
requires extensive scrolling.

Filter and search criteria

Use the filter and search criteria in this list to search for studies or orders.

Patient Enter the name, date of birth, or ID of the patient that you are looking for. If you do
not remember the exact name, date, or number, use wildcards.
For names that occur frequently, you might want to include the first name or other
components of the patient’s name in your search. To define such a search, you
need to know how patient names are stored in the database.
FamilyName GivenName MiddleName Prefix Suffix
The following example shows a search string for first name, last name, and title.
Doe John*Dr.
If you want to search for more than one patient, separate patient names with a
semicolon (;) or the pipe character (|). For example, Anderson|Alexander or
Miller;Milford.

170 Visage 7
Quality Assurance Query section

Date Select the Date box. Select if you want to search by Study Date or Insertion Date
(Study tab card), or by Modification Date (Order tab card).
The Insertion Date is the date when a study was transferred to the server from a
modality or an archive. The Modification Date is the date when an order was cre-
ated or modified on the RIS (radiology information system).
From ... To specifies a search period. Type dates in the format YYYY-MMM-DD, or
click the button to the right of a date entry box and select a date in the calendar.
Use the buttons Today, Yesterday, 1 Week, 2 Weeks as a quick way to specify
frequently searched periods in the correct format.
You can configure these four search-period buttons. Right-click one of the four but-
tons and select Hours > 1 Hour, for example, if you are frequently looking for stud-
ies that were performed within the last 60 minutes.

Modality Select the check boxes of all modalities whose studies you want to search:
CT (computed tomography), MR (magnetic resonance tomography), PT (positron
emission tomography, PET), US (ultrasound), CR (computed radiography), DX
(digital radiography), MG (Mammography), XA (X-ray angiography).
-Or-
Enter a modality abbreviation in the Others box. Separate multiple modalities by a
space, for example, CT PT MR.

Fields (Study tab card) Here you can specify additional search criteria.
Open the lists of available criteria with the double-arrow buttons and select a crite-
rion.

Specify your search string in the input box below the selected criterion. Remember
that you can use wildcards in your search.
If you want to search for more than one accession number, for example, separate
numbers with a semicolon (;) or the pipe character (|). For example, 12345|67890
or 09876;54321.
If the search strings themselves contain semicolons, pipe characters, or back-
slashes, as in Ward 4; Rm.6 or Ward 1\Rm.2, use the following notation:
Ward 4\; Rm.6;Ward 1\\Rm.2 or Ward 4\; Rm.6|Ward 1\\Rm.2
-Or-
Click the list button next to an input field.

Select an item.

Visage 7 171
Query section Quality Assurance

Study States (Study tab Click the Study States button and select study states in the Select State dialog
card) box.
If you want to search by QA status, ask your system administrator how these sta-
tus flags are assigned on your server.
Searching by study state Interpretation Status makes sense only if the modalities
that send data to the Visage 7 server set this flag. In Visage 7 you cannot set or edit
the interpretation status of a study.
If study states are included in your search, the Study States button label appears
italic and the Reset button next to it is available. Click this Reset button next to the
Study States button if you want to reset only study states but none of the other
search criteria.

Fields (Order tab card) Here you can specify two additional criteria when searching for scheduled proce-
dures. Open the lists of available criteria with the double-arrow buttons and select a
criterion. Then specify your search string in the input box below the selected crite-
rion. Remember that you can use wildcards in your search.

Status (Order tab card) Here you can filter the schedules procedures list. Choose whether to display either
only those scheduled procedures that are assigned to performed procedures or
only those that cannot be assigned.

Starting and resetting a search

Use these buttons to start a database search or to reset search criteria.
Click Query on the Study tab card to update the Performed Procedures list.

Click Query on the Order tab card to update the Scheduled Procedures list.

Click Reset to return to the default query preset (see Defining a preset, page 173).
If no default query preset has been defined, Reset removes all search criteria.

172 Visage 7
Quality Assurance Query section

Query presets
If you frequently use the same combinations of search criteria, you can save them in
a preset. Your presets are listed directly above the query section. Any presets that
you define are available for your own user account only. You cannot make presets
public.

Tip

A preset stores filter and search criteria on both tab cards (Study and Order tab
cards). It also stores the size and arrangement of the Performed Procedures
and Scheduled Procedures lists.

Quick search with a 1. Click a preset button to retrieve its search criteria.
preset

2. Depending on how you defined the preset, you might have to click Query to start
the search.

Defining a preset 1. On the Study and Order tab cards, select and type search criteria.
2. Click New Preset.

3. In the Preset dialog box, enter a name for your new preset.
4. Select Default if you want to make this preset the default query preset.
See also Starting and resetting a search, page 172.
5. Select Auto Query if you want the system to reenter your search criteria and
then run the search immediately. You do not have to click Query again.
-Or-
Select Default plus Auto Query to have the system run this search every time
you call up Visage 7 and Quality Assurance.
6. Save the preset.
A new preset button appears above the query section.

