software for healthcare

Inobitec DICOM Viewer version 2.16

User’s manual
Editions LITE and PRO
 The information contained in this User Manual belongs to the Inobitec Software FZ-LLC,
Dubai Media City, Building 05, Dubai, UAE, P.O. Box 73030. The Manual is delivered to the
users of Inobitec DICOM Viewer software product exclusively for the purpose of working with
this product. No part of the information contained herein can be modified, used for any other
purpose or delivered to any third party without the prior written consent of the Inobitec Soft-
ware FZ-LLC. The Inobitec Software FZ-LLC reserves the right to alter this Manual without prior
notice. Screenshots are made in Windows for the Dark style of the Viewer. Certain visual dif-
ferences between the Viewer interface and the images in the screenshots are allowable.

© Inobitec Software FZ-LLC 2009-2025. All rights reserved.

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Contents

Contents 3

About this Manual 16

Accepted Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Technical Support 17

About the Product 18

DICOM Viewer Functionality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
New Functions in Version 2.16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Installing, Uninstalling and Launching the Program 30

System Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Installing, Uninstalling and Running the Program on Windows . . . . . . . . . . . . . . 32
Installing the Program using the Installer . . . . . . . . . . . . . . . . . . . . . . . 32
Silent program Installation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Uninstalling the Program using an Uninstaller . . . . . . . . . . . . . . . . . . . . 41
Silent Uninstallation the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Running the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Installing, Uninstalling and Running the Program on Mac OS . . . . . . . . . . . . . . . 44
Installing the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Uninstalling the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Running the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Installing, Uninstalling and Running the Program on Linux . . . . . . . . . . . . . . . . 44
Running the program in AppImage Format . . . . . . . . . . . . . . . . . . . . . . 44
Uninstalling the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Launch multiple instances of the program . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Service files . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
First run of the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Launching the Web Viewer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

1 Program Window Elements 53

1.1 Main Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
1.1.1 File . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
1.1.2 Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

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1.1.3 Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
1.1.4 View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
1.1.5 Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
1.1.6 Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
1.1.7 Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
1.1.8 Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
1.2 Window Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
1.3 Tab Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
1.3.1 General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
1.3.2 Manage a Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
1.4 Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
1.5 Select Data Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
1.5.1 Select a CD, DVD or Local Folder as the Data Source . . . . . . . . . . . 64
1.5.2 Opening Zipped DICOM Studies . . . . . . . . . . . . . . . . . . . . . . . . 65
1.5.3 Opening DICOM studies by dragging and dropping . . . . . . . . . . . . 65
1.5.4 Opening DICOM studies from the context menu . . . . . . . . . . . . . . 66
1.5.5 Select a PACS Server or Local Storage as the Data Source . . . . . . . . 67
1.6 Save Studies and Series to the folder . . . . . . . . . . . . . . . . . . . . . . . . . 68
1.6.1 Save Studies to the folder . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
1.6.2 Save Series to the folder . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
1.7 Search Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
1.7.1 Saving the Search Parameters . . . . . . . . . . . . . . . . . . . . . . . . . 71
1.7.2 Searching for Studies by Preset Parameters . . . . . . . . . . . . . . . . . 72
1.8 Select Server Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
1.9 Study Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
1.9.1 Customize Study Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
1.9.2 Sort Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
1.9.3 Edit Patient Name and Description in a Study . . . . . . . . . . . . . . . . 75
1.9.4 Study List Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
1.10 Series Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
1.11 Studies and Series Download/Upload Panels . . . . . . . . . . . . . . . . . . . . . 78
1.12 Information Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
1.13 Uncompress series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
1.14 Tool Control Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81

2 View Flat Images 82

2.1 Open Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
2.2 Open Series with Current Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
2.3 Context Menu of the Image Viewer Tab . . . . . . . . . . . . . . . . . . . . . . . . 84
2.4 Working with Several Monitors and Split Screen . . . . . . . . . . . . . . . . . . . 86
2.5 Resampling filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
2.6 Image Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
2.6.1 Preset Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
2.6.2 User Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
2.6.3 Actions with Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
2.7 View Images in a Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
2.8 Switch between Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
2.9 View Several Studies at a Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

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2.10 View Multiple Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

2.10.1 Auto Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
2.10.2 Stacked Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
2.10.3 Grid Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
2.10.4 Custom Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
2.11 View Multiple Images in the Same Series Simultaneously . . . . . . . . . . . . . . 100
2.12 Viewing Several Series as a Single Multiphase Series . . . . . . . . . . . . . . . 102
2.13 Viewing Orthogonal Projections of Images . . . . . . . . . . . . . . . . . . . . . . 103
2.14 Play images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
2.15 Video recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
2.16 Zoom. Pan. Rotate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
2.16.1 Zoom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
2.16.2 Pan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
2.16.3 Rotate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
2.17 Set Window Level and Width . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
2.17.1 User Presets for Window Width and Level . . . . . . . . . . . . . . . . . . 110
2.17.2 Actions with presets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
2.17.3 Additional Width and Level Settings . . . . . . . . . . . . . . . . . . . . . . 113
2.17.4 Setting the Window Width and Level for Merged Series . . . . . . . . . . 114
2.18 Magnifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
2.19 Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
2.19.1 Ruler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
2.19.2 Displaying angles between intersecting rulers . . . . . . . . . . . . . . . . 117
2.19.3 Polygonal Ruler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
2.19.4 Angle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
2.19.5 Cobb angle meter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
2.19.6 Measure Intensity at a Point . . . . . . . . . . . . . . . . . . . . . . . . . . 120
2.19.7 Measure the Intensity Average and Standard Deviation in an Area . . . . 121
2.19.8 Measuring the Cardiothoracic Ratio (CTR) . . . . . . . . . . . . . . . . . . 122
2.19.9 Drawing Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
2.19.10 Move Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
2.19.11 Move Measurement Results . . . . . . . . . . . . . . . . . . . . . . . . . . 124
2.19.12 Delete Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
2.19.13 Measuring Dimensions and Area during Ultrasound Imaging . . . . . . . 125
2.19.14 Measuring the Time Interval and the Blood Flow Velocity during Ultra-
sound Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
2.20 Perfusion Parameters Estimation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
2.20.1 Open series in Perfusion Parameters Estimation mode . . . . . . . . . . . 126
2.20.2 Setting the Time Interval on the Perfusion Panel . . . . . . . . . . . . . . 127
2.20.3 Brain Perfusion Parameters Estimation . . . . . . . . . . . . . . . . . . . . 129
2.20.4 Map mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
2.20.5 Advanced Settings for Bayesian Estimation Algorithm . . . . . . . . . . . 136
2.20.6 Deconvolution Advanced Settings . . . . . . . . . . . . . . . . . . . . . . . 140
2.21 Evaluation of Blood Flow Parameters . . . . . . . . . . . . . . . . . . . . . . . . . 141
2.21.1 Opening a Series in the Blood Flow Parameters Evaluation Mode . . . . 142
2.21.2 Changing the Configuration Parameters for a PC MRI Series . . . . . . . 146
2.21.3 Building and Editing Vessels ROI . . . . . . . . . . . . . . . . . . . . . . . 146

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2.21.4 Blood Flow Analysis Panel. Displaying the Results of General Blood
Flow Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
2.21.5 Evaluating the General Blood Flow Analysis Parameters . . . . . . . . . . 151
2.21.6 Designing a Trajectory for the Pulse Wave . . . . . . . . . . . . . . . . . . 153
2.21.7 Getting the Results of Advanced Blood Flow Analysis without Building
a Pulse Wave Trajectory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
2.21.8 Blood Flow Analysis Panel. Displaying the Results of Advanced Blood
Flow Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
2.21.9 Evaluation of the Parameters for Advanced Blood Flow Analysis . . . . . 159
2.21.10 Blood Flow Parameters Evaluation for Two Slices . . . . . . . . . . . . . . 160
2.22 Image Stitching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
2.22.1 Opening a Series in the Image Stitching Mode . . . . . . . . . . . . . . . 165
2.22.2 Image Stitching Functional Toolbar . . . . . . . . . . . . . . . . . . . . . . 166
2.22.3 Adding Images for Stitching . . . . . . . . . . . . . . . . . . . . . . . . . . 167
2.22.4 Merging Images Manually . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
2.22.5 Merging Images Automatically . . . . . . . . . . . . . . . . . . . . . . . . . 169
2.22.6 Stitching Merged Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
2.22.7 Exporting Stitching Results . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
2.22.8 Printing the Image Stitching Results . . . . . . . . . . . . . . . . . . . . . . 171
2.23 Visualize Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
2.23.1 Select CLUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
2.23.2 Edit CLUTs List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
2.23.3 CLUT Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
2.23.4 Create and Edit CLUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
2.23.5 User CLUTs Import . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
2.24 SUV Measurement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
2.25 Calcium Scoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
2.25.1 Selection of measurement areas . . . . . . . . . . . . . . . . . . . . . . . . 182
2.25.2 Actions with measurement areas . . . . . . . . . . . . . . . . . . . . . . . 184
2.25.3 Measurement results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
2.26 Scout Lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
2.26.1 The Tool Menu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
2.26.2 Line Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
2.27 Set Up Viewer Workspace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
2.28 Export Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
2.28.1 Export to DICOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
2.28.2 Export to Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
2.29 DSA Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
2.29.1 Single-image subtraction view . . . . . . . . . . . . . . . . . . . . . . . . . 195
2.29.2 Series subtraction view . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
2.29.3 Viewing Several Series of the Same Study Fused in One Multiphase
Series with Subtraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
2.30 Image Information in the Series Window . . . . . . . . . . . . . . . . . . . . . . . 198
2.30.1 Orientation Cube . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
2.30.2 Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
2.30.3 Image Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
2.30.4 Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
2.31 View DICOM Tags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

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2.32 Viewing Structured Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

2.33 Graphic Label Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
2.33.1 General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
2.33.2 Create Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
2.33.3 Actions with Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
2.34 Synchronize Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
2.35 Synchronization by a Point . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
2.36 Mirror Image Horizontally/Vertically . . . . . . . . . . . . . . . . . . . . . . . . . . 207
2.37 Calibration sizes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
2.38 Apparent diffusion coefficient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209

3 Volume Reconstruction 210

3.1 View Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
3.2 Model Projection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
3.3 Actions with Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
3.4 Model Positioning Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
3.4.1 Model Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
3.4.2 Model Rotation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
3.4.3 Model Scaling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
3.5 «Select Model Point» Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
3.6 The Play Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
3.7 Video recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
3.8 Cutting Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
3.8.1 Polygon Cut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
3.8.2 Inverse Polygon Cut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
3.8.3 Cut object . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
3.8.4 Cut all except object . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
3.8.5 Cutting Tools Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
3.8.6 Brush Tools for Editing Volume . . . . . . . . . . . . . . . . . . . . . . . . . 217
3.8.7 Tools for intelligent volume editing . . . . . . . . . . . . . . . . . . . . . . 219
3.8.8 Remove Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
3.9 Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
3.10 Clipping Box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
3.11 Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
3.11.1 Ruler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
3.11.2 Polygonal Ruler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
3.11.3 Surface ruler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
3.11.4 3D Angle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
3.11.5 Customizing the Text Size for Measuring Tools . . . . . . . . . . . . . . . 228
3.12 Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228
3.13 Export Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
3.13.1 Export Rotation to Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
3.13.2 Export Rotation to Images . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
3.14 Render settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
3.15 Reconstruction by Series with Varying Distances between Slices . . . . . . . . . 231
3.16 Subtraction of Volumes for Fused Series . . . . . . . . . . . . . . . . . . . . . . . 232
3.17 Remove Bone Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
3.17.1 Remove Bone Tissue Manually (Interactive) . . . . . . . . . . . . . . . . . 234

