DIADISK Operating Guide

No part of this manual may be reproduced, copied, translated or transmitted in any form or by any means without the prior written permission of the original manufacturer. Information provided in this manual is intended to be accurate and reliable. However, the original manufacturer assumes no responsibility for its use, nor for any infringements upon the rights of third parties, which may result from its use.

For Release 5.5 of the DIADISK Viewer Software 1st Edition

Printed in Israel May 2003

Compatibility

Equipment described in these instructions for use may not be used in combination with other equipment or components unless such other equipment or components have been specifically designated as compatible by CDP Ltd.

A list of such equipment and components is available on request from CDP Ltd. at the address given below.

Changes and/or additions to the equipment may only be carried out by CDP Ltd. Or by third parties expressly authorized by CDP Ltd. to do so. Such changes and/or additions must comply with all applicable laws and regulations under the jurisdiction of the country concerned, and with the best engineering practices.

Compliance

This Medical Device meets the provisions of the Medical Device Directive 93/42 EEC (93) and FDA Class I.

If you have further questions regarding the applicable national or international standards, please address them to the company address below.

Company Address

CDP Ltd.
5 Efal Street
Petach Tikva, Israel 49511
Tel. (972) 3-925-4022
Fax (972) 3-924-9977

E-mail: cdp@cdp.co.il

Authorized CE Representative

CAM Diagnostic
20156 Milano
Via B. De Rolandi, 5
Tel. (39) 02-327-0155
Fax. (39) 02-327-1289
E-mail: camdia@camdiagnostic.com

0344

Chapter 1
Introduction

This manual is a user's guide for our image analysis and post processing software. It includes general information, navigating instructions, tool descriptions, and a tool usage guide. No installation instructions are required.

The DIADISK software is the result of extensive research to come up with a medical image manipulation and post processing software that can operate automatically from a transferable media (i.e., a CD_ROM). Some of its main features are:

§ Compatibility with almost any PC.

§ Minimal computer resource requirements.

§ Does not require installation and does not leave a trace on the computer.

§ High-speed performance allowing for maximum throughput.

§ Includes the most advanced features while maintaining an intuitive, user-friendly interface.

Images are recorded on a CD in compliance with the DICOM standard guidelines for recording images on transferable media. The DICOM standard defines the communication protocol for communicating with different digital imaging modalities thus enabling the manipulation and post processing of the images on:

§ Any PC using CDP’s DIADISK software.

§ Any third party workstation capable of loading DICOM images from a CD.

Every CD-ROM that is produced by the CDP CD-Printer contains:

§ The original medical images in their DICOM format, and

§ The DIADISK software for image manipulation and post processing.

The DIADISK software offers professional image processing tools for most types of image data. Once processed, images can be saved in a standard windows bitmap format for use in a non-medical environment, or they can be copied to the clipboard for convenient pasting into medical reports, presentations, or emails.

SYSTEM REQUIREMENTS

Though our CDs can be viewed on any PC operating under the Windows platform, the following configuration is recommended:

§ Minimum 32 MB RAM, preferably 64 MB

§ 17-inch color monitor

§ Super VGA, 1024x768, True Color

§ CD drive

REQUIRED PREVIOUS KNOWLEDGE

You must be familiar with the basic functions of a personal computer as well as the Windows operating system.

CONVENTIONS USED THROUGHOUT THE MANUAL

NOTE: Explanatory notes are formatted in italics and are separated from the surrounding text with a beginning and an ending line as in this example.

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Chapter 2
Getting Started

Images on the CD are organized according to the following hierarchy:

The following rules apply to all our CDs:

§ A CD may contain the images of one or more patients.

§ Patient studies can be from different medical devices such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound (US), Nuclear Medicine (NM), X-Ray Angiography (XA for cardiology or peripheral Angiography), Computed Radiography (CR), Direct Digital Radiography (DR), Fluoroscopy (RF) and any other DICOM compliant images.

