Abstract:
The present invention is directed in general to imaging technologies and more particularly to medical imaging and picture archiving and communication systems (PACS) having an image display wherein system features and functions are provided to a user via active overlays located over displayed images. A system and method are provided to imbed an ability to interact with an image by activating traditional annotations that are displayed in conjunction with an image in a PACS. Users are able to access program functionalities in an improved, quicker, accurate and more intuitive means. More specifically, the present invention relates to providing the capability to customize multiple context menus, and flatten the command hierarchy of an imaging system. The present invention also provides the ability to “overload” current text and graphic annotations that are already displayed within an image of interest.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a National Stage filing under 35 U.S.C. §371 of International Application No. PCT/US2009/065967, filed Nov. 25, 2009, which in turn claims the benefit of U.S. Patent Application No. 61/118,580, filed Nov. 28, 2008, both of which are hereby incorporated by reference in their entirety. 
     FIELD OF THE INVENTION 
     The present invention is directed in general to imaging technologies and more particularly to medical imaging and picture archiving and communication systems (PACS) having an image display wherein system features and functions are provided to a user via active overlays located over displayed images. A system and method are provided to imbed active text and graphic annotations onto images that are displayed with a PACS, for enabling direct user interaction with the system and direct manipulation of display images. Users are able to access program functionalities in an improved, quicker, accurate and more intuitive manner. 
     BACKGROUND OF THE INVENTION 
     In medical imaging, PACS are a combination of computers and/or networks dedicated to the storage, retrieval, presentation and distribution of images. While images may be stored in a variety of formats, the most common format for image storage is Digital Imaging and Communications in Medicine (DICOM). DICOM is a standard in which radiographic images and associated meta-data are communicated to the PACS system from imaging modalities for interaction by end-user medical personnel. 
     PACS display textual and graphical medical information that are associated with image attributes. Some of this information is received from DICOM and others are generated within the PACS as annotations that are associated with the images or measurements linked to anatomical regions of interest or markers that are produced by third party systems, such as Computer Aided Detection (CAD) applications. The DICOM standard recently introduced support for Structured Reports (SR) that can include CAD findings and GSPS (Grayscale Soft Copy Presentation State) non-image objects that are necessary to reproduce the same visualization of an image if displayed at two disparate PACS systems. Not all annotations are covered under the GSPS umbrella and often these attributes are displayed as static image overlays that can be turned on or off, based on the viewer&#39;s preference. 
     For example, certain attributes that are related to image processing are displayed as numerical value annotations that are associated with the rendering of a particular image. Such rendering may include image rotations, contrast adjustments such as window-level operation, particular proprietary image enhancements, zooming level, image compression level, etc. Traditionally, an end-user is able to manipulate the attributes of an image utilizing keyboard short cuts, combinations of mouse and keyboard buttons and mouse movement, or by simply launching tool menus to image tiles, context menus (often launched using right mouse click) or tool bars. The usability of accessing functions through these interfaces and techniques is rather low and presents a number of problems to the end-user. 
     Access to tools, whether associated with visualization, diagnostic workflow or clinical context driven measurements, is rather poor in existing PACS products. In the case of the Context Menu, which is conventionally launched by right clicking the mouse, navigating down the command hierarchy, access to particular command is often difficult and interferes with the user&#39;s ability to perform functions in a quick and efficient manner. What is needed is an intuitive and quick access to the context menu commands and other commands and features of the PACS, without further cluttering the screen real estate. The ability to access tools using active overlays within the image area, as opposed to the existing menu and toolbar driven approaches, reduces the number of commands that need to be exercised from menus. This in turn makes the menus more tractable. The aforementioned deficiencies identified are clearly not restricted to context menu, toolbars and toolboxes alone. There is also the broader issue of how to better utilize existing mediums or products to facilitate efficiency, ease of use and accuracy. 
     There is a need for an efficient, scalable, user friendly and robust technique to enable direct manipulation of image visualization parameters, provide access to other image related records, and enable modification and addition to measurement parameters while also providing access to toolbars and toolboxes. 
     The present invention fills these needs as well as other needs. 
     SUMMARY OF THE INVENTION 
     The present invention is directed to active annotated image overlays and providing access to features and functions of an imaging review system. The present invention provides the ability to “overload” current text and graphic annotations that are already displayed within an image of interest. Some of these annotations may be missing from certain images due to non-compliant DICOM modalities or non-DICOM images in general. The present invention includes automated and semi-automated generation of these annotations and their subsequent overloading. 
     More specifically, the present invention provides visual shortcuts to program functions, direct access to other images or relational information, and rapid selection of preferred image slices. 
     Even further, the present invention provides quick access to predetermined and often utilized menu item selections, in response to the user hovering over a particular region of the image containing an overloaded static text or graphics overlay. 
     Further still, the present invention enables the modification of information pertaining to image visualization, the image object and image measurements, without the need to search for menu items, and be distracted from the image of interest. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The above-mentioned and other features and advantages of this invention, and the manner of attaining them, will become apparent and be better understood by reference to the following description of the invention in conjunction with the accompanying drawings, wherein: 