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3.17.2 Removing Bone Tissue Manually (Automatic) . . . . . . . . . . . . . . . . 234

3.17.3 Remove Bone Tissue for Fused Series . . . . . . . . . . . . . . . . . . . . 235

4 Series Fusion 238

4.1 Create Series Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
4.2 Merge Series from Different Studies . . . . . . . . . . . . . . . . . . . . . . . . . . 240
4.3 Merge layers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
4.3.1 Locking the Frame of Reference for a Layer . . . . . . . . . . . . . . . . . 243
4.3.2 Merge layers automatically . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
4.3.3 Merge layers manually . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
4.3.4 Merge layers by control points . . . . . . . . . . . . . . . . . . . . . . . . . 245
4.3.5 Export and Import Matrices of Merge Layers . . . . . . . . . . . . . . . . . 248
4.4 Image registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
4.4.1 Series registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250
4.4.2 Phases registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252
4.5 Actions with the fused series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254
4.6 Image stitching mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
4.7 Volume Stitching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256

5 Multiplanar Reconstruction (MPR) 259

5.1 Open Study in Multiplanar Reconstruction window . . . . . . . . . . . . . . . . . 259
5.2 MPR View Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260
5.2.1 Customizing the Section Windows Arrangement . . . . . . . . . . . . . . 261
5.3 Resampling filter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
5.4 Image Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
5.5 Working with Orthogonal Planes . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
5.5.1 View Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
5.5.2 Working with Planes in 3D Cursor Mode . . . . . . . . . . . . . . . . . . . 265
5.5.3 Working with Planes in the Cutting Plane Mode . . . . . . . . . . . . . . . 266
5.6 Series Synchronization in MPR Reconstruction Tabs . . . . . . . . . . . . . . . . . 266
5.7 Curvilinear Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
5.7.1 Build Surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
5.7.2 Choosing a Display Mode for an Involute of a Curve . . . . . . . . . . . . 270
5.7.3 Curve settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
5.7.4 Actions with a Curve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
5.7.5 Position of a Curve, Its Nodes and Surface in Space . . . . . . . . . . . . 274
5.7.6 Curved Reconstructions Cross Sections Mode . . . . . . . . . . . . . . . . 274
5.8 Displaying Section Planes on 3D Models . . . . . . . . . . . . . . . . . . . . . . . 278
5.9 «Render settings» Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
5.10 The Play Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
5.11 Video recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
5.12 Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
5.12.1 General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
5.12.2 Add Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
5.12.3 Add Line Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
5.12.4 Poilygonal Marker line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
5.12.5 Actions with Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
5.12.6 Marker Properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285

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5.12.7 Position of Markers in Space . . . . . . . . . . . . . . . . . . . . . . . . . . 286

5.13 Reconstruction Modes. Slice Thickness . . . . . . . . . . . . . . . . . . . . . . . . 286
5.13.1 Render Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
5.13.2 Slice Thickness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
5.14 Rotate Image in the Section Plane . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
5.15 Mirror Image Horizontally/Vertically . . . . . . . . . . . . . . . . . . . . . . . . . . 288
5.16 Show labels tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
5.17 Export Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
5.18 Reslice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
5.19 Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292
5.20 Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
5.21 Volume Reconstruction window . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
5.22 Diffusion Tensor Imaging (DTI) Mode . . . . . . . . . . . . . . . . . . . . . . . . . . 293
5.22.1 Open series in DTI Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
5.22.2 Select Visible Fibers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
5.22.3 Fiber Color . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
5.22.4 Scalar Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
5.22.5 Building a Surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
5.22.6 Creating a Voxel Model of Fibers . . . . . . . . . . . . . . . . . . . . . . . 299
5.22.7 Saving data in a file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299

6 Segmentation 300
6.1 The Segmented Structures Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303
6.2 The Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
6.2.1 Creating a new structure and mask . . . . . . . . . . . . . . . . . . . . . . 307
6.2.2 Changing the structure mask using CLUTs . . . . . . . . . . . . . . . . . . 308
6.2.3 The Editing mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
6.2.4 Set Mask Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
6.3 Creating segmented structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
6.3.1 Creating a structure by copying . . . . . . . . . . . . . . . . . . . . . . . . 311
6.3.2 Creating a Structure with a Empty Mask . . . . . . . . . . . . . . . . . . . 312
6.4 Actions with structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312
6.5 Building surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314
6.6 Copying a Surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
6.7 Import and Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
6.7.1 Export surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
6.7.2 Import surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
6.7.3 Export a structure to the current study . . . . . . . . . . . . . . . . . . . . 323
6.7.4 Export a structure to DICOM RT . . . . . . . . . . . . . . . . . . . . . . . . 324
6.7.5 Importing a Structure from DICOM RT . . . . . . . . . . . . . . . . . . . . . 325
6.8 Changing the structure mask with segmentation tools . . . . . . . . . . . . . . . 326
6.8.1 Tools for automatic segmented structure mask filling . . . . . . . . . . . . 328
6.8.2 Brush restore tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
6.8.3 Region growing tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
6.8.4 Vessel tree segmentation tool . . . . . . . . . . . . . . . . . . . . . . . . . 332
6.8.5 Watershed segmentation tool . . . . . . . . . . . . . . . . . . . . . . . . . 334
6.8.6 Multi-segment growing tool . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
6.8.7 Segmented structures regions growing Tool . . . . . . . . . . . . . . . . . 338

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6.9 Union, subtraction and intersection of structures . . . . . . . . . . . . . . . . . . . 339

6.9.1 Union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339
6.9.2 Subtraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
6.9.3 Intersection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
6.9.4 «Subtract dilated» Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
6.10 Building Mask with Contours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
6.10.1 General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
6.10.2 Building a Structure Mask with Contours . . . . . . . . . . . . . . . . . . . 344
6.10.3 Work with Contours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
6.10.4 Setting the Contour Display Parameters . . . . . . . . . . . . . . . . . . . 347
6.11 Saving and Opening Segmentation Projects and DTI Projects . . . . . . . . . . . 348
6.11.1 Saving a Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348
6.11.2 Saving Projects Automatically . . . . . . . . . . . . . . . . . . . . . . . . . 350
6.11.3 Resuming Work with Segmentation Projects . . . . . . . . . . . . . . . . . 352
6.11.4 Opening a Project with Source DICOM Data . . . . . . . . . . . . . . . . . 354
6.11.5 Opening a Project without Source DICOM Data . . . . . . . . . . . . . . . 356
6.12 Histograms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356
6.12.1 Rendering a Histogram for a Structure . . . . . . . . . . . . . . . . . . . . 357
6.12.2 Histogram for a ROI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358

7 Vessel analysis module 360

7.1 Open Studies in Vessel Analysis Module . . . . . . . . . . . . . . . . . . . . . . . 360
7.1.1 Vessels list . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
7.2 «Render settings» Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
7.3 The Play Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
7.4 Video recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
7.5 Image Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
7.6 Centerline building mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
7.6.1 Building the centerline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
7.7 Vessel Analysis Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
7.7.1 Vessel borders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
7.7.2 Section analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
7.7.3 Curved surface analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
7.7.4 Export vessel surface mesh . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
7.8 Coronary Artery Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374

8 Cardiac function analysis 376

8.1 Opening Studies in the Cardiac Function Analysis Module . . . . . . . . . . . . . 376
8.2 Tools for Cardiac Function Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . 378
8.3 Building Contours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
8.3.1 Building Contours Manually . . . . . . . . . . . . . . . . . . . . . . . . . . 380
8.3.2 Evaluating the Left Ventricle Extension . . . . . . . . . . . . . . . . . . . . 381
8.3.3 Contouring the Left Ventricle Endocardium and Epicardium
Automatically . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 382
8.3.4 Actions with Contours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
8.3.5 Contours panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384
8.4 Evaluating Functional Parameters of the Heart . . . . . . . . . . . . . . . . . . . . 386

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9 PET analysis 389

9.1 Open Studies in PET Analysis tab . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
9.1.1 Fuse series from the same study in the PET analysis tab . . . . . . . . . . 390
9.1.2 Fuse series from different studies in the PET analysis tab . . . . . . . . . 391
9.1.3 Viewing Images of a Series in the PET Analysis Tab . . . . . . . . . . . . 392
9.2 PET Analysis Tab Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
9.2.1 PET Analysis tab Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
9.2.2 Setting the templates for windows arrangement in the PET analysis tab . 393
9.3 MIP mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
9.4 The Play Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
9.5 Video recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395
9.6 PET Window settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
9.7 Image Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
9.8 Visualize Images . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
9.9 Measurements and Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
9.10 Measure the Intensity Average and Standard Deviation in Space . . . . . . . . . 399
9.10.1 Create sphere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
9.10.2 Sphere location in space . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400
9.10.3 Actions with the sphere . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
9.10.4 Drawing Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 401
9.11 Synchronization in the PET analysis tab . . . . . . . . . . . . . . . . . . . . . . . . 402

10 Virtual Endoscopy 403

10.1 Open Studies in Virtual Endoscopy window . . . . . . . . . . . . . . . . . . . . . . 403
10.2 View Elements. Customize MPR Panel . . . . . . . . . . . . . . . . . . . . . . . . . 404
10.2.1 View Elements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404
10.2.2 Customize MPR Navigation Panel . . . . . . . . . . . . . . . . . . . . . . . 405
10.3 Move Camera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
10.3.1 Move Camera Automatically . . . . . . . . . . . . . . . . . . . . . . . . . . 406
10.3.2 Manage Camera Manually . . . . . . . . . . . . . . . . . . . . . . . . . . . 406
10.4 Video recording . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
10.5 Customize Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
10.6 Measurements and Markers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
10.7 Multiplanar Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
10.8 Surface Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
10.8.1 Create Surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
10.8.2 Surface Orientation and Navigation . . . . . . . . . . . . . . . . . . . . . . 410
10.9 Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411

11 ECG Viewer 412

11.1 Select Data Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
11.2 Open Series in ECG View window . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
11.3 View Graphs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
11.4 Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
11.4.1 Select Lead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
11.4.2 ECG Speed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
11.4.3 Scale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
11.4.4 Length Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415

11
CONTENTS

11.4.5 Value Interval . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415

11.4.6 Move to a Time Point on the Graph . . . . . . . . . . . . . . . . . . . . . . 416
11.4.7 Set Up Coordinate Plane . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
11.5 Frequency Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
11.6 Export series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418

