Education and Reference Guide

General
Copyright © 1997 - 2014 Vital Images, Inc. All rights reserved. Date of Publication 10-2014
VitreaWorkstation™ protected by U.S. Patents 5,986,662; 6,130,671; 6,219,059; 7,031,504; 7,136,064; 7,362,329; 7,574,029;
7,590,272; 7,660,481;7,929,748;7,991,210; 8,214756; 8,249,687 Other Patents Pending in the U.S. and other countries.
VitreaAdvanced® protected by U.S. Patents 5,986,662; 6,130,671; 6,219,059; 7,031,504; 7,136,064; 7,362,329; 7,574,029;
7,590,272; 7,660,481;7,929,748;7,991,210; 8,214756; 8,249,687 Other Patents Pending in the U.S. and other countries.
VitreaCore™ protected by U.S. Patents 5,986,662; 6,130,671; 6,219,059; 7,039,723; 7,136,064; 7,362,329; RE42,952; Other Patents
Pending in the U.S. and other countries.
VitreaView® protected by U.S. Patents 6,130,671; 6,219,059; 7,136,064; and 7,362,329. Other Patents Pending in the U.S. and other
countries.

VPMC-13501 B VitreaAdvanced - VitreaWorkstation General Education and Reference Guide

This publication is valid for VitreaAdvanced 6.7.1, Vitrea fX 6.7.1, and Vitrea Enterprise Suite (VES) 6.7.1 and later software versions.
No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic or
mechanical, including photocopying and recording, or by any information storage or retrieval system without permission in writing from
Vital Images.
Trademarks
Vital Images, Vitrea, VitreaAdvanced, VitreaExtend, VitreaView, ViTAL, and ViTAL U are registered trademarks of Vital Images, Inc.
All other marks are property of their respective owners.
Restricted Rights Legend
If this software or documentation is delivered to the Department of Defense (DOD) of the U.S. Government, it is delivered with Restricted
Rights as follows:
Use, duplication or disclosure of the software by the U.S. Government is subject to restrictions as set forth in subparagraph (c)(l)(ii) of the
Rights in Technical Data and Computer Software clause at DFARS 252.227-7013.
If this software or documentation is delivered to any unit or agency of the U.S. Government other than DOD, it is delivered with Restricted
Rights and use, duplication or disclosure by the U.S. Government is subject to the restrictions as set forth in FAR 52.227-19 (b)(3). If the
software or documentation is delivered to NASA, it is delivered with Restricted Rights subject to the restrictions set forth in 18-52.227-
86(d) of the NASA FAR Supplement.
Limits of Liability and Disclaimer of Warranty
VITAL IMAGES SHALL HAVE NO LIABILITY OF ANY KIND FOR ANY DIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES BASED
ON ANY DEFECT, FAILURE OR MALFUNCTION OF THE SOFTWARE,OR USE OF ANY VITAL IMAGES DOCUMENTATION, WHETHER
THE CLAIM IS BASED UPON WARRANTY, CONTRACT, TORT OR OTHERWISE. VITAL IMAGES MAKES NO WARRANTY, EXPRESS OR
IMPLIED, INCLUDING BUT NOT LIMITED TO, ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE
WHETHER ARISING FROM STATUTE, COMMON LAW, CUSTOM OR OTHERWISE.
Notice of Confidentiality
This software and the information in this software including, but not limited to, the ideas, concepts and know-how are proprietary,
confidential and trade secret to Vital Images, and the information contained therein shall be maintained as proprietary, confidential and
trade secret to Vital Images and shall not be copied or reproduced in any form whatsoever. This software and any information contained
therein shall not be disclosed to anyone other than authorized representatives of the user's employer, who is contractually obligated not to
disclose same without the express written consent of Vital Images. The user of this software and any information contained therein shall
not attempt to discern Vital Images' confidential and trade secret information and shall not reverse compile, disassemble, or otherwise
reverse engineer this software or any information contained therein.
Software License Notice
This software is a licensed product of and is distributed by Vital Images, and may only be used according to the terms of that license on
the system identified in the License Agreement. In the event of any conflict between these terms and the terms of any written agreement
or agreement assented to through electronic means with Vital Images, the terms of such written or assented agreement shall control.

Australian Sponsor: Australian Sponsor:

CELEO Pty Ltd Toshiba Australia Pty Ltd
15 Alvarado Court PO Box 350
Broadbeach Waters, QLD 4218 North Ryde, NSW 1670
Australia Australia

MDSS GmbH
Schiffgraben 41
30175 Hannover, Germany

CELEO Pty Ltd. and Toshiba Australia Pty Ltd are authorized sponsors in Australia and act on behalf of Vital Images, Inc. in the
communication of safety-related incidents and regulatory matters with Therapeutic Goods Administration in Australia. Distributors are still
the first line of communication with their customers regarding service and complaints.

Manufactured by: Vital Images, Inc.; 5850 Opus Parkway, Suite 300; Minnetonka, MN, US; 55343; Phone 866.433.4624

iii
VPMC-13501 B
Safety and Regulatory
Considerations
PLEASE REFER TO THE ABOUT VITAL IMAGES MEDICAL IMAGING
SOFTWARE DOCUMENT BEFORE USING THIS PRODUCT. This
document includes important information regarding general Vitrea Safety
and Regulatory considerations.

CAUTION: Federal law restricts this device to sale by or on the order of a

physician, as directed by 21 CFR 801.109(b)(1).

Contact Us
• For general, non-technical support questions, contact us through our
Web site: [Link].
• For customer technical support, contact us:
• In the U.S., call the Customer Support line at 1.800.208.3005.
• Outside the U.S., contact your Vital distributor.
• Send an email to support@[Link].
• For a printed version of the Release Notes, Education and Reference
Guide, or Installation Guides, contact Customer Support at
1.800.208.3005.

Release Notes
Vitrea Release Notes contain late-breaking information not available at the
time the Education and Reference Guide was released. This document is
available from your System Administrator or from Vital Images.

iv
VPMC-13501 B
Table of Contents
Safety and Regulatory Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Contact Us. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Release Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Introduction to VitreaAdvanced® & VitreaWorkstation™

9
Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
VitreaAdvanced and VitreaWorkstation Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
User Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Vital U . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Vitrea Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
The Study Directory Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
VitreaAdvanced Study Directory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
VitreaWorkstation Study Directory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Filtering Small Volumes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
The Gallery Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
The Viewer Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Analysis Tab Controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Visual Tab Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Batch Tab Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
The Report Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
The Review Window (VitreaWorkstation only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Additional Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Select a Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Loading Studies Through the Data Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Loading Studies into VitreaWorkstation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Loading Studies Through a PACS Integration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Loading Studies into VitreaCore . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Common Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Getting Started. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Table of Contents v
VPMC-13501 B
 Study Directory Tasks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Using the Vitrea Enterprise Suite Patient List . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Using the Data Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Using the VitreaWorkstation Patient List. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Gallery Window Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Viewer Window Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
2D Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
MPR Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
3D Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Image Batches and Movies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Study Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Study Viewer Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Study Viewer Image Control Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
Study Viewer Cine Mode Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Study Viewer Mouse Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Study Viewer Display Options and Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Study Viewer Keyboard Shortcuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

Distribute Findings. . . . . . . . . . . . . . . . . . . . . . . . . . . . 161

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Distribute Findings Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
The Report Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
The Review Window
(VitreaWorkstation only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Ortho (Joint Disarticulation) . . . . . . . . . . . . . . . . . . . . 179

Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Ortho Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Ortho Lesson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Additional Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Softread . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Softread Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
Loading Studies into Softread . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Buttons, Tools, and Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Keyboard Shortcuts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196

vi Table of Contents
VPMC-13501 B
 Working in Softread . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Assigning Mouse Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Mouse Function Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
Mouse Functions Palette . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Using the Ruler Tool. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Rulers, Angles, and Geometric ROIs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Basic Workflow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Scenarios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
Basic MR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208
Advanced MR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Lumbar MR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Nuclear Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Comparative Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Setting Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Viewing Findings (Key Images) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Closing Softread. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227

Table of Contents vii

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viii Table of Contents
VPMC-13501 B
Introduction to
VitreaAdvanced & ®

VitreaWorkstation™

Contents
• VitreaAdvanced and VitreaWorkstation Overview
• Vitrea Windows
• The Study Directory Window
• The Gallery Window
• The Viewer Window
• The Report Window
• The Review Window (VitreaWorkstation only)
• Additional Information

VitreaAdvanced and
VitreaWorkstation Overview
Vitrea® software is an advanced visualization solution from Vital that
creates 2D, 3D, and 4D images of human anatomy from CT (computed
tomography) and MR (magnetic resonance) image data. With this tool,
physicians can easily navigate within these images to better understand
disease conditions. The VitreaAdvanced and VitreaWorkstation products

Introduction to VitreaAdvanced® & VitreaWorkstation™ 9

VPMC-13501 B
 address specialists’ needs through various software options for cardiac,
colon, vessel probe, and other applications. In addition, VitreaAdvanced
software utilizes an intuitive clinical workflow and automatic settings to
improve speed and simplicity.

With VitreaAdvanced and VitreaWorkstation, you can do the following

things:

• Communicate with configured DICOM (Digital Imaging and

Communications in Medicine) devices to retrieve and export patient
data
• Load one or multiple CT or MR volumes for a patient
• Select from a gallery of predefined clinical viewing protocols
• Adjust visualization parameters to enhance images
• Review multiple image files in 2D, side-by-side views
• Measure regions of interest
• Locate and observe points of interest, using a mix of MPR (Multi-
Planar Reformatted), 2D, and 3D images
• Trim with 3D and 2D segmentation to focus images on regions of
interest
• Fly through or around anatomical images
• Save snapshots highlighting regions of interest for saving to PACS or
to a printable, Intranet-ready report
• Capture image sequences in batches to create printed reports or
make Intranet-ready digital movies

User Help

Click the Help tab at the bottom of the VitreaAdvanced window to access
the Learning Resources Help.

To view the .pdf files, you need to have Adobe Reader.

10 Introduction to VitreaAdvanced® & VitreaWorkstation™

VPMC-13501 B
Vital U

Vital U offers courses in a variety of settings to accommodate multiple

learning preferences and schedules. We provide education at the Vital U
customer education center, in cities around the U.S., at your facility, and
on our Web site.

Learn advanced visualization software in our dedicated classroom or at a

traveling classroom in a city near you. You can also bring a program to
your facility and customize your education to your specific workflow. Our
Web site offers distance learning through Vital U Live webinars and
eLearning content that’s available anytime.

In addition to our standard clinical applications, we offer specialty courses

for applications in oncology, neurology, virtual colonoscopy, and
cardiology. Select courses offer CME and CE credits to U.S. based
physicians and technologists.

Call the Vital U education coordinator at 952.487.9559 or e-mail

vitalu@[Link] to register for in-house, on-site, road show, or for
any other education-related questions.

Classroom Learning
Fundamentals for Advanced Visualization Software

This three-day post-processing course teaches the fundamentals of

Vitals’ advanced visualization software that creates 2D, 3D, and 4D
images of human anatomy. Participants receive an overview of the variety
of applications and disciplines within the software including cardiac,
peripherals, EP Planning, lung, tumor, joint disarticulation, perfusion,
pulmonary, and renal. Learn to manipulate 2D and 3D images, including
multi-planar reformatting (MPR), maximum intensity projection (MIP) and
volumes, through hands-on exercises delivered by experienced Vital U
clinical applications instructors. U.S. -based physicians and technologists
can earn CME and CE credits from this course.

Introduction to VitreaAdvanced® & VitreaWorkstation™ 11

VPMC-13501 B
 Each course module reinforces Vital U’s standardized learning
methodology with step-by-step instruction for image acquisition, protocol
assignment, case analysis, and image distribution.

Fundamentals for VitreaCore

This one-day post-processing course teaches the fundamentals of

VitreaCore software that creates 2D and 3D images of human anatomy.
Participants receive an overview of the variety of applications and
disciplines within the software including basic 3D, MPR, PET/CT, and
Vessel Probe. Learn to manipulate 2D and 3D images, including multi-
planar reformatting (MPR), maximum intensity projection (MIP) and
volumes, through hands-on exercises delivered by experienced Vital U
clinical applications instructors.

Each course module reinforces Vital U’s standardized learning

methodology with step-by-step instruction for image acquisition, protocol
assignment, case analysis, and image distribution.

Distance Learning
Register for a schedule of live webinars demonstrating Vital software,
while a physician or clinical applications instructor answers your
questions. You can also explore a library of recorded webinars at your
convenience. View the schedule of dates and topics or register at
[Link].

Administrator Education
This course is designed for IT professionals, PACS Administrators, field
engineers, or anyone who services, installs or supports Vitals’ advanced
visualization software. This course will teach your designated Vital
software administrator how to get the most out of Vitrea by fully
integrating it with your medical imaging systems. For more information,
contact the Vital U education coordinator at 952.487.9559 or e-mail
vitalu@[Link].

12 Introduction to VitreaAdvanced® & VitreaWorkstation™

VPMC-13501 B
On-site Learning
Any of our educational programs can be brought to your facility. Our
experienced applications instructors meet your learning needs by bringing
Vital U courses and hardware, if needed, to your site. On-site learning
customizes your education program to the specific workflow of your
physicians and technologists.

Customized Options
Packages include multi-user and multi-session formats to meet your
learning needs. To design your customized education program, contact
the Vital U education coordinator at 952.487.9559 or e-mail
vitalu@[Link].

Vitrea Windows
Tabs
Navigate through the VitreaAdvanced windows by selecting the
appropriate tab located at the bottom of the screen.

VitreaWorkstation Tabs

VitreaAdvanced Tabs

TIP: The Gallery and Back tabs become active when a patient study is
loaded.

Introduction to VitreaAdvanced® & VitreaWorkstation™ 13

VPMC-13501 B
The Study Directory Window
When you start Vitrea, the Study Directory opens.

If your Study Directory looks like this, go to the

VitreaAdvanced Study Directory on page 15:

If your Study Directory looks like this, go to

VitreaWorkstation Study Directory on page 21:

14 Introduction to VitreaAdvanced® & VitreaWorkstation™

VPMC-13501 B
VitreaAdvanced Study Directory

3 4 1
6
2

7
8

Callout Description
Number
1 Software Version
2 Column Headers

NOTE: Click to sort. Click then type the first few letters to search.
3 Conference Button (also displays at the bottom of the Viewer window)
4 Preferences Button
5 Patient List
6 DICOM Query tab
7 Series/Snapshots/Reports/Applications Tabs
8 Thumbnail tray

Introduction to VitreaAdvanced® & VitreaWorkstation™ 15

VPMC-13501 B
Study Status Icons
In the patient list, in the Status column contain folder icons. The color
represents the state of that study. Filter the study list to find studies of a
specific status.

Icons Description
(Blue with blue arrow) Incoming/Processing

(Green with yellow star burst) Unread

(Green with yellow star burst and Unread with evidence
snapshots)
(Red outline with padlock) Locked study
(Gray) Read
(Gray with snapshots) Read with evidence
(Gray with red check mark) Published
Requested DICOM study

Building DICOM study

NOTE: This icon is not

an indication of the
build process; it just
indicates the data is
received.

Patient List Column Headers

Filter and sort studies using the Patient List columns. Once you identify
studies, use the Series Thumbnail area to load images.

Filter, Sort, and Search the Patient List

Use the column headers in the Patient List to filter the list, sort the list, or
search for specific studies.

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Patient List Right-click Menu
When you right-click on a study, a menu displays containing the following
options:

Menu Item Description

Load Study If there is more than one series in the study, it loads two
series in a 2-up 2D viewer in VitreaCore. If there is only
one series, it loads the first image into a 1-up 2D viewer.
If there are more images in the study, click the forward
arrow to step through the images.
Delete Study Deletes the study from the server.
by Schedule
Email to Sends the images in an email.
Clinician
Change Changes the status of the study:
Status • Unread
• Read
• Published
Change Lock a study from deletion, or unlock a study you have
Study Lock locked.

NOTE: You can only unlock a study you have

locked. To unlock a study someone else locked,
contact your System Administrator.
Save Media Export data to media (CD/DVD/USB/Local Disk/Network
Data).
DICOM Export series to DICOM device.
Export

Mark a Study as Read

The Mark as Read option and the Status column in the Patient List are
only available if Enable mark study as read check box is selected during
server configuration, and if you are logged on with radiologist privileges.
For information about configuring the Vital Image Management Server
(VIMS), contact your System Administrator.

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Use DICOM Transfer
The Vitrea system consists of a server and one or multiple client PCs. The
client automatically queries the server at regular intervals to check for new
studies. You can export studies to, send queries to, and retrieve studies
from other DICOM servers or devices on the network at any time.
Manually query and retrieve studies from within the Vitrea server.

When finished working with a study on the client PC, you can export it to
other devices or servers on the network. Use the Save as DICOM File
option to save a worked-up study to the server. If DICOM forwarding is set
up for one or more devices on the network, the study you save to the
server automatically exports to the devices set up for forwarding.

Automatic Query
Vitrea contains two automatic query/retrieve features:

• Configuring a scanner to send all studies to the Vitrea server

automatically.
• Setting the client PC to query the Vitrea server at regular default
intervals to refresh the Study Directory. As soon as the client PC
receives them, studies display on the Study Directory screen.

Advanced Session Timeout

If the Advanced Session Timeout is triggered, the session will close and
no snapshot or batch is created. Any snapshots and batches that you
created during the session are automatically saved to the server. If you did
not create any snapshots or batches, no information is saved to the
server in the event of a Advanced Session Timeout.

TIP: Take snapshots periodically throughout your VitreaAdvanced

session to save your workflow.

User Types (VitreaAdvanced)

Loading studies into VitreaAdvanced depends on your user type. The
user types are determined by usernames and passwords. Your

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 organization assigns user types to individual usernames and passwords
depending on the role of the user.

NOTE: Contact your System Administrator for information regarding

the usernames and passwords associated with the different user
types.
• Clinician
• Diagnostic User
• Advanced Diagnostic User
• Administrator (not covered in this book)

NOTE: See the Vitrea Installation and Administration Guide for

information regarding the Administrator user type.

Clinicians
• Access VitreaCore.
• Load and interact in VitreaCore workflows using the
Load button.
• Restore snapshots for viewing in VitreaCore.

Diagnostic Users
• Access both VitreaCore Viewer and VitreaAdvanced Viewer. The
VitreaCore Viewer is the default viewer.
• Load and interact in VitreaCore Viewer workflows using
the Load button.
• Load and interact in Advanced Viewer workflows
by right-clicking and selecting Load in Advanced
Viewer.
• Restore snapshots into Advanced Viewer.

Advanced Diagnostic Users

• Access both VitreaCore Viewer and VitreaAdvanced Viewer. The
Advanced Viewer is the default viewer.
• Load and interact in Advanced Viewer Workflows using
the Advanced Viewer button.

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 • Load and interact in VitreaCore Viewer workflows
by right-clicking and selecting Load.
• Restore snapshots into Advanced Viewer.

Clinician Diagnostic Advanced

User Diagnostic
User
Load into VitreaCore Y Y Y
Load into N Y Y
VitreaAdvanced
Viewer
Restore workflow into Y N N
VitreaCore by default
Restore workflow into N Y Y
Advanced Viewer by
default
Send DICOM image N Y Y
Publish to Clinician N Y Y
Delete study N N Y
Vessel Probe N Y Y
DICOM query Y Y Y
(if configured
by System
Administrator)
Create evidence N Y Y
(snapshots, batches,
movies)
Delete evidence N Y Y
(snapshots, batches,
movies)

From here, skip to the Gallery Window section on page 26.

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VitreaWorkstation Study Directory

1
2

8
5 7

Callout Description
Number
1 Software Version
2 Preview Pane
3 Load Buttons
4 Patient List
5 DICOM/CD/Smart Query Area
6 DICOM/CD/Smart Query List
7 Progress Bar

NOTE: The progress bar displays only when it

is reporting a status.
8 Disk Space Indicator

Patient List
The Patient List displays all patient studies loaded in the
VitreaWorkstation.

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 A volume is an image file that VitreaAdvanced builds from a DICOM
dataset.

Study Directory Icons

The patient list displays color coded icons to identify the studies (folders)
and volumes (cubes)

Icons Description
New study or volume
(Green with
yellow star burst)
Previously loaded study or volume
(Gray)
Reported study or volume
(Gray with red
check mark)
Requested DICOM study

DICOM transfer in progress

Building DICOM study or building

volumes

NOTE: This icon is not an

indication of the build process;
it just indicates the data is
received.
Error while retrieving

Error building volume

Dataset is secondary capture

Suspected duplicate patient name

or ID
Locked study

Study has CAD results or CAD

results building

Right-click Menu
Right-click in the Patient List, then select from the menu to load or
manage patient studies.

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 Menu Option Description
Load in Vitrea To load selected study/volume into VitreaAdvanced.
Load in To load selected study/volume into Softread.
Softread
Load in Study To load selected study/volume into Study Viewer.
Viewer
Load in This option is only enabled if you are licensed for
Oncology Oncology Fusion.
Fusion
Lock To protect study/volume from deletion.
Delete To permanently delete a study/volume from Vitrea.
Edit Patient To edit the patient information for a study/volume.
Export To export DICOM images, snapshots, reports,
batches, workflows, etc. to other VitreaWorkstations
or DICOM devices.
Archive to CD/ To save a study/volume to CD or DVD.
DVD
Export to CAD This option is only enabled if you are licensed for
Server Veralook Colon CAD or Visia Lung CAD.
Process Colon This option is only enabled if you are licensed for
CAD Veralook Colon CAD.
Delete CAD This option is only enabled if you are licensed for Visia
Lung CAD or Veralook Colon CAD.
Launch MeVis This option is only enabled if you are licensed for
Webpage MeVis Dynamic Review.
Expand All To expand all the studies in the patient list.
Collapse All To collapse all the studies in the patient list.
Refresh Study To refresh the listings in the patient list.
Directory
Show DICOM To display a table of DICOM tags for the selected
Tags patient.

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Disk Space Indicator
The Disk Space Indicator indicates available disk
space.

If the system’s available disk space drops below a

pre-specified amount, you must delete studies or volumes to receive
more data.

NOTE: For information about configuring the disk space limit, contact
your System Administrator.
If Vitrea determines that performing AutoDelete frees enough disk
space to continue receiving data, a dialog box displays asking if you
want to run AutoDelete now.