         FIG. 1  is a block diagram illustrative of an image display in a PACS, to which the present invention would apply and be implemented; 
         FIG. 2A  is a screen shot of a window as displayed by a PACS showing an image along with the various text and informational items that are presented to a user; 
         FIG. 2B  is a screen shot of the window of  FIG. 2 , wherein the user has selected an active field and a text edit is displayed; 
         FIG. 3  is a screen shot of the window of  FIG. 2 , wherein the user has hovered over another active field causing the value to be highlighted and available values selections are displayed in a dropdown list; and 
         FIG. 4  is a block diagram generally illustrating a computing environment in which the invention may be implemented. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Generally, the tools and methods described herein for creating and implementing the active overlays to access, manipulate, and otherwise interact with images may be implemented in hardware, software or a combination thereof. 
     This document is organized as follows. In the first section, an overview of the techniques and implementation as provided by an exemplary PACS are provided and described. In the next section, an exemplary implementation of the present invention to access and manipulate attributes of an image series displayed in a tile window is discussed. Following this, other aspects of the invention as they pertain to accessing other features of the PACS, including manipulating the image window and images are discussed, along with the operational function of the present invention. Finally, an exemplary computer environment for the implementation and use of the invention is described. 
     The present invention provides a system and methodology to imbed the ability for user interaction with images, within image annotations. Although the following discussion and the present invention are described in relation to a biological imaging system (i.e., PACS), it should be understood that the invention is also applicable to other information/imaging technologies and systems. Such systems include those wherein image manipulation, image attributes and features of an imaging system are required to be intuitively and easily accessible to users, including non-medical systems, visual analysis and diagnostic tools, and other visual user interface environments. 
       FIG. 1  is a block diagram of an exemplary window of a PACS that illustrates an operational interface environment for application of the present invention. The illustrated window  100  represents a screen from a PACS, containing an image  102 , along with various other information and annotations. The information and annotations are generally stored as meta-data associated with the image  102 . Image  102  can include multi-spectral images, multi-modal (fusion) images, animations, or videos, and other textual clinical documents, such as radiology reports (structure or unstructured), lab results, pathology reports. The meta-data that is associated with image  102  can be thought of as belonging to three categories, namely: (1) information related to visualization of an image; (2) information related to the imaged object; and (3) measurements associated with the image. 
     Information related to visualization of an image includes such things as layout, pose (flip, rotation, pan, zoom), nature and position of artificial or assumed light (radiation, elasticity or sound among others) sources with respect to the imaged object(s), assumed light reflecting characteristics of imaged object(s), image rendering geometry and related characteristics (image thumbnail, key-image indicators, cut-plane location, slice thickness, frame rate, Maximum Intensity Projection, Volume rendering, MPR), color or gray-scale balance, color palette choice and association with image artifacts (Pixel or voxel value(s), velocities), segmentation map, specialized image processing parameters, field of view, frame-rate, image quality based on the level of data compression, quality of rendering (early ray tracing, empty space skipping), and level of image blending (PET-CT). 
     Information related to the imaged object includes name and location (monument name, person&#39;s name and unique id, body part, address and/or GPS coordinates of the image target), kind of image (X-ray, paysage, nature, family photo), date and time, link to and information about other related images and documents (letters, reports etc., Dicom Structured Reports, Dicom GSPS objects). 
     Measurements associated with the image include image histogram, optical density, region of interest size and boundaries (size of field associated with certain type of plantations, tumor sizes and boundaries, left ventricle size, ejection fraction ratio), velocity or flow rate (left ventricle ejection fraction, intravascular ultrasound based blood flow measurement, object tracking), pixel coordinates, image registration offset (PET/CT registration, offset between satellite and map views), pixel value, text or graphic annotations associated with regions of interest within the image (street name, Computer Aided Detection or Diagnosis findings, image number (if one of many in a stack of images), image based simulation (simulated placement of an orthopedic implant). 
     It is common that the meta-data associated with any of these three categories is displayed as static textual or graphical image overlays within dedicated applications designed to visualize the images, such as shown in the application window  100 . As shown, static textual annotations  104  to  168 , generally referred to herein as text annotations  103 , and graphical annotation  170 , overlay the image  102  and provide meta-data information to an end user. An end user of PACS needs to manipulate the image  102  or otherwise access both the displayed and other meta-data parameters and values. In general, the most relevant meta-data information is presented as an image annotation. The tools to modify or manipulate the values associated with these text annotations  103  exist within a specialized computer application and are made available to the user via functionalities within a toolbar, toolbox, keyboard shortcuts, mouse buttons and/or touch-screen device. However, the present invention circumvents this requirement and provides access to the tools, directly via the annotations  103  themselves. 
     Specifically and as shown in  FIG. 1 , the window  100  includes a number of annotative texts  103 . These annotations  103  are shown in the drawing figures and described herein as having relative positions in the window  100  merely for illustrative and explanatory purposes only. As would be appreciated by one skilled in the art such text and or images may be located anywhere within the window  100 . Suffice it to say that certain values and information that are relevant and useful to the end user are displayed as overlay annotations on the image  102 . In the upper left corner of the screen a first grouping of textual annotations, identified in table 1 along with a description and label number may be displayed relative to the image  102 . 
     