12 Image annotation 419

12.1 Licensing the Image Annotation Module . . . . . . . . . . . . . . . . . . . . . . . 420
12.2 Opening a Series in the Image Annotation Mode . . . . . . . . . . . . . . . . . . 421
12.3 Creating a Tree of Object Groups and Classes . . . . . . . . . . . . . . . . . . . . 422
12.3.1 Creating a New Class of Objects . . . . . . . . . . . . . . . . . . . . . . . . 423
12.3.2 Creating a Group of Object Classes . . . . . . . . . . . . . . . . . . . . . . 424
12.3.3 Operations with Object Classes and Groups . . . . . . . . . . . . . . . . . 424
12.3.4 Compatibility of Trees of Groups and Classes . . . . . . . . . . . . . . . . 425
12.4 Export and Import of the Tree of Groups and Classes . . . . . . . . . . . . . . . . 426
12.4.1 Export of the Tree of Groups and Classes . . . . . . . . . . . . . . . . . . 426
12.4.2 Import of a Tree of Groups and Classes . . . . . . . . . . . . . . . . . . . . 427
12.5 Marking Objects with Contours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
12.5.1 Actions with Object Contours . . . . . . . . . . . . . . . . . . . . . . . . . 428
12.5.2 Changing the Class of Object Contour . . . . . . . . . . . . . . . . . . . . 429
12.6 Saving and Opening Annotation Results . . . . . . . . . . . . . . . . . . . . . . . 430
12.6.1 Saving Annotation Results . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
12.6.2 Opening Annotation Results . . . . . . . . . . . . . . . . . . . . . . . . . . 430
12.7 Export of Annotation Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431

13 Network 433
13.1 Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
13.1.1 DICOM Service (PACS Server functionality) . . . . . . . . . . . . . . . . . . 433
13.1.2 HIS/HTTP Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434
13.1.3 Web Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
13.1.4 Secure DICOM Listener Service . . . . . . . . . . . . . . . . . . . . . . . . 436
13.2 Set Up PACS Server Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
13.2.1 Add PACS Server . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 440
13.2.2 Downloading Data from the PACS Server via WADO service . . . . . . . 441
13.2.3 Secure PACS Server connection via the TLS protocol . . . . . . . . . . . 442
13.2.4 Check PACS Server Availability . . . . . . . . . . . . . . . . . . . . . . . . 444
13.2.5 Configuring the connection of two applications Inobitec DICOM Viewer . 445
13.3 Network Operation Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446

14 The Local Storage 448

14.1 View Storage Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448
14.2 Verify Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
14.3 Clear Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
14.4 Automatic Local Storage cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . 449

12
 CONTENTS

15 Disk Creator 450

15.1 General information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
15.2 Add Data to Disk Creator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 452
15.2.1 Automatically Add Data to a Disk Image . . . . . . . . . . . . . . . . . . . 452
15.2.2 Manually Add Data to a Disk Image . . . . . . . . . . . . . . . . . . . . . . 452
15.2.3 Adding the Inobitec DICOM Disc Viewer to the Disk Image . . . . . . . . 453
15.3 Burn image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
15.3.1 Write to Disk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
15.3.2 Write to Memory Card or Folder . . . . . . . . . . . . . . . . . . . . . . . . 454
15.3.3 Burn an image to CD / DVD in Linux and macOS operating systems . . . 455
15.4 View studies written on disk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455

16 DICOM Viewer Settings 456

16.1 General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
16.2 User interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458
16.3 Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458
16.4 DICOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459
16.5 Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460
16.5.1 Setting an Additional Monitor . . . . . . . . . . . . . . . . . . . . . . . . . 460
16.5.2 Customizing the Screen Parameters . . . . . . . . . . . . . . . . . . . . . 461
16.5.3 High resolution monitor support . . . . . . . . . . . . . . . . . . . . . . . . 463
16.6 Skins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
16.7 Modules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464
16.7.1 Set Up Image Viewer Module . . . . . . . . . . . . . . . . . . . . . . . . . 464
16.7.2 Set Up Study List Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . 466
16.7.3 Set Up 3D Reconstruction Module . . . . . . . . . . . . . . . . . . . . . . . 466
16.7.4 Set Up Vessel Analysis Module . . . . . . . . . . . . . . . . . . . . . . . . 468
16.7.5 Set Up Network Support Module . . . . . . . . . . . . . . . . . . . . . . . 468
16.7.6 Set Up Local Storage Module . . . . . . . . . . . . . . . . . . . . . . . . . 469
16.7.7 Set Up «DICOM CD/DVD Creator» . . . . . . . . . . . . . . . . . . . . . . . 469
16.7.8 Set Up Series fusion Module . . . . . . . . . . . . . . . . . . . . . . . . . . 469
16.7.9 Set Up PET Analysis Module . . . . . . . . . . . . . . . . . . . . . . . . . . 469
16.7.10 Mouse Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470
16.8 Set Up Hotkeys Module . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470
16.9 Import and Export Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
16.9.1 Export Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
16.9.2 Import Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472
16.9.3 Import CLUTs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473

17 DICOM Tag Viewing 474

17.1 DICOM Tags. General Information . . . . . . . . . . . . . . . . . . . . . . . . . . . 474
17.2 DICOM Tag Viewer Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
17.2.1 Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476
17.2.2 Tag Tree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
17.2.3 Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477
17.3 Anonymize studies and series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 477

13
CONTENTS

18 Report Editor 481

18.1 Editor Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481
18.1.1 Toolbar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482
18.1.2 Text Editing Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
18.2 Working with Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
18.2.1 Creating an Empty Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
18.2.2 Creating a Report Based on a Template . . . . . . . . . . . . . . . . . . . 488
18.2.3 Saving a Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489
18.2.4 Exporting a Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
18.2.5 Viewing and Editing a Report . . . . . . . . . . . . . . . . . . . . . . . . . . 490
18.3 Report Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
18.3.1 Creating an Empty Template . . . . . . . . . . . . . . . . . . . . . . . . . . 491
18.3.2 Loading a Report Template from a File . . . . . . . . . . . . . . . . . . . . 492
18.3.3 Exporting a Report Template . . . . . . . . . . . . . . . . . . . . . . . . . . 492
18.3.4 Viewing and Editing a Report Template . . . . . . . . . . . . . . . . . . . . 492
18.3.5 Saving a Report Template . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492
18.3.6 Deleting a Report Template . . . . . . . . . . . . . . . . . . . . . . . . . . . 493

19 Print Images 494

19.1 Working with Print List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
19.1.1 Add/Delete Images in View Flat Images and Fusion windows . . . . . . . 495
19.1.2 Add Images in Multiplanar Reconstruction and Volume Reconstruction
windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
19.1.3 Add Series and Clear Print List . . . . . . . . . . . . . . . . . . . . . . . . . 496
19.1.4 Add Images from Different Studies . . . . . . . . . . . . . . . . . . . . . . 496
19.2 Edit print list in Preview window . . . . . . . . . . . . . . . . . . . . . . . . . . . . 496
19.2.1 Preview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 496
19.2.2 Set Up Page Templates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499
19.2.3 Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
19.2.4 Print Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
19.2.5 Reference image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502
19.3 Print Images on Film . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
19.3.1 Set Up DICOM Printers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
19.3.2 Set Up DICOM Printing Parameters . . . . . . . . . . . . . . . . . . . . . . 505
19.3.3 Setting Up the Default DICOM Print Parameters . . . . . . . . . . . . . . . 505
19.3.4 Print . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506
19.4 Print Images on Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
19.5 Printing Pages Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507

20 Integration 508
20.1 Launch from the Command Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
20.2 Launching the DICOM Viewer with a URL Command . . . . . . . . . . . . . . . . 511
20.2.1 Enabling the DICOM Viewer Launch with a URL Command
on Windows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
20.2.2 Enabling the DICOM Viewer Launch with a URL Command
on Linux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
20.2.3 Enabling the DICOM Viewer Launch with a URL Command
on macOS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511

14
 CONTENTS

20.2.4 Launching the DICOM Viewer with the help of a URL Command . . . . . 512
20.3 HTTP RPC service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
20.3.1 Command «DownloadAndOpenStudy» . . . . . . . . . . . . . . . . . . . . 513
20.3.2 Command «DisplayStudy» . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
20.3.3 Configuration Files of HTTP RPC service . . . . . . . . . . . . . . . . . . . 516

21 Licensing 521
21.1 Trial period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521
21.2 The First Launch and Licensing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521
21.2.1 Registration on the License Server Using Internet . . . . . . . . . . . . . . 521
21.3 Purchase of a License . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 522

22 Help System and User Assistance 523

22.1 Help System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
22.1.1 Launch the Help System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
22.1.2 Help System Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524
22.2 Tooltips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524

“Hotkeys” 525

Index 531

Glossary 531

15
About this Manual

About this Manual

This User Manual describes the functionality of Inobitec DICOM Viewer (version 2.16) and pro-
vides instructions on how to use this software product.

Accepted Conventions
Names of program interface elements, key names and important notes are printed in bold.
Image captions are printed in italics.
The page numbers which contain a detailed description of the subject are printed in bold
in the Index.

Warnings
Warnings are used to attract attention to important information. Warnings may be marked with
the following symbols:
Notifies the user that there is a great chance of unexpected and potentially
hazardous effect.

Is used to attract the user’s attention to important notes, advice and

recommendations.

16
Technical Support

Technical support of Inobitec DICOM Viewer users is provided by the Inobitec Software FZ-
LLC team. If you apply for technical support, please include the following information in your
message:

• your computer OS name, version and bitness (you can get this information from your
system administrator);

• DICOM Viewer version (e.g. 2.3.0.6631). To get your version number, select the About...
item from the main Help menu;

• product code. To find out the product code, select the License... item from the main
Help menu.

To apply for technical support, or if you have any further questions or comments, please
email us at [email protected]

17
About the Product

About the Product

Inobitec DICOM Viewer software is intended for visualization, analysis and printing of medical
data obtained from various DICOM equipment (modality). The program can be installed on
a diagnostic workstation and integrated with PACS. Inobitec DICOM Viewer brings the capa-
bilities of diagnostics to the new level and makes it possible to detect an abnormality in due
time, effectively predict its development and carefully plan the treatment.
To diagnose the Inobitec DICOM Viewer software should only be used by specialists who
have the necessary qualifications in the relevant field.
Inobitec DICOM Viewer software product and installer does not:

• collect and transfer confidential user information;

• intercept network traffic;

• show ads;

• send spam;

• show messages not related to work;

• automatically update itself without notifying the user.

After uninstalling you do not need to restore your operating system and browser settings.
Uninstalling is free of charge. Uninstalling does not adversely affect the operation of the com-
puter and installed software. Files not related to the DICOM Viewer are not removed and
changed after uninstalling. The DICOM Viewer functionality, installing, uninstalling, licensing
are fully described in this User Manual on the website inobitec.com. License Agreement is
available from the link https://inobitec.com/about/viewerLic/.
The DICOM Viewer is available in two editions:

• Lite: contains sufficient functionality for high-grade work, including storage and transfer
of information on a network. This edition does not contain tools for conducting highly
specialized studies. Its cost is much lower than the cost of the Pro edition.

• Pro: contains all the functionality which is currently available. In the User Manual the
description of the functionality is marked with the symbol «PRO ».

The edition of the DICOM Viewer which is recorded on the disk and the memory card
contains minimal functionality for viewing studies by patients.
Starting from version 1.11.0, specialized modules can additionally be connected to the Pro
edition. Such modules are licensed and paid for separately. The main functionality remains

18
 DICOM Viewer Functionality

available in the Pro edition. In the User Manual the description of additional functionality is
marked with the symbol «ADD ».
If the functionality is not available in the current edition, then a corresponding warning
appears. It indicates in which edition the functionality is available.
32-bit and 64-bit builds are available for Windows operating systems. 64-bit builds are
available For Linux and macOS. You can install only a 32-bit build of the program on a com-
puter with a 32-bit operating system, and any build on a computer with 64-bit one, but it is
recommended to install 64-bit, since it uses computer resources more efficiently. The func-
tionality that requires a large amount of RAM is available only in 64-bit builds.