If Vitrea determines that performing AutoDelete will not free enough

disk space to continue receiving data (due to its settings or because it
is not enabled), you must manually delete studies or volumes.

NOTE: For information about how your workstation’s AutoDelete

feature is configured, contact your System Administrator.

Filtering Small Volumes

Vitrea automatically prevents the display of small volumes (such as scout,

localizer, and MIP (Maximum Intensity Projections) images that are one
slice in size. To turn off this filtering feature, contact your System
Administrator.

Restoring Workflow From Study Directory

Restore the workflow of a study or volume by restoring its snapshot.

If the snapshot was saved with multiple volumes loaded, choose:

• load only the single volume that snapshot is associated with (may
take less time)
• load all the volumes, and their workflow states, that were loaded
when the snapshot was saved (may take more time)

24 Introduction to VitreaAdvanced® & VitreaWorkstation™

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 NOTE: In order to restore a snapshot saved using a licensed option, a
license for that option must be available.

1. Below the Preview pane, select Show Snapshots.

2. Click Restore Snapshot.

The Viewer window displays containing images with the visualization

settings in place at the time of the snapshot.

NOTE: A multiple-volume snapshot displays in the preview pane

with a multiple volume icon in the lower left corner.
If you selected the Multi-Volumes check box, the system loads all
volumes loaded when the snapshot was saved and restores the
workflow for all volumes.

If any associated volumes are no longer available on the workstation, a

warning dialog box displays. If you receive this dialog box, click
Cancel to return to the Study Directory.

CAUTION: Load all associated volumes when you restore a multi-volume

snapshot. Attempting to restore the snapshot without loading all associated
volumes may yield different results than the original calculations.

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The Gallery Window
After you load a patient study, the Gallery window opens. Select the
protocol and preset from the Gallery.

3
2

4
5
Callout Description
Number
1 Patient Information

TIP: If information is truncated, hover over the

words. A tool tip with the complete
information displays.
2 Protocol List
3 Gallery of Presets
4 Use Modified Presets and Automatically Remove
Bone
5 Progress Bar

NOTE: The progress bar displays only when it

is reporting a status.

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Patient Information
VitreaAdvanced displays the DICOM header information in the Patient
Information section.

Protocol List
The Protocol List contains the protocols available with the licensed
features.

Presets
Before you work with the images in the Viewer window, you must select a
preset.

NOTE: It is important that you regard each protocol and preset as a

convenient starting point for viewing the data.

Automatically Remove Bone

Select the Automatically remove bone check box if you want
VitreaAdvanced to automatically remove bone from the image.

NOTE: This option is only available for certain protocols.

CAUTION: Verify the results of auto-segmentation. If necessary, use the

sculpting tools to correct auto-segmentation.

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The Viewer Window
The Viewer window is the main working area in VitreaAdvanced and
includes the tools necessary to complete your workflow.

1
2

3 4

5 6

Callout Description
Number
1 Viewer Window Layout Buttons
2 Analysis, Visual, and Batch Tabs
3 VitreaAdvanced tools
4 In-view tools
5 Information area and Progress Bar

NOTE: The progress bar displays only when it

is reporting a status.
6 Conference button (VitreaAdvanced through Vitrea
Enterprise Suite only)

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Viewer Window Layout

Use the Viewer Window Layout buttons to change the number or kind of
views displayed in the Viewer window.

1. To change the Viewer window layout, click one of the Layout Buttons.

2. To access all available Viewer window

layouts for the selected protocol, click
one of the dropdown arrows next to a
Layout button.

TIP: 2D Montage formats use black

layout buttons, MPR/3D formats use blue layout buttons, and
special protocol-specific formats use red layout buttons

Button Format Description

2D Display 2D slices as acquired by scanner
Montage in one, four, nine, or sixteen slice images.
formats

All-Exams Two to nine 2D views displayed side-by-

side.

4-up One 3D view and three MPR views.

The 3D view displays in the lower left, and
MPR views display in the upper left
(sagittal), upper right (coronal), and lower
right (axial).

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 Button Format Description
5-up Two 3D views and three MPR views.
The 3D views display in the upper and
lower left, and the MPR views display in
the upper right (sagittal), middle right
(coronal), and lower right (axial).
This format is useful for:
• flying through a volume in the lower
3D view while maintaining an outside
or point-of-interest viewing
perspective in the upper 3D view, or
• for viewing the global perspective in
the lower 3D and a focused point-of-
interest view in the upper 3D view.
Targeted Two 3D views and three MPR views, with
Navigation one larger than the others.
3D views display in lower right and left,
and MPR views display in upper left (axial),
upper right (sagittal), and middle right
(coronal).
This format is useful for selecting a target,
such as an anatomical feature or lesion, in
the large MPR view and eyepoint in the
upper left, large MPR view, and viewing
the target in the lower left 3D view.
Runoff One large 3D view with three MPR
images.
Use this format to view large datasets.
Dual Two volumes displayed side-by-side, 2-up
Volume (one MPR and one 3D) views.
Use this format for side-by-side
comparative review of two volumes (prone
and supine, for example).
Use the dropdown arrows to customize the four instant-format buttons
that display for any preset so they represent formats used most frequently.
Then save your changes as part of a modified preset.

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2D and MPR Mouse Functions

Mouse Button Press to:

Click Activate Tool

Middle-click and drag Pan

Left + Middle click and drag Zoom

Right-click and drag Scroll

OR

Roll the mouse wheel

SHIFT + Auto-scroll
Press SHIFT, right-click and drag

Left + Right click and drag Window/Level

3D Mouse Functions

Mouse Button Press to:

Click Activate Tool
Click, then pause a
moment to activate the
tool
Click and drag Rotate
Click then drag right
away

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 Mouse Button Press to:
SHIFT + Auto-rotate
Press SHIFT, right-click and drag

Middle-click and drag Pan

Left + Middle click and drag Zoom

OR

Roll the mouse wheel

Left + Right click and drag Window/Level

Keyboard Shortcuts
Adjust views and perform other operations using keyboard shortcuts

Key Function
E Activate Ellipse tool
F Activate ROI tool
H Activate Crshair tool
L Activate Label tool
A Activate Arrow tool
R Activate Ruler tool
S Activate Snap tool
T Activate Trim tool
W Activate Win/Lev tool
CTRL-I Toggle the patient information on or off
CTRL-Y Re-do last undone action
CTRL-Z Undo last action (repeat to undo multiple actions)

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3D Keyboard Shortcuts
Some VitreaWorkstation systems include keyboard shortcuts, identified
with blue keycaps, for certain functions.

NOTE: Ifyou run VitreaAdvanced on a PACS, your shortcuts may differ

or you may not have blue keycaps.

Key Function
S-I [F2] Rotate volume Superior to Inferior -- 180° azimuth,
90° elevation, 0° twist
I-S [F3] Rotate volume Inferior to Superior -- 0°, -90°, 0°
A-P [F4] Rotate volume Anterior to Posterior -- 0°, 0°, 0°
P-A [F5] Rotate volume Posterior to Anterior -- -180°, 0°, 0°
L-R [F6] Rotate volume Left to Right -- -90°, 0°, 0°
R-L [F7] Rotate volume Right to Left -- 90°, 0°, 0°
OBLIQUE Rotate volume to oblique orientation -- 40°, 30°, 0°
[F8]
PREVIOUS Display previous image, or previous series or volume if
[F9] multiple series or volumes loaded.
NEXT Display next series or volume if multiple series or
[F10] volumes loaded.
UNDO [F11] Undo last action in Viewer window. Press repeatedly
to undo multiple actions.
REDO [F12] Redo last “Undo” in Viewer window.
ARROW Press an ARROW key to rotate volume by 10 degree
increments.

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 Key Function
SHIFT + Press and hold SHIFT and press an ARROW key to
ARROW rotate volume by 90 degree increments.
SPACEBAR Display arrows or annotations in the order they were
added. Press repeatedly to cycle through the
objects.
Left SHIFT 3D: Auto-rotate.
AUTO-VIEW 2D/MPR: Auto-scroll.
Left ALT Press and hold to use left mouse functions in 3D
3D TOOL view(s).
> Fly forward.
NAV FWD
< Fly backward.
NAV REV
? Flip the fly through view direction 180 degrees.
180°
SHIFT+ > Fly forward with continuous assisted navigation.
SHIFT + < Fly backward with continuous assisted navigation.
Right SHIFT Press and hold, then press DELETE to delete all
MULTI- contours.
CONTOURS
Right ALT Press and hold for point-and-go fly through navigation.
POINT & GO
A, E, or T Adjust the 3D rotation to a specific Azimuth, Elevation,
or Twist value. Type a valid value followed by the
appropriate letter:
• Azimuth (a) [valid values -180 to 180] -
degree of rotation right or left around the
center of volume
• Elevation (e) [valid values -90 to 90] -
degree of rotation forward or backward from
the center of volume
• Twist (t) [valid values -180 to 180] - degree
of tilt left or right around the center of the
volume

34 Introduction to VitreaAdvanced® & VitreaWorkstation™

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 TABLE 1. 3D Cardiac Quick Views:

Press... To rotate the volume... Press...

SHIFT-F2 Right 25 degrees, caudal 20 CX and LAD
degrees
SHIFT-F3 Right 30 degrees, cranial 25 CX
degrees
SHIFT-F4 35 degrees cranial LAD
SHIFT-F5 Left 45 degrees, caudal 20 Left Main
degrees (SpiderView)
SHIFT-F6 Right 10 degrees, cranial 30 LAD
degrees
SHIFT-F7 Right 30 degrees RM
SHIFT-F8 Rotate left 30 degrees Ostium of
RCA and
PDA/PLA
To switch the Viewer window to
display the...
F9 Previous loaded volume
F10 Next loaded volume

Right-click Menu and Tool Pane

For easy access to common tools used for the selected protocol, right-
click within a view.

Pan
Zoom
} Vitrea tools

W/L

• Click and drag to use the Pan, Zoom, and W/L buttons.

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Analysis Tab Controls

Tools available on the Analysis tab depend on the protocol and preset
selected on the Gallery window.

# Description
1 1 Viewer window tabs
2 VitreaAdvanced tools
2
3 Anatomy Segmentation
Area
4 Vessel Analysis Area

See the Common Tasks chapter for step-by-step instructions for using
the Analysis Tab tools.

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Visual Tab Controls

On the Visual tab of the Viewer window, change imaging controls or set
display options.

# Description
1 1 Visual tab buttons
2 Dropdown for selecting
preset window/level
settings
3 Options for determining
2 what objects display
along with the images in
the views and other
controls for dictating
3 view behavior

See the Common Tasks chapter for step-by-step instructions for using
the Visual Tab tools.

View Options

Option Description
Patient Info check box Show or hide patient info.
3D Crosshair check Show or hide the crosshairs in the 3D view.
box
Field of View check Show or hide the field of view cone in the
box MPRs.
AV Stats check box This feature is enabled when you use the
AVM tool. Once you locate a vessel using
AVM, use the AV Stats check box to turn on
the Auto Vessel measurements and cross
references in the viewer.
Target Nav check box Activate or disable targeted navigation in fly
through mode.

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 Option Description
Interact Fast check Activate or disable fast interaction between
box MPR and 3D views.
Noise Reduction Activate or disable automatic reduction in
check box visual noise in the 3D view.
Measurements check Show or hide measurements in the views.
box
TIP: Also shows or hides reference scale
on the right side of the 2D and MPR
views.
3D Box check box Show or hide an outer box in the 3D view.
Full Crosshair check Show full crosshairs (including intersection) or
box partial crosshairs (not including intersection).
Oblique Trim check Activate or disable trimming on an oblique
box plane.
Lock 3D Lock or unlock the 3D view while working
with MPRs.

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Batch Tab Controls

Make batches and movies on the Batch tab of the Viewer window.

# Description
1 Scripted batch controls
2 Directional controls for
scripted batches
3 Manual batch buttons
1 2
4 The interval (in mm)
between images in the
batch
5 Total number of images
in the batch
3 6 Entries for changing the
series description or
adding a cover page
7 Buttons for creating a
4 batch or movie
8 Controls for including
patient information or
5 forcing to secondary
capture
9 Button to display more
batching options

8
9

See the Common Tasks chapter for step-by-step instructions for using
the Batch Tab tools.

Introduction to VitreaAdvanced® & VitreaWorkstation™ 39

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The Report Window
VitreaAdvanced saves snapshots, batches, and movies you create to the
Report window. From here, create and distribute reports.

2
1
3

5
8

6 9

7 10

Callout Description
Number
1 Findings list
2 Filtering buttons
3 Findings tray
4 Findings management buttons
5 Findings management right-click menu
6 Template Layouts
7 Templates buttons
8 Report page
9 Report tools and navigation buttons
10 Report distribution buttons
See the Distribute Findings chapter for more information regarding
reporting.

40 Introduction to VitreaAdvanced® & VitreaWorkstation™

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The Review Window
(VitreaWorkstation only)
Use the Review window to view reports posted to your facility’s intranet.
Reports you post on the VitreaWorkstation can also be viewed from other
workstations.

1. Select the Review tab.

2. Enter information such as patient name or report date to see specific

reports
OR

Leave all the fields blank to see all posted reports.

3. Click Search.

4. Click Review next to the patient name for the report to view.

TIP: If the report includes a digital movie, the movie plays when you
view the report.

5. If the report contains more than one page, click Next Page or
Previous Page to view other pages.

Print reports posted to the Review window.

1. From the Reports List, display the report to print.

2. Click Print at the bottom of the Review window.

Delete posted reports when you no longer need them.

• Click Delete next to the report you want to delete.

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Additional Information
Storage Commitment
Storage Commitment is a transfer of data ownership between devices,
typically Modality or Workstation to an Archive or Storage Device in such
a way that the Storage Devices commits to storing the data and the
Workstation is no longer responsible for the ownership. The Vitrea
Workstation requests a Store of the data and then a Storage Commitment
for that data through DICOM messages.

Storage Commitment can be configured. Any exports on the configured

Entity will automatically request storage commitment for the data export.
There is no other requirement for requesting storage commitment.

Contact your System Administrator for information regarding configuring

Storage Commitment.

42 Introduction to VitreaAdvanced® & VitreaWorkstation™

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Select a Study

Contents
NOTE: This module demonstrates the various scenarios for loading
studies into Vitrea. Be sure you understand which type of Vitrea you
are using as the procedure varies depending on the type.
• Loading Studies Through the Data Manager
• Loading Studies into VitreaWorkstation
• Loading Studies Through a PACS Integration
• Loading Studies into VitreaCore

Select a Study 43
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Loading Studies Through the Data
Manager
Use this procedure if the Study Directory contains the Data Manager.

Data Manager

1. From the Study Directory, select a study.

2. Select the Applications tab.

3. Select the appropriate application view and double-click,

NOTE: This option loads all the data.
OR

Load a subset of the data:

44 Select a Study
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 a. Right-click on the appropriate application view and select Select
Application Data.

b. Select a series to load and click Start.

TIP: If you do not see the application that applies to the workflow you
are using, double-click the Core 3D thumbnail and choose a
protocol and preset.

NOTE: Once the study loads, VitreaAdvanced displays in the upper-left

corner.

Select a Study 45
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Loading Studies into
VitreaWorkstation
Use this procedure if displays in the upper-left corner
of the Study Directory.

1. From the Study Directory, select a study.

2. From the open folder, select a series.

3. Click .

4. From the Gallery, select a protocol and preset.

46 Select a Study
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Loading Studies Through a PACS
Integration
There are two ways to load studies through a PACS integration.

Option 1

With PACS-Integrated VitreaAdvanced, VitreaAdvanced automatically

launches and loads the patient study or series you select from the PACS
client.

NOTE: If Data Manager is not selected in the VES Administration Tool,

see the VIMS Installation Guide.
1. From the PACS client, right-click on the image for the patient study
and select Load in VES (or similar option).

NOTE: See the PACS user documentation for specific instructions on

launching Vitrea this way.

CAUTION: Verify that you have loaded the study you intended to load. If you
load a study that contains multiple series or contains 3D reconstructions, a
dialog box displays that asks you to select the series you want to load.
Make sure to respond to dialog box. If you do not, it is possible to return to
PACS and load a different study.

2. Select a protocol and preset from the Gallery window.

Select a Study 47
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 Option 2

1. Use the procedure below to load a study from the Data Manager.

TIP: The Data Manager displays at the bottom of the screen if Use
Data Manager is selected in the VES Administration Tool.

If Enable Partial Data is selected in the VES Administration Tool,

you may be prompted to confirm if you would like to retrieve
missing data for the request, or to proceed to the Data Manager
with the data currently available on VIMS.

If Disable Partial Data is selected and Auto-Sync Data is

unchecked in the VES Administration Tool, you may be prompted
to confirm if you would like to retrieve the missing data, or return to
PACS.

48 Select a Study
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 NOTE: If Auto-Sync Data is selected in the VES Administration Tool,
the system will automatically determine what (if any) study is
missing and will automatically begin retrieving the data.

2. On the Applications tab, perform one of the following:

• Select the appropriate application view and double-click to launch
the study.

TIP: This method of launching only loads the series that are defined as
“best candidates” and are pre-selected.

• To select Application Data:

a. Right-click on the Application and select Select Application

Data.
b. In the application selection dialog, select the appropriate
selections and click Start.

TIP: Click Cancel to close the Application Selection Dialog.

Select a Study 49
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Loading Studies into VitreaCore
See the VitreaCore Education and Reference Guide for detailed
VitreaCore workflows.
Use this procedure if the Study Directory contains the Data Manager.

1. From the Study Directory, select a study.

2. Select the Series tab.

3. In the Series Tray, select a series to load.

TIP: To load multiple series, press CTRL and click all the series to load.

50 Select a Study
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 4. Click or right-click and select Load.

NOTE: See the VitreaCore Course Modules for detailed VitreaCore

workflows.

Select a Study 51
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52 Select a Study
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Common Tasks

Contents
• Getting Started
• Study Directory Tasks
• Gallery Window Tasks
• Viewer Window Tasks
• 2D Imaging
• MPR Imaging
• 3D Imaging
• Image Batches and Movies
• Export
• Study Viewer

Getting Started
Log into Vitrea using Vitrea Enterprise Suite
1. On the client PC, launch Internet Explorer and enter the URL for the
VES server. If you do not know the URL, contact your System
Administrator.

NOTE: Ensure the following options are enabled in Internet Explorer:

Download Signed ActiveX Controls, Run ActiveX Controls and Plug-
ins, and Script ActiveX controls marked safe for scripting.

2. On the login screen, enter your Username and Password.

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 3. Click Sign In.
The Vitrea system opens to the Patient List tab.

Starting and Closing VitreaWorkstation

Start Vitrea for the Windows Desktop after the workstation is turned on.

1. If the Welcome to Windows dialog box displays, press

CTRL-ALT-DELETE.

2. Type vitrea in the Username field.

3. If your institution requires a password, type the password in the

Password field.

4. Click OK.

5. From the desktop, double-click .

Contact your System Administrator for information regarding registering

your software and for information regarding user-defined login
configuration settings.
• User Accounts (system defaults)
Account Password
Vitrea Administrator vital$
Vitrea User (none)
Vitrea VIP vip+

NOTE: If you change passwords, notify Customer Support.

Close Vitrea from any window except the Review window.

• Click in the upper-right corner of Vitrea.

See your PC operating systems’ user instructions for information

regarding shutting down your workstation.

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Study Directory Tasks
For detailed information regarding loading a study, see the Select Study
chapter.

When you start Vitrea, the Study Directory opens.

If your Study Directory looks like this, go to the Using the

Vitrea Enterprise Suite Patient List on page 56:

If your Study Directory looks like this, go to Using the

VitreaWorkstation Patient List on page 67:

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Using the Vitrea Enterprise Suite Patient List

Use the Patient List to select images for review and manipulation. The
Patient List displays studies and series in the Patients/Studies Area.
Thumbnails of the images contained in the Studies display in the Series
tab. If Vitrea is configured to automatically split series, the sub-series list
sorts the images within the selected series into categories.

EXAMPLE If the selected series is a set of MRA images containing

source, projection, and collapsed images, and auto-split is on, the
sub-series list contains three sub-series. For information on
configuring Vitrea to automatically split series, contact your System
Administrator.

Using Patient List Column Headers

The Patient List columns allow you to filter and sort the studies to better
manage your caseload. Once you identify the desired studies, use the
Series Thumbnail area to load images.

Filtering the Study List

When you set selection criteria to filter the list of studies, the Patient List
displays studies matching the selection criteria and studies that are
already open.

TIP: To further filter the Study List, set the selection criteria for multiple
columns.

EXAMPLE

1. Click in the field under the Modality header and select CT from
the dropdown list.
The Patient List displays only CT studies.
2 Click in the field under the Date of Last Study header and
select <2 days from the dropdown list.
The Patient List displays only CT studies occurring in the last 2
days.
3 Click the Patient Name header.

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 The Patient List displays CT studies occurring in the last 2
days, sorted by patient name in ascending order.
4 Click the Patient Name header again.
The Patient List displays CT studies occurring in the last 2
days, sorted by patient name in descending order.

Sorting Columns in Ascending or Descending Order

• Click the column header.
The list is sorted and an arrow displays to the right of the column
header to indicate the direction of the sort. Click again to reverse the
order.

Searching for Specific Studies in the Study List

• Click in the field below any searchable column header, type a text
string, and press Enter.
Enter a value for the following columns: Patient Name, Study
Description, Patient ID, Accession Number, Study ID, and Institution.
OR

Click in the field below any searchable column header and select an
item from the dropdown list.

Select a value from a dropdown list for the following columns: Status,
Date of Last Study, Modality, and Gender.

NOTE: The remaining column headers are not searchable.

Adjusting the Column Width

• Place the cursor on the line between columns, and drag the line.

Marking a Study as Read

The Mark as Read option and the Status column in the Patient List are
only available if the Enable mark study as read box is checked during
server configuration, and if you are logged on with radiologist privileges.
For information about configuring the VES server, contact your System
Administrator.

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 1. In the Patient List window, select the desired study.

2. Right-click, and select Mark as Read.

The study's status on the Patient List tab changes to Published .

Using a Predefined Worklist Filter

• Select a filter from the Worklist Filters dropdown menu at the top of the
screen.

The Patient List sorts according to the criteria in the filter. If the List is
blank, or does not return the expected results, try another filter, or
create your own.