       
         
               
               
               
               
             
           
               
                   
                 TABLE 1 
               
               
                   
                   
               
               
                   
                 Annotation Text 
                 Description 
                 Label 
               
               
                   
                   
               
             
             
               
                   
                 John Doe 
                 (patient name) 
                 104 
               
               
                   
                 45123456 
                 (patient ID) 
                 106 
               
               
                   
                 Feb. 7, 1957 
                 (birth date) 
                 108 
               
               
                   
                 42 YEAR 
                 (age) 
                 110 
               
               
                   
                 M 
                 (gender) 
                 112 
               
               
                   
                   
               
             
          
         
       
     
     In the upper right corner of the window  100 , a second grouping of textual annotations as identified in table 2 may be displayed. 
     
       
         
               
               
               
               
             
           
               
                   
                 TABLE 2 
               
               
                   
                   
               
               
                   
                 Annotation Text 
                 Description 
                 Label 
               
               
                   
                   
               
             
             
               
                   
                 Darien Diagnostic Imaging 
                 (institution name) 
                 114 
               
               
                   
                 MR 
                 (procedure description)  
                 116 
               
               
                   
                 Series Description 
                 (series description) 
                 118 
               
               
                   
                 Nov. 24, 1998 13:17 
                 (date, time) 
                 120 
               
               
                   
                 12345678 
                 (accession number) 
                 122 
               
               
                   
                 — 
                 (contrast/bolus agent) 
                 124 
               
               
                   
                 Blank 
                 (blank) 
                 126 
               
               
                   
                 LOC: 32 
                 (slice location) 
                 128 
               
               
                   
                 THK: 6 SP: 2 
                 (slice thickness, slice  
                 130 
               
               
                   
                   
                 spacing) 
                   
               
               
                   
                 HFS 
                 (patient position) 
                 132 
               
               
                   
                   
               
             
          
         
       
     
     In the lower right corner of the window  100 , a third grouping of textual annotations as identified in table 3 may be displayed. 
     
       
         
               
               
               
               
             
           
               
                   
                 TABLE 3 
               
               
                   
                   
               
               
                   
                 Annotation Text 
                 Description 
                 Label 
               
               
                   
                   
               
             
             
               
                   
                 9-INCH GP 
                 (coil type) 
                 134 
               
               
                   
                 NEX: 0.75 
                 (Number of Excitations) 
                 136 
               
               
                   
                 EC: 1 
                 (echo number) 
                 138 
               
               
                   
                 GR 
                 (scan sequence) 
                 140 
               
               
                   
                 FA: 60 
                 (flip angle) 
                 142 
               
               
                   
                 TR: 33.33 
                 (repetition time) 
                 144 
               
               
                   
                 TE: 8 
                 (echo time) 
                 146 
               
               
                   
                 AQM: 128\256 
                 (Acquisition Matrix) 
                 148 
               
               
                   
                 Blank 
                 (blank) 
                 150 
               
               
                   
                 Page: 1 of 2 
                 (page number, total pages) 
                 152 
               
               
                   
                   
               
             
          
         
       
     
     In the lower right corner of the window  100 , a second grouping of textual annotations as identified in table 3 may be displayed. 
     