DICOM Viewer Functionality

INOBITEC Products Comparison Table

Lite Pro Web

DICOM Viewer features and tools
General functions ✓ ✓ ✓
Multilingual user interface ✓ ✓ ✓
Autorun of the application ✓ ✓
Support for multiple monitors ✓ ✓
High resolution monitor support ✓ ✓ ✓
Full-screen mode ✓ ✓ ✓
Minimize application window to system tray ✓ ✓
Open/save file using Native OS dialogs ✓ ✓
Hotkeys ✓ ✓ ✓
Control of tools with different mouse buttons (left, right, or
✓ ✓ ✓
middle)
Export and import settings ✓ ✓
Integrated help system ✓ ✓ ✓
Displaying phases ✓ ✓
Viewing structured reports (SR) ✓ ✓ ✓
Viewing DICOM tags ✓ ✓ ✓
Viewing PDF documents ✓ ✓ ✓
Voxel and polygon rendering support (CUDA, OpenCL, Metal,
✓ ✓
CPU)
Showing the patient’s name on the tab stub ✓ ✓ ✓

19
About the Product

Lite Pro Web

DICOM Viewer features and tools
Displaying labels for images of the series and 3D
✓ ✓ ✓
reconstruction
Highlighting tag labels and other information ✓ ✓
Remote viewing with restricted functionality via the Web
✓
browser
Integration with third-party systems ✓ ✓ ✓
Launching the program from the command line with
✓ ✓
parameters
Executing commands via URL using the protocol inobitec:// ✓ ✓
HTTP RPC service ✓ ✓
Opening a study by a link ✓
Basic measuring tools for series images and MPR slices ✓ ✓ ✓
Ruler ✓ ✓ ✓
Polygonal ruler ✓ ✓ ✓
Angle ✓ ✓ ✓
Cobb angle ✓ ✓ ✓
Point value ✓ ✓ ✓
ROI ellipse ✓ ✓ ✓
ROI rectangle ✓ ✓ ✓
ROI polygon ✓ ✓ ✓
Histogram display for ROI ✓ ✓
Measurement of speed and time interval for dopplergram ✓ ✓
Distance measurement on ultrasound studies ✓ ✓
Angle measurement between the rulers ✓
Annotation tools for series images and MPR slices ✓ ✓ ✓
Ellipse ✓ ✓ ✓
Polygon ✓ ✓ ✓
Arrow ✓ ✓ ✓
Text ✓ ✓ ✓
Pencil ✓ ✓
Special tools ✓ ✓ ✓

20
 DICOM Viewer Functionality

Lite Pro Web

DICOM Viewer features and tools
Calibrating image sizes ✓ ✓ ✓
Digital Subtraction Angiography (DSA) ✓ ✓
Calcium scoring ✓
Cardiothoracic ratio tool ✓
Measurement of apparent diffusion coefficient (ADC) ✓
Blood flow parameters evaluation on the basis of
✓
phase-contrast images
Visualization of Diffusion Tensor Imaging (DTI) ✓
Fusion on the basis of differentiating color contrasting of series ✓
Image stitching ✓
Processing of display of series images and MPR slices ✓ ✓ ✓
Zoom ✓ ✓ ✓
True size ✓ ✓
Pan ✓ ✓ ✓
Magnifier ✓ ✓ ✓
Rotate ✓ ✓ ✓
Flip image ✓ ✓ ✓
Adjust W/L ✓ ✓ ✓
W/L settings ✓ ✓ ✓
Full dynamic W/L ✓ ✓
Custom W/L presets ✓ ✓
CLUTs ✓ ✓ ✓
User CLUTs ✓ ✓
Support for color lookup tables (CLUTs) embedded in DICOM
✓ ✓
data
Choose image resampling filter ✓ ✓
Image filters (sharpen, blur, median) ✓
Video recording and playback ✓ ✓ ✓
Play images ✓ ✓ ✓
Choosing a playback speed ✓ ✓ ✓
Playback looping ✓ ✓ ✓

21
About the Product

Lite Pro Web

DICOM Viewer features and tools
Play video contained in DICOM files ✓
Video recording ✓
Choosing an encoder for video recording ✓
Export images ✓ ✓ ✓
View screenshot ✓ ✓ ✓
Visible image screenshot ✓ ✓
Raw image data capturing ✓ ✓
Export images to a new series of DICOM images ✓ ✓ ✓
Export images to a graphic file (JPEG, PNG) ✓ ✓
Opening DICOM studies from various sources ✓ ✓ ✓
Opening DICOM studies from a folder ✓ ✓ ✓
Opening DICOM studies from a PACS server ✓ ✓
Opening DICOM studies from a local storage ✓ ✓ ✓
Opening DICOM studies from zip archives ✓ ✓
DICOMDIR reading ✓ ✓
Loading images in the background ✓ ✓
Work with DICOM studies ✓ ✓ ✓
Uploading to the PACS server with storeSCU ✓ ✓ ✓
Downloading from the PACS server with C-GET and C-MOVE ✓ ✓ ✓
Work as a PACS server, support C-FIND, C-MOVE and C-STORE
✓ ✓

Export studies and series to the folder ✓ ✓ ✓

Export studies and series to the zip archive ✓ ✓ ✓
Search for studies ✓ ✓ ✓
Saving the search parameters ✓ ✓
Editing patient name and discription of study in local storage ✓ ✓
Anonymize studies and series with the ability to edit DICOM
✓ ✓
tags
Downloading from the PACS server via WADO ✓ ✓
The support of secure connection with TLS ✓

22
 DICOM Viewer Functionality

Lite Pro Web

DICOM Viewer features and tools
View images ✓ ✓ ✓
Customized split screen ✓ ✓ ✓
Displaying several studies at the same time ✓ ✓ ✓
Scrolling images ✓ ✓ ✓
Opening series from the context menu ✓ ✓ ✓
Customized arrangement depending on the study modality ✓ ✓
Automatic filling of windows with study series ✓ ✓
Building orthogonal projections ✓ ✓
Merge series into a multiphase series ✓ ✓
Data synchronization ✓ ✓ ✓
Synchronizing Window / Level for images ✓ ✓ ✓
Synchronize moving and zooming for images ✓ ✓ ✓
Synchronizing the image change ✓ ✓ ✓
Synchronization modes (automatic and manual
✓ ✓ ✓
synchronization)
3D cursor ✓ ✓ ✓
Displaying slice projections ✓ ✓ ✓
Synchronization of MPR tabs on different monitors ✓ ✓
MPR ✓ ✓ ✓
Viewing axial, frontal, and sagittal sections ✓ ✓ ✓
Rotate cutting planes ✓ ✓ ✓
Setting MPR modes (Average, MIP, MinIP) ✓ ✓ ✓
Set slice thickness ✓ ✓ ✓
Display of MPR planes on 3D model ✓ ✓
Customizing windows arrangement ✓
Export sections of any of the planes with a selectable
✓
increment to a series
Fusion on the basis of differentiating color contrasting of series ✓
Viewing Diffusion Tensor Imaging series (DTI) ✓
Curvilinear reconstruction ✓ ✓
Curve slices ✓

23
About the Product

Lite Pro Web

DICOM Viewer features and tools
Basic editing tools for a 3D model ✓ ✓ ✓
Canceling and reverting changes ✓ ✓ ✓
Polygon cut ✓ ✓ ✓
Inverse Polygon Cut ✓ ✓ ✓
Cut object ✓ ✓
Cut all except object ✓ ✓
Measuring tools for a 3D model ✓ ✓
Ruler ✓ ✓
Polygonal ruler ✓ ✓
3D Angle ✓ ✓
Surface ruler ✓
Markers for MPR and 3D reconstruction ✓ ✓
Point marker ✓ ✓
Line marker ✓ ✓
Polygonal line marker ✓ ✓
Volume reconstruction (3D) ✓ ✓ ✓
MIP (Maximum Intensity Projection) ✓ ✓
Clipping box ✓ ✓
Switching projection ✓ ✓
Remove bones ✓ ✓
Remove table ✓ ✓
Center of model ✓ ✓
Setting render quality of the model ✓ ✓
Export of several images obtained by rotating the model to a
✓ ✓
graphic file ( jpg, png)
Export of several images obtained by rotating the model to a
✓ ✓
new series of DICOM images
Deleting bone structures with the help of a native series ✓
Segmentation ✓
Showing the editing mask and its outline ✓
Canceling and reverting changes ✓

24
 DICOM Viewer Functionality

Lite Pro Web

DICOM Viewer features and tools
Polygon cut ✓
Inverse polygon cut ✓
Cut object ✓
Cut all except object ✓
Brush cut ✓
Brush restore ✓
Brush opening operation ✓
Brush closing operation ✓
Segmentation from point by mask ✓
Region growing ✓
Vessel tree segmentation ✓
Watershed segmentation ✓
Region growing of segmented structures ✓
Contour segmentation ✓
Boolean operations with structures ✓
Grow/Shrink ✓
Creating a surface with a mask ✓
Export surface (PLY, OBJ, STL, GLB) ✓
Import surface (PLY, OBJ, STL) ✓
Series fusion ✓
Stitch images ✓
Volume stitching with different modality/intensity ranges ✓
Export of volume stitching ✓
Series fusion from one study ✓
Series fusion from different studies ✓
Subtracting images ✓
Fit layers by points ✓
Merge layers automatically ✓
Merge layers manually ✓
Image registration ✓

25
About the Product

Lite Pro Web

DICOM Viewer features and tools
Recording a study on a CD/DVD ✓ ✓
Recording data to CD/DVD ✓ ✓
Recording a study on a USB medium ✓ ✓
Recording several studies ✓ ✓
Print ✓ ✓
Print images on paper ✓ ✓
Print images using a DICOM printer ✓ ✓
Arbitrary arrangement of images on the page ✓ ✓
Images arrangement templates ✓ ✓
Adding images to the header and the footer ✓ ✓
Changing several images simultaneously ✓ ✓
Adding reference images ✓ ✓
Exporting pages to the PACS server for printing ✓ ✓
Virtual endoscopy ✓
Manually navigate the inside a cavity ✓
Automatic synchronization with multiplanar reconstruction ✓
Centerline ✓
Fly-through camera ✓
Cavity scan ✓
Build cavity surfaces ✓
Video recording ✓
Perfusion parameters estimation ✓
CT and MRI studies support ✓
Results of perfusion parameters evaluation in the form of CBV,
✓
CBF, MTT, and Tmax maps
Creation of report ✓
Edit and format text ✓
Create and edit tables ✓
Insert images from the clipboard ✓
Create report templates ✓

26
 DICOM Viewer Functionality

Lite Pro Web

DICOM Viewer features and tools
Autocompletion of tag values from study series ✓
Export a report in a PDF file ✓
Export a report in a DICOM DOC series ✓
View ECG ✓ ✓ ✓
View graphs ✓ ✓ ✓
Measure time intervals and values on graphs ✓ ✓ ✓
Using filters ✓ ✓
Export graphs to a new series of DICOM images ✓ ✓

«Web» is the Inobitec Web DICOM Viewer, an individual product with the functions com-
parable to those of the desktop DICOM Viewer version. More information can be found in the
Products and Downloads pages.