Defining a Worklist Filter

1. Use the Patient List column header, sort and filter the List as needed.

2. Select Save as New... from the Worklist Filters dropdown menu at the
top of the screen.

3. Edit the criteria in the Query Filter box, if needed, and enter a Filter
Name.

NOTE:The Query Filter box contains criteria that matches those in the
column headers.

4. Click Save.
The Filter is saved and is available the next time you select it from the
list.

5. Select the filter you just created from the Worklist Filters dropdown
menu.

Conferencing

1. Click , then select Join Conference. The Join Conference

dialog box displays.

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 TIP: The Conf button displays at the top of the Study Directory and at
the bottom of the other windows.

TIP: To hide the Conf button, which may be necessary when

reviewing cardiac phases, hover the cursor over it for three
seconds.

2. Click the conference name in the list.

OR

In the Conference Name field, enter the conference name.

NOTE:The Conference Name and Password are context sensitive.

Check for proper upper- and lower-case entry.

3. In the Password field, enter the conference password.

4. Click Join.

The participant's viewer displays the same image information as that

of the conference owner's viewer. The owner controls the image
display, mouse movement, and annotation information. All viewer
attributes are updated in real time during the conference.

Using the Data Manager

The Data Manager displays below the Patient List. The Data Manager
provides access to the Applications, Series, Snapshots, and Reports
available for the currently selected patient.

Use the Data Manager to:

• Load a study into an application

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 • Load one or more series into either 2D or 3D viewers
• Send a series or study to a DICOM device (see the DICOM section)
• Restore a snapshot
• Save a snapshot locally
• Load reports

Accessing the Data Manager

• Select a study in the Patient List.

The Data Manager displays the data available for the patient, in the
lower portion of the screen. This can include Vitrea Series, Snapshots,
and Reports.

Loading a Study into an Application

1. Select the Applications tab.

2. Double-click the appropriate application.

NOTE: This option loads all the data.

OR

Load a subset of the data:

a. Right-click on the appropriate application view and select Select

Application Data.

b. Select a series to load and click Start.

TIP: If you do not see the application that applies to the workflow you
are using, double-click the Gallery thumbnail and choose a
protocol and preset.

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Loading One or More Series
1. To select an individual series, click one of the thumbnails.

TIP: To select multiple series, CTRL-click or SHIFT-click to load:

TIP: To select multiple contiguous series, click the first thumbnail of the
group, press and hold SHIFT, then click the last thumbnail of the
group. A check mark displays in the corner of each thumbnail.

TIP: To select multiple distinct series (non-contiguous), press and hold

CTRL, then click each desired series. A check mark displays in
the corner of each thumbnail you clicked while holding down
CTRL.

2. Right-click one of the checked thumbnails and select Load Study or

Load.

Restoring a Snapshot
1. Select the Snapshots tab.

2. Double-click the desired snapshot icon.

OR

Click the Restore Snapshot bar of the icon. The snapshot displays in
the Viewer tab.

CAUTION: Verify the accuracy of all contours and confirm all measurements
when restoring snapshots from previous software versions created through
the use of region editing.

Saving Snapshots and Movies Locally to Your Computer

1. Select the Snapshots tab.

2. Right-click the snapshot or movie thumbnail and select Save As.

3. In the dialog box, indicate the file location, file name, and file type.

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 CAUTION: Be careful when saving and working with these types of files.
Patient information is not included on the snapshot or movie. It is possible
to misrepresent or confuse these kind of snapshots or movies.

Loading Reports
1. Select the Reports tab from the Data Manager.

2. Right-click and select Preview to load the report.

Using the Vitrea Enterprise Suite DICOM Transfer

The VES system consists of a server and one or multiple client PCs. The
client automatically queries the server at regular intervals to check for new
studies. At any time, export studies to, send queries to, and retrieve
studies from other DICOM servers or devices on the network. Manually
query and retrieve studies from within the VES server.

When you are finished working with a study on the client PC, export it to
other devices or servers on the network. Use the Save as DICOM File
option to save a newly worked-up study to the server. If you have DICOM
forwarding set up for one or more devices on the network, the study you
are saving to the server is automatically exported to the devices set up for
forwarding.

VES contains the following two automatic query/retrieve features:

• Configure a scanner to send all studies to the VES server

automatically.
• The client PC automatically queries the VES server at regular default
intervals to refresh the Study Directory. As soon as the client PC
receives them, studies display on the Study Directory screen.

Querying a Device or Server Manually

1. Select the DICOM Query tab from the Study Directory.
The DICOM Query tab displays, where you query the local VES server
or any remote servers to which you have access.

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 2. Select a server or device from the Server dropdown list at the top of
the tab.

3. Specify sort criteria in the query list columns, if desired.

4. Click the Query button.

The query list is updated with studies from the selected server that
match the specified sorting parameters.

NOTE: Although the query list displays matching studies, no studies

are transferred to the local server until you select one or more desired
studies and click the Query button.

Retrieving the Queried Studies

1. Highlight one or more studies from the query list.

2. Click the Query button.

The selected studies are sent to the local server.

NOTE: The newly retrieved studies display in the Patient List the next
time it is refreshed.

Importing Datasets from Media

Import patient studies saved to a CD, DVD, USB, or a local disk.

1. Click .

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 2. Use the Media Manager to browse
for a file.

3. Configure searching options.

4. Click Import.

Export Data to Media

Right-click the study and select Save to Media to launch export Media
Manager.

1. Click Browse, then navigate to the destination folder or drive.

2. Select the media to save which include DICOM files, snapshots,

batches, movies, or report.

3. Click Export.

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 4. To remove identifying patient health information from the dataset prior
to export, select the Anonymize on Export check box.

NOTE: This creates a special purpose, de-identified version of an

already existing dataset. It neither replaces the original SOP instance
nor acts as the primary representation of the clinical dataset in image
archives. These de-identified images are useful, for example, in
creating teaching or research files, where the identity of the patient
should be protected, but still be accessible to authorized personnel.

5. To compress image data in order to save space on the media, select

the Compress Image Data check box.

NOTE: This is useful for large datasets exported to CD/DVD media.

Export Study to DICOM

Right-click the study and select DICOM Export to launch the DICOM
export manager.

1. Select the DICOM device.

2. To remove identifying patient health information from the dataset prior

to export, select the Anonymize on Export check box.

NOTE: When DICOM data with empty PatientID is imported into the
VIMS Server, the StudyUID of the anonymized data will display as the
PatientID within VitreaCore.

3. To set the Anonymization Options, click Configure.

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 The Anonymization Options dialog displays:

a. Enter new values for the specific fields.

b. To remove private tags from the study, select Anonymize Pvt
Tags.

NOTE:For perfusion studies, it is recommended that you CLEAR the

Anonymize Pvt Tags checkbox. Perfusion studies require the
manufacturer’s private tags to build volumes.

NOTE: If Anonymize Pvt Tags is selected, all private tags,

including Vital private tags needed for snapshot restore, are
removed from the study. Evidence does not display in the Report
tab of the Data Manager, but it does display as a 2D series on the
Series tab.

NOTE: If Anonymize Pvt Tags is cleared, all private tags are

retained and any patient information in the private tags remain in
the anonymized study. The study has new IDs, but any snapshots
would still refer to original study. Evidence does not display in either
the Report tab of the Data Manager or as a 2D series on the Series
tab for the new patient name.
c. Click OK.

4. Click Export.

From here, skip to Viewer Window Tasks on page 76

66 Common Tasks
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Using the VitreaWorkstation Patient List

Preview Pane
The Preview Pane displays images of the selected dataset.

1. Select Show Preview Slices to display the middle image of the

selected dataset(s). With multiple series selected, an image from each
series displays.

TIP: To adjust the window/level of the preview slice, click and drag in
the image.

TIP: To scroll through the series slices in the Preview Pane, right-click
and drag or roll the mouse wheel.

TIP: With multiple series selected in the patient list:

a. Hold CTRL and click one or more preview images to select the
desired series.

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 b. Click the dropdown and select Load
Highlighted to load only those series.

NOTE: Clicking Load Volume loads all series selected

in the Patient List.

2. Select Show Snapshots to display saved snapshots.

TIP: Select a snapshot then click to restore

workflow.

NOTE: When you restore the workflow to the Viewer window, you lose
all manually added pages, images, and annotations.

CAUTION: Verify the accuracy of all contours and confirm all measurements
when restoring snapshots from previous software versions created through
the use of region editing.

TIP: The Multi-Volumes check box indicates whether the snapshot

was taken with multiple volumes loaded. Clear the check box to
load only the selected volume.

CAUTION: Load all associated volumes when you restore a multi-volume

snapshot. Attempting to restore the snapshot without loading all associated
volumes may yield different Vitrea-generated measurements or calculations
than the original calculations. If the workflow you are restoring does not
include these measurements, this caution does not apply. It is not advisable
to restore a multi-volume workflow if you cannot load all associated
volumes.

3. Select Show Sub-volume Selection to load a portion of a large

dataset.

TIP: Drag yellow lines in the preview pane to indicate the range of

slices to load, then click .

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Sort and Search Study Information
Use the column headings above the Patient List to sort or search.

1. To sort, click the desired column header.

2. To search, click the desired column header, then type the first few
letters of the search criteria.

3. To filter, click in the Filter row under the desired column header, then
type the filtering criteria.

NOTE: You can filter the following columns: Patient, ID, ACC#/CKern,
Description, Modality.

Show-Hide Volumes
• Use the Show-Hide arrow to the left of the study line to show
or hide volumes within a patient study.

Select Multiple Studies or Volumes

• Press CTRL then click desired studies or
volumes.

TIP: To select several studies or volumes in order, select the first, press
SHIFT, then click the last.

TIP: To clear one or more volumes, hold CTRL and click the volume.

Reconcile or Edit Patient Information

When a patient study arrives on the VitreaWorkstation, Vitrea checks the
patient information against all other studies in the patient list. If it finds any
patient studies with matching IDs and names that do not match, an alert
displays when you try to load the study.

If your site is configured to require reconciliation, you may need to

reconcile the studies before you load either of them in Vitrea.

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 If your site is not configured to require reconciliation, Vitrea warns you
about possible duplicate patient studies, but allows you to load them.

Edit patient information for any study or volume.

CAUTION: Do not use the Edit Patient feature to anonymize DICOM data.
This method does not anonymize DICOM data in a HIPAA compliant manner.
To make the patient anonymous in the DICOM file, click Export, then click
Anonymize in the DICOM Export dialog box.

NOTE: If you edit patient information for a study containing snapshots,

the snapshots are deleted. Consequently, you will be unable to restore
any previously saved workflows.

NOTE: If you edit patient information for a locked study, Vitrea deletes
the old study and creates a new, unlocked study.
If there are multiple studies with the same ID but different names, Vitrea
alerts you when you try to load the study. Use the Edit Patient feature to
reconcile the studies. Edit any study at any time.

1. Right-click the study and select Edit Patient (or Reconcile Patient).

2. Complete information in dialog box.

3. Click Submit.

Lock/Unlock Studies
Lock important studies to protect from deletion.

1. Right-click the study and select Lock.

2. To unlock, right-click the locked study and select Unlock.

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Load Studies
• Select a study (or multiple studies/volumes) in

patient list then click .

TIP: The Load Volume button changes depending

on the selections you made in the Preview Pane.

Archive to CD/DVD

• To archive the selected study to CD/DVD, click .

TIP: Save these types of files to CD or DVD:

• Patient DICOM files (.dcm files)

• Patient Volumes (.avol files)
• Patient report files (.htm files posted to the Intranet)
• Patient media files (such as .png, .avi, and preset files)

NOTE: If you record one or more volumes on a CD or DVD, and at a

later time want to add more volumes, be sure you do not attempt to
record the same volume twice on the CD or DVD. If you do this, the
CD or DVD becomes unreadable.

DICOM Export
Export original DICOM data, evidence, or both to a DICOM server.

1. Right-click a patient study or volume file, and select Export.

NOTES:
• Study-level export includes original DICOM data, 3D volumes,
and any 2D series. You can also include snapshots and
batches.
• Volume-level export includes original DICOM data, 3D volumes,
and any 2D series. You can also include snapshots if they are
associated with the selected volume. Batches cannot be
exported at the volume level.

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 • When exporting to another VitreaWorkstation, please note that
the receiving system must have the original volume data
present in order for snapshots to be received and restorable.

2. Select a server from the list.

3. Select Export original data only, Export original and snapshot

data, or Export snapshots only.

NOTE: Evidence consists of snapshots and batches.

4. To anonymize the patient information, select Set anonymization.

NOTES:
• Anonymization can only be performed for study-level exports.
• If a study contains evidence, anonymization is only allowed for
Export original and evidence data.
• Snapshots will not be restorable if they are anonymized.
• Anonymizaation will not remove demographic information
burned int a snapshot or batch image.

5. Click Export.

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DICOM/CD/Smart Query
Query any DICOM device or CD/DVD for patient studies. Queried patient
data retrieved from DICOM devices contain only the original DICOM slice
data. Query other workstations at your site if they are configured as
DICOM query devices.

NOTE: Vitrea will retrieve at a series level if the DICOM device supports
it.

Query and Retrieve

1. In the Query area, select the tab of the server or CD to query.

NOTE: Server names are unique for your site.

Contact your System Administrator for the ID of the server where the
data is stored and for other information regarding configuring your
workstation’s query feature.

2. To filter the query results, make selections using the dropdown lists.

3. Click .

4. Select the studies in the Query List to retrieve.

5. Click .

NOTE: Server names are unique for your site. To get server names,
click Server menu in DICOM Query area of the Study Directory.
Contact your System Administrator for the ID of the server where
the data is stored.

EXAMPLE To find studies where names start with I, type i in the

Patient Name field. To find a patient ID, select Patient ID from the
list and enter the exact patient ID or as much of it as you know, in
the field.

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 Use an asterisk to indicate a wild card for part of any data value or
name, except Accession Number.

NOTE: If you are querying a DICOM device to verify it received the

exported images, and you notice a discrepancy between the number
of images listed for the study in the Study Directory and the number
listed in the DICOM Query/CD list, check the number of snapshots
exported with the study, if any. Vitrea exports snapshots as hidden
files and does not include them in the number of images listed on the
Study Directory. DICOM devices, however, count the snapshot images
as part of the series or study, so the number of images displayed for
the study in the DICOM Query/CD list includes them. If you did not
export snapshots with the study, or the discrepancy between the
number of images is significant, there may have been an export
problem. Contact Vital Technical Support for assistance.

Find Related Studies (Smart Query)

Use the Smart Query feature to find related patient studies from an
archive.

1. Select the study in the Patient List.

2. In the Query area, select the Smart Query tab.

3. Set the query criteria.

4. Click .

5. Select the studies in the Query List to retrieve.

6. Click .

Importing DICOM or DICOMDIR Data from Media

When scanners and workstations write data to media, it is usually in a
format called DICOMDIR, a standardized media format that specifies the
organization of data. When images are saved in DICOMDIR format, a
summary file is generated, with some brief information about the data it

74 Common Tasks
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 references, such as patient name, patient ID, and study description. You
can view images saved in this format in Study Viewer or Softread by
importing DICOMDIR data from CD into the Study Directory. Then load
the images into Softread or the Study Viewer.

Gallery Window Tasks

Using Modified Presets

CAUTION: Wait until segmentation completes before saving a modified

preset. The status message at the bottom of the window displays the
progress of the segmentation.

To set your own visualization preferences, create a Modified Preset

available in the Gallery.

1. Load a study.

2. Select one of the default presets.

3. Change any of these settings on the Viewer window:

• Viewer window format
• Imaging controls
• Display options
• View options
• Image appearance

4. When finished, press CTRL-P.

5. Click OK.

TIP: This saves the settings as a customized preset. The standard

presets are not affected.

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 TIP: The next time you select the same protocol, the modified preset is
available. All modified preset names contain the word (modified).

Viewer Window Tasks

Accessing Tools with the Right-click Menu and Tool Panel

For easy access to common tools used for the selected protocol, right-
click within a view.

Panning
Move the image within the viewport by:

• Middle-click and drag.

• Right-click in the image, then click and drag .

Zooming In and Out

Increase or decrease the magnification of the images by:

• Left + middle-click and drag up or down.

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 • Right-click in the image, then click and drag .

• Click and drag the Zoom icon in the lower right

corner of the view.
The zoom factor (in %) is displayed in the lower right
corner of the view.

Zoom Presets:

• Right-click in the image and click multiple times to toggle

through a series of preset zoom factors.
• Click the Zoom icon in the lower right corner of the
view multiple times to toggle through a series of
preset zoom factors.

Adjusting the Window/Level

Adjust the window/level settings of any 2D and MPR views.

1. Right-click in the view, then click .

TIP: Or, from the Analysis or Visual tab, click .

2. Click and drag in the view.

• To make the window wider or narrower, drag left/right.
• To adjust level, drag up/down.
• To adjust both at once, drag diagonally.

TIP: To specify precise window and level settings, with cursor

anywhere in the view, type a number followed by W or L.
OR

• With any tool activated, left + right-click and drag in the view.
OR

• Right-click in the view, then click and drag .

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Using Predefined Window/Level Settings
To select a preset window/level setting, click the window/
level dropdown arrow in the lower right corner of the view
and select a value.

1. Select the Visual tab.

2. Click the dropdown menu in the Window/Level area.

3. Select an option.

Create custom window/level settings:

1. Click the dropdown menu in the Window/Level area.

2. Select New.

TIP: Select Edit to edit an existing window/level setting.

3. Complete the Name, Window, and Level fields.

TIP: To set the window/level setting as “key,” select the Key check
box.

4. Click Save.

Key window/level settings display as bolded in the Window/Level menu.

Scroll through key settings to quickly view an area of interest

at different settings:

TIP: For example, to examine a suspected polyp in a colon study,

scroll through the other window/level settings to see if there is air
in the area of interest.

• Press INSERT to scroll through the key settings.

Using the Crosshairs

Move crosshairs and display data values (HU for CT studies; intensity for
MR studies) and coordinates in 2D, MPR views.

1. Right-click in the view, then click .

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 TIP: Or, from the Analysis or Visual tab, click .

2. Click and drag in the view to display HU or SI values.

OR

Click in the view to place crosshairs.

TIP: In 2D views, this displays single pixel data values, but no

crosshairs.

TIP: Click in the 3D view to move the crosshairs in the MPR views.

Drawing Rulers and Calipers

Add simple rulers to 2D or MPR views:

NOTE: Perform linear measurements in 2D or MPR views only. It is

possible to add rulers to 3D images. If you do, be sure to fully rotate
the 3D view to be sure the ruler is placed where you want it.

1. Right-click in the view, then click .

TIP: Or, from the Visual tab, click .

2. Click in the view where you want the ruler to start and drag to where
you want the ruler to end and release.

TIP: You may scroll in the view between endpoints to make a ruler over
more than one plane.

TIP: To move the number associated with the measurement, click and
drag the number.

TIP: To change the font size of the number associated

with the measurement, right-click the ruler, select
Change Size, and select a new font size.

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 TIP: To add the 2D or MPR ruler to the 3D view, right-click the ruler or
measurement figure and select Show in 3D.

Add calipers to 2D or MPR views:

A caliper is a ruler or angle drawn on one image that continues to display
as you scroll through the view.

NOTE: Calipers are not available in 3D views or curved planar

reformatted views.
1. Draw a ruler in a 2D or MPR view.

2. Place the cursor on the ruler, right-click and select

Caliper.

3. Scroll through the view.

Move Between Rulers and Calipers:

1. Press the SPACEBAR to navigate between images with rulers or
calipers.

NOTE: When you are navigating to a caliper, Vitrea will display the
plane where the caliper was last edited.

Edit Rulers:

1. Click and drag an endpoint to relocate the end of the ruler.

2. Click and drag the center of the ruler to relocate the entire ruler.

NOTE: Relocating the entire ruler is only available on single-plane

rulers.

Delete Rulers:
1. Right-click the ruler or measurement figure to select it.

TIP: The ruler turns purple.

2. Select Delete or Delete All.

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Adding Labels and Annotations
Type text directly onto any image in the Viewer window.

1. Right-click in the view, then click .

TIP: Or, from the Visual or Analysis tab, click .

2. Click the image where you want to place the label.

3. Select a term from the list.

OR

Type the annotation in the text area.

TIP: To remove a user-created listing from the

annotation directory, right-click it and select
Delete. Default listings cannot be deleted.

4. Click OK.

TIP: To add an arrow to the corner of the label, click the label, position
the cursor to the corner where you want the label, and drag.

• To edit a label, double-click the label and make font, size, color, or text
changes in the dialog box that displays.

• To reset the font size of a 3D label, right click it and select a new font
size.
• To delete a label, right-click it to select, then press Delete or Delete
All.
• To move a label, click and drag it.
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 • To add a 2D or MPR annotation to the 3D view, right-click it, then
select Show in 3D.

NOTE: For MPR views, text created by annotations, measurements, or

labels will fully display on the screen without running off the viewport. If
the text is too large to fit within the MPR viewport with the font size
selected, the font size will dynamically change to a lower setting which
does fit.

NOTE: For 3D views, all or part of the text may move or be displayed
off the viewport. During rotation or panning of the 3D view, part of the
text may be obscured by the volume or overlay views.

NOTE: Undo/redo operations are not available for font changes. Re-
edit the text to apply changes.

Taking Snapshots
Capture images to save to PACS, add to a report, or restore workflow.

TIP: To hide or show crosshairs in the snapshot, right-click and check

or clear Hide Crosshairs in Snapshot.

NOTE: The Hide Crosshairs in Snapshot setting is saved for all

future Vitrea instances.

1. Right-click in the view, then click .

Or, from the Analysis or Visual tab, click .

2. Click in the view.

• Hold ALT, then click in the view to take multiple snapshots.
• Hold CTRL, then click in the view to take one snapshot of the whole
viewer.

Trimming the Image

Trim data from an image to isolate areas of interest in 2D and MPR views.

TIP: Trimming MPR views also trims the 3D view.

1. Click to display a yellow trim box.

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 2. Place the cursor on a corner or side of the trim box and drag it to the
new location.
OR

With active, click and drag a colored border around the image.

TIP: To reposition the entire trim box, click inside it and drag it to the
new location.

TIP: To undo the trim, click the Reset Trim Limits icon.

Drawing Angles
Add angles to 2D or MPR views.

1. Right-click in the view, then click .

TIP: Or, from the Visual tab, click .