Tip

Right-click presets that you defined earlier. A context menu appears, which helps
you to manage presets. For example, you can remove preset buttons that you no
longer need.

Visage 7 173
Performed procedures and scheduled procedures lists Quality Assurance

Performed procedures and scheduled procedures lists

The Performed Procedures and Scheduled Procedures lists display the results
of the last query that you performed on the Study and Order tab card.

Information in the performed procedures list

Performed Procedures lists all studies that are currently stored on the Visage 7
server.

Patient Name Name of the patient.

Click the pin symbol in front of a patient name to retain this patient in the performed
procedures list before you start a new database query.
This way, you can combine the results of subsequently performed procedures que-
ries (that is queries on the Study tab card).

Issuer The institution that issued the patient ID.

Patient ID The patient’s identification number.

Date of Birth The patient’s birth date.

Sex The patient’s sex: M (male), F (female), O (other or unknown).

QA Status This provides meaningful information only if your Visage 7 is connected to a RIS
(radiology information system). In this case, the QA Status of a study indicates
whether the study (performed procedure) can be matched to a RIS order (sched-
uled procedure).
COMPLETED: This QA status indicates that this study has been matched with a
RIS order either automatically or manually.
SCHEDULED: This QA status indicates that the study cannot be matched with a
RIS order automatically. You either need to assign this study to an order manually
or wait until a new order message arrives from the RIS.
DISCONTINUED: This QA status indicates that quality assurance for this study was
terminated.
NOT SCHEDULED (column remains empty): This QA status indicates that no
matching of performed procedure to scheduled procedure was planned for this
study.
Use the Study States button on the Study tab card to search for studies of a spe-
cific QA status.

Date/Time Date and time when the study or series was performed. The format is YYYY-MMM-
DD and HH:MM:SS (24 hour clock).

Accession Number Job number of the study in the RIS (radiology information system).

Study ID Identification number of the study.

174 Visage 7
Quality Assurance Performed procedures and scheduled procedures lists

Modality Modality or modalities where the patient was examined.

Body Part The part of the body or anatomical region that was examined in this study or series.
Use one of the Fields boxes on the Study tab card if you want to search for studies
by DICOM flag Body Part.

Images Number of images in a study or series.

Description Study or series description.

Comment A study comment, if such a comment exists for a study.

A study comment can either have been sent from the modality or entered in the
Study Info dialog box of the Visage 7 View window.

Performing Physician Name of the physician who performed a study.

Use one of the Fields boxes on the Study tab card to search for studies by per-
forming physician.

Institution/Station Name Name of the institution or department or name of the device where the study was
performed.

Information in the scheduled procedures list

Scheduled Procedures lists all orders that have been sent from a connected RIS
(radiology information system). If your Visage 7 is not connected to a RIS, the
scheduled procedures section is nevertheless shown, however, the list will remain
empty.

Patient Name Name of the patient.

Patient ID The patient’s identification number.

Birth Date The patient’s date of birth.

Sex The patient’s sex: M (male), F (female), O (other or unknown).

Assigned This column indicates whether a scheduled procedure (RIS order) has been
assigned to a performed procedure.
The corresponding study in the performed procedures list has the QA status COM-
PLETED.
Use the Status box on the Order tab card to search for scheduled procedures that
have already been assigned or that cannot be assigned.

Order Status Status of the RIS order.

Study Date/Time Date and time of the study. The format is YYYY-MMM-DD and HH:MM:SS (24 hour
clock).

Accession Number Job number of the study in the RIS (radiology information system).

Visage 7 175
Performed procedures and scheduled procedures lists Quality Assurance

Modality Modality or modalities where the patient was examined.

Organizing and rearranging procedures lists

You can rearrange the performed procedures and scheduled procedures lists for a
better overview.

Enlarging or reducing Drag the split bar above the Scheduled Procedures list up or down to enlarge or
window sections reduce this window section.

If your Visage 7 is not connected to a RIS, you might choose to hide the scheduled
procedures list altogether. Drag the split bar all the way to the bottom of the Quality
Assurance window in this case.

Rearranging columns 1. Right-click the column header of the performed procedures or scheduled proce-
dures lists.
2. Cancel the selection for any columns that you want to hide or move.

3. Point to a column to the right of which you want to reinsert a hidden column.
4. Right-click and select the column again.

Expanding or collaps- The performed procedures list is arranged in a hierarchical tree view.
ing the performed pro-
Use the + (plus) button in front of an entry to expand it and show lower levels of
cedures list
information.
-Or-
Click the Expand To button below the performed procedures list to show the
study level or the study and series level for all performed procedures.

-Or-
Use the - (minus) sign in front of an entry to collapse this level, or click Collapse All
to show only the patient level.

176 Visage 7
Quality Assurance Quality assurance tasks

Quality assurance tasks

Quality assurance typically involves different tasks, depending on whether your
Visage 7 is connected to a RIS (radiology information system) or not.

Quality assurance with RIS

When your Visage 7 is connected to a RIS, quality assurance is performed automat-
ically and in the background.