27
About the Product

Additional modules to the Pro edition, purchased separately:

Name Features and tools

Bones deletion
Displaying a section
Building the centerline
Vessel contours
Vessel Analysis Editing vessel contours
Lumen
Short and long diameters
Percentage of stenosis
Export vessel surface
Displaying a section
Building the centerline
Vessel contours
Editing vessel contours
Coronary Artery Analysis
Lumen
Short and long diameters
Percentage of stenosis
Export vessel surface
Fusion PT and CT series
SUV measurement
PET Analysis
VOI Sphere
Customized split screen
Saving the segmentation results in the .spj format
Extended Segmentation
Autosave
Custom classes
Combining classes in groups
Image Annotation Marking objects with contours
Saving image annotation results
Export image annotation results with DICOM
Building contours for the left and right ventricle manually
Building contours for the left ventricle automatically
Contour panel for navigation
Cardiac function analysis
Evaluating the main parameters for the left and the right
ventricle (EDV, ESV, SV, EF, CO, CI, myocardial mass)
Volume graphs

28
 New Functions in Version 2.16

New Functions in Version 2.16

Available in
Function edition
Lite Pro
Option to set the image scrolling tool as default ✓ ✓
Opening multiple studies from the study list ✓ ✓
Opening multiple studies with a single command ✓ ✓
Enhanced behavior of the brush editing tool ✓ ✓
Image stitching ✓
Brush opening operation ✓
Brush closing operation ✓
Volume stitching with different modality/intensity ranges ✓
Improved export functionality for fused series ✓
Contour panel in the Cardiac Function Analysis Module +

✓ — Functionality is available in this edition

+ — Functionality is available in an additional module to the Pro edition

29
Installing, Uninstalling and Launching the Program

Installing, Uninstalling and Launching the

Program

System Requirements
Minimum System Requirements
Operating system:

• Windows 7 32-bit;

• macOS version 10.13;

• Ubuntu version 18.04;

• Ubuntu version 20.04;

RAM: 2 GB;
free disk space: 300 MB;
CPU: 1,5 GHz;
video card: without hardware acceleration support;
keyboard: standard;
mouse: two-button with a scroll wheel;
display: resolution 1024x768;
network card.

Recommended System Requirements

Operating system:

• Windows 7 64-bit and greater;

• macOS version 10.15 and greater;

• Ubuntu version 18.04;

• Ubuntu version 20.04;

30
 Recommended System Requirements

RAM: 16 GB (for full-fledged 3D and 4D reconstruction);

free disk space: 500 MB;
CPU: 3 GHz (4 or more cores);
video card: GeForce GTX 700 series with embedded memory of 4 GB (with CUDA sup-
port). For optimal performance, when working with segmentation functions, we recommend
to run the program on a hardware with Geforce GTX 1070 and up with minimum 8GB VRAM;
keyboard: standard;
mouse: two-button with a scroll wheel;
display: two displays, resolution HD 1920x1080;
network card.
Rendering devices based on CUDA are not supported by 32-bit operating
systems and macOS

31
Installing, Uninstalling and Launching the Program

Installing, Uninstalling and Running the Program on Windows

Installing the Program using the Installer

To install the program:

1. Run the installer by double-click.

2. Click CONTINUE in the window shown in Fig. 1.

Figure 1: Beginning of the installation

3. It is strongly recommended to update graphics adapter drivers (integrated or discrete)

from the official manufacturer‘s website, in order to prevent possible failure in operation
of DICOM Viewer. If you are sure that drivers are up to date check the The drivers on
this device have been updated box in the window shown in Fig. 2, and click CONTINUE.
Otherwise stop installation (click CANCEL and in the confirmation dialog click Yes) and
update drivers. To return to the previous installation step click GO BACK.

32
 Installing and Uninstalling the Program

Figure 2: Software recomendation

4. Read the License Agreement carefully. Its text is also available from the link
https://inobitec.com/about/viewerLic/. If you agree the terms and conditions, check
the item I accept the license and click CONTINUE (Fig. 3). Otherwise click CANCEL
and in the confirmation dialog box that appears click Yes.

33
Installing, Uninstalling and Launching the Program

Figure 3: License Agreement

Figure 4: Select users

34
 Installing and Uninstalling the Program

5. Select for whom you want to install the program (Fig. 4). If you select Anyone who uses
this computer (all users), then the program will be installed to the system folder, and
you will need administrative privileges.

6. If necessary, change the Installation Folder (Fig. 5). We recommend leaving the default
value. Click CONTINUE.
Attention:
• it is prohibited to specify a path with only the disk root (e.g. D:\);
• it is prohibited to specify folders created by other users and third-party
software;
• when the program is being installed for all the users, specify a folder
that can be accessed by all the users.

Figure 5: Installation Folder

7. If another version of the program is already installed in the selected folder, then the
message The directory you selected already exists and contains an installation. To
install the product the installation will be uninstalled first will be displayed.
To uninstall, click Yes. The uninstaller will start (see the Section Uninstalling the Pro-
gram on Windows). After the uninstall the installation will continue.
To leave the already installed version of the program and select a new folder to install,
click No and in the window shown in Fig. 5, specify another folder.

35
Installing, Uninstalling and Launching the Program

8. If you select installation for all users, then you need to specify the Common Directory
to store the program service information (Fig. 6). If necessary, change the path to the
Common Directory. We recommend leaving the default value. Click CONTINUE.

Figure 6: Common Directory for service information

9. If the DICOM Viewer is meant to be integrated with third-party systems, activate the
program launch with the help of URL commands by checking the Register the schema
«inobitec» to launch a viewer with parameters from browser box in the Extended pa-
rameters window (Fig. 7). The box is unchecked by default. For details on how to launch
the program with URL commands, see Section 20.2.

10. To enable launching the DICOM Viewer and opening studies via the Explorer context
menu, check the Launch the viewer from the context menu box in the Extended pa-
rameters window (Fig. 7). The box is checked by default. For details on opening studies
from the context menu, see Section 1.5.4. After the program is installed, this function can
be controlled from the Behavior section of the DICOM Viewer configuration window (see
Section 16.3).

36
 Installing and Uninstalling the Program

Figure 7: The Extended parameters window

11. In the Select Components window, (Fig. 8) select the required components by check
the boxes. To expand or collapse the component tree, click on the symbols to the left of
the component group name (highlighted in red and green in the Fig. 8):

• the Help group:

– Slideshow tips: Compact movies for tooltips;

– Assistant (English): English integrated help system;
– Assistant (Russian): Russian integrated help system;
– User manual PDF (English): English user manual in PDF format;
– User manual PDF (Russian): Russian user manual in PDF format.

• the Languages group contains available languages.

For detailed information about a component select it with the mouse.

37
Installing, Uninstalling and Launching the Program

Figure 8: Select Components Window

Figure 9: Start Menu Shortcuts

38
 Installing and Uninstalling the Program

12. If necessary, change the folder for the program’s shortcuts in the Start menu (Fig. 9). We
recommend leaving the default value. Click CONTINUE.

Figure 10: Confirm installation

13. In the confirmation window click the INSTALL button (Fig. 10).

14. Wait until the installation process is complete (Fig. 11). Click the DONE button.

39
Installing, Uninstalling and Launching the Program

Figure 11: Installation complete

Silent program Installation

Silent installation allows you to speed up and automate the process of installing the program
by submitting the installation parameters to the installer through the file. Such installation can
be launched automatically on domain computers using Microsoft Active Directory.
To prepare the installer for a silent installation:
1. Unpack the installer to a folder using an archiver (for example, 7-zip).
2. Go to the folder where the installer is unpacked.
3. Edit the following parameters in the autoinstall.qs file:
(a) AllUsers = false to install only for current user (by default) or AllUsers = true to
install for all users;
(b) TargetPathName: path to folder to install the DICOM Viewer. If AllUsers = true then
the default value is C:\Program Files\InobitecDICOMViewer<Edition><Version>,
if AllUsers = false then default value is
C:\Users\<CurrentUserName>\InobitecDICOMViewer<Edition><Version>.
If necessary, specify another value.
(c) CommonPath: path to the common folder (only if AllUsers = true). The default
value is C:\ProgramData\InobitecDICOMViewer<Edition><Version>. If necessary,
specify another value. All users must have write access to the specified folder.
(d) LocalStoragePath: path to the local storage. The default value is
C:\Users\<username>\InobitecDICOMViewerWorkspace.

40
 Installing and Uninstalling the Program

(e) OptionsFilePath: path to the file with settings exported from an already installed
DICOM Viewer. For details on how to export settings see Section 16.9. If the file is
not specified, the default settings are used.
(f) ForceInstall = false to remove the previously installed version of the DICOM Viewer
in the folder selected for installation.

If national characters are used save the autoinstall.qs file in utf-8 encoding.

To install the DICOM Viewer run the silent_install.bat file. Log is written to file
%temp%\install%DATE%.log, where %temp% and %DATE% are Windows system variables.

Uninstalling the Program using an Uninstaller

To uninstall the program:

1. Run the uninstaller using one of the following methods:

(a) select Inobitec Dicom Viewer -> Uninstall in the Start menu or
(b) use Programs and Features in the Control Panel.

2. Make sure that the item Remove all components is selected in the window shown in
Fig. 12 and click the CONTINUE button.

Figure 12: Beginning of the uninstallation

3. In the confirmation window click the UNINSTALL button (Fig. 13).

41
Installing, Uninstalling and Launching the Program

Figure 13: Confirm uninstallation

Figure 14: Uninstallation complete

42
 Installing and Uninstalling the Program

4. In the confirmation window click the DONE button (Fig. 14).

Silent Uninstallation the Program

Silent uninstallation allows you to automate the process of uninstalling of the program similar
to silent installation.
To prepare the installer for a silent uninstallation:
1. Unpack the installer to a folder using an archiver (for example, 7-zip).

2. Go to the folder where the installer is unpacked.

3. Change the <Disk:\Full\Path\To\Installed\DICOMViewer\You\Want\To\Uninstall>

text for the path to the folder with the DICOM Viewer to uninstall in the silent_uninstall.bat
file.
To uninstall the DICOM Viewer run the silent_install.bat file. Log is written to the
%temp%\uninstall%DATE%.log, where %temp% and %DATE% are Windows system variables.

Running the Program

Starting from version 2.6 the DICOM Viewer shortcut in Windows operating systems is dis-
played in the format: <Inobitec><Edition><Version>.
The editions available are:
• PRO — professional;

• LITE — simplified;
For example Inobitec PRO 2.6.0.
Each version and edition of the DICOM Viewer installed in Windows has their own shortcuts
on the Desktop and the Start Menu to ensure the convenience of launching.
To launch the program, double-click on the desktop shortcut or click on the shortcut from
the Start menu.
On Windows, the DICOM Viewer may be launched by dragging and dropping the data
folder on the program icon. The studies contained in the folder will be opened in a new tab
DICOM data in the folder, and, depending on the data type, the first series of the first study
on the list will be opened:
• In the Flat image viewing tab;

• In the ECG viewing tab;

• With the PDF viewer (if installed), by default;

• In the DICOM Tag Viewing tab, if the series cannot be opened in the above mentioned
tabs/by the above mentioned programs.
If the DICOM Viewer has already been launched, the data will be opened in it. If there are
no data in the folder to be displayed, an empty tab DICOM data in the folder will pop up.
You will find detailed information about launching the DICOM Viewer with third-party soft-
ware and software suites in Chapter 20.