2. Click and release in the view where you want the ruler to start.

3. Move to the next location for the line segment, then click and release.

4. Repeat step 3 as many times as necessary.

TIP: The angle points may be added to different slices.

5. Double-click on the last point to end the line.

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 TIP: To add the 2D or MPR angle to the 3D view, right-click the angle
or measurement figure and select Show in 3D.

TIP: To set the angle as a caliper so that it continues to display as you

scroll through the view, place the cursor on the angle, right-click
and select Caliper.

NOTE: The Caliper feature is not available on angles created on

more than one slice.

Delete Angles:
1. Right-click the ruler or measurement figure to select it.

TIP: The angle turns purple.

2. Select Delete or Delete All.

Adding Arrows

Add arrows to 2D, MPR, or 3D views:

1. Right-click in the view, then click .

TIP: Or, from the Visual tab, click . The Arrow tool must be active

to use the spacebar to move through the arrows.

2. Click in the view where you want the point and drag to where you
want the end.

TIP: All views where the arrow intersects display the arrow.

Delete Arrows:
1. Right-click the arrow to select it.

TIP: The arrow turns purple.

2. Select Delete or Delete All.

TIP: To temporarily hide arrows, clear the Measurements check box.

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 Jump between images that contain arrows:
• Press SPACEBAR to jump forward in sequence through images that
contain arrows.
• Press SHIFT-SPACEBAR to jump backward in sequence through
issues that contain arrows.

Drawing Elliptical Contours

Add elliptical contours to 2D and MPR views. Surface area measurements
display once you draw the contour lines.

1. Right-click in the view, then click .

OR

From the Analysis or Visual tab, select the ROI dropdown and click

2. Click and drag in the view to draw.

3. To edit an elliptical contour, click one of the corner points and drag to
the new location.

4. To rotate an elliptical contour, click the top-center point and drag.

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 5. To move a contour, click the center square and drag to the new
location.

6. To delete the contour, click the contour to select it, then press
DELETE.

Drawing Freehand Contours

Add ROI contours to 2D and MPR views. Surface area measurements
display once you draw the contour lines.

1. Right-click in the view, then click .

OR

From the Analysis or Visual tab, select the ROI dropdown and click

2. Click and drag in the view to draw.

OR

a. Click around the perimeter of the area of interest placing anchor

points.
b. Double-click to place the final anchor point.

3. To edit a freehand contour, put the cursor on the contour, then drag
the edge to the new location.
OR

Click to add more anchor points.

3D Viewer Functions
Use the 3D-specific options in the right-click menu.

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 Menu Option Description
3D Box Displays a yellow 3D box around the volume
indicating the oblique trim plane position.
Reset Orientation Returns you to the initial orientation.
3D VR This option is grayed out in normal mode. If you
are in one of the bottom 4 modes on the right-
click menu, select 3D VR to return to normal
mode and turn off the cut planes.
Native Thickness Displays an image with original scan thickness.
MPR
Thick Slab MIP Displays a 10mm thick MIP image.
Thick Slab VR Displays a 10mm thick volume rendered image.
Oblique Trim To trim in an oblique plane.
Front Cut Plane Displays a 1 cut plane. Use this option to view
heart chambers.
If you select the Native Thickness MPR, Thick Slab MIP, Thick Slab VR, or
Front Cut Plane option from the right-click menu, it allows you to view a
different part of the volume by clicking and dragging. The center of
rotation is in the middle of the volume view.

• Click and drag in the center of the volume view to pivot the view on
the cut plane.
• Pan to move the volume and change the center of rotation.

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 • Right-click and drag up and down to move the cut plane closer or
farther away from the eye.
• Right-click and drag right and left to adjust the slab size.
• Click and drag on an outer edge of the view to rotate the volume.

Switching Active Volumes

With multiple volumes loaded, switch the selected volume by using the
Volume Navigation buttons at the bottom of the Viewer window.

NOTE: The Volume Navigation buttons display when there are two or
three loaded volumes, and are available with all protocols except Liver
CT, Brain Perfusion, Body Perfusion, Colon CT, Aorta Stent CT, and all
Cardiac CT.

TIP: To change the label on the button for the currently selected
button:

a. Click and select a name or type a new one.

b. Click to go on to the next volume, or click to finish.

Performing Segmentation
Segmentation is a way of isolating some parts and removing other parts
of a volume. With Anatomy Segmentation, you assign definitions to
various regions and apply visualization settings to each region.

Automatically Segment Bone

The automatic bone segmentation will perform best when the HU intensity
of the vessel lumen is below 1550 HU. If there are artifacts, such as metal

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 artificial joints, present in the image, the automatic segmentation will
perform best when the HU intensity of the artifacts is below 1976 HU.

NOTE: Automatic Bone Segmentation is available for the following

protocols:
• Vascular: Aorta CT
• Vascular: Carotid CT
• Vascular: CoW CT
• Vascular: Runoff CT
• Vascular: Renal CT
• Generic CT
• Abdominal CT
• Larynx/Airway CT
1. In the Segment Anatomy area,
click AutoBone.

TIP: If you have multiple volumes loaded, click the dropdown to

choose:

• This Volume - applies bone segmentation

to the currently selected volume only.
• All Volumes - applies bone segmentation
to all loaded volumes.
• Current - Apply all Volumes (for coincident studies only) -
applies bone segmentation to the current volume then
segments the same voxel locations in the other volumes.

NOTE: If there was previously-performed bone segmentation, a dialog

will display that allows you to replace the existing bone region or to
merge the bone regions.

2. Review the segmentation and use the Manually Segment Bone

technique to segment any additional bone regions.

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 Manually Segment Bone
1. In the Segment Anatomy area,
click Bone.

2. In the 3D view, click on a bony

area.
OR

In the 2D view, click a portion of cortical (brightest white) bone.

Vitrea displays a blue overlay on areas that will be segmented. Use this
as a guide to determine if you need to include more or less to the
selected area.

TIP: Be sure the blue overlay is on bone areas only. If it displays on

vessels, click , or adjust the HU slider, to select a smaller
HU range.

3. To remove a portion of the selected (blue) area:

a. Place the cursor over the area until a purple overlay displays.
b. In the 3D view, roll the mouse wheel to increase or decrease the
size of the purple overlay.
OR

In the MPR views, press the + or - keyboard keys.

c. Click the purple overlay.

That area will not be segmented with the rest of the Bone area.

4. From the in-viewer Multi-pick Bone box, click or as

needed.

TIP: The Less and More buttons decrease or increase the HU range
by 20.

5. Adjust the HU slider bar to adjust the HU range as needed.

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 TIP: You can also click an HU number and enter a specific value.

6. Click or as needed.

TIP: The Dilate and Erode buttons decrease or increase the selected
area by 1 pixel in the 2D views and 1 voxel in the 3D views per
click.

TIP: When you use the Dilate button, be sure the blue overlay does
not “bleed” into an area you do not want selected.

7. Repeat from step 2 to segment all the bones in the view.

8. Click .

Vitrea adds a listing to the

Anatomy Management area. The default show
setting for Bone is unselected, so it does not
display.

NOTE: With two or three coincident volumes

loaded, an All Phases check box displays so
you can select to have the segmentation apply to all phases loaded.

NOTE: Vitrea does not save a manually adjusted HU range. The next
time you click on a bone region, the default HU range is used.

Remove Fragments

1. To remove fragments, click .

2. Review the blue overlay to be sure all the fragments are selected.

TIP: Review the blue overlay to be sure only fragments, and not
vessels, are selected.

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 TIP: To adjust the size of the fragments selected, click the Smaller or
Larger buttons.

3. Verify that the Add To dropdown indicates

Recycle Bin, then click .
Vitrea adds a listing to the Anatomy Management area. The default
show setting for Recycle Bin is unselected, so it does not display.

4. In the Anatomy Management area, select Base to change the

window/level settings.

5. Right-click in the 3D view, then select .

6. Click and drag in the view.

TIP: Drag up to remove tissue from the view. Drag down to bring in
tissue to the view.

Segment Vessels Using Single-click Picking

1. In the Segment Anatomy area,
click the drop down arrow.

2. Click .

3. Click a vessel in the 3D view.

4. Adjust the selection area as necessary, using the blue overlay as a

guide.

TIP: Click on more vessels to add them to the Vessels listing.

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 5. Click .

Vitrea adds a listing to the

Anatomy Management area.

NOTE: With two or three coincident volumes loaded, an All Phases

check box displays so you can select to have the segmentation apply
to all phases loaded.

Segment Vessels Using Dynamic Growing

1. In the Segment Anatomy area,
click the drop down arrow.

2. Click .

3. Click and hold on the vessel to grow the vessel

branches.

4. Adjust the selection area with the Vessel Grow

slider. Use the cyan area in the image as a guide.

TIP: Apply MIP rendering and some thickness to the

MPR views to better visualize the selected area.

5. Click .

NOTE: The W/L settings of the view determine what is selected. Before
beginning this workflow, adjust the W/L so the vessel is visually
distinct from surrounding tissue. Doing so will reduce the chance of
accidentally selecting other nearby tissue.

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 Vitrea adds a listing to the Anatomy
Management area.

NOTE: With two or three coincident volumes

loaded, an All Phases check box displays
so you can select to have the segmentation
apply to all phases loaded.

Segment Organs

TIP: If necessary, adjust the Base window/level settings so the organ

appears to be full and solid.

1. In the Segment Anatomy area,

click Organ.

TIP: If necessary, click the

dropdown to select the
Organ button.

A green overlay displays around the cursor.

NOTE:It is possible to perform organ segmentation in the oblique

MPR mode; however, the green overlay will not display.

2. To increase or decrease the HU density range of the voxels to be

included in the selected region, press the + or - key.

3. Click the organ.

4. If only a portion of the organ is selected (blue), keep selecting the

organ until the segmentation is complete.

5. Scroll through the view to verify the organ is correctly selected.

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 6. In the dropdown box, select and highlight Other in the box and type
the name of the organ.

7. Click .
Vitrea adds a listing to the Anatomy
Management area.

NOTE: For visibly distinct regions, use the

Visible button and apply the workflow above.

NOTE: With two or three coincident volumes

loaded, an All Phases check box displays
so you can select to have the segmentation apply to all phases
loaded.

Sculpting in 3D

NOTE: Vitrea does not allow using the Sculpt tool to edit any of the
following existing regions: nodules, tumors, liver resection regions, or
brain perfusion summary map regions. Use the Edit tool to edit these
regions.
Sculpt in the 3D view to create a new region or add to the Base or
Recycle Bin regions.

1. In the Segment Anatomy area,

click Sculpt.

2. In the 3D view, draw a contour

around the region to sculpt.

3. In the 3D Sculpt dialog, choose an option:

• Keep - adds the data within the contour to the region listed below
the button (a region that is showing)
• Remove - adds the data within the contour to the region listed
below the button (a region that is hiding)

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 • AddTo: - adds the data within the contour to the region listed in
the dropdown. Click the dropdown arrow to change the region.

NOTE: With two or three coincident volumes loaded, an All Phases

check box displays so you can select to have the segmentation apply
to all phases loaded.

Sculpting in an MPR

NOTE: Vitrea does not allow using the Sculpt tool to edit any of the
following existing regions: nodules, tumors, liver resection regions, or
brain perfusion summary map regions. Use the Edit tool to edit these
regions.
Sculpt in the MPR view to create a new region or add to the Base or
Recycle Bin regions.

1. In the Segment Anatomy area,

click Sculpt.

TIP: To maximize the MPR view,

click .

2. Draw a contour around the region of interest.

• Click, hold, and drag to draw a true freehand contour.
• Click, release, and drag to draw a contour that attempts to
automatically define the edge of the region (based on HU units).

TIP: To aid drawing the automatic contour, click along the region to
drop anchor points.

3. Scroll a few slices, then repeat step 2.

NOTE: Interpolated contours between automatic contours are truly

interpolated and do not necessarily follow the edge of the region.
Edit interpolated contours if necessary.

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 4. Continue to scroll and draw until you reach the last slice displaying the
region.

TIP: Vitrea automatically displays a colored surface on the 3D view.

5. If you had the MPR maximized, minimize it to see the 3D view.

6. Rotate the 3D view to verify that the surface contains the whole area
to sculpt.

7. Verify the correct region name is listed in the Region dropdown, then
click .

TIP: Click the dropdown to change the region.

NOTE: With two or three coincident volumes loaded, an All Phases

check box displays so you can select to have the segmentation apply
to all phases loaded.

Automatically Segment Skin

NOTE: Automatic Skin Segmentation is available for the following

protocols:
• Vascular: Aorta CT
• Vascular: Carotid CT
• Vascular: CoW CT
• Vascular: Runoff CT
• Vascular: Renal CT
• Generic CT
• Abdominal CT
• Larynx/Airway CT
• Liver CT

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 1. In the Segment Anatomy area, click the
dropdown arrow, then select AutoSkin.

2. Click .

TIP: If you have multiple volumes loaded,

click the dropdown to choose:

• This Volume - applies skin segmentation

to the currently selected volume only.
• All Volumes - applies skin segmentation
to all loaded volumes.
• Current - Apply all Volumes (for coincident studies only) -
applies skin segmentation to the current volume then segments
the same voxel locations in the other volumes.

NOTE: If there was previously-performed skin segmentation, a dialog

will display that allows you to replace the existing skin region or cancel
the request.

NOTE: The show or hide properties of the skin region is dependent

upon the selected visibility option.

Re-display the Bone and Make It Semi-Transparent

1. In the Anatomy Management list, select
Bone.

2. Drag the Transparency Slider to the

desired value.

TIP: The bone in the view changes

transparency as you drag the slider.

TIP: Click a visibility preset button.

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 Tint Regions in MPRs
1. In the Anatomy Management list, select a listing.

2. Select the Tint/MPR check box for that

region.

TIP: The MPR views display a tinted overlay

for the selected region(s).

NOTE: The tinted area may appear to be too

big, too small, or to overlap in certain cases,
for example, in oblique orientations or extremely zoomed views. This is
a result of the sub-voxel rendering. The contours that define the tinted
area are still correct, regardless of how the tinting appears to display.

Edit Regions
1. Select a region.

2. Click .
Contours defining the region display in the MPR views.

3. Choose which MPR view to work in.

TIP: To maximize the MPR view, click .

4. Click and drag the edge of the contour.

5. Scroll, and continue editing.

6. Click .

Display a Thumbnail of a Region

1. In the Anatomy Management list, hover over a listing.

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 A small view of the region displays, even if the region is currently
hidden.

Manage the Regions

1. In the Anatomy Management list, click the
Options dropdown for a listing or right-click
a listing.

2. Select an option:
Edit—Edit the contours defining the region. Same
as the Edit button. See page 99.
Delete—Delete the region from the list and return it
to the Base region.
Rename—Rename the region. See below.
Highlight & Tint/MPR—Tint the region in the
MPR views. Same as the Tint/MPR check box.
See page 99.
Change Colors—Change the color of the region.
See page 101.
Edit Opacity & Colors—Create a custom color
scheme. See page 102.
Dilate or Erode—Dilate or Erode the region.
Merge—Merge two regions. See page 101.
Show Volume—Display the volume measurement
of the region in the 3D view. See page 129.
Export as STL—Export the region as an .stl file.
Batch Segmented Region — Create a new
DICOM series in which all voxels outside the
segmented region are masked (“blacked out”).

NOTE: Not all options are available for the Base region.

3. To Rename a Region, right-click the region name and select Rename.

NOTE: Vitrea reserves certain names (depending on the protocol) for

protected or non-editable regions. If you attempt to name a non-
protected region to a protected region name, Vitrea will include a

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 numeral at the end of the name. For example, if you attempt to
rename a region called “Other” to “Tumor,” Vitrea will change it to
“Tumor-0.”

4. To Delete a Region from the List, right-click the region name and
select Delete. The region is added back to the Base region.

Merge Regions
1. Select a region and right-click.

2. Select Merge.

3. Select another region from the list.

Change the Appearance of a Region

1. In the Anatomy Management list, select a listing.

2. Click the Options dropdown in the listing.

3. Select Change Colors.

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 4. Choose a preset.

The selected region changes to match the preset you clicked.

OR

Click .

5. Select a color scheme from the menu.

6. Click OK.

Create a Custom Color Scheme

1. In the Anatomy Management list, select any listing.

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 2. Click the Options dropdown.

3. Select Edit Opacity and Colors.

4. Change the color and opacity settings as desired.

b c

a. Click a box in the color point bar.

b. Choose a color in the color panel.
c. Adjust the hue.
d. Click and drag the W/L bars to adjust the HU.

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 3

1 18
2

4
5
12
6
8 9 13 14
7 11 10
15 16 17

Callout Description
1 Transparency Setting — Drag the slider (or type a value) to
adjust the percent opacity.
2 Curve Editor area — Drag control points to adjust opacity
curve. Double-click along curve line to add control points.
3 Window/Level Range — Drag the yellow lines to adjust the
window width. Drag the red line to adjust the level.
OR

Enter values in the text boxes that correspond to the lines.

4 Color Gradient — Click a box in the color scale, then
choose a color for that point.
5 Curve scroll — Drag to scroll along the length of curve.
6 Opacity fct. (function) button — Click to display preset
opacity curve options.
7 Colors button — Click to display preset color gradient
options.
8 Color Picker — Click a color to set the selected point of the
curve.
9 Shade Selector — Drag the arrow along the bar to adjust
the shade of the selected color.
10 Color Model options — Select RGB to use the Red Green
Blue color model. Select HSL to use the Hue Saturation
Lightness color model.
11 Color Model Values — Type specific values for the RGB or
HSL color models. The range is 0 to 255.
12 Sample Color Swatch — Displays the sample color you
selected.

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 Callout Description
13 Zoom button — Click and drag upward to zoom in on the
Curve Editor. Click and drag downward to zoom out.
14 Reset Zoom button — Click to reset the Curve Editor zoom
level.
15 Save Preset button — Click to save the settings as a preset.
16 Reset button — Click to reset the settings to the default.
17 Close button — Click to close the VR Editor.
18 Log Scale — Select this box to apply logarithmic scaling.

5. Click and choose an opacity curve.

6. Click and select a color gradient.

TIP: To save your changes as a new preset, click and type a

name and click Save.

7. Click .

Setting Lighting and Visualization Options

Lighting illuminates an image to allow you to see it more clearly. There are
several ways to adjust lighting settings.

• To change the 3D image background color, click Lighting and select

Select 3D Background Color to display a color palette.

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 Change the Appearance of the Whole View

• Click a visibility preset option .

TIP: Click to expand the preset

selector options.

TIP: The scene changes to match the preset you

selected.

Multi-Volume Fusion
Create a fused 3D image by combining two to four series.

1. Load 2, 3, or 4 series.

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 NOTE: The volumes must have the same frame of reference or be
coincident (for comparative viewing).

2. Select a protocol and the Dual Vol preset.

NOTE: Multi-Volume Fusion is only available with the following

protocols:
• Generic CT
• Abdominal CT
• Larynx/Airway CT
• Lung CT: Airway Analysis and Pulmonary Analysis presets only
• Musculoskeletal CT
• All Vascular CT protocols, except TAVR and Stent Planning
• All MR protocols, except Brain MR
• All XA protocols

3. Perform segmentation and trimming to best display the desired

regions in all volumes.

TIP: To switch the currently selected volume, click the volume buttons
at the bottom of the viewer window.

4. Select the Fusion check box.

A fused 3D volume displays in the
selected volume (with “Fusion” indicated

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 in the lower right corner) and region listings for all the volumes display
in the Anatomy Management list.

NOTE: When the Fusion check box is selected, the 3D image may
appear slightly less concentrated than the non-fused image.

5. Use any of the Anatomy Segmentation features (transparency, tint

MPRs, preset options, etc.) with any of the regions.

NOTE: Keep the following information in mind while working with fused
volumes:
• The crosshair location will be determined by the first visible
intersection point in the fused view.
• Regional window/level and visualization settings still apply in
the fused view.
• Arrows and rulers placed in a single volume will display in the
fused volume.
• Arrows drawn on the fused volume will be associated with the
base series (the series that the others are fused into).

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Vessel Type Drop-down List
The vessel type is determined by the protocol you select.

EXAMPLE If you select the Carotid CT protocol, the

Carotid vessel type is selected by default. If you select
the Generic CT or MR protocol, the Generic vessel type
is selected by default.
The Vessel Type dropdown list specifies the type of vessel
you are probing according to the following maximum diameters:

Generic 18.0mm
Neuro 7.0mm
Carotid 14.0mm
Coronary 7.0mm
Peripheral 10.0mm
Pulmonary 9.0mm
Renal 8.0mm

Performing Vessel Probe

When you probe a vessel, the Vitrea software traces the vessel lumen,
highlighting it with a vessel indicator line. The vessel indicator displays in
the 3D view. If you work in Curved MPR mode, the software plots a line
through the center of the vessel lumen in one of the views. If you work in
Oblique MPR mode, the software automatically displays the best view of
the vessel in an oblique plane, along the length of the vessel.

NOTE: Because of the high HU value of contrast media in 100kV

scans, the reliability of calcium detection within the vessel lumen is
expected to be lower than that of regular kV scans.

NOTE: Vessel Probe is not recommended for probing the aorta.

1. Right-click in the view, then click .

TIP: Or, from the Analysis tab, click .

2. Click the vessel.

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 TIP: Vitrea adds a listing to the Vessel Management area.

TIP: If the probe tool did not select enough of the vessel, extend it:

a. Right-click in the view, then click .

b. To extend the vessel, click a point farther along the already selected vessel.
c. To refine the vessel indicator line, drag the cursor along the vessel indicator
line to a desired end point and click.

NOTE: As you drag the cursor, the vessel indicator line

disappears. It will not be removed until you click.

TIP: To edit what the probe tool selected:

a. Click .

The cursor changes to a pen.

b. Assess the centerline to verify accuracy.
c. Move the cursor (pen) to a specific point along the centerline and click to
plot a point to modify the path of the vessel centerline.

NOTE: As you plot points, a new red line displays to show you
how the centerline displays if you click . This line
displays as a reference line in the 3D view.
d. If necessary, move the cursor (pen) to a different point along the centerline
and click to plot a point. Continue to plot all additional points. As you plot
additional points, the line updates to go through all the user control points.

NOTE: Click and drag the line and it dynamically shows the
resulting line as you drag. The point displays after you release
the mouse button.

NOTE: Rotate, zoom, and scroll the curved view while the line
is being created.