Automatic data consoli- When a RIS connection exists, Visage 7 is typically configured in such a way that all
dation incoming studies are automatically matched with orders from the RIS. If study data
contain errors, for example, if the patient name was misspelled during patient regis-
tration, these errors are automatically corrected with information from the RIS order.
Studies that can be matched to RIS orders receive the QA status COMPLETED.
These studies require no further user interaction.

Assigning studies to When your Visage 7 is connected to a RIS, you only need to perform manual quality
orders assurance if automatic matching of studies and RIS orders fails. A common sce-
nario for this is when scans are performed without Modality Worklist and incomplete
or incorrect information was entered at the modality.
1. In the Performed Procedures list, search for studies with QA Status SCHED-
ULED.
Use the Study States button on the Study tab card to define such a query. Start
the search with the Query button on the Study tab card.
2. In the Scheduled Procedures list, search for orders that have not yet been
assigned to studies.
In the Status box at the bottom of the Order tab card select NOT ASSIGNED.
Start this search with the Query button on the Order tab card.
3. Select a study in the Performed Procedures list and the corresponding order in
the Scheduled Procedures list.
Use Accession Number information or patient information (columns Patient
Name, Patient ID, Birth Date, and Sex) to identify studies and orders that
require matching.
4. Click Assign Order to Study on the toolbar.

A message appears that asks you to confirm study to order assignment.

If patient data for study and order are not identical, a second message appears.
5. Click Update to update the patient data of the study.
-Or-
Click Create New Patient to correct the patient information stored in the order.

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Assigning series to 1. In the Performed Procedures list, search for and select the series that you want
orders to reassign.
2. In the Scheduled Procedures list, search for and select the order to which you
want to assign the series.
3. Click Assign Order to Study on the toolbar and confirm.

The system now splits the study from the Performed Procedures list, assigns the
series to the new study and the new study to the selected order in one step.

Quality assurance without RIS

If your system is not connected to a RIS (radiology information system), quality
assurance means completing patient information or correcting errors that were
made during patient registration.

Completing data of an 1. On the Study tab card, search by study date and modality, for example.
emergency registration
2. Click Query.

3. Select an emergency patient in the Performed Procedures list.

4. Click Edit.

5. Overwrite any preliminary information with the correct patient information.

6. Click OK.
The Performed Procedures list is updated automatically now.

Merging patients 1. Search for an emergency study or a patient whose name is misspelled.
2. Click the gray pin symbol in front of the patient name.

The pin symbol turns blue when you select it.

>

3. Search for the correct patient name.

4. In the Performed Procedures list, select the emergency patient or misspelled
patient.
5. Press and hold Ctrl or Cmd while you also click the correct patient name.

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6. Click Merge Patients.

7. Select the correct patient name.

8. Click OK.
The Performed Procedures list is updated. Only the correct patient name is dis-
played now and the study has been moved. The emergency or misspelled patient
entry has been deleted.

Moving studies, series, If studies, series, or images were assigned incorrectly, move the data to another
or images patient, study, or series. You proceed in a similar way in all these operations.
1. Select the study, series, or images that you want to move and the patient, study,
or series that you want to move the data to.
2. Click Move.

3. Read the message and confirm with OK.

-Or-
1. Select a study, series, or image that you want to move to a patient, study, or
series that does not yet exist in your database.
2. Click Split.

3. Enter the new patient, study, or series information in the Edit Patient, Edit
Study, or Edit Series dialog box.
4. Click OK.

Tip

For series Split means moving the series to a new study of the same patient.
If you want to move the series to a new study of a new patient, use the Move to
New Patient button instead.

Editing patient, study, 1. Select a patient, study, series, or image.

series, or image infor-
2. Click Edit.
mation

3. Overwrite the patient, study, series, or image information in the Edit Patient,
Edit Study, Edit Series, or Edit Image dialog box.
4. Click OK to confirm and close the dialog box.

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Deleting patients, stud- Note that deleting images, series, or studies is rarely required. If images were
ies, series, or images scanned under a wrong patient or study, it is generally strongly preferred to correct
the images using the QA functions described above (for example, order assign-
ment) instead of deleting them and re-sending them from the modality.
However, if circumstances arise where you do need to re-send images to Visage 7
with modified metadata (for example, different patient ID), then you should delete
the images on the Visage 7 server before the corrected study is sent to the Visage 7
server again. Otherwise, the study might be partially or fully rejected or other prob-
lems may result.
Before deleting data, ensure that the data is no longer required by your users. After
you have deleted a study from the server, you cannot restore it again, unless there
is an independent copy that you have access to, such as a long-term archive. Note
that in some installations delete operations may propagate to other systems, such
as long-term archives.
1. Select one or several patients, studies, series, or images.
2. Click Delete.

A dialog box appears, which prompts you to specify a reason.