       
         
               
               
               
               
             
           
               
                   
                 TABLE 4 
               
               
                   
                   
               
               
                   
                 Annotation Text 
                 Description 
                 Label 
               
               
                   
                   
               
             
             
               
                   
                 SEG: MPVR 
                 (segment) 
                 154 
               
               
                   
                 PR: 
                 (preset) 
                 156 
               
               
                   
                 Z: 3.19 
                 (zoom) (monitor res at 1152 × 864) 
                 158 
               
               
                   
                 C: 203 
                 (window center) 
                 160 
               
               
                   
                 W: 503 
                 (window width) 
                 162 
               
               
                   
                 DFOV: X x Y cm 
                 (Displayed Field of View in cm) 
                 164 
               
               
                   
                 Blank 
                 (lossy image compression ratio) 
                 166 
               
               
                   
                 IM: 56 SE: 1 
                 (image number, series number) 
                 168 
               
               
                   
                   
               
             
          
         
       
     
     For the sake of brevity, and because the particulars of each of the annotated texts  103  is not critical to an understanding of the present invention, the details for each of the annotations  103  will not be discussed in detail herein. However, a few examples of the annotated texts  103  will be described to convey the concept, implementation and advantages of the present invention. 
     For example, the current zoom factor of the currently displayed image  102  is represented by the annotated text field Z  158  having a value of 3.19. The image positioning, represented by center annotated text C  160 , and width annotated text field W  162  and having values of 203 and 503 respectively, represents the relative position of the image  102  within the window  100 . As the view or position of the image  102  is manipulated, the text overlay fields  158 ,  160 ,  162  are updated with corresponding values. 
     As can be appreciated from the number of annotated texts  103 , the numbers of other capabilities respecting the image  102  that fall into the aforementioned three categories of image related meta-data parameters, are rather large. As such it would be difficult for a user to navigate through icons, context menus, and through hierarchies to find the right command to achieve a desired function on an image  102 . The use of dedicated hot keys has heretofore been the preferred way for advanced user to access the available functions. However, this approach has drawbacks of its own. The large number of commands along with environments that require simultaneous use of other input devices such as, dictation equipment or the use of low light levels to clearly view a keyboard make it difficult for a user to find the right short cut or hot key strokes. Attempts to overcome some of these shortcomings have included the use of backlit keyboard keys such as those designed for computer garners. However, these solutions tend to introduce a level of light that can interfere with the required adaptation of receptors in the human eye and can impede the user&#39;s ability to properly do their job, such as in radiological image review. 
     For repetitive tasks that require expedient review and manipulation of a large number of images, the use of a right mouse-click context-menu, toolbar and toolbox becomes less efficient since the user needs to take the user&#39;s attention away from the actual image. This is especially true in environments that require the use of multiple input devices such as a dictation microphone, a canvas or a keyboard. The diverted attention result in context switching in the visual task and possibly interferes with the eye&#39;s innate ability to adapt to the light balance within the target images. In applications such as those involving visual target detection (mine detection, or screening of pathology images or of breast mammograms), such distractions may result in loss of concentration, which in turn may lead to catastrophic errors and/or diminished operator productivity. 
     The present invention introduces a number of concepts and a unique paradigm for accessing information, features and functions of a PACS in connection with image visualization, review and analysis. However, as would be appreciated by one skilled in the art, the invention may be applicable to other Image processing and implementations, the references and discussion provided herein are strictly for illustrative purposes and are not intended to limit the scope of the invention. The present invention is described with reference to an embodiment wherein access is provided to perform functions on medical images, by overloading the previously described text annotations  103  as well as graphic annotations  107  that are displayed within an image  102  of interest. 