NOTE: Hover over a plotted point. The pencil changes to a

hand. Click to move the plotted point.

NOTE: Click if you want to clear the red

centerline and start over.

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 e. Click to apply the modified (red) centerline to be the final

centerline.

Measure Centerline Length

The Length tool measures length along the centerline between two points
on the vessel centerline.

1. Click to change the volume view to a 1-up image and display a

vessel probe view.

2. Click located under Vessel Tools.

3. Click and drag to draw a length measurement between two points on

the vessel.

4. Click and drag either end to edit the length.

The value of the length displays at the proximal end of the length
measurement. It represents the length along the centerline between
the two specified points.

Create Centerline Angles

The Angle tool creates an angle along the centerline.

1. Click to change the volume view to a 1-up image and display a

vessel probe view.

2. Click the dropdown for the first button

located under Vessel Tools.

3. Select .

4. In the curved view, click and release to start the angle.

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 5. Move the cursor to the vertex location on the centerline and click and
release.

6. Move the cursor to the end point of the angle and click and release to
complete the angle.

Define a Lesion
The Lesion tool defines a lesion in the vessel in either of the CPR views.

1. In the Vessel Tools area, click the dropdown for the second button.

The dropdown contains the following tools:

Single — When you draw a lesion using the Single
method, Vitrea identifies a point as the reference point.
Vitrea displays the area and minimum diameter at the
narrowest point and at the reference point, and uses
these measurements to calculate the area and diameter
stenosis.

TIP: The reference point may need to be moved

manually.
Average — When you draw a lesion using the Averaged
method, Vitrea calculates the average of the area and
minimum diameter for the start and end points. It
compares these measurements to the area and minimum
diameter at the narrowest point to create stenosis
measurements.
Dual — When you draw a lesion using the Dual Reference
method, Vitrea calculates the average of the area and
minimum diameter for the reference points marked with
green lines. It compares these measurements to the area
and minimum diameter at the narrowest point to create
stenosis measurements.

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 Volume — When you draw a region using the Volume
method, Vitrea displays the volume of the lumen and
outer wall. It also identifies the maximum outer wall
diameter. Use this option for thrombosed regions.
Landing Zone — Use the Landing Zones option to define
specific regions for in-depth analysis.

2. Select a tool.

3. Click in the CPR view just above the start of the lesion
and drag to just below the end.

TIP: Vitrea adds an entry in the Vessel Management

area.

TIP: Vitrea identifies:

Feature Identified by
Identified lesion Cyan lines
Point of maximum Red arrows
narrowing (stenosis)
Lumen diameter at the Number in the curved view with red
stenosis point border, corresponding to the red arrows
(displays in the two-up curved view)
Reference point(s) for Green line(s)
single or dual-reference • Be sure to review the locations of
lesions
each reference line and decide if
it is accurate for the identified
lesion. If necessary, drag the
green line to move it to the
nearest normal section of vessel.

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 Feature Identified by
Lumen diameter at the Number(s) in the curved view with green
reference point border, corresponding to the green
line(s) (displays in the two-up curved
view)
Stenosis measurements Table at the bottom of the CPR view

Define a Landing Zone

Use the Landing Zone option to define specific regions for in-depth
analysis.

1. Click .

2. Click the dropdown for the second button in the Vessel Tools area.

3. Select .

4. Click and drag in the curved view to define the proximal and distal
ends of the zone.

TIP: After you define the landing zone, it displays in the Measurements
box. Right-click to rename the landing zone.

5. View the diameters for the landing zone.

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2D Imaging

Use the 2D formats to view slices as they were acquired by the scanner.

Four labels display along the sides of the views indicating orientation of
the image: S - Superior, I - Inferior, A - Anterior, P - Posterior, L - Left, R -
Right.

TIP: Change the view orientation placing the cursor over the upper-left
corner of the view and dragging the corner to another corner

of the view .

TIP: To resequence views, click and drag the upper-left corner of a

view pane to another view pane.

Scrolling Through Slices

Scroll through slices in a particular Montage slice view, as though you
were seeing a movie made from a series of slices. Scroll manually or
autoscroll through 2D slices.

Scroll by:

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 • Right-click and drag up or down
• Roll the mouse wheel up or down
• Press RIGHT or LEFT ARROW
• To autoscroll, press SHIFT, then right-click and drag
• To page through images, press PAGE UP or PAGE DOWN

Displaying a 2D Montage
1. Select a Viewer window layout that shows four, nine, or
sixteen slices.

2. Roll the mouse wheel in any of the 2D slice views to scroll through the
slices.

3. Use any of the Visual or Analysis tab buttons to complete workflow.

Stacking Images
Create 2D images from the average data values of up to 10 slices. This is
useful when viewing a volume scanned using a very small slice thickness.

• Click and drag the Slices to Stack slider to the

number of slices you want to use in the stack.

Performing 2D Comparative Review

Review multiple volumes for the same patient ID using the 2D All Exams

Viewer window format .

1. Load multiple volumes (2 - 25) from the Study Directory.

2. Select the desired protocol.

3. Select a preset that includes the All Exams format.

TIP: Or, select the All Exams format from the Viewer window.

TIP: Adjust individual visual settings, such as window/level, and

orientations.

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 4. To group the images, click the upper-left corner of each view to
include in the group.

TIP: The corner and border of the view turns yellow to indicate that it is
included in the group.

5. Right-click and drag in any grouped image to scroll through all

grouped images.

TIP: All images scroll side-by-side locked at the slices you selected
when you grouped the images.

TIP: To remove a volume from the group, click the upper-left corner of
each view containing an image you want to remove from the
group.

TIP: To return to viewing a single volume, click any viewer window

format button.

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MPR Imaging
With most 3D view format options, three MPR (Multi-Planar Reformatted)
images also display in the Viewer window along with the 3D view.

In Orthogonal MPR mode the three MPR images lie in sagittal, coronal,
and axial planes. The border color indicates the plane the image lies in
while the colors of the crosshairs indicate the other two MPR views.

Orientation Border Crosshairs Labels

Sagittal Blue Vertical: Green (coronal) A-P
Horizontal: Red (axial) S-I
Coronal Green Vertical: Blue (sagittal) S-I
Horizontal: Red (axial) R-L
Axial Red Vertical: Blue (sagittal) A-P
Horizontal: Green R-L
(coronal)

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Scrolling Through MPRs
Scroll through the MPRs to view multiple images within the plane.

• Roll the mouse wheel in the view

• Right-click and drag in the view
• Press LEFT or RIGHT ARROW.

Maximizing/Minimizing (1-up/Return)
Maximize a view to full-screen size, then minimize to its original size.

1. To maximize the view to 1-up, click in the lower left corner.

2. To minimize the view to its original size, click in the lower left
corner.

Rotating MPRs
Rotate the placement of the three MPR views.

• Click in the lower left corner of an MPR view.

TIP: Use this to switch MPR views in 1-up MPR viewing.

MPR Rendering

Select MPR rendering modes to change the appearance of the MPR

views.

1. Click the MPR rendering dropdown.

2. Select a rendering option.

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Applying MPR Color and Lighting
The MPR Colored and Lit rendering option applies to the MPR images the
same color, transparency, and lighting settings applied to the 3D image(s).
This is most noticeable when you have slice thickness set higher than 1.

This setting is useful for the same applications as volume rendering, with
the additional slice thickness setting for mini-slabs.

• Average (10 mm thickness maximum) — A shading setting that

displays data using the average data values for all voxels in an
image.

This setting is particularly useful for viewing coronal and sagittal

views of noisy images, or for simulating a slice thickness other than
what was scanned. Using slice thickness and averaging also
allows you to scroll through the dataset quicker.

NOTE: The MPR Averaging thickness is limited to 10 mm. If you

choose Oblique/Curved MPR mode, MPR Averaging is disabled and
views change to volume rendering automatically.
• MIP (100 mm max thickness) — A shading setting that displays
data using only the highest data values for each voxel of the image.
MIP is a good setting to use when competing features composed
of voxels with similar or higher values might be obscuring the
feature of interest.

With the separate MPR MIP option you can view a volume
rendering side-by-side with MPR MIP images.

This setting is particularly useful when performing these

operations:

• Differentiating between contrast and calcium in vessels

• Viewing thick slab MPRs with many tiny, loose body bone
fragments
• Viewing carotids, the Circle of Willis, renals, runoffs, or any
vessel to show plaque
• Viewing a thick slab MPR, showing all liver vessels in one plane

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 • Volume Render (100 mm max thickness) — uses all voxel
values.

The separate MPR Volume Render option gives you the capability
of viewing a 3D MIP rendered volume side-by-side with MPR
volume rendered images.

This setting is useful for showing vessel depth.

• Colored and Lit (100 mm max thickness) — The color provides

different attenuation factors on a thick slab view. The lit portions
cast shadows to produce brilliant colors.

NOTE: If you are using the Colored and Lit MPR option, the same
color, transparency, and lighting settings applied to the 3D image(s)
also apply to the MPR images. This is most noticeable when you
have slice thickness set higher than 1.
The colored and lit setting is useful for the same applications as
volume rendering, with the additional slice thickness setting for
mini-slabs.

• MinIP (100 mm max thickness) A shading setting that displays

data using only the lowest data values for each voxel of the image.
MinIP is a good setting to use when features composed of similar
or higher voxel values might be obscuring a feature of interest
composed of lower voxel values in a scanned image.

This setting is particularly useful when looking at air or fluid in mini-

slabs. For example, lung airways or dilated pancreatic or bile
ducts.

Adjusting MPR Thickness

Create “mini-slabs” of MPR views containing
multiple slices.

• Click and drag the thickness slider to the desired value.

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 TIP: If is active, the MPR views display a dashed line on either

side of the crosshairs to indicate the thickness of the slab.

TIP: For best results, verify the MPR rendering is set to MIP.

Sculpting in MPRs
Sculpt in the MPR views to isolate or define anatomical structures.

1. In an MPR view, scroll to find the beginning point of the area to define.

TIP: Maximize (1-up) the MPR view to magnify the view.

2. Right-click and select .

3. Click and drag to draw a closed shape around the area to define.
• Click, hold, and drag to draw a true freehand contour.
• Click, release, and drag to draw a contour that attempts to
automatically define the edge of the region (based on HU units).

TIP: To aid drawing the automatic contour, click along the region to
drop anchor points.

4. Scroll a few slices, then repeat step 3.

NOTE: Interpolated contours between automatic contours are truly

interpolated and do not necessarily follow the edge of the region.
Edit interpolated contours if necessary.

5. Continue to scroll and draw until you reach the last slice displaying the
region.

TIP: Vitrea automatically displays a colored surface on the 3D view.

6. If you had the MPR maximized, minimize it to see the 3D view.

7. Rotate the 3D view to verify that the surface contains the whole area
to sculpt.

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 8. Verify the correct region name is listed in the Region dropdown, then
click .

TIP: Click the dropdown to change the region.

Switching MPR Imaging Modes

There are three imaging modes for MPR views. The
MPR views include a button in the lower right corner.
The icon on the button indicates the current mode.

Mode Description
Orthogonal The three MPR views display in exactly the sagittal,
coronal, and axial planes.
Oblique One or more MPR views display in an oblique plane.
Useful for features that lie in a plane other than one of
the orthogonal planes.
Curved Curved MPR mode creates curved multi planar
images.
Switch modes by clicking the button, or click the
dropdown arrow next to the button and select the mode.

Using Oblique MPR Mode

In Oblique MPR mode, change orientation of the MPR views by rotating
the crosshairs in one or two of the MPR views.

1. Right-click in the view, then click .

2. In one of the MPR views, position the cursor over one of the
crosshairs .

TIP: This view remains in Orthogonal mode, and the other two views
display images at oblique angles.

3. Drag the crosshair in the view while watching the other views.

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 TIP: As you drag, the crosshairs rotate around their intersection point,
staying perpendicular to each other.

TIP: Rotate crosshairs in more than one view.

TIP: To move the crosshair intersection point, click the spot where you
want the crosshair to intersect.

4. To “walk” a vessel, click and drag in the view.

TIP: The center of the crosshairs act as a fulcrum point.

Using Curved MPR Mode

In Curved MPR mode, use one of the MPR views to define a curve and
display the reformatted (“flattened”) curve in another view.

1. Decide which plane is the reference view where you direct the
crosshair to follow the curve.

TIP:

• For coronal images of the renal arteries, work in the axial plane.
• For sagittal reformats of a spine and aorta, work in the coronal
plane.
• For coronal reformats of a spine or aorta, work in the sagittal
plane.

2. In the lower-right corner of the reference view, click twice until the
icon shows .

TIP: The labels in the lower-right corner change to Reference, Curved,

and Transverse.

3. In the lower-left corner of the reference view, click .

4. Roll the mouse wheel in the view until you see beginning point of the
curve you want to define.

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 5. Click the endpoint of the green line and drag it to the beginning point
of the curve.

6. Follow the curve by dragging the green line to various points along the
center of the anatomy.

TIP: A green X displays where you place the green line.

TIP: Use the mouse wheel to scroll up and down in the view to follow
the center of the anatomy.

7. Continue along the entire curve.

8. Click the endpoint of the green line and drag it to the end of the curve.

9. Click in the lower left corner of the view.

10. In lower-left corner of the Curved view, click .

11. Review the yellow centerline to be sure it follows the center of the
curved region.

TIP: If necessary, click and drag the centerline to reposition it.

12. Drag the smaller, lighter line (Measuring line) to a point along the
centerline to measure.

13. Drag the longer, darker line (Transverse line) to the other point along
the centerline to measure.

TIP: The measurement between the two lines

and the measurement of the entire
centerline display.

14. To rotate the curved view along the centerline,

click and drag in the view.

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Displaying 3D Crosshairs
To change images displayed in the MPR views, move the 3D crosshairs in
a 3D view to a new position. As a result, MPR views automatically update
to display slices corresponding to the 3D crosshairs intersection.

1. Select the 3D Crosshair check box.

2. Click in the 3D image at the new location.

3D Imaging
The 3D volume views can be viewed from the outside or inside. Turn them
and view them from any angle, trim them, add arrows, and much more.

Switching 3D Imaging Modes

There are four imaging modes for 3D views. The 3D views
include a button in the lower right corner. The icon on the
button indicates the current mode.

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 Some modes are not available in some situations.

Mode Description
Fly Around To view the volume from the outside.

Fly Through To view the inside of an air or contrast-filled

lumen.
Point of Interest (POI) To view a small amount of the image
immediately surrounding the crosshair
position.
Reverse View To view the image opposite of the image in
the primary 3D view.
Oblique Trim To trim in an oblique plane.

TIP: To activate the Oblique Trim mode,

right-click in the 3D view and select
Oblique Trim.
To switch 3D modes, click the mode button until the icon for the desired
mode displays on the button.

TIP: If the icon you want does not display, the mode is not currently
available. Resolve this by selecting a different Viewer window
format.

Performing Volume Render and Rotation

Click the rotation shortcut buttons at the bottom of the 3D view to rotate
the image.

• Superior
• Inferior
• Anterior
• Posterior
• Left
• Right
• Oblique

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 Use the Volume Render dropdown to change the appearance of the 3D
view.

1. Click the Volume Render dropdown.

2. Select a volume rendering option.

• Normal — Turns lighting off.
• Volume Render — View a 3D MIP rendered volume side-by-side
with MPR volume rendered images. Useful to show vessel depth.
• MIP (Maximum Intensity Projection) — A shading setting that
displays data using only the highest data values for each voxel of
the image. A voxel is the smallest resolvable cubical area of an
image on a screen. MIP is a good setting to use when competing
features composed of voxels with similar or higher values might be
obscuring the feature of interest.
• MinIP (Minimum Intensity Projection) — A shading setting that
displays data using only the lowest data values for each voxel of
the image. This is useful when features composed of similar or
higher voxel values might be obscuring a feature of interest
composed of lower voxel values in a scanned image.
• Inverted MIP — A MIP setting that displays inversely.
• Inverted MinIP — A MinIP setting that displays inversely.
• Normal-Cut Plane — Removes the rendering artifact. The
normal-cut plane provides a clean surface.

Rotating

Rotate by Dragging
1. Click and drag in the 3D image to free-rotate in any direction.
A tool-tip displays how far (in degrees) you have rotated in a single
direction. Each time you click the image to drag, the tool-tip starts at
0.

2. Click and drag at the edge of the 3D view to spin the image on the
same plane.

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 Rotate with the Arrow Keys
1. Press any of the ARROW keys to rotate the image 5 degrees in that
direction.
A tool-tip displays the cumulative amount you have rotated. If 10
seconds elapses after you press an ARROW key, the tool-tip restarts
at 0.

Rotate by Entering Exact Positions

Type rotation values to rotate the volume to exact positions:

• Azimuth (a) [valid values -180 to 180] - degree of rotation right or

left around the center of volume
• Elevation (e) [valid values -90 to 90] - degree of rotation forward
or backward from the center of volume
• Twist (t) [valid values -180 to 180] - degree of tilt left or right
around the center of the volume
• To adjust the rotation to a specific value, type the value followed by the
appropriate letter.

Performing Volume Measurements in the 3D View

To measure the volume of a 3D region, first segment the region and
display a surface.

1. Click .

2. In an MPR view, locate and click on the anatomy.

3. Rotate the 3D view to verify the surface is accurately defined.

4. If necessary, use the tools in the in-viewer Multi-Pick box to adjust the
selection area.

5. In the in-viewer Multi-Pick box, click the Anatomy dropdown to select

a name for the region.

6. Click .

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 7. In the Anatomy Management area, right-click
the region and select Show Volume.

TIP: The volume measurements display in the

3D view.

NOTE: Mean HU and the standard deviation display for CT studies.

Signal intensity mean value and the standard deviation display for MR
studies.

3D Sculpting
Use 3D sculpting to remove the scanner table or other artifacts from the
3D view.

1. Right-click and select .

2. Draw a contour around the area to sculpt.

3. Click the Add To dropdown and select Recycle Bin.

4. Click Done.

TIP: Use 3D sculpting to add objects to other regions as well.

Performing Oblique Trim

Trimming along orthogonal planes does not always reveal the image you
want. Select the Oblique Trim check box to trim the volume along an
oblique plane.

1. Check the Oblique Trim check box.

TIP: All data ‘closer to you’ than the trim plane is removed.

TIP: The 3D Box check box is checked automatically, and a yellow 3D

box displays around the volume indicating the oblique trim plane
position.

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 2. With the crosshair tool active, click and drag to rotate the view about
the point indicated by the yellow cross.

3. Middle-click and drag the yellow cross to move the axis of rotation.

4. Middle-click and drag the volume to rotate the plane around.

5. Right-click and drag to move trim plane forward or backward.

TIP: Trim in fly-through views. To display the portion that was trimmed
in fly-through views, switch to a 5-up Viewer window format and
set the upper 3D view to Reverse View mode.

TIP: To redisplay the full volume after using oblique trim, clear the
Oblique Trim check box.

Denoising
Use Denoising to filter images with regard to noise reduction.

NOTE: Be sure to view images with Denoising applied in conjunction

with the original images by switching between the primary image and
the denoised image.
• After you have applied a Denoising filter, press D to switch
between an image with Denoising applied and the image with no
filter.
1. Click the Denoising drop down arrow to display
the menu.

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 2. Choose a preset filter value.

3. To create a new preset, select Presets.

a. Select a preset to use as a starting point for the new preset.

b. In the Denoising Preset Editor, adjust the Smoothness or Contrast
settings.
c. Click New.
d. Rename the preset if desired.
e. To edit the denoising strength, select Advanced and choose a
value from the dropdown arrows.
f. Click Ok.

4. To edit a custom (user-created) preset:

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 NOTE: To edit a predefined preset, create a new preset using the
predefined preset as a starting point.
a. Select the preset.
b. In the Denoising Preset Editor, adjust the Smoothness or Contrast
settings.
c. Click Save.

5. To change the filter settings interactively in the MPR view, select

Interactive.

a. Drag the cursor in the view using the S/C (Smoothness/Contrast)

value as a guide.

TIP: The area inside the yellow box will interactively change as you
move the cursor.

b. Release the mouse button to set the denoising value.

c. Select another tool, such as Crshair, to exit interactive denoising.

6. To save interactive settings as a new preset, select Save As.

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 a. In the Create New Filter Editor, adjust the Smoothness or Contrast
settings.
b. To edit the denoising strength, select Advanced and choose a
value from the dropdown arrows.
c. Click Ok.

7. To create a batch of images in the selected orthogonal plane that is

exported as a new series, select Save New Series.

Changing Visibility Settings

Visibility options control how 3D images display in region segmentation.
Apply visibility options to all regions or to a single region.

Apply a visibility scheme to all regions:

•Click one of the preset visibility options, or click the

dropdown arrow to display a panel of additional
choices.

Change the color of a single region:

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 1. Select the region in the Anatomy Management
list.

2. Click the Options dropdown.

3. Select Change Colors.

4. Double-click a preset.
OR

Click to select from a menu of color gradients or solid colors.

Apply window/level settings to a single region:

1. Select the region in the Anatomy Management list.

2. Right-click in the view, then click .

3. Click and drag in the view to adjust the window/level settings for the
region.

Create a custom region preset:

1. Select the region in the Anatomy Management list.

2. Click the Options dropdown.

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 3. Select Edit Opacity & Colors.

4. Adjust the colors for the HU values as desired:

• Click to select a predefined gradient.

• Click a box along the color bar (notice the HU value for that point
displayed in the upper-right corner), then choose a color from the
palette to apply to that HU value.
• Double-click along the curve to add a new box along the color bar.
• Right-click on a square in the color bar and select Apply Color to
All to apply that color to the entire range of HU values.

5. Click to save your settings as a preset.

Using Lighting Options

Lighting illuminates an image to allow you to see it more clearly.

1. Click to display the lighting menu.

2. To change the background color:

a. Select 3D Background Color.

b. Choose a color from the color palette.

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 3. To change the lighting options, select Lighting Options.

Callout Description
1 Light Direction control — Drag the
white dot to adjust the direction of the
light source.
1 2 Light Properties dropdown menu
—Select a light properties option.
3 Ambient slider — Adjust the ambient
2 light.
4 Diffuse slider — Adjust the diffuse
3 light.
5 Specular slider — Adjust the
4 specular light.
6 Projection dropdown menu -- Select
5 a field-of-view option.
6 7 OK button — Accept the changes.
8 Cancel button — Cancel the
changes.
7 8

Changing the Field of View

Change field of view using the Projection dropdown menu on the Options
menu.