3. Select a reason for data deletion and click OK if you are sure you no longer need
this data on the server.

Modifying patient ID If subsystems that send data to the Visage 7 server or that receive data from the
mappings Visage 7 server use different patient IDs than Visage 7, IDs can be mapped. In the
Quality Assurance window, you can edit patient ID mappings.
1. Select a patient, study, series, or image.
2. Right-click and select Mapped Patient IDs.
3. In the Mapped Patient IDs dialog box, add new patient ID mappings or delete a
mapping that is no longer valid.

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Visage 7 users can customize the Visage 7 Client in various ways. For some of
these configuration options advanced user rights are required, others are available
for all Visage 7 users.

Tip

If you cannot find some of the configuration options described in this section on
your user interface, ask your system administrator about your user rights.

Basic settings
Basic configuration settings can be made by all Visage 7 users. Users do not need
advanced user rights to access these commands and dialog boxes.

UI appearance and display size

Select View > UI Appearance and Native Style, Visage Bright, Visage Dark, or
Visage Medium to adapt the user interface to the ambient light conditions of your
workplace.
Point the cursor to a screen or section of a screen, hold the Ctrl key down, and
rotate the mouse wheel to display image text larger or smaller.

Change Password dialog box

configuration8password
You should change your password from time to time for data security reasons.
1. Select File > Preferences > Change Password.
2. Enter your Old Password, the New Password, and repeat the new password in
the Retype New box.

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3. Press Return.
Use the new password from now on when you log in.

Reset all warnings

If you have selected Do not show again ... for any warning that has appeared since
you called up Visage 7, View > Reset All Warnings revokes this selection. From
now on, all warnings are shown again.

Streaming compression
configuration8streamingcompression
With View > Streaming Compression you can select a compression level for
image transfer from the server to your computer.

Note

Depending on the system configuration and your user role, you might not see all
the compression options listed here. Furthermore, Visage Imaging's customer
service can fine-tune the compression settings to optimize performance and net-
work use in your organization. Contact your system administrator if you have fur-
ther questions on this topic.

Select a compression level depending on the network you are working in and on the
image quality you require.
• Auto analyzes the current network bandwidth and the latency characteristics
and optimizes the compression level.
• Lossless Only transfers only losslessly compressed data with full image quality.
Select this option only for fast networks, for example, in local area networks
(LANs). Your server needs to be configured to support this function.
• High Quality applies a low compression level that ensures high image quality.
Select this option in fast networks.
• Medium applies a medium compression level. Select this option, for example, in
a slow local area network (LAN) or in a wide area network (WAN).
• Strong applies a high compression level for fast data transfer at the expense of
image quality. Select this option, for example, if you are working in a slow or very
busy network.

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Note

If images are displayed with reduced image quality because of streaming com-
pression settings, a red bullet appears in the lower right corner of the viewer.
Wait until the red bullet has disappeared to ensure that the images that you are
looking at do not show any compression artifacts.

Monitor Configuration dialog box

configuration8monitors
If you are working with more than one monitor, you use this dialog box to define
which Visage 7 window is shown on which monitor. For example, use a large high-
resolution monitor exclusively for viewing images and use another monitor to find
studies, create reports, or perform quality assurance.
1. Select File > Preferences > Monitor Configuration.

Tip

Point to a monitor box to show the resolution of this monitor as a tooltip.

2. Select display settings for each window.

Select Full Screen Mode to show the windows on this monitor in fullscreen
mode right after program start, that is without a window border. During a session
you can return to window size with the Restore Window button in the upper
right corner of the program window.

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Select Docked into Single Window if you want to show all Visage 7 windows in
the same program window. Clear this option to be able to show Visage 7 win-
dows side by side on the monitor.

Note

The selections Full Screen Mode and Docked into Single Window become
effective only if you select or clear these options for all windows of one monitor.

3. If the monitor that you use for reading images is a grayscale monitor, also select
Grayscale for the View window.
This selection enhances the readability of thumbnails and highlights the bright
border that indicates the active viewer for grayscale monitors.
4. Select which windows you want to show on which monitor.
Browse represents the Study Browser, Patients represents the Patient
Search window, View represents the View windows, Export represents the
Export window, and QA the Quality Assurance window.
5. Decide whether you want to show the Windows taskbar when Visage 7 Client is
shown in fullscreen mode.
Showing the Windows taskbar facilitates switching over to other program win-
dows such as the RIS (radiology information system).
6. Select Split Monitor 1 if you are using only a single monitor with this Visage 7
Client but are used to dual monitors at your regular workplace.
Splitting a single monitor allows you to use the same protocols that you are used
to in dual-monitor mode.
7. Click Save to save the monitor configuration for your own user account.
-Or-
Click Reset to Default to reset the monitor configuration to the system default.

Tip

If studies are loaded in more than one View window (more than one tab card with
a patient name is shown in the title bar) when you change the monitor configura-
tion, reload these studies so that the new monitor configuration becomes effec-
tive in all View windows.

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Render Settings dialog box

configuration8rendersettings
In this dialog box, you can change technical parameters for the way 2D and 3D
images are generated by Visage 7. Change these parameters only if your system
administrators or Visage Imaging customer service instructs you to do so.
1. Select View > Render Settings.