§ A patient record may contain any number of studies.

§ All study-specific images are stored as a series. A series can have any number of images.

§ All CDs include the DIADISK software required for image manipulation and post processing.

§ All images are saved in their original resolution (pixel for pixel).

§ All manipulations performed on an image are automatically applied to all of the images in a coherent series.

NOTE: For optimum viewing, we highly recommend setting your computer resolution to 1024x768 pixels. For diagnostic purposes, the Color Palette should be set to True Color. For High resolution imaging (e.g. CR/DR please refer to local regulations).

AUTOMATICALLY STARTING THE DIADISK SOFTWARE.

Place the CD in the CD-ROM drive. Wait for a few seconds while the CD-ROM drive completes the process of accelerating the CD.

The DIADISK software should run automatically on any computer unless the AUTOPLAY function of the CD-ROM drive has been disabled. If within a few seconds there is no indication that the program is running, you will need to start the software manually.

MANUALLY STARTING THE DIADISK SOFTWARE.

1 On the Desktop, double-click the My Computer icon . The My Computer window is displayed.

2 Double-click the CD-ROM drive icon . The CD-ROM drive window is displayed.

3 Double-click the Viewer.exe file icon .

General information form highlights software version, copyrights, certification and special instruction information.

Press to continue

You are now ready to begin working with the medical images on the CD.

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Chapter 3
Pre-Selection

SELECTING A PATIENT\STUDY\SERIES

The DIADISK software automatically launches the pre-selection window displaying the contents of the CD-ROM.

"CD contents" form appears automatically on top of the viewing screen.

The form may contain studies of several patients \ studies \ series.

In case of a "Single Patient" CD, the study will be already open in the background

To view Press

In case of a "Multi Patient" CD, the first patient's folder will be open and the study active in the background.

To view first patient of a multi-patient CD press

3

2

1

1- To select a specific patient\study\series highlight the checkbox

2 - Press

3 – Press

NOTE: Highlighting the patient checkbox will prepare all of his/her studies/series/images to be reviewed as a single sequence on the screen.

NOTE: Highlighting the study checkbox will prepare all the series contained within the study to be reviewed as a single sequence on the screen.

NOTE: Highlighting a series checkbox will prepare all of the series' images to be reviewed as a single sequence on the screen..

NOTE: Some unique image synchronization functions may be disabled when mixing different formats of images ( e.g. monochrome and color images)..

NOTE: Icon images should be displayed providing that they were created within the original DICOM image file. Otherwise an X will appear instead of the icon image.

NOTE: Study and series description should be displayed if such were created with the original DICOM images.

NOTE: If study contains a LOCALIZER image the software will automatically display the mini localizer image + slice position reference marker on the bottom left corner of the screen. For more information on the localizer functionality please refer to the localizer functionality in the Tools chapter.

RESELECTING A NEW PATIENT\STUDY\SERIES FROM APPLICATION WINDOW

To recall the pre-select window press from the top menu bar.

Pre-select window will reappear and you can reselect

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Chapter 4
User Interface

USING TOOLS

Designed to enable first time users an intuitive use, the DIADISK software includes three parallel tool activation mechanisms:

1. Selecting Tools from the menu bar followed by pressing the required tool.

2. Selecting any tool from the toolbar on the top of the screen.

NOTE: This option is the most intuitive and enables first time users to start working instantaneously.

3. Pressing the mouse right button anywhere on the screen activates a dropdown toolbar.

NOTE: This enables the professional user to activate tools from anywhere on the screen without the need to constantly move up and down throughout the screen.

FLOATING MENUS

Whenever a tool is activated a floating window is displayed on the work area enabling further utilization of that tool.

When you call up a new function the previous floating window is added to the top toolbar.

Functions available with each floating window:

Minimize	Adds tool to the top toolbox
Maximize	Displays the tool in a floating window format in the work area
Close	Closes the tool's floating window without adding it to the top toolbar
Reset	Reverts to the image original parameter relating to the specific tool functionality (e.g. zoom, window level …)

USING THE MOUSE

To simplify the use of the mouse, all functions are activated by using the left mouse button .