The Orthographic mode displays the view as if the object lines are
perpendicular to the projection plane.

In the other modes, the object lines have perspective applied, making
distant parts of the object appear smaller.

• Orthographic — view with no perspective applied

• Telephoto — eliminate peripheral image data from view
• Moderate — view with a field of view greater than Telephoto
• Wide Angle, Very Wide Angle, Ultra Wide Angle — view with
wide fields of view

NOTE: Specific options available are associated with the protocol

selected on the Gallery window. The initial setting is determined by the
view you chose. The width of the field of view (in degrees) is listed in
the menu for each view option.

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 NOTE: If you select Orthographic in the Projection list, and you change
a 3D view to Fly Through mode, the Projection list automatically
changes to a perspective option.
• If you change the field of view when you are in Fly Through mode,
this causes a significant change in the appearance of the volume.
Decreasing the field of view makes the volume appear much larger.
Similarly, increasing the field of view makes the volume appear
much smaller. If you later switch to Fly Around mode, the volume
image remains the same size as it was in Fly Through mode.

Flying Through Volumes

Use the fly through feature to navigate through passageways in the
anatomy. On the Gallery window, select a preset that has Fly Through in
the name.

1. Be sure the Viewer window format includes a 3D view.

2. Zoom in and rotate the 3D view as necessary to position the area to fly
through to the center of the view.

3. Click the mode button in the lower-right corner of the

3D view until it changes to Fly Through mode
,
OR

from the Preset Selector dropdown on the Analysis

tab, select Flythrough Contrast from the Preset
Selector dialog box.

4. Press right-ALT and click on the area in the 3D view to fly into.

TIP: Click in the MPR view on the area where to start flying.

5. Begin flying using one of these methods:

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 • Right-click and drag
• Roll the mouse wheel
• Press right-ALT and click in the view further along the passageway
• Use a keyboard shortcut

Press... To...
> Fly forward
< Fly backward
SHIFT > Fly forward with continuous assisted navigation
SHIFT < Fly backward with continuous assisted navigation
ARROW Change the direction by a small amount
SHFT + Change the direction by a larger amount
ARROW
? Flip the view direction 180 degrees
left-ALT + Move the eyepoint. Also works during batch creation.
click
right-ALT + Move the view direction. Also works during batch
click creation.

TIP: To fly continuously, press SHIFT, then right-click and drag.

6. Turn by clicking and dragging in the direction to turn.

While flying through the lumen, examine a feature of interest

in the MPR views.
1. On the Visual tab, verify the Target Nav check box is cleared.

2. Press and hold left-ALT, then click the point of interest in the 3D view.

TIP: The crosshairs in the MPR views change to the spot you clicked.
The eye point in the 3D view does not change. This causes the
eye point to be temporarily out-of-sync with the MPR crosshairs.

3. To re-sync the MPR and 3D views, fly to a new position.

Fly in dynamically changing oblique MPR planes.

1. Click MPR mode dropdown and select Oblique.

2. Fly into the volume.

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 Use these navigational aids:

Method Steps
MPR
• With active, click in an MPR view.
crosshairs
Field of 1. Click .
View Cone
2. In the Projection dropdown, select a view option
other than Orthographic.

TIP: The wider the angle, the larger the cone.

3. Select the Field of View check box under the

Display Options on the Visual tab.

TIP: To change the eye point of the cone, click ,

then click in the MPR view.

TIP: To change the direction of the cone, click ,

then press left-ALT and click in the MPR view.

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 Method Steps
3D 1. Select a 5-up Viewer window format
Crosshairs
2. Change the upper 3D view to Fly Around mode.

3. On the Visual tab, in the View Options area, select

the 3D Crosshair check box.

4. Fly through the lower 3D view.

TIP:The 3D crosshairs in the upper 3D view change

as you navigate in the lower 3D view.
Reverse 1. Select a 5-up Viewer window format.
View
2. Change the upper 3D view to Reverse View mode.

3. Fly forward in the lower 3D view.

TIP: The upper 3D view displays from the same

point as the lower view, but looking backward.

Image Batches and Movies

Make batches of 2D, MPR, and 3D images. Batches can be printed or
saved to a DICOM server. Like snapshots, they are stored on the Report
window. Make image batches into digital movies.

Accessing the Batch Settings

You can access the batch settings from the right-click menu, or from the
More Options button on the Batch tab. The Batch Settings dialog box
contains the Size, Movie, and Curved MPR tabs.

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 Batch Settings - Right-click menu
The batch settings are available from the
right-click menu to provide you with the
ability to change the batch settings without
having to go to the Batch tab.

• Right-click and select Batch Settings

to access the Batch Settings dialog
box.

Batch Settings - More Options button

1. From the Batch tab, select the More
Options button to access the Batch
Settings dialog box.
• The Size tab contains the existing batch
output size settings.

TIP: There are separate options for slice

and 3D batches. The Batch Output
Size will display either “3D” or “Slice”.

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 • The Movie tab allows you to view and edit the existing movie
settings.

• The Curved MPR tab allows you to change the step size
(degrees), number of images generated, and the rotation angle for
an auto curved MPR batch that is accessible from the right-click
menu.

2. The Save Settings as default option saves any modified settings for
a future Vitrea session. Otherwise, the new settings will only be
available for the current session.

3. Select OK to save the settings.

TIP: Select Cancel to go back to the modified settings.

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Annotate Batches
Add a series description that
displays in the Findings Tray and
when the batch is exported.

1. In the Series description

field, enter a value.
OR

Select a value from the dropdown.

Add a cover page with a label to the front of the batch or movie.

2. Select the Show cover image with label: check box.

3. Add a value to the field.

OR

Select a value from the dropdown.

NOTE: Take care to label series descriptions and cover pages with
correct and appropriate information.

Creating Scripted MPR Batches

Create a scrolling batch of MPR images based on the selected settings.

1. Set up the MPR view in the Viewer window the way you want the
images to display in the batch.

TIP: Scripted MPR batches are available in orthogonal mode only.

2. Select the Batch tab.

3. In the Scripted Batch area, under MPR Scroll,

select one of the MPR planes.

TIP: The other two planes display cross-

reference lines showing the slices of the
batch.

4. Under Direction, select a scroll direction.

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 5. If desired, adjust the Step Size or Number of
Images sliders. The cross-reference lines on
the other two planes adjust accordingly.

TIP: In orthogonal or oblique MPRs, the other

two planes display cross-reference lines
showing the slices of the batch.

6. To reposition the start and end points of the batch, click and drag the
starting or ending cross-reference lines in one of the other views.

EXAMPLE You are creating a batch of the coronal view. Click and drag
the starting or ending cross-reference lines in either the axial or sagittal
view to edit the batch. The batch will be created in the coronal view.

7. To anonymize the batch or movie, clear the check

box.

8. Click to create a batch that is saved to the Report window.

OR

Click to create a digital movie that is saved to the Report

window.

9. To adjust quality, playback, and swing settings for movies, click .

TIP: After you click one of the output buttons, a preview of the batch
displays in a separate window.

Creating Manual 2D and MPR Batches

To make batches of 2D images, portions of MPR images, or oblique or
curved MPRs, create a manual batch.

1. Set up the 2D or MPR view in the Viewer window the way the images
should display in the batch.

2. Select the Batch tab.

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 TIP: The button is automatically activated.

3. In the view to batch, scroll to the starting point.

4. Click in the view.

TIP: A green check mark displays in the view.

TIP: The button is automatically activated.

5. Scroll to the ending point.

6. Click in the view.

TIP: In orthogonal or oblique MPRs, the one or both of the other views
display cross-reference lines showing the slices of the batch.

7. To reposition the start and end points of the batch, click and drag the
starting or ending cross-reference lines in one of the other views.

EXAMPLE You are creating a batch of the coronal view. Click and drag
the starting or ending cross-reference lines in either the axial or sagittal
view to edit the batch. The batch will be created in the coronal view.

8. If desired, adjust the Step Size or Number of Images sliders.

9. To anonymize the batch or movie, clear the check box.

10. If you make a mistake, click to start over.

NOTE: If you clear the batch, everything, including series

descriptions and cover page labels, is cleared.

11. Click OR .

Creating Scripted 3D Batches

Create a rotating batch of 3D images based on the selected settings.

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 1. Set up the 3D view in the Viewer window the way the images should
display in the batch.

TIP: Scripted 3D batches are available in fly-around and POI mode

only.

2. Select the Batch tab.

3. In the Scripted Batch area, under 3D Rotation,

select the degree of rotation.

4. Under Direction, select a rotation direction.

5. To anonymize the batch or movie, clear the

check box.

6. Click OR .

Creating Manual 3D Batches

For 3D rotations in varying directions, or for fly-throughs, create a manual
batch. Select starting, intermediate, and ending images, and Vitrea adds
images in between to create smooth transitions.

1. Set up the 3D view in the Viewer window the way the images should
display in the batch.

2. Select the Batch tab.

TIP: The button is automatically activated.

3. In the 3D view, rotate or scroll to the starting point.

4. Click in the view.

TIP: A green check mark displays in the view.

TIP: The and buttons are automatically activated.

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 5. For rotation batches, rotate view in desired direction.
OR

For fly-through batches, begin flying.

6. Click in the view to capture an intermediate image.

7. For fly-through batches, check the Auto 3D Via Points check box
to automatically capture intermediate images.

8. Repeat steps 5 and 6 until you have captured all intermediate images.

9. Click .

10. Click in the view.

11. To anonymize the batch or movie, clear the check

box.

12. If you make a mistake, click to start over.

NOTE: If you clear the batch, everything, including series

descriptions and cover page labels, is cleared.

13. Click OR .

Export
Auto Export Snapshots and Batches
Use auto export to save your DICOM findings back to PACS. Available for
VitreaAdvanced only.

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 1. After you create your findings (snapshots or batches) and close the
study, the Auto Export Dialog displays.

NOTE: The findings export in the same format in which it was created.

2. From the Group dropdown menu, select the location where you want
to export the findings.

NOTE: For multi-site customer deployments where data is being

pushed to a central VIMS location, the dropdown menu populates
with a list of pre-configured group receive locations. The selected
Group is matched based on the institution name stored in the original
data. If no match is found, the populated list displays the last selected
Group. The default group 'All' represents all possible receive locations.

3. Select one of the following options:

Option Description
Export Selected Export the selected snapshots and
batches.
Export All Export all snapshots and batches.
Exit Does not export the findings, but the
findings remain on VIMS.
Cancel Close the Auto Export Dialog without
exporting snapshots or batches.

Export a Single Region as STL

Export a single segmented region as an .stl file.

NOTE: Only available with VitreaWorkstation, Vitrea Powerstation, and

VitreaExtend Host System.

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 1. From the Anatomy area, select a
segmented region.

2. Right-click on the region name and

select Export as STL.

Vitrea displays the volume measurements for the selected region.

3. Verify the segmented area in the MPR and 3D views.

4. From the dialog box, select the desired STL options.

5. Click Create STL.

6. Identify the file location in the next dialog box and click OK.
The status area at the bottom of the window shows the progress of
the STL creation.

NOTE: The software renders the data as a volume rendering with a flat
transfer function. It does not render the STL as a surface. The final
STL model generated may look different than what is visualized in

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 Vitrea. The export quality will also influence how much detail will be
included in the final STL model. Verify the STL model in an external
STL viewer.

Export Multiple Regions as STL

Export multiple segmented regions as separate .stl files.

1. In the Anatomy area, select Show for each segmented region to be

exported.

2. Click .

3. Select Export Regions STL.

Vitrea displays the volume measurements for the
selected regions.

4. Verify the segmented area in the MPR and 3D

views.

5. From the dialog box, select the desired STL options.

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 6. Click Create STL.

7. Identify the file location in the next dialog box and click OK.
The status area at the bottom of the window shows the progress of
the STL creation.

NOTE: The software renders the data as a volume rendering with a flat
transfer function. It does not render the STL as a surface. The final
STL model generated may look different than what is visualized in
Vitrea. The export quality will also influence how much detail will be
included in the final STL model. Verify the STL model in an external
STL viewer.

Batch a Single Region for DICOM Export

Create a new series of only a single segmented region. Voxels outside the
segmented region are “blacked out.”

1. From the Anatomy area, select a

segmented region.

2. Right-click on the region name and

select Batch Segmented Region.

Vitrea displays the volume measurements for the selected region.

3. Verify the segmented area in the MPR and 3D views.

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 4. In the dialog box, click Save Region.

5. Click OK in the next dialog box.

Vitrea creates a new series which will display in the Study Directory.
From there, you can export the series to a DICOM location.

6. Verify the resulting series is built as you expect.

Batch Multiple Regions for DICOM Export

Create a new series of only segmented regions. Voxels outside the
segmented regions are “blacked out.”

1. In the Anatomy area, select Show for each segmented region to be

saved.

2. Click .

3. Select Batch Segmented Regions.

Vitrea displays the volume measurements for the
selected regions.

4. Verify the segmented area in the MPR and 3D

views.

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 5. In the dialog box, click Save Region.

6. Click OK in the next dialog box.

Vitrea creates a new series which will display in the Study Directory.
From there, you can export the series to a DICOM location.

7. Verify the resulting series is built as you expect.

Study Viewer
The Study Viewer feature lets you preview scanned images from CT, MR,
PET, US, CR, DR, and Secondary Capture.

NOTE: RT studies are not supported in Study Viewer.

Use this feature to:

• View original scanned images before loading and viewing them as

volume files in Vitrea
• Stack all images from a study to quickly review multiple series in an
Exam
• Quickly review DICOM images

Launch Study Viewer from Study Directory

1. From the Study Directory, right-click a study.

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 2. Select Load in Study Viewer.

TIP: Snapshots; secondary capture images; and non-CT, MR, or PET

series may be loaded directly into Study Viewer by double-clicking
the entry in the Study Directory.

Launch Study Viewer from Desktop

1. Double-click the Study Viewer Icon.

2. From the browser, select the study.

TIP: A typical path would be Desktop|VESData|Patients.

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Study Viewer Controls

Use the Study Viewer controls to adjust the scanned image.

# Description
1 Image Control
tools
2 Cine Mode
1 controls
3 Mouse Control
tools
4 Display options
and Help

Study Viewer Image Control Tools

• To rotate the image left, click .

• To rotate the image right, click .

• To flip the image vertically, click .

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 • To invert the grayscale of the image, click .

• To cine to the next or previous series in the stack,

click one of .
• To go to the next or previous tagged image (image with a
measurement drawn), click one of .
• To reposition the top or bottom of the image stack,

click one of .

• To change the window/level value, click and select a preset

from the list.
OR

Type new values in the text boxes.

• To display or hide measurements, check or clear the Measurements

check box.
• To display or hide patient information, check or clear the Patient
Information check box.

Study Viewer Cine Mode Controls

• To auto-scroll forward through the series, click .

• To auto-scroll backward through the series, click .

• To stop scrolling, click .
• To control the outcome of auto-scrolling, select an option:
• Loop - scroll from beginning to end and then start at the
beginning again.
• Swing - scroll from beginning to end and then from end to
beginning.
• Once - scroll from beginning to end once.

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Study Viewer Mouse Controls

Each of the three mouse buttons is assigned a control that activates when
you press that button in the view.

The default control assignment is:

• Left - Window/Level
• Middle - Measure
• Right - Manual Cine

Changing the Mouse Button Assignments

1. Click the left, middle, or right Mouse Control button in the Study
Viewer control panel.

2. Click the desired control.

TABLE 1. Study Viewer Mouse Controls

Control Description
Manual Cine

Window/Level

Measure

Pan

Zoom

Mouse Wheel
Roll the mouse wheel to manually cine through the images.

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Study Viewer Display Options and Help

Custom Display Layout Window

Change the header information that displays on the layout window.

1. Click .

2. Select a header tag and drag it to one of the four panels representing
the corners of the view.

3. Click OK.

DICOM

• To display the DICOM tags for the current image, click .

Study Viewer Help

• To display Study Viewer on-line help, click .

Study Viewer Keyboard Shortcuts

Press: To:
ALT-TAB Toggle between Study Viewer and Vitrea
HOME Go to the bottom of the stack
END Go to the top of the stack
UP ARROW Go to the next slice in the stack
DOWN ARROW Go to the previous slice in the stack
PAGE UP Go to the beginning of the next series in the
stack
PAGE DOWN Go to the beginning of the previous series in
the stack
ESC Cancel auto-cine
F1 Display the on-line help

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160 Common Tasks
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Distribute Findings

Contents
• Distribute Findings Overview
• The Report Window
• The Review Window (VitreaWorkstation only)

Distribute Findings Overview

VitreaAdvanced saves snapshots, batches, and movies you create to the
Report window. On the Report window:
• Create, save, print, publish/post, or copy reports containing up to 24
patient images per page.
• Use protocol-specific templates with editable text fields.
• Add image batches and digital movies.
• Add arrows, annotations, and comments to the report.
• Use snapshots to restore a previous workflow to the Viewer window.
• Save the snapshots or batches to any networked DICOM device or
PACS.

Access the features below from the Report window:

• A Findings list, which allows you to filter the entire list of snapshots to
review and select based upon workflow.
• A set of protocol-specific report templates including text pages with
selectable and editable text fields.

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 • Tools for selecting snapshots, working with snapshots, adding pages
to the report, and working with reports.

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The Report Window
Vitrea saves snapshots, batches, and movies you create to the Report
window. From here, create and distribute reports.

2
1

3 5
8

9
6
7 10

Callout Description
Number
1 Findings list
2 Filtering buttons
3 Findings tray
4 Findings management buttons
5 Findings management right-click menu
6 Template layouts
7 Templates buttons
8 Report
9 Report tools and navigation buttons
10 Report distribution buttons

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Findings List
Click a line in the Findings list to filter snapshots, batches,
and movies that display in the Tray.

Filtering Buttons
Use the snapshot filtering buttons to display
snapshot currently in or not currently in the
report.

Click: To:
Display all snapshot, batch, and movie thumbnails for the
patient study.
Display only snapshots, batches, or movies not currently
included in the report.
Display only snapshots, batches, or movies currently
included in the report.

Findings Tray
Displays thumbnail images of snapshots, batches, and movies.

1. To select a finding, click the thumbnail image.

TIP: To select more than one finding, press CTRL and click the
thumbnail images.

NOTE: Findings with in the lower-right corner are not restorable.

2. Double-click the snapshot to preview a larger image of a finding.

3. To preview a movie, double-click the movie thumbnail, or click the

Movie link.

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 4. To review a batch of images, double-click the batch thumbnail then
right-click and drag on the image.

Findings Management Buttons

Use the Findings Management buttons to distribute findings.

Click: To:
Restore a workflow back to the Viewer window. The
snapshot workflow will be restored.

NOTE: Findings with in the lower-right corner are

not restorable.
Delete the selected snapshot, batch, or movie.

Export the selected snapshot or batch to destination.

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 FIGURE 1. Export Findings

Callout Description
1 Series List: a list of the selected findings and the associated
series information. Findings are listed in order of how they
were selected.
TIP: Click a header to sort the list by that field.
To change the order of the series to be exported, select a
series description and drag it up or down.

To rename the series description, double-click a series

name and enter a new description. Click Update when
finished.

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 Callout Description
2 The Export to: box displays a multi-selection list of export
destination servers.
Select the check box for the appropriate destination(s).
Select the check box in the header to select all destinations
listed.
3 Export Options:

TIP: To display the full panel of Export Options,

click on the right side of the Export Options
title bar.

Change all series descriptions — modify the series

descriptions for all series in the series list. This may be left
blank.
Export as a separate series — export selected
snapshots and batches in the Series List as separate
item(s). This does not modify the series grouping. This is the
default option.
Export as a single series — export all selected
snapshots and batches as a single group with the same
series ID.
Export by clinical application —export each selected
snapshot image or batch grouped by protocol used to
create the snapshot/batch. Each group is a single series
with the same series ID.
For example: all findings created with the Vascular: Renal CT
protocol are grouped in a single series and all findings
created with the Vascular: Aorta CT protocol are grouped in
another series.
Export Images with annotations — exports images with
annotations (rulers, angles, arrows, labels, etc.) included.
This is applied to all evidence and makes the snapshots
secondary capture. The snapshots are restorable.

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 Callout Description
4 Image Options:

NOTE: Snapshots exported with either of these options

selected are not restorable.
Force conversion to monochrome — converts
snapshots and batches to grayscale monochrome.
Reduce size of DICOM files — removes private tags and
reduces the size of the files.

Restoring Saved Images and Workflows

From the Report window, restore a snapshot for the currently loaded
volume to the Viewer window. Or, from the Study Directory, restore a
Snapshot for an unloaded volume directly from the Preview pane. Use this
feature to return to a saved image for further investigation.

CAUTION: Verify the accuracy of all contours and confirm all measurements
when restoring snapshots from previous software versions created through
the use of region editing.

When you restore a saved image to the Viewer window, the “workflow” is
also restored. The workflow includes images of the patient volume and
the state of the Viewer window at the time the image was saved,
including:

• Selected protocol and preset

• Visual settings at the time you took the snapshot
• Viewer window format
• 3D or MPR mode(s)
• Any labels, rulers, and arrows
• Any segmentation or calcium scoring results

NOTE: Findings with in the lower-right corner are not restorable.

NOTE: Batches and movies are not restorable.

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 NOTE: In order to restore a snapshot saved using a licensed option, a
license for that option must be available.

NOTE: Restore workflows from snapshots saved for the currently

loaded volume only. If you try to restore a snapshot from a volume that
is not currently loaded, you will be prompted to load the volume first.

Findings Management Right-Click Menu

Use the right-click menu to perform various tasks.

Select: To:
Add All Add All automatically places all snapshots at the end of
your report, or press CTRL and click to select snapshots
and drag to the report template.
Select All Select all of the snapshots in the Findings tray.
Delete Delete the selected snapshot, batch, or movie.
Export Export snapshots to destination.
Preview View the selected snapshot, batch, or movie.
Restore Restore a workflow to the Viewer window state to when
the snapshot was taken.
Series Modify the series description.
Description

Save As VitreaWorkstation only - Save the file in

a specific format.

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Template Layouts
Select a tab to display the different template types: Images, Worksheets,
Full Reports. Use the Templates area to select general and protocol-
specific report templates.

