How to de-identify angiograms

# Overview
In many jurisdictions it is illegal to transport medical images with patient identifiers.  Patient identifiers include, but are not limited to name, date of birth, and patient ID.  It is imperative that angiograms are properly de-identified before they are transported.  This page gives step-by-step instructions on two ways to properly de-identify angiograms before transporting them.  Our recommended approach is using the first the ViewPlus software.  If that does not work for you, the second option, using the DICOM Cleaner, may work better for you.  Both programs are available to download for free.

# Before You Begin
Here are a few pieces of information that are important to know before you begin.
- The process of de-identification requires a new, blank CD to burn the de-identified angiogram onto.  The first part of the de-identification process is re-saving the angiograms in a de-identified format onto your computer.  The second part is burning this new angiogram onto a CD so that it can be transported to other locations.
- These two particular programs only support angiograms in DICOM file format, which is a common format for digital angiograms.
- The instructions and screen shots provided below were generated using a PC running Windows.
- The ViewPlus software is the recommended software for de-identifying angiograms.
- The term "cinerun" refers to the angiographic motion picture that is analyzed for diagnostic and research purposes.

# Loading ViewPlus Software on Your Computer
Step 1: Click here to start the download process.  The download will start automatically.
Step 2: One or two windows with security warnings may pop up.  This is normal.  Click Run both times.
The first window will look like this:
The second window will look like this:
Step 3: The file will begin downloading.  It may take a few minutes.  When the download is complete, the ViewPlus  Installation program will automatically start.  When this happens, click Next.
Step 4: The next window will ask you where you would like to save the program to.  The default setting is to save it as C:/Program Files/ViewPlus.  This is the recommended way to save the program.  Simply click Next, unless you would prefer to save it in a different format.
Step 5: ViewPlus will ask you to select the proper drive that corresponds to your CD-drive. 
If you are not sure how to answer this question, go to My Computer and locate the drive that shows a CD or DVD drive.   It will probably be shown under a header labeled Devices with Removable Storage.  In the screenshot shown below, the proper drive is the E drive, although yours may be different.
Once you have selected the proper drive in the ViewPlus Installation program, click Next.
Step 6: ViewPlus will ask you to choose a format for dates.  Choose the second option (dd/mm/yyyy), and then click Finish.
Step 7: The installation will begin to load.  It may take a few minutes for this step to be completed.  When the download is complete, click OK to return to the desktop.
The installation is now complete.  In the future, you should skip these steps and follow the following steps for de-identification with ViewPlus.

# De-identifying Angiograms Using ViewPlus Software
Step 1: Put the angiogram that you wish to de-identify into the CD drive that you selected in Step 6 of the installation process.  Wait for a few moments to see if the CD opens up its own internal software or if a window automatically pops up.  If it occurs, close the software or window to return to your desktop.
Step 2: Locate the new ViewPlus icon and double click it to open ViewPlus.  The icon is pink, black, white, and gray, and says ViewPlus, shown on the screen shot below.
Step 3: When the program opens, you will see the interface of the program.  On the left side of the screen, there will be a column with thumbnail images of all the cineruns.  Double check that the angiogram has multiple cineruns  by double-clicking the thumbnails, or clicking "Play All" and watching them play one at a time.  Look to see if any identifying information (name, date of birth, patient ID number, etc.) is shown on any of the images or cineruns.
- If there are no patient identifiers on any of the images, you may skip to Step 9.  Be sure to check every cinerun and still image before skipping the next few steps.
Step 4: If there is any identifying information on the cineruns or images themselves, click the button shown below.
Step 5: When the new screen shows up, click and drag the mouse across the area with identifying information to form a black-out bar (also called a hider).  When you are done, press OK, or if you want to delete what youve done, press "Cancel" to go back to the previous screen.  Note: You can only create one black-out bar at a time.
- Always make the blackout bars as small as possible, and make multiple smaller blackout bars rather than one big black-out bar.
Step 6: When you press OK, a window will pop up.  Click Yes and your blackout bar will be added to all images in the series.
Step 7: If you have made a mistake with a black-out bar, click the button with the red X through it, shown below.  Then, click Yes when the next window pops up.  Note: This button will delete ALL of the black-out bars you have created.
To make more blackout bars, repeat Steps 4-7 until all patient identifiers are obliterated.
- When you have completed this task, be sure to click through all of the cineruns again to be sure that you haven't missed anything (see Step 3).
Step 8: Once you are sure that you have blacked out all identifying information on the angiogram, look for the word Anonomyze, and determine whether there is a check mark in the small box to the left of Anonomyze.  If there is no check mark, click the small box so that a check mark appears.  Then, click Make CD.
After you click Make CD, it may take a few minutes for the DICOM files to be de-identified.  While this is occuring, the screen will look like this:
Once it is complete, the screen will look like this:
Step 9: Take out the CD and insert a blank CD or blank DVD into the drive.
Step 10: Click the small button with the downward arrow on it to pull down a list of possible drives.  Select the appropriate drive, and then click Write Disc.
Step 11: When the CD is done burning, the CD drive will pop open, and the ViewPlus screen will become blank.  Click the Exit button, which will return you to the desktop.
Step 12: Double check that the process was successful by re-inserting the new disc (the one that just popped out of the CD drive) into the drive and clicking the ViewPlus icon (see Step 2).  When ViewPlus opens, double click all of the thumbnails (see Step 3) to ensure that they play properly.  Make sure that that all of the cineruns are present and that all identifying information is properly blacked out so that it cannot be seen.  If you find that you have missed any information, you will have to repeat steps 4-12 with the new CD to properly de-identify it.  Remember, it is imperitive that all patient identifiers are obliterated.
Congratulations! You have now successfully de-identified an angiogram!