     With continued reference to  FIG. 1 , the current invention converts static image overlays to active overlays thereby enabling direct manipulation of image visualization parameters, easy access to other records related to the image, modification and additions to existing measurement values, and direct access to relevant functionalities imbedded within toolbars and toolboxes. Since all annotations are not necessarily active any number of indicia may be provided to indicate an active element. One method to indicate that an element is active is to display a different font style, type and size. Active graphical overlays also provide a different indication such as, when hovering over the active overlay graphic (could be text as well) results in the active overlay flashing, vibrating or being encircled by a line etc. This indication of an active element may occur after a predetermined delay. This behavior is configurable by each user and can be muted globally or per overlay element. In another embodiment of the present invention, a “TAB” function is provided. The TAB function enables the display of all active overlays in an image tile one after another. In operation, the manipulation of the view, position or other attribute of the image  102  is accomplished by directly manipulating the displayed annotated image parameters, such as by editing the text overlay fields  158 ,  160 ,  162  of the earlier described scenario. The overlay fields  158 ,  160 ,  162  are presented as active overlays in the present invention. 
     Active overlay as used herein describes a new complex image based user interface. Depending on the operation to be performed, it incorporates different types of low-level user interaction. In the preferred embodiment of the present invention, the implemented prototype highlights a field when the mouse pointer is over the object or of interest. An edit box is then displayed for text input after the mouse is clicked or the object is otherwise selected. Provided that the text input is accepted, the affected field value is changed via the appropriate operation. Depending on the field, other types of user interaction and operations can be done. For example, the highlighting can be replaced with the placement of ticker lines and bold fonts to signal the selected field of interest. 
     In an embodiment of the present invention, the implementation of an active overlay occurs in various files. First, in order to make a field active, the field is flagged in the text overlay template. Second, the low level user interface must know the bounding rectangle of the field on the view. And third, in order to update the field value, the field property and operation must be available as a context menu, toolbar or toolbox option or other PACS operation. 
     In another embodiment of the present invention, when the user moves the mouse over any rectangle that is in the Active Field, that rectangle is highlighted in red (an arbitrary user configurable color or these fields can be indicated by increased line thickness and/or bold fonts). Nothing else occurs unless the user then clicks the left mouse button. When the user presses the left mouse button when over an active rectangle, an edit control is created and placed over this rectangle so that the text is exactly aligned. Editable text field even some graphical annotation can be associated with a dropdown list of preset choices that can be displayed in addition or in lieu of the text field making it easier for the user to select a preset value. 
     Direct manipulation of visualization parameters in this context means hovering over the active overlay area by means of a mouse, gesture, canvas or touch sensitive screen and selecting from the drop down menus (this may require a right mouse click after the area becomes active following a pause threshold) or directly editing the text fields based on the annotation context (this may require a mouse click on the text portion of after the overlay becomes active). Easy access to other records, for example, may include the use of the date overlay field  120  to display a list of historical and related images or documents upon activation. This list can be in the form of thumbnails or a timeline. The active overlay may then enable the operator to select a subset of historical studies and display the studies next to each other according to a user specified layout. 
     Thus, each of the annotated texts  103  and the annotated graphics  170  are active fields that overlay the image  102 . In other words, when the user, utilizing a mouse or other pointing device, hovers over the annotated text  103  or graphics  107 , a user interface hint is provided and the click of a mouse button will result in an action or response by the PACS. In operation, for any field that is designated as active, bold fonts and grid lines or color may be used to differentiate between the active and regular overlays. The active overlays are preferably customizable by user on a roaming profile basis in a computer network. 
     In the preferred embodiment of the present invention, a user is able to interact with the image  102 , by utilizing the active annotations  103 ,  107 . In effect, this allows a user, in the case of the previously described image positioning values, to not just read static numeric values, but to actually hover over and click the requisite values C  160  or W  162  and edit the entries, thereby manipulating the window/level of the image  102 . This operation is in sharp contrast to manipulating the window/level by using the mouse or hunting for the appropriate menu context and command to adjust the image  102 . An advantage of the present invention is that it also allows the user to reach a desired value directly, instead of trying to adjust to reach a desired value via mouse movements, which are less precise when an exact window/level value is desired. For example, in a situation where a user needs to have the same level of magnification (Zoom) in order to more accurately compare multiple images, the ability to provide a precise value greatly simplifies and expedites the process. 
