# Presentation: 510810

## VistaRad in Your Hands- Part 2

- Creating Hanging Protocols for US, CT, and MRI

## Tiling versus viewports

- Tiled: One series (and one viewport) is split into multiple images
- US: 9 images visible at a time
- ?No info lines along bottom of each image
- Layout can be easily changed
- Viewports: Each viewport contains one image or one series of images
- Layout of the viewports cannot be changed in the viewer window
- Layout can be easily changed in the browser

## Stages

- Different layouts in the same hanging protocol
- Approach it as if it is all one layout:  If a series is displayed on one stage it won’t be displayed on another unless specifically directed
- Useful when one layout is not adequate
- Useful to display a case differently with or without prior exams.

## Browser

- Extremely flexible viewer window
- Can be placed anywhere, any size
- Current or prior exam can be displayed on it by double clicking the title bar in the preview window
- Is not incorporated into the HP
- Useful to see priors that did not initially hang as part of the HP
- Also can be used to view any exam
- Color images can be viewed

## Initial preparation

- Find and save names of cases in each modality
- At least 1 prior exam
- Similar related priors if appropriate
- Abdomen series: prior CXR
- Shoulder MRI; prior shoulder radiograph
- Longer exams are better
- Larger number of series in MRI and CT
- Both for the current exam and prior

## Initial preparation

- Try the default Hanging Protocols for each case, by simply double-clicking on the current study
- You can do this with other Radiologists to get a consensus
- Note things you would like to change
- Some of these changes can be made on the system HP
- Some changes will require creating a new HP

## Initial Preparation

- Identify common exams that have a standard technique
- MRI shoulder, MRI brain
- Can be a problem if you have different magnets, or different CT scanners
- Try to get the series names to be similar
- Save cases with priors
- The default HP’s may not have linked images to your preference

## Initial preparation

- Review and add templates
- System templates:
- 1up 1up
- 1up 2up
- 2up 2up
- 4up 4up
- 9up 9up
- 1 wide
- Use the same naming system for new templates
- 2up 4up
- Note if it is on a monitor with outlying resolution (i.e. 5MP when everyone else uses 3MP): 1up 1up 5MP

## Templates

- Naming is very important
- Each time a user creates a HP, the template used will be saved by them and they will need to type the name in.  It will say “This name already exists”, so when it is re-saved you want to be sure it’s the identical template.
- Be sure to note a different resolution for this reason because the outlying template will be filtered out on a different resolution monitor and cannot be used in a default HP

## Naming Hanging Protocols

- The list displays in alphabetical order, not by modality
- List can become long
- Begin each HP name with the modality
- MR shoulder
- CT chest
- This way they will group together
- The HP’s also group under each users name: They don’t need to label it “Wilson’s CT chest”

## Auto selection of an HP

- When you open an exam the HP used automatically will be selected in this order
- Personal CPT-specific HP
- System custom CPT-specific HP
- Personal modality-specific HP
- System custom modality-specific HP
- 	Default HP (usually modality-specific)

## Initial preparation: With VISTA team

- Review printsets
- Better to have these adjusted prior to creating specific hanging protocols
- For example:  Chest/abdomen/pelvis CT:  Keep chest separate? It could hang separately and be dictated separately
- Pelvis and hip films: We always take a pelvis film with the hip film: they are linked as a printset
- Simplifies dictating

## Initial preparation: With VISTA team

- Review and adjust “similar CPT’s” and “Modality and body part” groupings
- These are groups of CPT codes you can create:
- Abdomen 3V, abdomen 1V
- CXR 1V, CXR 2V, CXR obliques
- Do you want that prior to display as a comparison exam?
- Only for studies that are truly similar
- HP’s can display any specific CPT as a prior, (or its “similar CPT’s”)

## Creating your first custom HP

- You’ve identified a case that does not open in a way you like with default HP
- You have a complete case with priors
- Go to the Manager View/settings/viewport and adjust the “apply to set” boxes
- If creating HP for CT/MRI/US, check all of the boxes on
- If creating HP for CR/DX, unclick W/L and orientation

## Creating your first custom HP

- Next: Select the current exam and priors (using **<ctrl>**), “open with” button, and then choose the appropriate template
- Start by creating the Stage that displays prior exams: A later stage will display the current exam on both monitors, and that can be marked to “open when there is no prior”

## Ultrasound: Stage 1

- Left monitor: current exam. One viewport: Images are displayed in a tile of 9.
- Can easily change the HP to display a different number, thus a different size of images

## Ultrasound: Stage 2

- No prior
- Default box in case information of HP
- Current exam displays on both monitors
- Unfortunately, images go horizontally across both monitors
- Use the page down button when viewing

## CT 

- Stage 1:
- 2up 2up
- Soft tissue and lung windows (explicit map)
- Current and prior
- Stage 2:
- Choose template based on typical long exam (ex  4 series)
- 4up 4up
- All series display, default modality

## MRI

- Stage 1: 9up 9up
- Current on left monitor, prior on right
- Stage 2: 4up 4up
- No priors: all current exam
- 6up 6up may not enlarge the image size compared to 9up 9up