If you are using a mouse with a roller, the DIADISK software enables navigation between images using the mouse roller.

NOTE: The right mouse button is only used to toggle the tools from anywhere on the screen.

USING THE KEYBOARD

The following functions can be activated using the keyboard keys:

	Right Arrow	Proceed to next image
	Left Arrow	Go back to previous image
PgUp	Page Up	Go back to previous image page
PgDn	Page Down	Proceed to next image page
Delete	Delete	Delete active measurement or annotation

NOTE: Navigating to next\previous image page is useful when the screen is in a "Matrix" mode (displaying several images simultaneously).

MINIMIZING APPLICATION

Pressing button on the top right corner of the screen will minimize the DIADISK application to the windows task bar.

TOGGLING FULL SCREEN

Pressing button on the top right corner of the screen will close all tools menus and maximize the active image screen size.

CLOSING APPLICATION

Pressing button on the top right corner of the screen will close the DIADISK application.

Alternatively, press FILE on the top left corner of the screen and select EXIT from the file menu.

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Chapter 5
Working with dual monitor or split screen

The DIADISK software is designed to allow split screen or dual monitor functionality for the purpose of viewing and comparing several studies\series side by side.

TOGGLING DUAL MONITOR \ SPLIT SCREEN MODE

The following tutorial will demonstrate the selection and comparison of two sequences of images as well as image linking and localizer selection for dual monitor or split screen.

1. Press the dual monitor icon

Options available are:

· Single monitor

· Dual monitor horizontal split

· Dual monitor vertical split

2. Select dual monitor vertical split

SELECTING IMAGES FOR LEFT MONITOR

3

4

3. Select series to be displayed on left side of the screen or left monitor

The DIADISK software automatically recognizes dual screen mode and prompts with buttons.

4. Press to display selected images on left side or left monitor

SELECTING IMAGES FOR RIGHT MONITOR

5

6

5. Select series to be displayed on right side of the screen or right monitor

6. Press to display selected images on right side or right monitor

Images are now displayed on both screens as selected by the user

7. Press to start working

Application window should appear as above with a highlighted active window

LINKING SCREEN NAVIGATION

Optionally: To synchronize both screens\panels to navigate simultaneously

(an operation referred to as "Linking").

8. Press the link button

MANUALLY SELECTING LOCALIZER IMAGE FOR DUAL SCREEN

10

11

9

Optionally: To manually create a localizer – reference image:

9. Press the "Select patient" button to review study images

10. Select series\image to be used as localizer by highlighting it's checkbox

11. Press or to select for which screen the localizer will be used

A split screen used to compare two studies\series + mini localizer on bottom left of the screen.

RETURNING TO SINGLE MONITOR MODE

Press dual screen button and select single screen mode

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Chapter 6
Navigation

DIADISK software enables several methods of performing navigation, using many of the industry's established tools:

Navigation toolbar
Keyboard	PgUp PgDn
Mouse roller
Cine tool
Stack navigator tool

NAVIGATION TOOLBAR

Use the Image Navigation toolbar as follows:

Click the … button	To…	Comments
	Move to First image
	Move to Previous image page	Useful for navigating between pages when viewing a matrix of images
	Move to Previous image	Can be pressed continuously for continuous movement
	Move to Next image	Can be pressed continuously for continuous movement
	Move to Next image page	Useful for navigating between pages when viewing a matrix of images
	Move to Last image

When navigation toolbar is in the floating position an extra navigation handle is available:

Continuously pressing this handle with the mouse left button and moving sideways enables dynamic navigation between images.