Select the Images tab to select a layout for the images.

Select the Worksheets tab to select a worksheet template. The

worksheets are a one-page report.

TIP: Select the worksheet template that is appropriate for the study
you are working on. For example, select the CA Score worksheet
for Calcium Scoring VScore.

Select the Full Reports tab to select a specific report template.

NOTE:The Full Cardiac template contains a comprehensive report of

CA Score, CFA, and Coronary Artery.

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Templates Buttons
Use the Template buttons to change or add pages to the report.

Click: To:
Add a new page of the selected template to the end of
the report.
Replace the current report with the selected template/
layout.
Copy the contents of the Report template to the
Windows clipboard. Paste the contents into a Word
document or another text program (email, 3rd party
reporting application).

NOTE: Microsoft Word must be installed in order to

paste the contents into a Word document.
Right-click Create a new report, insert a new page of the selected
and select template before or after the report page displayed, or
append a page.

Create the Report

Create the report on the Report window.

1. In the Templates section, select the Images tab.

2. Select a template and click Add.

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 3. To add snapshots, batches, or movies, drag the thumbnail to an
image area of the report.

TIP: To replace an image in one of the frames, drag and drop a

different thumbnail on top of it.

NOTE: When you place an image in a frame, be sure that the margins
do not cut off important information such as anatomy or
measurements.

4. To add text areas to the report, click the ab label and type new

text and press Enter.

5. To edit text areas on the report, click any text with a rectangle, then
type new text.

Report Tools

Use the Report Tools buttons to save, restore, or

mark-up a report.

Click: To:
Save a draft of the report.

Restore a saved draft report.

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 Click: To:
Select a report pane.

Add a label to a report pane.

TIP: To edit a label, click it, then click the text box.
Press Enter.

TIP:To delete a label, click it, then press DEL.

Add an arrow to a report pane.

TIP: To delete an arrow, click it.

TIP: When you hover over the arrow, it turns yellow.

Delete the current report page.

Delete the selected image from the report page.

Undo the last action.

Redo the last undone action.

Save and Restore a Draft Report

1. Click to save the current findings as a draft report.

2. Click to restore a report for viewing or to add new findings.

3. To add new findings to a saved report, restore the report in the Report
tab. Use the Viewer tab to create new findings.

TIP: Restore a report before adding new findings. If restoring a

workflow from a snapshot, both the workflow snapshot and the
report need to be restored.

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Report Navigation

Use the Report Navigation buttons to navigate between pages of a report.

Click: To:
Jump to first or last report page.

Jump to previous or next report page.

Including Snapshots from Multiple Volumes on One Report

After you place snapshots from one volume for a patient on a report,
return to the Study Directory, load a new volume for the SAME patient ID,
take snapshots, and place them on the same report. This allows you to
include images from different volumes in the same report for comparison
purposes.

CAUTION: Make sure you can identify the volumes that the images came
from. If you include images from more than one volume for the same
patient, the report headings, if any, will identify the volume you loaded most
recently.
• Use a report format that includes a Comments field, enter comments
to indicate which images came from which volume, then print the
report on a PostScript printer.
OR

Type annotations or arrowtations directly onto images in the report,

then print the report on a DICOM printer.

NOTE: The Findings Tray accumulates snapshots as you work within a

study, so when you are ready to create a report, all snapshots saved
for volumes or series within the study are available in the Findings Tray
if you want to associate them with the report. If you load a different
study (patient) or restart Vitrea, the Findings Tray clears, then starts
accumulating snapshots for the next loaded study. This prevents you

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 from accidentally placing images from different patients into the same
report.

Report Distribution

Use the VitreaAdvanced Report Distribution buttons to distribute the

report.

Click To
Print a paper report for distribution.

TIP: Use the Preferences button on the Print

dialog box to set the orientation to landscape
if desired (for example, templates C1,2 and
C1,3 may print better in landscape
orientation).
Print the report to a DICOM printer.

Post the report to your institution’s intranet.

Save the report to a DICOM server.

Save the report to a CD or DVD (VitreaWorkstation

only).

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 1

Callout Description
Number
1 The Export to: box displays a multi-selection list of
desired export destination servers.
2 Series Options:
Series Description - Enter text in this field to apply it as
the series description for all selected snapshot/batches
upon export. The default series description is the study
description.

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Customized Templates
Customize the text areas on the report templates.

1. Click a heading or text

area enclosed by a box.

2. Enter the new text.

3. Click outside the box.

TIP: To delete text, select the text from the dropdown, and click
Delete.

Certain templates allow you to show or hide the Institution Name and the
Patient Info in the header.

• Click + to include the Institution Name or Patient Info.

• Click - to hide the Institution Name or Patient Info.

Customized Report Page

The default report page can be customized with your facility name,
address, and logo. See your System Administrator for more information.

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The Review Window
(VitreaWorkstation only)
Use the Review window to view reports posted to your facility’s intranet.
Reports you post on the VitreaWorkstation can also be viewed from other
VitreaWorkstations.

1. Select the Review tab.

2. Enter information such as patient name or report date to see specific

reports,
OR

Leave all the fields blank to see all posted reports.

3. Click Search.

4. Click Review next to the patient name for the report to view.

TIP: If the report includes a digital movie, the movie plays when you
view the report.

5. If the report contains more than one page, click Next or

Previous to view other pages.

Print reports posted to the Review window.

1. From the Reports List, display the report to print.

2. Click Print at the bottom of the Review window.

Delete posted reports when you no longer need them.

• Click Delete next to the report you want to delete.

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Ortho (Joint Disarticulation)

Contents
Ortho Overview

Ortho Lesson

I Select Study
II Choose Protocol and Preset
III Perform Analysis
• Window Level
• Isolate the Joint
• Disarticulate the Joint by Sculpting in the MPR
• Examine Each Region
• Take Snapshots
IV Distribute Findings

Additional Procedures

• Switching Active Volumes

• Bone Tool Segmentation
• View Metal Implants
• Segment Metal Implants

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Ortho Overview
Vitrea gives you many options for viewing many different types of
orthopedic anatomy from metal hardware within the spine to artificial
joints.

Vitrea also allows you to disarticulate joints by a simple sculpting method.

Ortho Lesson

I. Select Study

Load an orthopedic study.

See the instructions for your Vitrea type (VitreaAdvanced Through the
Data Manager or VitreaWorkstation) in the Select Study chapter of the
VitreaAdvanced-VitreaWorkstation General Education and
Reference Guide.

II. Choose Protocol and Preset

Use one of these procedures:

Data Manager
• Double-click the Musculoskeletal application thumbnail.

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Gallery Window
1. On the Gallery window, select the Musculoskeletal CT protocol.

The Gallery choices update automatically.

2. Click next to the 3D Analysis preset.

III. Perform Analysis

Window Level
Window level in the 3D image to add in soft tissue like muscle or tendons.

1. Left + right-click and drag to window level the 3D image.

2. Drag towards you to window level the muscle back in.

TIP: Hold briefly until the window level icon displays.

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Isolate the Joint

3. Click to magnify the image.

4. Press T to activate the Trim tool.

5. Click and drag the yellow lines in the MPRs to trim around the joint.

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Disarticulate the Joint by Sculpting in the MPR

6. Right-click and select .

7. On the axial MPR images,

draw contour lines around
anatomy of interest. For
example, head of femur,
distal portion of femur, or
proximal portion of tibia.

Start at one end and draw

contour lines all the way
down the anatomy to the
other end. Skip a few slices
between your contour lines.

TIP: Draw a contour whenever the anatomy changes size, shape, or

location.

• Click, hold, and drag to draw a true freehand contour.

• Click, release, and drag to draw a contour that attempts to
automatically define the edge of the region (based on HU units).

TIP: To aid drawing the automatic contour, click along the region to
drop anchor points.

8. Scroll a few slices, then repeat step 7.

NOTE: Interpolated contours between automatic contours are truly

interpolated and do not necessarily follow the edge of the region.
Edit interpolated contours if necessary.

9. Continue to scroll and draw until you reach the last slice displaying the
region.
Vitrea automatically displays a colored surface on the 3D view.

10. If you had the MPR maximized, minimize it to see the 3D view.

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 11. Rotate the 3D view to verify that the surface contains the whole area
to sculpt.

12. Select the dropdown and

select Bone, or type a
name.

Examine Each Region

13. Right-click one of the objects in the Anatomy list and select Highlight
& Tint/MPR.

14. Rotate the object in the 3D view.

Take Snapshots

15. Right-click and select (or press S) to activate the camera.

16. Move the cursor to the image and click.

Snapshots, measurements, rulers, W/L, or segmentation option can

be restored from the Report page or the Study Directory.

IV. Distribute Findings

The snapshots you save in the Viewer window are saved to the Report
window.

1. Click at the bottom of the window.

2. Export your findings or create a report.

See the Distribute Findings chapter of the VitreaAdvanced-

VitreaWorkstation General Education and Reference Guide for
instructions on exporting findings, restoring workflow, and creating
reports.

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Additional Procedures
Switching Active Volumes
With multiple volumes loaded, switch the selected volume by using the
Volume Navigation buttons at the bottom of the Viewer window.

• To change the label on the button for the currently selected button,
click and select a name or type a new one.

Bone Tool Segmentation

1. In the Segment Anatomy area, click Bone.

2. In the MPR view, click on cortical bone (white bone).

3. Click Keep Bone.

4. In Anatomy Segmentation area, right-click the Bone region and select

Rename.

5. Type the name in the New Name box.

6. Click OK.

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View Metal Implants
1. In the Visual Preset section,
click the arrow.

2. In the Preset Selector, click

Bone Implant.

Segment Metal Implants

1. Select Base in the Anatomy Manager.

2. Window/level in the 3D view until the soft

tissue and bone are removed and only the
device displays.

TIP: Move the mouse straight up.

3. Click .

4. Click the device in the 3D image.

5. Review the blue area in the MPRs to be sure the device is fully
segmented.

6. Click on more areas or click as needed.

7. In the Multi-Pick dropdown, select Implant.

8. Click .

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 9. Click Semi Transparent Bone

in the Region Visibility area.

10. Take snapshots.

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188 Ortho (Joint Disarticulation)
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Softread

Contents
• Softread Overview
• Loading Studies into Softread
• Buttons, Tools, and Controls
• Keyboard Shortcuts
• Working in Softread
• Assigning Mouse Functions
• Basic Workflow
• Scenarios
• Setting Preferences
• Viewing Findings (Key Images)
• Closing Softread

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Softread Overview

CAUTION: To use Softread, your monitor should have a luminance of at

least 50 foot-Lamberts. The monitors provided with the Vitrea Windows NT
or XP workstations meet this requirement. Vital Images does not assume
any responsibility for customer-supplied hardware or monitor calibration.

The Softread software is designed for viewing original 2D images in a

variety of modalities, including CT, MR, CR/DR/DX, SC, US, NM, PET, XA,
and RF.

NOTE: RT studies are not supported in Softread.

Using Softread, you can perform the following tasks:

• View a series in 2D
• Compare multiple series for multiple patients, side-by-side
• Cine, window/level, pan, zoom
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 • Rotate right or left 90 degrees, invert grayscale
• Make linear and polygonal rulers, measure angles, and outline ROIs
• Switch to Vitrea to examine a 3D volume (if one exists for the series)
• View grayscale images as color images
• View grayscale images with pseudo-color maps
• Mark key images for use in dictation, or take snapshots for saving to
the Vitrea Report page

Loading Studies into Softread

1. From the Patient List, select a patient name.

2. Load in one of the following ways:

Through the Data Manager, double-click the Softread application

thumbnail.

OR

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 Through the VitreaWorkstation, right-click on the patient name and
select Load in Softread.

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Buttons, Tools, and Controls

Toolbar at the bottom of the viewer:

Toolbar at the bottom of the viewer in 6- (or more) up format:

One-way scroll Two-way scroll

arrow arrow

NOTE: Some of these tools are buttons and others are controls. As
explained in the Use column in the following table, controls behave
differently than buttons. The controls have a little blue cross symbol in

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 the lower right corner. The buttons do not. You can float the cursor
over any of the buttons and controls in the toolbar at the bottom of the
viewer for tips on how to use them.
Buttons and controls in the toolbar at the bottom of the viewer:

Button/ Name Use

Control
View Volume Click to load the study’s corresponding volume in
button Vitrea.

NOTE: If no volume exists, Vitrea will display an

error message.
Cine control Click and drag on the control to cine quickly
through the images.
Window/Level Without moving the cursor off the control, click and
control drag on the control to adjust the window/level
settings in the viewer.
Pan control Without moving the cursor off the control, click and
drag on the control to move the image around in the
viewer.
Zoom control Without moving the cursor off the control, click and
drag on the control to magnify or minify the image in
the viewer.
Key Image flag Click the flag to mark an image as interesting.
(button)
Key images are saved to the Findings window.
Previous/Next
Click the Previous or Next arrows to jump
(key image)
between key images.
arrows
Add image to Click the button to lock the image with other images
locked set on the screen.
button
You can cine through images in locked sets
simultaneously.
Tools menu Click the button to display the Tools menu, which
button contains the following options: Rotate right, Rotate
left, Flip, Invert, Pseudo-color, Slice Stacking,
Montage, Image filter, Reset, Copy to clipboard.

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 Button/ Name Use
Control
Snapshot Click the button to take a snapshot of the image in
button the viewer.

The snapshot will be saved to the Windows

clipboard for pasting into other applications.
Swap contents Click the control and drag it into one of the other
control viewers to switch the images displayed in the two
viewers.
Add images NOTE: To use this control, both source series
control must contain the same number of images.
Click the control and drag it into one of the other
viewers to create a new dataset, which is the result
of adding the images in the current viewer to the
corresponding images in the other viewer, slice by
slice.
Subtract images NOTE: To use this control, both source series
control must contain the same number of images.
Click the control and drag it onto one of the other
viewers to create a new dataset, which is the result
of subtracting the images in the current viewer from
the corresponding images in the other viewer, slice
by slice.
Concatenate Click the control and drag it onto one of the other
series control viewers to create a new dataset, which is the result
of linking the series in the current viewer to the
series in the other viewer.

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 Button/ Name Use
Control
One-way scroll Click the arrow to scroll the toolbar to the left.
arrow
This button appears on the toolbar when the
viewers are too small to display the entire width of
the toolbar. This happens in 6- (or more) up format.
Two-way scroll Click the right arrow to scroll the toolbar to the right.
arrow
Click the left arrow to scroll the toolbar to the left.

This button appears on the toolbar when the

viewers are too small to display the entire width of
the toolbar. This happens in 6- (or more) up format.

Keyboard Shortcuts
To display a dialog box containing all Softread keyboard shortcuts, click
the Help menu, and select Keyboard help.

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Working in Softread
If a study contains multiple series, you can use Softread to initially
examine the entire study. For detailed investigation of a specific area of
interest, you can then load the corresponding volume into 3D. Unlike 3D,
Softread is series based, so you can cross-reference, lock, and cine
through multiple series side-by-side.

Once you load volumes in Softread, you can work with the images using
several available hanging protocols.

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 Within the Softread application, you can compare studies, link images,
cine, pan, zoom, adjust window/level, scroll, rotate, invert, draw rulers,
outline regions of interest (ROIs), and take snapshots of your work to
paste into other applications

Assigning Mouse Functions

In Softread, you can assign separate functions to each of the three mouse
buttons (left, middle, and right). When you click the mouse button, the
function you assign is activated. You can then drag the mouse in the
viewer to perform the assigned action. You assign mouse button
functions in one of two ways: using mouse function groups, or the mouse
functions palette.

Currently assigned
mouse function buttons:
Left (top) Middle Ruler
(middle), and Right
(bottom). ROI

Eraser
Click to assign default
Measure actions to the
Click to assign
three mouse buttons. This
default actions to
combination is shown
the three mouse
here. Click to assign
buttons.
default Zoom/Pan
actions to the three
mouse buttons.

Mouse Function Groups

Softread provides three pre-assigned mouse function groups. The groups

provide a shortcut for assigning all three mouse button functions at once.
You select a mouse function group by clicking on the corresponding

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 button below the mouse picture in the Mouse Functions area. The
following pre-assigned groups of mouse functions are provided:

Function Measure Zoom/Pan Default

Left Ruler Zoom Window/Level

Middle ROI Pan Crosshair

Right Eraser Cine Cine

Mouse Functions Palette

You can access additional mouse functions, and assign one mouse
button function at a time using the mouse functions palette.

In the Mouse Functions area, you display the mouse button function
palette by clicking anywhere on the mouse picture, or on any of the three
currently-assigned mouse function buttons, to the right of the mouse
picture.

The right mouse button has two additional options: the outlined hammer
and yellow hammer, as shown below.

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 Button Name Use
Ruler Draw single or multiple straight or
polygonal rulers, create angles, or draw
geometric ROI outlines on an image.
Arrowtation Pinpoint and label anatomical features.
Enter text in the dialog box, adjust font
and color, then click and drag to draw an
arrow from any corner of the text box. You
can only draw one arrow for each text box.
Cine Scroll through the images in the viewer
(and any same-plane locked images).
Window/ Adjust window and level settings for the
Level image in the viewer.
ROI Draw freehand borders around ROIs.

Softread displays the area in sq. cm.

Crosshair Navigate to a point of interest in the
images in the opposite plane. If you use
the crosshair tool in the axial plane, the
images in the sagittal plane will
automatically update to display the slice
you are clicking on and vice versa.
Pan Move the image around in the viewer.

Zoom Magnify/minify the image in the viewer.

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 Button Name Use
Eraser Erase ROI borders, annotations,
arrowtations, or rulers you have drawn.
Hammer (Available for the right mouse button only.)
Display the Viewer tools right mouse
button menu.
Yellow (Available for the right mouse button only.)
Hammer Display the mouse button function palette.
Use the palette to change the function
assigned to the left mouse button only.

Using the Ruler Tool

Before you can create rulers and measurements in Softread, you must
first assign the Ruler tool to a mouse button.

To assign the Ruler tool to a mouse button:

NOTE: For the purposes of the following procedures, you will assign
the Ruler function to the left mouse button. However, you could assign
it to the middle or right mouse button, instead.
1. In the Mouse Functions area, select Measure.
OR

Click the mouse picture, then left-click the Ruler button.

OR

Click the top mouse function button, then click the Ruler button.

Rulers, Angles, and Geometric ROIs

In Softread, you use rulers to draw single or multiple straight or polygonal

rulers, to create angles, or to draw geometric ROI outlines.

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 NOTE: You draw rulers in Softread differently than in 3D. Softread
rulers were designed to follow standard Microsoft Windows
conventions.
If the image is calibrated, Softread displays the following measurements:

• lengths of all rulers in millimeters

• angles (degrees) between two adjoining rulers
• average tissue density (pixel units)
• range of tissue densities (pixel units)
• area (square centimeters (cm))
• total length of the perimeter (millimeters (mm)) of geometric ROI
outlines

NOTE: If the image is not calibrated, Softread displays all length and
area measurements in pixels only.
Marking an image with any kind of ruler automatically flags that image as a
key image and places it on the Findings tab. Deleting the ruler from the
image does not remove the image from the Findings tab. If you try to
remove the key image flag from an image with rulers, you will be
prompted to delete all other rulers from the image.

To draw a ruler:
1. Click and drag in the viewer.

2. To end the ruler, release the mouse button.

Softread assigns an incremental ruler number (1) and displays the
length measurement in millimeters (mm) in the lower left corner of the
viewer.

The image is flagged as a key image and saved to the Findings tab.

To add another ruler:

1. Click and drag in the viewer.

2. To end the ruler, release the mouse button.

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 Softread assigns an incremental ruler number (2) and displays the
length measurements for both rulers (1 and 2) in millimeters (mm) in
the lower left corner of the viewer.

The image on the Findings tab is updated with the new ruler and
measurements.

To shorten a ruler:
1. Click one of the ends of the ruler, and drag toward the other end.

2. When you reach the desired length, release the mouse button.
The ruler shortens.

To create an angle measurement:

1. Press and hold the CTRL key on the keyboard, then click and drag
from the end point of the first ruler.

2. To end the ruler, release the mouse button.

Softread displays the angle created by the intersection of the two
points, and the measurements for each line in millimeters (mm) in the
lower left corner of the viewer.

It labels the lines Xa and Xb, where X is the incremental number

assigned to the first ruler.

The image is flagged as a key image and saved to the Findings tab.

To create a multiple-segment line measurement:

1. Press and hold the CTRL key on the keyboard, then click and drag in
the viewer.

2. To end the line segment, release the mouse button, while continuing
to press the CTRL key.

3. Click the end of the line segment where you want to attach the next
line segment, and drag.

4. To end the line segment, release the mouse button, while continuing
to press the CTRL key.

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 5. Repeat steps 2-4 for all additional line segments.

6. When you are finished creating line segments, release the CTRL key.
Softread displays the length of the entire line in millimeters (mm) in the
lower left corner of the viewer.

The image is flagged as a key image and saved to the Findings tab.

To create a ruler connected along the length of another ruler:

1. Press and hold the SHIFT and CTRL keys on the keyboard, then click
a point along the length of one ruler, then drag to create the second
ruler.

2. To end the second ruler, release the mouse button.

Softread gives the ruler a new number, and displays its length
measurement in millimeters (mm) in the lower left corner of the viewer.

The image on the Findings tab is updated with the new ruler and
measurements.

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To connect rulers to form a geometric ROI outline:
1. Press and hold the CTRL key on the keyboard, then click and drag
from the end point of the first ruler to the end point of the second ruler.

2. To end the ruler, release the mouse button.

This creates the third ruler, and the final border of a triangular ROI
outline.

Softread assigns an incremental number to the entire outline, and

displays the average tissue density inside the outline (pixel units),
range of tissue densities inside the outline (pixel units), area of the ROI
(in square centimeters (cm)), and total length of the perimeter in
millimeters (mm) in the lower left corner of the viewer.

The image on the Findings tab is updated with the new ROI outline
and measurements.

To edit ruler properties:

1. Right-click the ruler, then select Properties.
The Edit Measure #X dialog box displays.

2. To adjust line thickness, click the dropdown arrow at the end of the
Thickness field, and choose from Thick, Medium, or Thin.

3. To change the color, click the orange (or other colored) field.
The Set Color dialog box displays.

4. Pick a color, or define one of your own.

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 5. 6 Click OK.
The Set Color dialog box closes.