43
Installing, Uninstalling and Launching the Program

Installing, Uninstalling and Running the Program on Mac OS

Installing the Program
To install the program uncompress the dmg file and drag DICOMViewer.app into the open
Applications folder. The icon is displayed on the file while dragging. Release the mouse
button and wait for the program installation to complete.

Uninstalling the Program

To uninstall the program remove the DICOMViewer.app from the Applications folder.

Running the Program

To launch the DICOM Viewer, go to the Applications folder and click on the DICOMViewer.app
icon.
On macOS, the DICOM Viewer may be launched by dragging and dropping the data folder
on the program icon. The studies contained in the folder will be opened in a new tab DICOM
data in the folder, and, depending on the data type, the first series of the first study on the
list will be opened:

• In the Flat image viewing tab;

• In the ECG viewing tab;

• With the PDF viewer (if installed), by default;

• In the DICOM Tag Viewing tab, if the series cannot be opened in the above mentioned
tabs/by the above mentioned programs.

If the DICOM Viewer has already been launched, the data will be opened in it. If there are
no data in the folder to be displayed, an empty tab DICOM data in the folder will pop up.
You will find detailed information about launching the DICOM Viewer with third-party soft-
ware and software suites in Chapter 20.

Installing, Uninstalling and Running the Program on Linux

Running the program in AppImage Format
Inobitec DICOM Viewer software for Linux OS is comprised of only one file in <InobitecDI-
COMViewer><Bitness><Edition><Version> format with AppImage extension. The file con-
tains the program with all the libraries required for its functioning.
Example: InobitecDICOMViewer-linux-64-bit-pro-2.7.0.AppImage.
To install and run the program in AppImage format, proceed as follows (for Ubuntu):

1. We advise you to transfer the downloaded Inobitec DICOM Viewer file from the Down-
loads file directory to the directory you need.

44
 Installing and Uninstalling the Program

2. Provide the AppImage file a permission to be executed. For that purpose, mouse over
the file and click the right mouse button. On the context menu, select Properties. When
the Properties menu (Fig. 15) pops up, go to the Permissions tab and check the Allow
executing file as program box. Close the Properties menu.

3. To run the program file, double-click on it with the left mouse button.

Figure 15: «Properties» menu

If to run the AppImage you need to install FUSE

On Linux OS, FUSE (filesystem in userspace) software is required to work with Applmage
files.
The Inobitec DICOM Viewer distribution for Linux OS in AppImage format requires FUSE 2
functionality.
If the FUSE 2 is not installed in your operating system, install and configure it manually.
You will find detailed instructions on how to install and set up FUSE 2 together with command
examples at https://docs.appimage.org/user-guide/troubleshooting/fuse.html.
The resource may not be available. In this case you will have to find the information on in-
stalling and setting up FUSE 2 on your system for yourself.

Uninstalling the Program

To uninstall the program in AppImage format remove the file from the directory.

45
Installing, Uninstalling and Launching the Program

Launch multiple instances of the program

If the DICOM Viewer has already been launched, you cannot launch this program again on
the same computer. If you try to launch the DICOM Viewer again, the window of the launched
program will be activated. If you try to launch the DICOM Viewer again with command line
parameters, the parameters will be sent to the program that has already been launched (see
Sections 20.1 and 20.2).
If the DICOM Viewer has already been launched and minimized to the system tray, the pa-
rameters will be sent to the current program regardless of the version and the edition chosen
by the user (see Section 1.2).
If the program was launched on behalf of one user, it cannot be accessed by another user.
In such a case, the current user has to shut down the program forcibly and then relaunch it.
To do that, enable the Allow to close the application running as different users option in the
program settings (see Section 16.3).
You can only launch another program version or edition after the currently running program
is shut down.
Note that sometimes the program cannot exit immediately when the main window closes
(e.g. if data is being transferred over the network, or if information is being written to a disk
or flash card). In this case, if you try to launch the program, the main window of the launched
instance does not open and you should wait until the launched instance exits and then launch
the program again.

Service files
Service files are located in the following folders, depending on the operating system:

Windows C:\Users\<Username>\AppData\Local\Inobitec\<program name>

Linux ~/.local/share/Inobitec/<program name>
macOS ~/Library/Application Support/Inobitec/<program name>

The following files are service ones:

• log files (are located in the subfolder Logs);
• memory dumps, written if the program crashed (are located in the subfolder Dumps).
Only for Windows;
• configuration files (are located in the subfolder Configs);
• CLUTs (are located in the subfolder Configs);
• 3D image renderer files (are located in the subfolder OpenCL).
E.g. Smith user‘s log files for Inobitec DICOM Viewer Pro version 1.9.1 installed in Windows
are located in C:\Users\Smith\AppData\Local\Inobitec\Inobitec DICOM Viewer Professional
Edition 1.9.1\Logs folder.
Path to log files can be changed (see Section 16.1).

46
 Getting Started

Getting Started
To avoid problems with the DICOM Viewer, do the following before you start working with the
program:

1. Limit the access to the computers with the program installed in order to protect the
patients’ personal data.

2. If you need to print images on a DICOM printer, make sure that the printer is available
and print a test page.

3. If you need to record data on a CD/DVD, make sure that the disk drive is available and
make a test record.

4. If you need to download data from the modality to the local storage, check the modal-
ity connection settings by downloading test data. Errors may occur when studies are
opened, depending on the modality settings (e.g. the modality may make an error in
recording the width and the level of the window; in this case you will need to change
the window width and level settings manually while viewing the images).

5. Make sure that the data downloaded from the modality can be viewed in the modes
chosen (e.g. a study contains several phases for viewing images in the digital subtraction
angiography mode).

Before starting a procedure that requires flawless operation of the DICOM Viewer, do the
following:

1. If there is an uninterruptible power supply unit, make sure it is in working order.

2. Check the DICOM servers availability; depending on the tasks to be performed, check
the ability to upload, download and search for data.

3. If you need to download studies in the local storage, check the amount of free space on
the hard disk drive where this storage is placed.

First run of the Program

When you first start the DICOM Viewer, the welcome panel opens (Fig. 16). The welcome panel
may also be displayed at the first startup after the upgrade the DICOM Viewer. Initialization of
the DICOM Viewer is performed in the welcome panel.

47
Installing, Uninstalling and Launching the Program

Figure 16: Welcome panel

The following information is displayed in the welcome panel:

• Link More. Download page Inobitec DICOM Viewer is available at this link.

• Link Documentation. Clicking the link brings up the help system of the DICOM Viewer.
If the help system for the current language is not installed, a dialog box is displayed with
a warning and a link to online help.

To cancel the DICOM Viewer launch and initialization, press Esc on the keyboard. Select
YES in the dialog box for cancelling initialization and launch (Fig. 17). If you do not want to
cancel initialization and launch the DICOM Viewer click the NO button.

Figure 17: Dialog box for cancelling initialization and launch

To complete initialization and launch of the DICOM Viewer main window, you need to follow
all the setting up steps provided in the welcome panel. If the user cancels the DICOM Viewer
initialization, the welcome panel will pop up the next time the program is launched.
To go to the next page, click the CONTINUE button.

1. On the page Local Storage (Fig. 18) change the path to the Local Storage DICOM data.
We recommend leaving the default value.

48
 Launching the Program

The path to the Local Storage can be changed by the user after initialization of DICOM
Viewer. For more information see Section 16.1.

Figure 18: Path to the Local Storage

To make the Local Storage for all the users of this PC, check the Shared settings (for
all users) box. This mode is disabled by default. It can only be done if the DICOM
Viewer was launched by a user with administrator privileges. The users who do not have
administrator privileges cannot check or uncheck this box. In this case, an informational
message is displayed (Fig. 19).

Figure 19: Dialogue warning about lack of administrative privileges

To continue initialization the DICOM Viewer click on the NO button. To close the wel-
come panel without saving parameter values, click on the YES button. The DICOM
Viewer does not start in this case. The welcome panel will be launched at the next
the DICOM Viewer start.
Click on the Next button to go to the next page, or Back to return to the previous page.

2. On the page DICOM Listener (Fig. 20) set the parameters of the DICOM listener service.

49
Installing, Uninstalling and Launching the Program

Figure 20: DICOM Service

• Enter the computer name (AE Title) in the field. The length of AE Title value shall not
exceed 16 characters. Cyrillic letters and «\» symbols in AE titles are not allowed.

• Enter the port. Default value 3000.

This functionality is descrided in Section 13.1.1 and can be configured later. If this func-
tionality has already been configured in this computer, then the window shown in Fig. 20
will contain the values specified earlier. Parameters specified earlier for a specific user
will not be changed if you install the program for another user or for all users.

To save the current settings for all the users of this PC, check the Shared settings (for
all users) box. This mode is disabled by default. It can only be done if the DICOM
Viewer was launched by a user with administrator privileges. The users who do not have
administrator privileges cannot check or uncheck this box. In this case, an informational
message is displayed (Fig. 19).

To continue initialization the DICOM Viewer click on the NO button. To close the wel-
come panel without saving parameter values, click on the YES button. The DICOM
Viewer does not start in this case. The welcome panel will be launched at the next
the DICOM Viewer start.

Click the NEXT button to go to the next page or the BACK button to return to the previous
page.

3. Take part in the survey by answering the two questions on the Survey pages (Fig. 21
and 22).

50
 Launching the Program

Figure 21: The first survey question

To answer a question, choose one of the options provided by selecting the respective radio
button. The NEXT button will be activated as soon as the user chooses one of the options.
To go to the previous step, click BACK.

Figure 22: The second survey question

The DONE button will be activated as soon as the user chooses one of the options.
Click the DONE button, to complete the initialization of the DICOM Viewer, or BACK to
return to the previous page. If you return to the previous step, the current survey results are
saved.

51
Installing, Uninstalling and Launching the Program

Launching the Web Viewer

Functionality is available in the Pro edition

To use the Web Viewer, you should enable web access (see Section 13.1.3).
To open the Web Viewer:

1. Open any Web browser.

2. Enter the link in the address bar to access to the Web Viewer. You can see this link in the
services settings dialog (see Section 13.1.3). The link looks like http://youraddress:port.
Replace youraddress with the ip address or the computer name on which the DICOM
Viewer is installed and replace port with the web access port specified in the Services
dialog.

3. Go to the entered link.

4. Enter the user name and user password specified in the services settings dialog.

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Chapter 1

Program Window Elements

The main application window looks as follows (Fig. 1.1).

Figure 1.1: Main application window

The DICOM Viewer window consists of several elements.

53
CHAPTER 1. PROGRAM WINDOW ELEMENTS

1.1 Main Menu

The Main menu is shown in Fig. 1.2 (highlighted in red).

Figure 1.2: Location of the main menu in the DICOM Viewer window

The main menu includes several items.

1.1.1 File
The File menu item contains the following sub-items:

• Study list opens a new tab in the program window;

• Report templatePRO opens a submenu for creating, deleting, and editing a report sample
(Chapter 18);

• Open image annotation results...ADD opens a dialog box for selection of a JSON-file with
annotation results that were saved earlier (Chapter 12);

• Open project...ADD opens a dialog box for selection of a segmentation project or DTI
file containing source DICOM data. The project will be opened in the default tab (see
Section 6.11.4);

• Open project as...ADD opens a dialog box for selection of a segmentation project or DTI
file containing source DICOM data. This option allows the user to open a part of the
project and select the tab where it will be opened (see Section 6.11.4);

• Preview opens the image preview tab for printing on paper;

• DICOM preview opens the image preview tab for DICOM printing;

• Page layout opens the settings for printing on paper;

• Print opens the system dialog for printing on paper;

• Exit shuts down the program.