KEYBOARD

Use the keyboard as follows:

Click the … button	To…	Comments
PgUp	Move to Previous image page	Useful for navigating between pages when viewing a matrix of images
	Move to Previous image	Can be pressed continuously for continuous movement
	Move to Next image	Can be pressed continuously for continuous movement
PgDn	Move to Next image page	Useful for navigating between pages when viewing a matrix of images

MOUSE ROLLER

Roll upwards	Move to Previous image
Roll downwards	Move to Next image

CINE TOOL

Use the cine tool as follows:

Click the … button	To…	Comments
	Activate\deactivate "CINE" mode	Button toggles between pause and play
	Reverse direction of cine	Button toggles between reverse and forward
	Continuous\single loop	By default this button is pressed and causes cine to continuously loop. Deactivating this button cause cine to stop at the last image
	Control cine speed	Dragging the speed handle changes the cine frame rate.
	Speed reset	Resets the speed to the original speed indicated by the DICOM data or a default one.

STACK NAVIGATOR

Select tool to activate the stack navigator.

Continuously holding the left mouse button down and moving up and down on the image screen will navigate forward and backwards accordingly.

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Chapter 7
Tools

DIADISK software enables user three methods of activating the tools: through Menu commands, through the toolbar, or by right clicking anywhere on the work area.

NOTE: Refer to chapter 4 – User interface – using tools for instructions on the different user interfaces to activate the tools.

Tool Function table

Button

Attribute

Display

Dual screen

Enables selection between three modes:

· Single monitor

· Dual monitor horizontal split

· Dual monitor vertical split

Image linking

Enables synchronized navigation of images on both screens.

Once pressed, any navigation is automatically synchronized between both screens.

Supports linking of studies\series with different slice increments.

Useful to compare:

· Previous and current study.

· Same study with different window\level values

Multi-image display

Pressing this icon displays a dynamic matrix enabling you to select an image display matrix.

Each dark square represents an image on the screen.

Stack Navigator

After selecting this tool the mouse cursor turns into the following shape

Pressing left mouse button continuously and moving upwards\downwards causes images to advance\regress accordingly.

Pan

Useful when image size exceeds screen.

After selecting this tool the mouse cursor into the following shape

Pressing left mouse button continuously and moving will pan the image in the same direction.

Measurements

Pressing this button causes a floating measurement window to appear.

The default tool is the distance measurement.

The measurement line color is a negative of it's background enabling the use with monochrome monitors

When using a color monitor the user can press the COLOR radio button and press APPLY to accept the default color,

or press CHANGE COLOR to select a different color.

This will cause measurements and annotations to appear in color.

Calibration

In a non calibrated image, a reference object with known size can be used to calibrate measurements.

Measure reference object, press Calibration tab, type in the length in mm and press Apply.

All other measurements be calibrated to this reference.

NOTE: Most digital images do not need calibration due to pixel/mm ratio data which is created by the imaging system and included with the DICOM file.

Distance

Measures distance between two points.

Press mouse left button to create first point and drag line to second point. Measurement will be fixed when mouse button is released.

Measurement handles can be grabbed at any time to drag and modify the measurement.

For most digital images result will automatically be in mm units.

Images without pixel to mm conversion in the DICOM data will show measurements in pix units (pixels). Calibration to an object of known size can be done to get absolute measurements.

NOTE: Measurement handles and text box disappear when measurement is processed to improve visibility.

Angle

Measures angles.

Press mouse left button to create first point and drag line to second point. This will create one side of the angle.

Freely move mouse to third point and press button to fix the end point of the second side of the angle.

Measurement handles can be grabbed at any time to drag and modify the measurement.

NOTE: Measurement handles and text box disappear when measurement is processed to improve visibility.

Point Density

Measures the density of a pixel.

Pressing the mouse button will indicate a density value for the point.

Releasing mouse button will affix the result on the image.

Continuously pressing the mouse button and dragging over the image dynamically displays density values for the pixels without affixing the results on the image.

ROI Density

Measures the density of an ellipse depicting a region of interest (ROI).

Press mouse left button to indicate middle top corner of ellipse.