6. To save your ruler properties as the default for all other rulers you
draw, click the Save as Default button.

7. To restore the previously saved ruler properties (in this case, orange,
thin lines), click the Restore Defaults button.

8. To see your changes without exiting the dialog box, click the Apply
button.

9. To close the dialog box, click the OK button.

10. To disregard your changes, click the Cancel button.

The dialog box closes.

To delete a ruler:
• Right-click the ruler you want to delete, then select Delete.
OR

If you have assigned the Eraser function to one of the mouse buttons,
click that button and drag over the ruler.

Basic Workflow
Use these steps to complete a basic workflow in Softread:

1. Select one or multiple studies to review.

2. Launch Softread and a default workflow (reading protocol) is

automatically chosen based on the studies selected.

The following three workflows are available:

• Generic Read - initiated when you load one study for one patient, or
when you load studies for different patients

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 • Comparative Read - initiated when you load more than one study for
one patient
• Lumbar Read - initiated when you load a spine study

Workflow menu:

Workflow indicators:

3. Use the Softread tools to review images, mark findings, take

measurements, mark key images for use on the Findings tab, and take
snapshots to place on the clipboard and paste in another application.

Scenarios
This section will give you some examples of how to apply the features of
Softread when reading various types of cases.

NOTE: The tools and techniques discussed within these scenarios can
be applied to other types of studies as well.
• Basic MR studies, such as orthopedic and head MR
• Advanced MR cases, such as cardiac perfusion (4D) and dual echo
• Lumbar MR studies
• CT cases, such as localizers or multi-phase studies
• Other modality studies, such as nuclear medicine or ultrasound.

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Basic MR

To view a Basic MR case:

1. On the Study Directory in Vitrea, click the MR study you want to load
in Softread.

2. Click the 2D application thumbnail.

The Softread application launches, displaying the images in the 4 up
Series hanging protocol.

The 4 up Series hanging protocol sorts the study by series number

and each individual series by image number. When hanging the series,
Softread ignores the localizers. Each viewer displays either the first or
middle image in the series, depending on the Preferences, Start
Middle Image setting. All available series in the study display as
thumbnails in the thumbnail viewer in the lower left corner of the
window.

Thumbnail Borders
Borders and underlines around the thumbnails indicate viewing status, as
shown below. The presence of a border, along with the type of border,
indicates how many images within the series have been previously
viewed. The presence of an underline indicates that the series is currently
displayed in at least one of the viewers. The brightness of the underline
indicates if it is displayed in the active viewer.

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 Dot border with bright, solid
No border: You have not
underline: You have viewed
viewed any of the images in
all of the images in the
the series, nor is the series
series, and the series is
displayed in any of the
currently displayed in the
viewers.
active viewer.

Dash dot border with no

Dash dot border with solid
underline: You have viewed
underline: You have viewed
some of the images in the
some of the images in the
series, but the series is not
series, and the series is
currently displayed in any
currently displayed in one of
viewer.
the viewers (not the active
viewer).

Patient and Exam Information:

Clinic, referring
Patient Information physician, exam
and acquisition type and
date and time modality, and
span series number

Image number,
number of slices
in the series,
Acquisition window/level
parameters settings and
patient position
(X,Y,Z)

3. Click and drag different series into the viewers from the thumbnail
viewer on the right, or press PAGE UP or PAGE DOWN keys.

4. For a list of keyboard shortcuts, in the menu bar, select Help, then
select Keyboard help.

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 5. Ensure the mouse buttons are set to the Default function group:
Window/Level (left), Crosshairs (middle), Cine (right), or that the left
mouse button is assigned the Window/Level function.

6. Adjust the window and level settings:

• In any of the viewers, click and drag.
OR
• Select from the pre-defined Window/Level settings by doing the
following:

a. In the menu bar, select Format. The Format menu displays.

b. Select from the following window/level settings:
• W/L - Image Default
• W/L - Full Range
• W/L - Estimated

7. Scroll (cine) using any of the following methods:

• Roll the mouse wheel.
• Use the assigned mouse button.
• Use the Cine control in the toolbar at the bottom of the viewer.
• Use the Cine Tools to auto-cine.

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 Head MR:

8. To take snapshots, click the Snapshot button in the toolbar at the

bottom of the viewer.

9. To mark key images, click the Key Image Flag button in the toolbar
at the bottom of the viewer.

10. Cine in multiple viewers simultaneously:

a. Click the Lock button in the toolbar at the bottom of the viewer.
The Lock button is outlined by a solid square line.

b. Repeat step a for every viewer you want to lock.

c. Use the Cine mouse function button or the Cine control in the
toolbar at the bottom of one of the viewers to cine through images.
The locked viewers cine simultaneously.
• To unlock a viewer, click the Lock button again.

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 The solid square outline around the Lock button disappears.

11. Rotate or invert an image:

a. Click the Tools menu button in the toolbar at the bottom of the
viewer.
b. In the tools menu, select one of the following options:
• To rotate the image in the viewer left, click Rotate left.
• To rotate the image in the viewer right, click Rotate right.
• To flip the image in the viewer upside down, select Invert.

12. Swap images between viewers:

• In the toolbar at the bottom of one of the viewers, click the Swap
Contents control and drag the control into the viewer with which
you want to switch images.
The two viewers swap series.

13. Use cross-reference lines to locate an ROI in the opposite plane:

• As you scroll through images in one viewer, watch the blue dotted
line move in the other(s).

NOTE: If the two viewers contain images in (relatively) the same

plane, the cross-reference lines do not display.
OR

a. Ensure one of the mouse buttons is assigned the Crosshair func-

tion.
b. With that mouse button, click the POI.
In the opposite plane viewers, a blue plus (+) sign appears at the POI.
In viewers displaying images in the same plane, a short blue line intersects with
the blue cross-reference line at the POI. The size of the plus (+) sign is relative to
the thickness of the image at the POI.

14. Switch to Vitrea to examine a volume:

• In the toolbar at the bottom of the viewer, click the Volume button.

NOTE: If the series containing the image does not contain any
volumes, you will receive an error message.

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Advanced MR

By default, all MR and CT studies display in the 4 up Series hanging

protocol. For 4D cardiac studies, it is often preferable to view the series
organized by time rather than position. To do this, you can switch the
Softread window to one of the hanging protocols named with the word
Time. These hanging protocols create an image set for each position at
various time increments within the series.

To view a 4D cardiac case:

1. On the Study Directory in Vitrea, select a cardiac perfusion study.

2. Click the 2D application thumbnail.

The Softread application launches.

3. To change the hanging protocol so you can see as many image sets
as will fit on the screen separated by time:

a. On the menu bar, select Format.

The Format menu displays.

b. Select Load Hanging Protocol.

The list of hanging protocols displays.

Format menu - Load hanging protocol:

c. Select the N up Time protocol.

The Softread window rearranges to display as many viewers as will fit. Each
viewer displays a stack of images for a given time increment.

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 Cardiac perfusion:

4. To cine through the images, in the Cine Tools area, click the Play
button.

Rewind Stop Play

5. To cine through the images in the next time series, use the mouse
button to scroll in the next viewer.

NOTE: You do not have to click the Stop button, then click the Play
(right arrow) button to do this.

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To view a Dual Echo study:
1. On the Study Directory in Vitrea, select a dual echo study.

2. Click the 2D application thumbnail.

The Softread application launches, displaying the images in 4 up
Series hanging protocol.

3. Select Format, Load Hanging Protocol, 4 up Split Series, or 4 up

Volumes.
In the Available Series area, thumbnails display for all of the sequences
in the dual echo series.

4. To display the T1 and T2 images in side-by-side viewers, click and

drag the thumbnails into the viewers.

Dual Echo MR:

5. Adjust the Window/Level.

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 6. Lock the same plane viewers together by clicking on the Lock button
in each viewer.

7. Cine (scroll) through the locked images.

8. Mark an ROI

a. Assign one of the mouse buttons the ROI function.

b. In the viewer where you want to mark the ROI, click and drag with
that mouse button around the border of the ROI.
Softread automatically connects the two ends of the line you draw, and displays
the average (pixel units), range (pixel units), area (sq. cm) and length (perimeter)
of the ROI outline (mm).

Lumbar MR

Softread contains a hanging protocol specifically designed for lumbar MR

studies. The hanging protocol displays two sagittal image sets in the
upper viewers and two axial image sets in the lower viewers.

NOTE: The advantage to viewing lumbar cases in Softread is that

Vitrea breaks the series into volumes (one for each angle or
orientation), whereas Softread displays the entire series, so you can
see it in its entirety.

To view a lumbar MR case:

1. On the Study Directory in Vitrea, select a lumbar MR study.

2. Click the 2D application thumbnail.

The Softread application launches.

NOTE: If the study description does not contain the word lumbar, the
images display in the 4 up Series hanging protocol. To reformat the
viewer into the lumbar hanging protocol, select Workflow, Lumbar
Read.

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 Lumbar MR:

3. Click a sagittal image, then press the PAGE UP or PAGE DOWN keys
on the keyboard to display the next or previous sagittal image set.

4. Click an axial image, then press the PAGE UP or PAGE DOWN keys
on the keyboard to display the next or previous axial image set.

5. Scroll in a sagittal viewer and watch the cross reference lines move in
the axial views.

6. Ensure the crosshair function is assigned to your middle mouse

button.

7. Click and hold the middle mouse button on a point of interest in one of
the views.
In the perpendicular views, a small blue plus (+) sign displays at the
POI.
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 In the matching plane view(s), a small minus sign crosses the cross-
reference line at the POI.

CT

Many times with CT studies, you will want to examine the same image for
various tissue types.

To view a CT case:
1. On the Study Directory in Vitrea, select a CT study.

2. Click the 2D application thumbnail.

The Softread application launches the 4 up Series hanging protocol.

CT study:

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 3. Drag the thumbnail for the series you want to examine into all four of
the viewers.

4. Adjust the Window/Level settings to Liver, Lung, Soft, and Bone.

5. Lock all four viewers together by clicking on the Lock button in each
viewer.

6. Cine.

7. Add the images in one viewer to the images in another viewer:

• In the toolbar at the bottom of one of the viewers, click the Add
Images control and drag the control into the viewer displaying the
series into which you want to add the images.
The images from the first viewer are added into the images in the second viewer.
A thumbnail is added, labeled series number X + Y.

8. Subtract the images in one viewer from the images in another viewer:
• In the toolbar at the bottom of one of the viewers, click the
Subtract Images control and drag the control into the viewer
displaying the series from which you want to subtract the images.
The images from the first viewer are subtracted from the images in the second
viewer. A thumbnail is added, labeled series number X - Y.

9. Connect the series in one viewer to the series in another viewer:

• In the toolbar at the bottom of one of the viewers, click the
Concatenate Series control and drag the control into the viewer
displaying the series to which you want to connect the series in the
first viewer.
The series from the first viewer is linked to the end of the series in the second
viewer. A thumbnail is added, labeled series number X ++Y.

10. Double-click any of the viewers to examine the image in a 1 up

format.

11. Double-click again to go back to the previous viewer format.

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Nuclear Medicine

You can apply color scales to nuclear medicine images in Softread.

• Heat scale
• Warm metal
• Rainbow
• Nuclear
• 16 color

To apply a color scale to a nuclear medicine study:

1. On the Study Directory in Vitrea, select a nuclear medicine study.

2. Click the 2D application thumbnail.

The Softread application launches.

3. In the toolbar at the bottom of the viewer, click the Tools button.
he tools menu displays.

4. Select Pseudo-color.
The list of pseudo-color scales displays.

5. Select the color scale you want to use.

Softread applies the colors to image(s) in the viewer.

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 Kidneys shown in pseudo-color (Nuclear):

Comparative Review

For two or more studies for the same patient, you can do a comparative
review in Softread. The Comparative workflow parameters take effect
when you load two or more studies for the same patient.

The PAGE UP or PAGE DOWN keys behave a bit differently for

comparative review. They replace the contents in the active viewer(s) -
upper or lower, with images from the corresponding study.

In addition, the thumbnail viewer splits in half. Instead of showing

thumbnails for all Available Series, the upper half contains thumbnails for
the primary study. The bottom half contains thumbnails for the secondary
study or studies.

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To load multiple studies for comparative review:
1. On the Study Directory in Vitrea, select the studies you want to
compare.

2. Click the 2D application thumbnail.

The Softread application launches.

The Softread window displays the 4 up Series hanging protocol in

Comparison workflow mode. This hanging protocol displays four
viewers, two image sets for the first study in the left viewers, and two
image sets for the second study in the right viewers.

They are labeled Primary and Secondary studies. The primary study
has the most recent acquisition time. The patient name for the
secondary study is displayed as ‘reverse video’ (highlighted).

Comparative Review:

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Setting Preferences
Using the Preferences menu, you can select the items that display on the
Softread window and specify the window behaviors.

NOTE:Individual preferences are saved by user, according to your

Windows login ID.

To control the information displayed in the viewers:

• Select or deselect Cross-reference to display or hide the blue cross-
reference lines in the viewers perpendicular to the plane in which you
are scrolling.
• Select or deselect In-plane cross-reference to display or hide the
cross-reference box in the viewers of the same plane as the one in
which you are scrolling.
• Select or deselect Patient Information to display or hide all patient
information.
• Select or deselect Measurements to display or hide measurements
for any rulers you draw or ROIs you mark.
• Select or deselect Scale bar to display or hide the perspective scale
bar that displays alongside the image.

To control additional Softread window behaviors:

• Deselect Follow focus if you do not want the thumbnail viewer to
reflect the current (active) viewer.

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 • By default, the viewer displays the first image in the image set. Select
Start middle image if you want the viewers to first display the middle
image in every new or just-opened image set.
• Deselect Exit warning if you do not want to see the warning dialog
box when you close Softread.
The warning dialog box displays, There are X number of unvisited
images remaining in the study. Do you still want to exit?

Viewing Findings (Key Images)

When you mark an image as a key image, Softread saves it to the
Findings tab for use during report dictation.

To display the Findings tab:

1. At the bottom of the Softread window, click the Findings workflow
indicator.
The Findings window displays, including the total number of pages of
key images.

2. To manipulate the images, use the mouse functions you assigned on

the Softread window, or the buttons and controls in the toolbar at the
bottom of one of the viewers.

3. To page through all of the pages of key images, click the Prev and
Next arrow buttons.

4. To change the viewing format to see more or fewer images on the

page, click the dropdown arrow in the Page Format field and select a
different format.

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Closing Softread
• Click the X (Close) button in the upper right corner of the Softread
window.
OR

Click File on the menu bar, then select Exit.

OR

Click Study Directory on the bottom of the Softread window.

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226 Softread
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Index
NUMERICS C
1-down button 119 79
Calipers
1-up button 119 Centerline Angle button 111
2D Comparative Review 116 Change Colors option 135
2D Montage Format buttons 29 Change Status 17
3D Box check box 38 Change Study Lock 17
3D Boxoption 87 Change the Appearance of a Region 101
3D Crosshair check box 37 Change the Appearance of the Whole View 106
3D Crosshairs 126 Classroom Learning 11
3D Imaging Modes 126 Clinicians 19
3D Sculpting 130 Clipboard button 171
3D VR option 87 Collapse All option 23
Color Gradient scale 104
A Color Model options 104
Add To button 123 Color Picker 104
Administrator Education 12 Colored and Lit option 121
Advanced Diagnostic Users 19 Colors button 135, 136
Advanced Viewer button 19 Contact Us 13
All Exams button 116 Contours 85
All-Exams format button 29 Coronal 118
Ambient slider 137 Create a Custom Color Scheme 102
Angle button 83 Create Centerline Angles 111
Angles 83 Create the Report 171
Annotate Batches 144 Crosshairs 78
Applications tab 44, 60 Crshair button 79
Archive CD/DVD button 71 Curve Editor area 104
Archive to CD/DVD option 23 Curve scroll 104
Arrow button 84 Curved button 123
Arrows 84 Curved MPR 124
Auto Export 148 Customized Options 13
Automatic Query 18 Customized Templates 177
Automatically Remove Bone 27, 88,
97
Automatically Remove Bone check box 27 D
AV Stats check box 37 Data Manager 59
Average option 120 Delete button 165, 169
Average Reference Method Lesion Delete CAD option 23
button 112 Delete option 23
Axial 118 Delete Study 17
Diagnostic Users 19
B DICOM Export 17
Batch a Single Region for DICOM Export 152 DICOM Export button 175
Batch button 145 DICOM Print button 175
Batch Multiple Regions for DICOM Export 153 DICOM Transfer 62
Bone button 90, 185 Diffuse slider 137
Bone Tool Segmentation 185 Dilate button 91
Disarticulate the Joint by Sculpting in the MPR 183
Display a 2D Montage 116
Distance Learning 12

Index 227
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Dual Reference Method Lesion button L
112 Label button 81
Dual Volume format button 30 Labels and Annotations 81
Dual-Volume Fusion 106 Launch MeVis Webpage option 23
Lesion button 113
E Lesion Volume button 113
Edit Ctline button 110 Less button 90
Edit Patient option 23, 70 Light Direction control 137
Edit Regions 99 Light Properties dropdown menu 137
Ellipse button 85 Lighting 105, 136
Email to Clinician 17 Lighting button 136
Erode button 91 Lighting Options button 140
Expand All option 23 Load button 19, 20, 51
Export a Single Region as STL 141 Load Fusion option 23
Export button 165, 169 Load in 2D 17
Export Multiple Regions as STL 151 Load in Advanced Viewer option 19
Export option 23 Load in Softread option 23
Export to CAD Server option 23 Load in Study Viewer option 23
Extend button 110 Load in Vitrea option 23
Load Snapshots button 68
F Load Volume button 46
Load Volumes button 71
Field of View check box 37 Lock 3D check box 38
Field of view, changing 137
Lock option 23
Filter, Sort, and Search the Patient List 16 Locking/Unlocking Studies 70
Filtering Buttons 164
Log into VitreaCore 53
Findings List 41, 164
Findings Management Buttons 165
Findings Tray 164 M
Fly Around Mode button 127 Manual 2D and MPR Batches 145
Fly Through format button 30 Manual 3D Batches 147
Fly Through Mode button 127 Manually Segment Bone 90
Fly Through Volumes 138 Mark a Study as Read 17, 57
Front Cut Plane option 87 Maximize/Minimize (1-up/Return) 119
Full Crosshair check box 38 Measurements check box 38, 84
Merge Regions 101
G MinIP option 121
MIP option 120
26
Gallery
Moderate view option 137
Grow button 93 Modified Presets 75
More button 90
H Mouse Functions 31
Help tab 10 Movie button 145
Help Window10 MPR Imaging Modes 123
Highlight & Tint/MPR option 184 MPR Rendering 119
MPR Thickness 121
I
Interact Fast check box 38 N
Intranet Post button 175 Native Thickness MPR option 87
Isolate the Joint 182 New Report button 171
Noise Reduction check box 38
K
Keyboard Shortcuts 32, 33 O
Oblique button 123
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Oblique MPR Mode 123 Right-click Menu and Tool Panel 36, 76
Oblique Trim 130 ROI button 86
Oblique Trim check box 38 Rotate MPRs 119
Oblique Trim Mode button 127 Rotating 128
Oblique Trim option 87 Ruler button 79
On-site Learning 13 Rulers 79
Opacity fct. button 104 Runoff format button 30
Opacity Setting slider 104
Options dropdown 135 S
Organ button 129 Sagittal 118
Orthogonal button 123 Save as DICOM File option 62
Save Media 17
P Save Preset button 105
Passwords 54 Scripted 3D Batches 146
Patient Info check box 37 Scripted MPR Batches 144
Patient Information 27 Scroll Through the MPR Views 119
Patient List 21 Scrolling Through Slices 115
Patient List Column Headers 16, 56 Sculpt button 122, 130, 183
Patient List Right-click Menu 17 Sculpting in MPRs 96, 122
POI Mode button 127 Segment Metal Implants 186
Presets 27 Segment the Kidneys 94
Process Colon CAD option 23 Segment Vessels 92
Projection dropdown menu 137 Segmentation 88
Protocol List 27 Select Application Data option 60
Publish button 175 Select button 109
Selecting Multiple Studies or Volumes 69
Q Series tab 50
Query button 63, 73, 74 Shade Selector 104
Show All button 164
Show Reported button 164
R Show Snapshots option 25
Reconcile or Edit Patient Information 69 Show Volume option 130
Re-display the Bone and Make It Semi-Transparent Show-Hide Volumes 69
98 Single Reference Lesion button 112
Refresh Study Directory option 23 Slices to Stack slider 116
Remove Fragments 91 Smart Query tab 74
Report Snap button 82
adding snapshots from multiple volumes Snapshots 82
174 Snapshots tab 61
Report Distribution 175 Sorting and Searching Study Information 69
Report Navigation 174 Specialty Course for Advanced Visualization
Report Tools 172 Cardiac 13
Report Window 40, 163 Specular slider 137
Reports tab 62 Stack Images 116
Reset Orientation option 87 Start and Close Vitrea 54
Restore button 165, 169 Start button 146
Restore Snapshots button 68 STL 149
Restoring saved images (workflow) Study Directory 14, 55
from Report window 168 Study Directory Icons 22
Restoring Workflow From Study Directory 24 Study Status Icons 16
Retrieve button 73, 74
Reverse View Mode button 127 T
Right-click Menu 22 Tabs 13
Index 229
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Target Nav check box 37
Targeted Navigation format button 30
Telephoto view option 137
Template Layouts 170
Thick Slab MIP option 87
Thick Slab VR option 87
Tint Regions in MPRs 99
Trim 82
Trim button 82

U
Use DICOM Transfer 18
Use Modified Presets check box 75
User Accounts 54
User Types (Vitrea Enterprise Suite) 18

V
Vessel Probe 109
View Metal Implants 186
View Options 37
Viewer Window 28
Viewer Window Layout 29
Visibility Settings 134
Visible button 186
Vital U 11
Vitrea Enterprise Study Directory 14, 15, 44, 55
VitreaAdvanced Workstation Study Directory 14,
21, 46, 55
Volume Measurements 129
Volume Render and Rotation 127
Volume Render option 121

W
Wide Angle view options 137
Window/Level 77, 115
Window/Level Range lines 104
WinLev button 77

Z
Zooming In and Out 116

230 Index
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5850 Opus Parkway, Suite 300 | Minnetonka, MN 55343 | 866.433.4624 | [Link]

VPMC-13501 B