# De-identifying Angiograms Using DICOM Cleaner Software
If the above process does not work for you, you can try to de-identify angiograms with the following process.  The program works best if it is restarted for each angiogram that needs de-identification, so follow each and every step for all angiograms.
Step 1: Go here to start the software download.  The download will start automatically.
Step 2: Select "Open with" and then "OK" to launch the program.
Step 3: Once it is launched, click "Run" and the program should open. It will look like this:
Step 4: Click the "Import" button on the middle bar of the program interface.
Step 5: After clicking Import search for your CD/DVD Drive (usually this is the D: drive or the E: drive) and click "Open."  This drive can be found by clicking My Computer on the left-hand side of the window.
Step 6: Once the media import is complete, the cineruns and the patient identfiers will appear in the left column of the program.  Type in the patient's name and patient ID or study date (if necessary to de-identify) on the "Query" line (located under the "Configure" button) and click "Clean" (located next to "Import").
Once the information is cleaned, the cleaned information will appear on the right-hand column of the program, as shown below.
Step 7: Next, you'll have to click on the first image under the "Cleaned" column (the right-hand column) and click "Blackout." After clicking Blackout the angiographic cinerun will be displayed (see below). This will allow you to blackout information on still images or cineruns.
Step 8: If there is information on the image that needs to be cleaned, right click and drag over any information you want blacked out.  When you are finished, click "Apply." Your image will look like this:
If there is no information on the cinerun, skip to Step 9.
Step 9: Click "Next" to go to the next image or cinerun.
- Repeat Steps 8-9 to continue to blackout any necessary information on each cinerun. Make sure to check every single cinerun and image.
Step 10: When you are finished blacking out all the information on the angiogram, click "Save" to save all of the blackout bars.
Step 11: Once you have saved your black-out bars, you wil be brought back to the main screen of the program. Make sure you have the top folder in the "Cleaned" column selected, as shown below.  Then click Export and select the location you would like to save the files to.  Your desktop is a good place to save it.
Step 12: Once the films are exported, you must take out the old CD and place a new, blank CD or DVD into the CD/DVD drive.
Step 13:   Burn the folder that you just created onto the blank CD or DVD using any CD burning program you have.
If you do not have a CD burning program, complete the following steps:
- Go to My Computer and select the CD or DVD drive that contains the blank CD.
- Once the drive is open, you should see an empty window that looks like this:
- Simply drag the folder from your desktop into the empty window, and then click File and then Write these files to CD.
- A "CD Writing Wizard" will pop up.  Follow the directions of the program to burn the disk.
Note: When you name the CD, be sure not to name it with any patient identifiers.  The date of the angiogram may be an appropriate title.
- Note: When you name the CD, be sure not to name it with any patient identifiers.  The date of the angiogram may be an appropriate title.
Step 14: Once your new CD is burned, be sure to double-check that the CD was properly burned by playing the angiogram in a DICOM viewer.  If you do not have a DICOM viewer, check to see that the CD contains the appropriate number of files.  For example, if there were twelve cineruns on the original angiogram, you should see twelve DICOM files within the folder on the CD.  You can determine this by going into the Start Menu (click on the botton on the very bottom left corner of your screen), and then going to "My Computer," right clicking the CD drive, and selecting "Open in new window" or "Open to view files."  Then, count the files that you see in the window.
Congratulations! You have now successfully de-identified an angiogram!