Drag mouse downwards to create the ellipse.

Ellipse is fixed when mouse button is released.

Measurement handles can be grabbed with mouse pointer and adjusted at any time

NOTE: Measurement handles and text box disappear when measurement is processed to improve visibility.

Delete active measurement

Deletes active measurement.

Active measurement is indicated by a different color or thicker line.

To activate measurement select it with mouse (preferably by grabbing handles).

Delete active screen

Deletes all measurements within active screen.

Active screen is indicated by a white frame.

To activate a screen select it with mouse.

Delete all measurements

Deletes all measurements within the active study.

Window \level

Enables dynamic manipulation of the contrast and brightness of the image.

You can change contrast and brightness by:

1. Selecting a preset option. Options are based upon object density. Presets 1 and 2 revert the image to original settings.

2. Using the floating window functions where W is equiv. to Contrast and L is equiv. to Brightness.

3. Moving the cursor within the image: Up or Down to decrease or increase Contrast and Left or Right to decrease or increase Brightness.

Zoom

Enables dynamic zooming of the image.

You can zoom an image in or out by:

1. Moving the cursor within the image while continuously pressing left mouse button.

2. Using the floating window functions.

When this button is pressed, application will automatically resize images to fit into the active window size.

NOTE: In any case where application automatically resizes image to a size which is less than 100%, the zoom window will automatically appear on the image displaying the reduced zoom factor

To revert to 100% pixel representation, disable the button and press "reset", or manually set zoom factor to 100%.

NOTE: Application uses image interpolation techniques to smooth pixels at zoom factors larger than 100%.

Magnify

Magnifies a region within the image by pressing the left mouse button.

By continuously pressing the left mouse button and dragging it across the image different regions can be magnified.

By pressing arrows user can increase or decrease the magnification factor.

Checking the optimization option enables an automatic contrast optimization process to be carried out within the magnified image, As can bee seen in image across.

Selecting different radio buttons sets the magnifying glass size. in pixels.

Rotate

Enables rotation, flipping and mirroring of the image(s).

Localizer

Switches localizer window on and off

Pressing opens a localizer toolbar.

Pressing switches between 50% and 100% zoom factor display of the localizer image.

Pressing enables selection of a different reference image from the series which has been selected for the localizer.

Pressing switches between different modes of displaying the scanning lines.

Pressing inverts the localizer image.

Invert

Inverts the image

Reset

Restores the original image attributes

There is a general reset button on the Icon toolbar that restores all image attributes to the original settings.

Within many function tools there is a reset function that restores the specific tool’s attributes to the original settings.
(e.g., Zoom, WindowLevel, Rotation).

Save image to clipboard

Enables selecting a region of interest for copying to the Windows clipboard for pasting into other applications.

Image is automatically saved to clipboard when mouse button is released.

Use the windows paste function to paste image into any application.

Convenient for pasting images into:

§ Medical reports

§ Presentations

§ Emails

Save image to file

Saves image(s) in a standard windows bitmap format for use in non-medical environment.

Convenient for pasting images into:

§ Medical reports

§ Presentations

§ Emails

Toggle active screen

Switches between active screens when working in a dual monitor environment.

Synchronize

This button causes all image processing and manipulation performed on an active image to be applied to all the images in the stack.

This function is enabled by default for most applications except for CR and DR where the user can manually select to synchronize Image manipulation.

Cine

Use the cine tool as follows:

Click the … button	To…	Comments
	Activate\deactivate "CINE" mode	Button toggles between pause and play
	Reverse direction of cine	Button toggles between reverse and forward
	Continuous\single loop	By default this button is pressed and causes cine to continuously loop. Deactivating this button cause cine to stop at the last image
	Control cine speed	Dragging the speed handle changes the cine frame rate.
	Speed reset	Resets the speed to the original speed indicated by the DICOM data or a default one.

Dicom info

Activates a window displaying all of the DICOM data attributed to the image.

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