54
 1.1. MAIN MENU

1.1.2 Network
The Network main menu item contains the following sub-items:

• Network status...;

• Servers...;

• Services;

• DICOM printer setup...

For details on how to work with the network, see Chapter 13.
The DICOM printer settings are described in Chapter 19.

1.1.3 Storage
The Storage main menu item contains the following sub-items:

• Storage status...;

• Check storage...;

• Clear storage...

For details on how to work with the storage, see Chapter 14.

1.1.4 View
The View main menu item contains the following sub-items:

• Image viewer;

• Volume reconstruction;

• MPR reconstruction;

• Vessel analysisADD ;

• Coronary artery analysisADD ;

• Cardiac function analysisADD ;

• Virtual endoscopyPRO ;

• Series fusionPRO ;

• PET AnalysisADD ;

• Open pdf document;

• ECG viewer.

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CHAPTER 1. PROGRAM WINDOW ELEMENTS

If a sub-item name is displayed in grey, it means that the command is unavailable for the
selected study. If all sub-item names are displayed in grey, it means that no study has been
selected from the study panel. Section 1.5 describes how to select studies. Three display
modes are available for each sub-item:

• Show at window 1 opens images in a new tab;

• Show as detached window opens images in a separate window;

• Show fullscreen opens images in the full screen mode. To exit the full screen mode,
press Esc or F11 on the keyboard.

If the DICOM Viewer is set up for working with two displays, and/or if the screen is split,
there are up to four options for displaying a tab.The monitor settings are described in Sec-
tion 16.5.

1.1.5 Studies
The Studies main menu item contains the following sub-items:
• Open DICOM CD/DVD...;

• Scan DICOM folder...;

• Open zip archive... (see Section 1.5.2);

• Search;

• Download selected studies to Local Storage;

• Upload selected studies to remote server;

• Add selected studies to Local Storage;

• Remove selected studies from Local Storage;

• Add the selected studies to DICOM CD/DVD image;

• Save studies to folder;

• Create anonymized copies of selected studies... (see Section 17.3);

• Export study list to CSV... (see Section:Study Panel);

• Edit patient name (see Section 1.9.3);

• Restore patient name;

• Edit description (see Section 1.9.3);

• Restore description.
For details on how to select data source, see Section 1.5. Sub-items Server search and
Local storage search are available for the sub-item Search.
For details on how to work with studies, see Section 1.11.

56
 1.1. MAIN MENU

1.1.6 Series
The Series main menu item contains the following sub-items:

• Download selected series to Local Storage;

• Upload selected series to remote server;

• Add selected series to Local Storage;

• Remove selected series from Local Storage;

• Add selected series to DICOM CD/DVD image;

• Save series to folder (see Section 1.6.2);

• Create uncompressed copy of series (see Section 1.13);

• Create anonymized copy of series... (see section 17.3);

• Sort.

Sub-items Sort by description, Sort by time and Sort by series number are available for
the sub-item Sort.
For details on how to work with series, see Section 1.11.

1.1.7 Options
The Settings main menu item contains the following sub-items:

• Settings...;

• Export settings...;

• Import settings....

The DICOM Viewer settings are described in Chapter 16.

1.1.8 Help
The Help menu item contains the following sub-items:

• Contents... opens the Help System;

• License... opens a window to enter the license key;

• License from file... opens a window to load a trial version activation key file;

• About... displays a window with the information about the DICOM Viewer.

The Help System is described in Chapter 22.

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CHAPTER 1. PROGRAM WINDOW ELEMENTS

1.2 Window Management

To the DICOM Viewer does not shut down but closed to the system tray, when you close it,
check the box Show system tray icon (see Section 16.3). To restore the main window from the
tray, double-click on the tray icon in the system tray or right-click on the tray icon and select
the Restore item. To shut down the application right-click on the tray icon and select the Exit
item (Fig. 1.3).
To enable the DICOM Viewer to minimize to the system tray, check the box Minimize to
tray.

Figure 1.3: System tray icon

When you shut down the DICOM Viewer click OK to shut down the DICOM Viewer in the
dialog box that appears, or Cancel to continue to work with the program. If you want the
DICOM Viewer to always shut down without this confirmation, check the box Don‘t show this
dialog again and click OK. If you want the DICOM Viewer to show the confirmation dialog,
check the box Confirm on exit (see Section 16.2).

1.3 Tab Panel

1.3.1 General
A tab is a window fixed in the main program window. You can switch from tab to tab using
buttons on the tab panel. The tab panel is highlighted in red in Fig. 1.4.

Figure 1.4: Tab panel location in the DICOM Viewer window

58
 1.3. TAB PANEL

Each tab opened in the DICOM Viewer window corresponds to a stub on the panel. To
switch to a particular tab, click the corresponding stub (Fig. 1.5). The file path or other infor-
mation about the tab content is displayed on the tab stub.

Figure 1.5: Multiple tabs. The Image viewer tab is active

To show the patient’s name on the tab stub, enable the Show patient name in a tab option
in the program settings (see Section 16.2). This option is enabled by default. In the figure, you
can see the type of the tab shown only as an icon on the left-hand side of the patient’s name
(Fig. 1.6).

Figure 1.6: Patient names are displayed on the tab stubs. The Image
viewer tab is active

If several studies have been opened in the same tab, the patients’ names will be separated
with «/». If a patient’s name is too long, it will be truncated and the «…» sign will be placed at
the end, e.g. Patient name.../ Patient name.../ Patient name...
If there are fewer than 5 symbols left for each patient’s name, then the tab will only show
the name of the first patient and the number of the patients’ names left, e.g. Patient name…+4.
When you place the cursor on the tab stub, a tip with a complete list of the patients’ names
will pop up.
On the stub of a fused series tab, you will see the name of the patient from the first layer.

1.3.2 Manage a Tab

To manage a tab, use the buttons in its top right-hand corner (highlighted in red in Fig. 1.7).

Figure 1.7: Tab management buttons

Tab management buttons:

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CHAPTER 1. PROGRAM WINDOW ELEMENTS

The Full screen button displays the tab in the full screen mode. The tab
management buttons are unavailable. To exit, press Esc or F11.
The Separate window button displays the tab in a separate window.

To switch to the full screen mode, you may as well press F11, and to go back, you can use
F11 or Esc. If the tab is displayed in a separate window, the DICOM Viewer workspace looks
as shown in Fig. 1.8.

Figure 1.8: A tab opened in a separate window

The window management buttons are located in the top right-hand corner of the window
(highlighted in red in Fig. 1.8). Window management buttons:

The Fix window button embeds the window as a tab in the main DICOM Viewer
window.
The Full screen button displays the window in the full screen mode. The window
management buttons are unavailable. To exit the full screen mode, press Esc or F11.
The Minimize window button reduces the window to an icon located at the bottom
of the screen (highlighted in red in Fig. 1.9). The window title is written on the icon.
The Expand button expands the window to the full screen. Unlike the full screen
mode, the window management buttons will be available.

60
 1.4. TOOLBAR

The Close button closes the window.

The Restore down button restores the initial window size.

Figure 1.9: Window reduced to an icon

To unfold a window from an icon, double-click the left mouse button on the icon.

1.4 Toolbar
The Toolbar is shown in Fig. 1.10 (highlighted in red).

Figure 1.10: Toolbar location in the DICOM Viewer window

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CHAPTER 1. PROGRAM WINDOW ELEMENTS

Data source selection buttons on the toolbar:

The Open DICOM CD/DVD, which contains DICOMDIR metafile button sets a
CD or DVD as the source of DICOM data and opens the folder selection dialog.
The Scan a folder for DICOM data button sets a folder as the DICOM data source
and opens the folder selection dialog.
The Open a zip archive with DICOM data button provides a folder with zipped
studies as the DICOM data source and opens the folder selection dialog.
The Search data on the remote PACS Server button sets a PACS server as the
DICOM data source and opens the search panel.
The Search data in the Local Storage button sets a local storage as the DICOM
data source and opens the search panel.

For details on how to work with the search panel, see Section 1.7.
The button corresponding to the selected data source is displayed on a light background.
Image view buttons on the toolbar:

The Image viewer button opens images in the flat image view window.

The Volume reconstruction button opens images in the volume reconstruction

window.
The MPR Reconstruction button opens images in the multiplanar reconstruction
window.

The Vessel analysis opens images in the Vessel Analysis windowADD .

The Coronary artery analysis opens images in the Coronary Artery Analysis
windowADD .
The Cardiac function analysis opens images in the Cardiac Function Analysis
windowADD .
The Virtual endoscopy button opens images in the virtual endoscopy windowPRO .

The Series fusion button opens images in the series fusion windowPRO .

The PET analysis button opens images in the PET Analysis windowADD .

The Show image tags button opens DICOM tags for the selected series of the
selected study (see Chapter 17).

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 1.4. TOOLBAR

The Open pdf document button opens the pdf document contained in the study
in the default pdf viewer.

The ECG Viewer button opens images in the ECG view window.

The Report button opens the report editor windowPRO (see Chapter 18).

If the action corresponding to a button is not available, the button looks pale and cannot
be pressed (inactive).
All the buttons in this group are made up of two parts (Fig. 1.11).

Figure 1.11: Button with location options

If you click on the arrow (right side of the button highlighted in green), a menu with options
for displaying the information on the screen will pop up.

• display at monitor1 opens images in a new tab;

• show as detached window opens images in a separate window;

• show fullscreen opens images in the full screen mode.

To open an image in a new tab, click on the button (highlighted in red).

The DICOM Viewer provides an opportunity to open selected series in various tabs with
certain key combinations. Hotkeys have been assigned by default to the most popular tabs
(the key combinations for the macOS operating system is shown in parentheses):

• Image viewer Alt + I (Option + I);

• MPR reconstruction Alt + M (Option + M);

• Volume reconstruction Alt + D (Option + D);

• Vessel analysis Alt + V (Option + V);

• Coronary artery analysis Alt + C (Option + C).

You can change a hotkey combination or assign new hotkeys to other tabs in the Tabs
section of the Hotkeys settings (see Section 16.8).
A series may be opened with the help of a key combination from the list of studies or from
another tab where the respective buttons are provided.

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CHAPTER 1. PROGRAM WINDOW ELEMENTS

The DICOM CD/DVD Creator button opens the creator for disks containing
DICOM data. The disk write is described in Chapter 15.
The Advanced search button opens the advanced search panel at the top of the
tab. To hide the panel, click the button again. If the search panel is open, the
search button will be displayed against a light background. For details on how to
work with the search panel, see the next section.
The Save studies list to the folder button allows you to save the selected studies
to the specified folder. This function is available as well from the study context
menu. For details on how to save studies see Section 1.6.1

1.5 Select Data Source

If the DICOM data contains text in national coding that does not match the coding of the main
data, then a meaningless sequence of characters in the names of studies, series, etc may be
displayed. In this case, to display the text correctly, you must select the target encoding in the
settings (see Section 16.4). By default, the encoding of the data source is set. It is the one that
is specified in the DICOM files.

1.5.1 Select a CD, DVD or Local Folder as the Data Source

To open studies stored on a CD, DVD or in a local folder:

1. Select a CD or DVD as the data source by clicking the button on the toolbar, or a

local folder by clicking on the button. Commands Open DICOM CD/DVD... and
Scan DICOM folder... are available as well from the Studies menu.