     In a further embodiment of the present invention, a user may hover over an active overlay such as a CAD marker and be presented with a menu from which a selection can be made for an appropriate workflow action. 
     In an even further embodiment, the present invention provides the ability to activate the Anterior (A)  108   a , Posterior (P)  108   b , Right (R)  108   c  and Left (L)  108   d  markers, which are typically displayed to indicate the direction of an X-ray imaging procedure. The activated markers  108  of the present invention enable a user to flip the image  102  as desired. Selection of the A  108   a , or P  108   b  markers would flip the image  102  around a vertical axis, while selection of the R  108   c , or L  108   d  markers would flip the image around a horizontal axis. Further still, hovering over any of these markers  108 , would display activated overlay double headed arrows  110 . Clicking or otherwise selecting one head of arrow  110  would rotate the image  102  ninety degrees in the corresponding direction of the user selected arrow  110  head. 
     In yet another embodiment the, present invention provides a mechanism whereby a slice number  164 , may be edited to allow a direct jump to a specified slice in a stack of images, thereby eliminating any sequential pagination to reach the desired slice. A drop down menu may also be displayed to enable the user to jump to a particular anatomy or to the bottom or top of a stack. 
     In a further embodiment, when editing of the zoom Z field  158 , clicking on the active overlay or hovering over the field displays a drop down list of pre-configured selections such as, 0.5*True size, 2*True size; etc. This enables a form of ‘short-cut’ to a desired zoom level or factor. 
     In an even further embodiment, user inputs into active overlay fields are validated against bounds for the current filed property. When a provided entry is out of bounds, the image remains unmodified and the active field reverts to the previous valid entry. 
     To further illustrate the features and benefits of the present invention, a screen shot of a window as displayed in a PACS depicting an image of a gated thorax abdominal aorta is next described with reference to  FIG. 2 . As shown, the window  200  includes various text annotations  203  and informational items that are presented to a user, along with a graphical annotation  270 . The image  200  and annotations  203 ,  270  are consistent with those shown and earlier described with reference to  FIG. 1  and are similarly labeled. A different prefix number is used in the labeling of each figure merely to indicate the relevant drawing figure. For example, the zoom field of  FIG. 1  is identified as  158 , and the zoom field of screen shot of  FIG. 2  is identified as  258 . 
     The graphical annotation  270  illustrates an entire subject region and the location of the slice that is currently displayed as image  202 . Of particular interest in  FIG. 2A , is the center field  260 , which is shown in a red box. This view is representative of a user having hovered over the center field  260 . As previously described, the outlining of the field  260  provides an indication to the user that the field is an active field that is responsive to a click or other selection by the user. 
     When the field  260  is selected, a text edit is displayed as shown in  FIG. 2B . Notably, all of the text, i.e. “30”, is selected so that user can immediately start typing a new value. As previously described, the newly typed value is bound checked and if accepted would result in an appropriate modification of the image  202 . 
     In  FIG. 3 , a slight variation results from the selection of a different type of an active field, namely the preset field  356 . As with  FIGS. 2A and 2B , the image  300  and annotations are consistent with those shown and earlier described with reference to  FIG. 1  and are similarly labeled. A different prefix number is used in the labeling merely to indicate the relevant drawing figure. For example, the SEG field  154  of  FIG. 1 , and the SEG field  354  of screen shot of  FIG. 3  refer to the same field in a different view. As shown in the screen shot of the window of  FIG. 3 , when the user hovered over the active preset field PR  356 , the value is highlighted and available values selections are displayed in a dropdown list  372  below the PR field  356  rather than highlighting the field. This option provides the user an alternative method of providing a new parameter as opposed to typing one in. The list  372  allows the user to select from one of Bone, Abdomen, Lung, Head, or Display as acquired. 
     Having described the system and method of the present invention and an embodiment thereof, an exemplary computer environment for implementing the described design and execution is presented next. 
       FIG. 4  shows an exemplary computing environment  400  that can be used to implement any of the processing thus far described. The computing environment  400  may comprise a computer  412  including a system bus  424  that couples a video interface  426 , network interface  428 , one or more serial ports  432 , a keyboard/mouse interface  434 , and a system memory  436  to a Central Processing Unit (CPU)  438 . Computer  412  may also include a Graphics Processing Unit (GPU) or one or more other special or general purpose processing units. A monitor or display  440  is connected to bus  424  by video interface  426  and provides the user with a graphical user interface to view, edit, and otherwise manipulate digital images. The graphical user interface allows the user to enter commands and information into computer  412  using a keyboard  441  and a user interface selection device  443 , such as a mouse or other pointing device. Keyboard  441  and user interface selection device are connected to bus  424  through keyboard/mouse interface  434 . The display  440  and user interface selection device  443  are used in combination to form the graphical user interface which allows the user to implement at least a portion of the present invention. Other peripheral devices may be connected to computer through serial port  432  or universal serial bus (USB) drives  445  to transfer information to and from computer  412 . For example, CT scanners, X-ray devices and the like may be connected to computer  412  through serial port  432  or USB drives  445  so that data representative of a digitally represented still image or video may be downloaded to system memory  436  or another memory storage device associated with computer  412  to enable processes and functions in accordance with the present invention. 