2. Select Auto for Local Rendering and Rendering Subsystem to have the sys-
tem identify and select the option best suited for your system configuration.

Caution

OpenGL is an advanced graphics standard that is not always properly supported

by client-computer graphics hardware.
In the View > Render Settings dialog box, you should set Rendering Subsys-
tem to OpenGL only if you are certain that this mode is supported properly by the
graphics card of your client computer.

3. Also adapt Volume Rendering parameters, if necessary.

4. Click OK to save your settings.
Any modifications that you made to Local Rendering and Rendering Subsystem
settings are stored permanently for your client. Modifications to Volume Rendering
settings are reset to their defaults when you restart Visage 7 Client.

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Configure Window/Level Presets dialog box

configuration8windowlevelpresets
Window level presets are combinations of image brightness and contrast settings.
You can save these presets for specific image types.
While you are reading images, you can select predefined window presets from a
drop-down list in the viewer controls, from a list shown when you click the Show
Window Level Presets button on the tool palette, or with a keyboard shortcut.

1. Select File > Preferences > Window/Level Presets, or select Window/Level

Presets from the viewer controls.
The image type of the currently loaded data is already selected.

2. Select the modality for which you want to define a preset and a preset number.
Preset numbers correspond to the keyboard shortcuts that you can use to select
presets quickly while you are reading images.
Undefined presets are listed as <Name>.
3. Enter a Preset Name.
4. Enter or select window level settings.
Fixed value range: Enter the window width as a range value or in terms of a
minimum and maximum value. The Center and Width and Min and Max boxes
are synchronized.
-Or-

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Automatic W/L based on histogram: This setting adapts the data window to
the value range available in an image dataset.
-Or-
Value range embedded in DICOM image: Select one of the window level pre-
sets that are stored with the image. Last represents the most recently stored
DICOM window preset.
-Or-
Click Copy values from active viewer to copy window level settings from the
currently active viewer into the Configure Window/Level Presets dialog box.
5. Change the Gamma correction factor, if necessary.
Gamma correction can be used to compensate for distortions in image bright-
ness that are caused by the monitor.
6. Select Save Preset to save your settings.
-Or-
Select OK to close the dialog box and choose whether to save or ignore
unsaved changes.

Configure Keyboard Shortcuts dialog box

configuration8keyboardshortcuts
Some of the functions and options that are represented by toolbar buttons can also
be selected with keyboard shortcuts. These keyboard shortcuts are active even if a
toolbar or button is currently not displayed in any of the toolbars on the screen.

Factory-default key- A number of keyboard shortcuts have been predefined for your system.
board shortcuts
Select Help > Keyboard Shortcuts on the main menu to show the list of factory-
default shortcuts.

Configuring your own If you feel that the factory-default shortcuts are not intuitive, you can redefine them
keyboard shortcuts and also assign other functions to keyboard shortcuts.
1. Select File > Preferences > Keyboard Shortcuts.

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2. In the search filter box above the Available Tools list, type the name or part of
the name of the tool that you are looking for.
-Or-
Scroll down the list of Available Tools.
3. Select a tool and drag it into the box of a keyboard shortcut on the right.
You can assign tools to function keys, alphanumeric keys, or special keys and
also to combinations of these keys with the Shift or Alt key.
If you drag a function to the box of a key or key combinations that already con-
tains a tool, this replaces the original key assignment.

Returning to factory Click the Revert to System Defaults button to reject any recent or previous key
defaults assignments or reassignments.
The factory-default keyboard shortcuts, which you can also find under Help > Key-
board Shortcuts, are now active again.

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Configure Tool Palette dialog box

configuration8toolpalette
When you right-click in a viewer, either the viewer context menu, or a tool palette, or
both are shown. The tool palette offers a quick way of calling frequently used func-
tions.
1. Select File > Preferences > Tool Palette.

2. In the search filter box above the Available Tools list, type the name or part of
the name of the tool that you are looking for.
-Or-
Scroll down the list of Available Tools.
3. Select a tool and drag it onto the Tool Palette to the right.
Moving a tool to a box that is already occupied by another tool replaces that tool.
4. Select whether to show the tool palette, the viewer context menu, or both when
you right-click a viewer.
5. Click the Revert to System Defaults button to reject any recent or previous
assignments or reassignments.
6. Click OK to confirm and close the dialog box.

Tip

You can even configure a shortcut to the Configure Tool Palette dialog box
itself.

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Properties and protocols Customizing Visage 7 Client

Properties and protocols

Properties and protocols are Visage 7 concepts for controlling and adapting the
user interface and the default behavior of functions at various levels.