     The system memory  436  is also connected to bus  424  and may include read only memory (ROM), random access memory (RAM), an operating system  444 , a basic input/output system (BIOS)  446 , application programs  448  and program data  450 . The computer  412  may further include a hard disk drive  452  for reading from and writing to a hard disk, a magnetic disk drive  454  for reading from and writing to a removable magnetic disk (e.g., floppy disk), and an optical disk drive  46  for reading from and writing to a removable optical disk (e.g., CD ROM or other optical media). The computer  412  may also include USB drives  445  and other types of drives for reading from and writing to flash memory devices (e.g., compact flash, memory stick/PRO and DUO, SD card, multimedia card, smart media xD card), and a scanner  450  for scanning items such as still image photographs to be downloaded to computer  412 . A hard disk interface  452   a , magnetic disk drive interface  454   a , a optical drive interface  456   a , a USB drive interface  445   a , and a scanner interface  458   a  operate to connect bus  424  to hard disk drive  452 , magnetic disk drive  454 , optical disk drive  456 , USB drive  445  and a scanner  458 , respectively. Each of these drive components and their associated computer-readable media may provide computer  412  with non-volatile storage of computer-readable instruction, program modules, data structures, application programs, an operating system, and other data for the computer  412 . In addition, it will be understood that computer  412  may also utilize other types of computer-readable media in addition to those types set forth herein, such as digital video disks, random access memory, read only memory, other types of flash memory cards, magnetic cassettes, and the like. 
     Computer  412  may operate in a networked environment using logical connections with image capture devices such as MRI, CT scanners, Ultrasound, Positron Emission Tomography (PET) or X-ray devices. Network interface  428  provides a communication path  460  between bus  424  and network  402 , which allows images to be communicated through network  402  from any of the previously identified imaging devices, and optionally saved in a memory, to the computer  412 . This type of logical network connection is commonly used in conjunction with a local area network (LAN). Images may also be communicated from bus  424  through a communication path  462  to network  402  using serial port  432  and a modem  464 . Using a modem connection between the computer  412  and imaging devices may be used in conjunction with a wide area network (WAN) or the internet. It will be appreciated that the network connections shown herein are merely exemplary, and it is within the scope of the present invention to use other types of network connections between computer  412  and any imaging devices including both wired and wireless connections. 
     The present invention provides a useful, novel and non-obvious means to enable access to context menu, keyboard short-cuts and mouse button/movement combination functionalities within a diagnostic workstation through the use of relevant annotations that have been historically displayed along-side images but did not provide any capability for user interaction. By making the annotations active, several advantages are provided to the user, not the least of which is that the user does not need to divert attention away from the image and by so doing can increase his/her productivity. 
     From the foregoing, it will be seen that this invention is one well adapted to attain all the ends and objects hereinabove set forth together with other advantages which are obvious and which are inherent to the method and apparatus. It will be understood that certain features and sub combinations are of utility and may be employed without reference to other features and sub combinations. This is contemplated by and is within the scope of the claims. Since many possible embodiments of the invention may be made without departing from the scope thereof, it is also to be understood that all matters herein set forth or shown in the accompanying drawings are to be interpreted as illustrative and not limiting. 
     The constructions described above and illustrated in the drawings are presented by way of example only and are not intended to limit the concepts and principles of the present invention. As used herein, the terms “having” and/or “including” and other terms of inclusion are terms indicative of inclusion rather than requirement. 
     While the invention has been described with reference to preferred embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof to adapt to particular situations without departing from the scope of the invention. Therefore, it is intended that the invention not be limited to the particular embodiments disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope and spirit of the appended claims.