Properties dialog box

configuration8properties
Properties define the default settings for many program functions. You can open the
Properties dialog box either from the File menu or from various context menus or
buttons. Depending on how you open the dialog box, it presents either the complete
set of properties or only a context-dependent subset. You can change properties for
your own user account, for all users, or for the currently active protocol, depending
on your user rights.
1. Select File > Preferences > Properties from any of the Visage 7 windows to
open a dialog box with all program properties.
-Or-
Select View > Viewer Properties in the View window if you want to redefine
only a subset of user interface settings for the View window.
-Or-
Click the Properties or Defaults button in a dialog box or on a tool card to mod-
ify only the properties of the corresponding function.
-Or-
Right-click a configurable tool or tool card and select Properties to modify the
properties of the corresponding function.
2. Decide on the level on which you want to save your changes.
System: This saves your changes on a system-wide basis.
User profile: This saves your changes in your user profile. The new settings will
be effective in all studies that you view from now on.
Protocol: This saves your changes in the protocol definition. The new settings
will be effective in all studies that use this protocol.
If you select Protocol, do not forget to save the protocol to make your changes
permanent. See Save Protocol dialog box, page 201.
3. Open the tree view of the function or feature that you want to modify.
The column Defined in tells you the level of the currently valid values: factory
default, system, user profile, or protocol.
-Or-
Type the name or part of the name of the property you are looking for in the filter
box above the property list.
4. Select the property that you want to modify and adapt its value in the second col-
umn.
Modified values have a check mark in the Modified column. When you clear this
box, you undo changes for this feature.

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Tip

When contradicting property settings exist at the various levels at which property
settings can be defined, the following rule applies.
Protocol settings overrule user profile settings, user profile settings overrule sys-
tem settings, and system settings overrule factory defaults.
Settings that will be overruled by settings of a higher priority are highlighted with
orange text.

5. Click Save to save your changes and close the dialog box.
-Or-
Click the Remove from ... button to reset properties settings to the settings of
the next higher level.

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Automatic loading of prior studies

configuration8autopriorrules
Automatic loading of prior studies can be configured either for the entire system, for
specific user levels, or for individual user profiles.
When configuring automatic loading of prior studies you should consider the actual
requirements of your users closely, because loading prior studies unnecessarily will
slow down system performance.

Configuring automatic loading of prior studies

1. Select File > Preferences > Properties.
2. Open the list of options for Automatic Loading of Prior Studies.
3. Review and adjust settings.
If you select any of the rule-based options here, move on to the Edit Auto-prior
Rules dialog box to review or define rules.

Editing rules for automatic loading of prior studies

1. Select File > Preferences > Edit Auto-prior Rules.
2. In the Edit Auto-prior Rules dialog box, select System or User below the rules
list to show either only system rules or only the rules of your user profile.
3. Select a rule.
-Or-
Click New Rule.
4. For a system rule, you can specify for which user level or user levels the rule will
apply.
Type a user level number (e.g. 3).
-Or-
Type several user level numbers separated by a space (e.g. 3 4 5).
5. Under If study matches the following, define current studies for which the rule
will apply.

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6. Under Additionally load these prior studies, specify the prior studies that will
be loaded together with the current study.

7. Always double-check your automatic loading configuration. Use the Properties

button as a shortcut to the Automatic Loading of Prior Studies configuration.
Parameters in the Properties dialog box and auto-prior rule settings are AND-
combined. For example, you might define a rule intended to load prior studies of
both the modalities CT and MR for current CT studies. However, you also select
the option Rule-based but only same Modality for the property Automatically
Load Prior Studies in the Properties dialog box. This will result in MR studies
being ignored and only prior CT studies will be considered.
8. Click Save.

Tip

If you want to adapt a system rule for your user profile, you can copy it to your
user profile. Likewise, and with appropriate user rights, you can move rules from
your user profile up to system level. Use the buttons Copy to User and Move to
System to copy and move rules.

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Modifying and creating protocols

Protocols control the screen layout and the scope of functions that are available
when a user loads different types of images or a combination of image types. Typi-
cally the system preselects the protocol best-suited for a selection of data when a
user loads data into the View window. If users do not agree with this choice, they
can select a different protocol. Users with appropriate user rights can prioritize pro-
tocols for specific image types or even edit or create protocols of their own.
Protocols are a very powerful and complex concept in Visage 7. Therefore, we rec-
ommend that you attend a dedicated training course before you attempt to perform
complex protocol editing tasks.

Simple protocol editing

The easiest way to modify a protocol is to make changes in the View window and
then to save these modifications.

Examples of simple The following list presents some typical examples of simple protocol editing tasks:
protocol editing tasks
• Hiding toolbars or showing additional toolbars
• Showing or hiding the thumbnail section or tool cards
• Changing viewer linking and viewer alignment
• Changing viewer types or viewer properties such as color maps, window level
presets, image orientation, slice thickness, and rendering mode selection.
• Rearranging the Layouts toolbar.

Procedure in simple 1. Load images into the View window.

protocol editing
2. Check which protocol is currently selected, or select a different protocol from the
Protocol menu.
3. Make your changes.
For example, show a toolbar that was previously hidden.
4. On the Protocol menu, select Protocol Editing > Save Protocol.
5. Change the protocol name and add a comment, if required.
6. Click Save Protocol.
When you proceed as described here and change no other parameters in the Save
Protocol dialog box, the protocol is saved as a user-level protocol. The priority of
the new protocol is the same as the priority of the original protocol. User-level proto-
cols have a higher priority than system-level protocols. Therefore, the new user-
level protocol will be selected the next time you load images of this image type.

Prioritizing protocols As a further step, you might want to call up the Protocols dialog box. In this dialog
box you can change the priority of the modified protocol and disable obsolete proto-
cols for your user account.
For more information, see Protocols dialog box, page 195.

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Protocols dialog box

configuration8protocols
In the Protocols dialog box, you prioritize, activate or deactivate protocols in your
own user profile.
Changing protocol priorities does not change the protocol definition itself but only
stores customized protocol priorities in your user profile.
When you load images, Visage 7 automatically identifies the protocol best-suited for
these images. Each protocol contains a number of matching criteria, which include
a monitor configuration, DICOM tags, and other metadata. The software uses these
matching criteria to identify protocols that are suitable for the selected image data.
From among these candidates the software chooses the protocol with the highest
priority in your user profile.
1. Select File > Preferences > Protocols from any of the Visage 7 windows.
-Or-
Select Protocol > Protocol Editing > Protocols in the View window.

Because the list of protocols that you find here is most likely very long, filter the
list before you begin.
2. Select if you want to show Active Protocols Only.

-Or-
Filter by protocol name. Type a search string in the Filter box and press Return.
For example, show only those protocols that apply to CT datasets or to a combi-
nation of CT and other modalities.

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Note that you cannot use wildcards in the Filter box.

-Or-
Show only those protocols that apply to specific monitor configurations.

-Or-
Combine any of these filter criteria.
3. Select Active for all protocols that will be considered when you load data. From
these protocols the system selects the one best suited for the selected data.
Protocols for which Active is not selected are not considered. Also be aware that
only active protocols are listed in the Protocol menu and available for manual
protocol selection.
4. Double-click the priority rating of a protocol to overwrite the value.

Protocols with a high priority ranking are more likely to be selected by the system
when you load data into the View window. Protocols with a high priority ranking
also show up at the top of the list when you drop down the Protocol menu.
5. Delete protocols only if you are sure you no longer need them.

When you delete a protocol you remove it from the system. The protocol will no
longer be available, either for your own user account or for all other users.
To be able to delete protocols you need appropriate user rights.
6. Click OK to confirm your configuration settings and close the dialog box.
-Or-
Click Reset to reject any recent and previous changes in this dialog box and
return to the factory-default settings.

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Advanced protocol editing

Advanced protocol editing requires that you thoroughly understand the principles
and concepts of the Visage 7 protocol mechanism.

Tip

We recommend that you attend a training course before you attempt to perform
these tasks. Alternatively, leave these tasks to trained administrators or Visage
Imaging service personnel.

Protocol definition Visage 7 expects you to base the definition of a new protocol on an existing proto-
workflow col. Moreover, the system expects you to edit some aspects directly in the View
window and adapt others with the protocol editing commands on the Protocol
menu.
The workflow for protocol modification therefore comprises the following steps:
1. Loading appropriate image data into the View window
Choose a study that is typical for the cases for which you want to create a new
protocol.
2. Selecting a base protocol on the Protocol menu
Choose a protocol that resembles the one you want to create.
The protocol editing options of the Visage 7 Client do not permit you to modify or
define all aspects of a protocol. Therefore, it is important that you start protocol
editing with a protocol that interprets the data in the correct way. In particular,
ensure that all images or image stacks that you want to present are available as
thumbnails. If you cannot find a suitable protocol, contact customer service.
3. Creating and editing layouts
A layout defines the arrangement of viewers on the screen. See Edit Layout dia-
log box, page 198.
4. Editing image assignment
Image assignment defines criteria for selecting images or image stacks and for
showing them in the viewers of a layout. Typically, you combine interactive
image selection in the View window and definition of criteria in the Image
Assignment dialog box in this step. See Image Assignment dialog box, page
200.
If you define no image assignment rules, images are distributed across viewers
in the order in which they were acquired.
5. Adapting image display and tool selection
Use the tools of the View window to modify image display settings such as slice
thickness, rendering modes, window level settings, or viewer linking. Also show
tools and tool cards as required.
6. Saving the protocol
Use the Save Protocol dialog box to save the modified protocol and to change
its name, priority, access and matching criteria. See Save Protocol dialog box,
page 201.

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Defining conditions Conditions are rules that help Visage 7 to identify specific types of images. See Edit
Conditions dialog box, page 203.

Note

Only very advanced users with the most advanced user rights are permitted to
edit conditions and therefore have access to the Edit Conditions dialog box.

Service-level protocol The various options and dialog boxes for advanced protocol editing allow adapta-
editing tion of existing protocols or definition of new protocols based on existing protocols.
Visage 7 Client users are not permitted to build protocols from scratch or to modify
certain protocol properties which, if modified incorrectly, might render the system
unusable. This level is reserved for service personnel who have been trained for
these tasks specifically.

Tip

Do not hesitate to contact customer service if you require protocol changes that
you cannot perform yourself, for example, because you do not have the neces-
sary user rights.

Edit Layout dialog box

In the Edit Layout dialog box, you can configure layouts for the protocol that is cur-
rently active.
1. Before you open the Edit Layout dialog box, inspect the layouts of your current
protocol.

By default, Visage 7 hides layouts that are not suitable for the currently loaded
data. If you want to review these layouts nevertheless, select Protocol > Proto-
col Editing > Show All Layouts.
-Or-
Right-click in the Layouts toolbar and select Show Layout and a layout that is
currently hidden.
2. Select Protocol > Protocol Editing > Edit Layout.

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Customizing Visage 7 Client Properties and protocols

3. Select or clear the check box in front of a layout to activate or deactivate it.
A layout that you deactivate is no longer shown on the toolbar irrespective of
whether you select Protocol > Protocol Editing > Show All Layouts.
4. Drag a layout up or down in the Select Layout list to change its position on the
Layouts toolbar.
5. Select an existing layout that you want to modify, or create a new layout.
We recommend that you create new layouts by cloning existing ones.
6. Assign layouts to monitor configurations.
7. Use the Layout Priority and Condition boxes to define which layout is selected
automatically when a user loads this protocol.
Refer to customer service for detailed instructions about how to define priority
settings and conditions.
8. Modify viewer arrangement and viewer sizes
Use the buttons in the lower half of the dialog box to add or remove viewers from
this layout.
-Or-
Resize viewers by dragging their borders in or out, or move viewers by dragging
them to a different position.

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Image Assignment dialog box

Image assignment means assigning specific images to specific viewers by defining
matching rules. For example, in MR studies you might want to assign axial T1
images to the upper left viewer.
Image assignment typically combines interactive steps, which you perform in the
View window, and fine-tuning of rules in the Image Assignment dialog box.
1. Switch to the layout whose image assignment you want to modify.

2. Drag images, image stacks, or series from the thumbnail section into the various
viewers.

You can only drag image sets that are represented by a thumbnail. You cannot
assign subsets of images or a combination of thumbnails to a viewer. Therefore,
if the base protocol does not group the data in appropriate image sets, select a
different base protocol, or contact customer service.
3. Select Protocol > Protocol Editing > Image Assignment.

4. In the Image Assignment dialog box, refine the criteria the system uses to
select images for the active viewer.
Refer to customer service for detailed instructions about how to define and com-
bine conditions in image assignment rules.
5. Click Apply.

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6. In the View window, select another viewer.

You can leave the Image Assignment dialog box open while you select a differ-
ent viewer in the background.
7. Define image assignment criteria for this viewer as well.

Save Protocol dialog box

1. Select Protocol > Protocol Editing > Save Protocol.
The Save Protocol dialog box has four tab cards.
2. On the General tab card, change the name, comment, and protocol priority.
For example, if you want to make sure that your new protocol is always chosen
instead of an existing one, you should increase its priority by at least 1.
Click the Protocols button to review the priority settings of all other protocols
that are available for your user account.

3. Also select which of the attributes that you have changed since you selected this
protocol you want to save.
4. Click Next to move on to the Access tab card.

-Or-
If you do not want to change other aspects of the protocol, click Save to create a
new user-level protocol.
5. On the Access tab card, select whether you want to make this protocol available
for all users or for specific user groups only.

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6. Click Next to move on to the Monitors tab card.

7. On the Monitors tab card, define the monitor configuration for which this proto-
col will be considered suitable by the system.
The configuration considers only those monitors that display the View window.
When users load images and their monitor configuration does not correspond to
the configuration defined here, this protocol is not selected automatically by the
system. Users can nevertheless select this protocol on the Protocol menu.

8. Click Next to move on to the Matching tab card.

9. On the Matching tab card, you define for which image type or image types the
new protocol will be considered suitable by the system.

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10.Refer to customer service for instructions about how to define conditions and
build matching rules.
11.Click Save to save the protocol under the name you specified earlier and with
the required access level.

Edit Conditions dialog box

Conditions are rules that help Visage 7 to identify specific types of images. Condi-
tions refer to the DICOM tags of images and series. Conditions combine these tags
and their values to form complex selection criteria.
Conditions are used in various protocol definition steps:
• Definition of layout priorities: see Edit Layout dialog box, page 198.
• Image assignment to viewers: see Image Assignment dialog box, page 200.
• Matching of protocols to studies: see Save Protocol dialog box, page 201.
Moreover, conditions are used by the system to group images in image sets. Image
sets are presented as thumbnails in the thumbnail section of the screen. The rules
for this process are not visible on the Visage 7 Client user interface.
Only very advanced users with the most advanced user rights are permitted to edit
conditions and therefore have access to the Edit Conditions dialog box.

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Refer to customer service for instructions about how to define conditions.

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