2. In the window that appears, select the folder containing the images, and click Select. To
cancel the action, click Cancel.

The studies stored in the selected location will be displayed on the study panel.
The studies being transferred from the local folder may be opened in the Image
viewer, ECG viewer, and DICOM tag viewer tabs before all the files have been read. PDF
documents are also available to work with.
You will be able to open studies in other tabs, save them, record or send to the server after
all the study directories have been read. If there are several series in a folder with a study, a
complete list of such series will be displayed only after all the files have been read.
The process of uploading studies from a local folder is reflected on the information panel
in the form of a progress bar. If you close the tab before the files have been read, the process
of reading files is stopped.
Attention! If you switch to a different data source and then return to the
current one, the study list will be cleared.

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 1.5. SELECT DATA SOURCE

1.5.2 Opening Zipped DICOM Studies

The DICOM Viewer provides an opportunity to open and view zipped studies.
To open a zipped study from a local folder, proceed as follows:

1. Choose a local folder with zipped files as the data source by pressing the Open a
zip archive with DICOM data button on the toolbar. Command Open zip archive...» is
also available from the Studies menu.

2. Choose one or several archives in the box that pops up and click Open. Click Cancel to
cancel.

The studies stored in the selected location will be displayed on the study panel.
The work with zipped studies is performed in the same way as the work with the studies
from a local storage.
The thumbnails for the series from ZIP archives are provided with pictograms. Dam-
aged ZIP archives and damaged files from ZIP archives are ignored by the DICOM Viewer.
If an encrypted ZIP archive is opened, a dialog box (see Fig. 1.12) pops up. Enter the pass-
word and click OK to open the encrypted ZIP archive or Cancel to cancel.

Figure 1.12: Entering the ZIP archive password dialog box

Attention! If you switch to a different data source and then return to the
current one, the study list will be cleared.

1.5.3 Opening DICOM studies by dragging and dropping

You can open DICOM studies in several ways:

1. Dragging and dropping studies on the DICOM Viewer shortcut. Drag and drop one
or more folders with DICOM studies or ZIP archives from the explorer window to the
DICOM Viewer shortcut (this option is only available on Windows and macOS). The list
of studies will be opened in a new tab DICOM data in the folder or DICOM data in the
zip archive. Besides, the Image viewer tab with the first series of the first study will be
opened.
The opportunity to drag and drop both, ZIP archives and unzipped data folders with
DICOM data, to the DICOM Viewer shortcut is supported. In this case, the study lists are
opened in new tabs DICOM data in the zip archive and DICOM data in the folder. New
Image viewer tabs with the first series of the first studies from each list will be opened.

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CHAPTER 1. PROGRAM WINDOW ELEMENTS

If the DICOM Viewer has already been launched, then studies from a folder
will be opened in the currently running program regardless of the version
and the edition of the program chosen by the user (see Section Launch
multiple instances of the program).

2. Dragging and dropping studies to the DICOM Viewer study list. Drag and drop one
or more folders with DICOM studies or ZIP archives from the explorer window to the
DICOM Viewer study list. The list of studies will be opened in a new tab DICOM data in
the folder or DICOM data in the zip archive. Besides, the Image viewer tab with the
first series of the first study will be opened.
Dragging and dropping of ZIP archives and unzipped data folders with DICOM data to
the DICOM Viewer study list is supported. In this case, the study lists are opened in new
tabs DICOM data in the zip archive and DICOM data in the folder. New Image viewer
tabs with the first series of the first studies from each list will be opened.

3. Dragging and dropping studies to the Image viewer window of the DICOM Viewer.
Drag and drop one or more folders with DICOM studies or ZIP archives from the explorer
window to the Image viewer window of the DICOM Viewer. The study and its series are
added to the series panel. The first series of the study will be opened in a new Image
viewer window.
Dragging and dropping of ZIP archives and unzipped data folders with DICOM data to
the Image viewer window of the DICOM Viewer is supported. Studies and their series
are added to the series panel. The first series of the study will be opened in a new Image
viewer window.

4. Dragging and dropping studies on the Image viewer tab stub of the DICOM Viewer.
Drag and drop one or more folders with DICOM studies or ZIP archives from the explorer
window on the Image viewer tab stub of the DICOM Viewer. The study and its series are
added to the series panel. The first series of the study will be opened in a new Image
viewer window.
Dragging and dropping both, ZIP archives and unzipped data folders with DICOM data
to the Image viewer tab stub of the DICOM Viewer is supported. Studies and their series
are added to the series panel. The first series of the studies will be opened in a new
Image viewer window.

1.5.4 Opening DICOM studies from the context menu

This function is only available on Windows.

On Windows, DICOM studies can be opened in the DICOM Viewer via the explorer con-
text menu. To do that, you have to enable the Launch the viewer from the context menu
option in the Extended parameters window when installing the DICOM Viewer (see Fig. 7). To
change this setting, go to the Behavior section of the DICOM Viewer configuration window
(see Section 16.3).
To open a study via the explorer context menu, proceed as follows:

1. Open the Explorer window and choose the folder with the study.

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 1.5. SELECT DATA SOURCE

2. Right-click on the selected folder and choose the Open with Inobitec DICOM Viewer
<Edition> <Version> option on the context menu.

If several DICOM Viewer versions or editions were installed on the same

operating system, then on the context menu, you will see several options for
launching the required program version or edition.
The list of studies from the folder will be opened in a new DICOM data in the folder tab,
and the first series of the first study on the list will be opened in a new Image viewer tab.
If the DICOM Viewer has already been launched, the list of studies and the first series of
the first study will be opened in new tabs of the currently running program.
If the DICOM Viewer has already been launched and minimized to the system tray, it is
activated (see Section 1.2).
To open a study in a different program version or edition via the explorer context menu, you
need to shut down the running program first (see Launch multiple instances of the program).

1.5.5 Select a PACS Server or Local Storage as the Data Source

To open studies stored on a PACS server or in a local storage:

1. Select the PACS server as the data source by clicking the Search data at remote PACS
server button on the toolbar, or the local storage by clicking Search data in the

local storage . These commands are available as well from the Study context
menu.

2. Search for data using the search panel that opens. For details on how to work with the
search panel, see Section 1.7. The studies that satisfy the search criteria will be displayed
on the study panel. The series panel will display the series of the first retrieved study.

Attention! If you switch to a different data source and then return to the
current one, the study list will be cleared.
To automatically open a Local Storage when you start the DICOM Viewer check this option
(Section 16.7.2) and set up a default search period.
If you open a study from the PACS server, it will be downloaded to the Local Storage.
When you close this study the message like 1 series have been downloaded automatically
from server. Would you like to keep them on your local storage? will be displayed. To keep
the study in the Local Storage, click Yes, to remove, click No. If you want to always perform
the selected action, check the box Remember my choice and do not show this dialog again.
For details on how to change your choice, see Section 16.7.2.
For the study, added to the Local Storage at least partially, the import date is displayed on
the Study Panel.
When the DICOM Viewer is used as the PACS server, data from remote devices are added
to the local storage. Data transfer may be initiated by a transmitting device, such as a CAT
scanner, DICOM Server, or DICOM Viewer installed on another computer.
The list of the studies in the local storage is automatically updated each time data are
received from a supported source.
New studies that were transferred to the local storage from other sources are marked on
the study list with . This icon will be deleted after the new study is selected or after a

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CHAPTER 1. PROGRAM WINDOW ELEMENTS

search is performed (i.e. the SEARCH button on the search panel is clicked). The new studies
that were received from third-party devices but do not comply with the search parameters will
not be shown on the study list (for details see Section 1.7).

1.6 Save Studies and Series to the folder

1.6.1 Save Studies to the folder
The DICOM Viewer allows you to save one or more studies from the Local Storage, from a
folder, from a Compact Disk or from a PACS Server to a folder.
Attention! Saving studies from a PACS server in C-MOVE mode is not
possible. To do it, connect to PACS Server using C-GET mode or first
download the studies to the Local Storage and save them to a folder from
the Local Storage.
When you try to save studies from the server in c-move, the error «Unsupported server
mode» appears.
The PACS Server connection settings are described in Section 13.2.
If you compress data, then the studies are saved to a zip file.
To save studies:

1. Select data source (Local Storage, Folder, Compact Disk, PACS Server to which the DI-
COM Viewer is connected in C-GET mode). For details on how to select data source,
see Section 1.5.

2. Search for data using the search panel that opens. For details on how to work with the
search panel, see Section 1.7. The studies that satisfy the search criteria will be displayed
on the study panel.

3. Select one or more studies on the Study Panel. For details on how to work with the
Study Panel, see Section 1.9.

4. Click the Save studies to the folder button.

5. In the dialog that opens (Fig. 1.13) set up the following parameters:

• Path to save: path to the folder to save studies;

• Folder name (File name): if only one study is selected for saving, this parameter
is editable. Otherwise the DICOM Viewer generates a folder name (archive file
name) and the Folder name (File name) field is empty. If an archive file with the
same name already exists, the DICOM Viewer offers to overwrite it;
• the Compress files check box: if set, the saved data is compressed into a zip
archive;
• if several studies are selected, then the Save each study into separate folder (file)
check box appears. It allows to save each study into separate folder (archive file);
• the Anonymize check box allows to anonymize saving data. For details, see Sec-
tion 17.3;

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 1.6. SAVE STUDIES AND SERIES TO THE FOLDER

• The Add file extension «.dcm» box provides an opportunity to save all the data
files with .dcm extension. The box is unchecked by default.
When files with .dcm extension are saved, a special DICOMDIR file is not created;
• to restore default settings, click the DEFAULTS button.
6. Click the OK button to save or CANCEL to cancel.

Figure 1.13: Saving studies to the folder dialog

The data saved into the folder is supplied for later recording onto a Compact Disk using
the operating system. The Compact Disk opens in the same way as if it were recorded using
the DICOM Viewer (without adding the Inobitec DICOM Disc Viewer to the disk image).

1.6.2 Save Series to the folder

The DICOM Viewer allows you to save one or more series of a single study from the Local
Storage, from a folder, from a Compact Disk or from a PACS Server to a folder.
Attention! Saving DICOM data from a PACS server in C-MOVE mode is not
possible. To do it, connect to PACS Server using C-GET mode or first
download the studies to the Local Storage and save them to a folder from
the Local Storage.
When you try to save studies from the server in c-move, the error «Unsupported server
mode» appears.
The PACS Server connection settings are described in Section 13.2.
To save series:
1. Select data source (Local Storage, Folder, Compact Disk, PACS Server to which the DI-
COM Viewer is connected in C-GET mode). For details on how to select data source,
see Section 1.5.
2. Search for data using the search panel that opens. For details on how to work with the
search panel, see Section 1.7. The studies that satisfy the search criteria will be displayed
on the study panel.
3. Select a study on the Study Panel. For details on how to work with the Study Panel, see
Section 1.9.

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CHAPTER 1. PROGRAM WINDOW ELEMENTS

4. Select one or more series on the Series Panel. For details on how to work with the Study
Panel, see Section 1.10.

Fused series cannot be saved in a folder.

5. Select the Save series to folder option in the Series section of the main menu. If among
the selected series there are no series that can be saved in a folder, the Save series to
folder button will be unavailable. If there is such a series among the selected series,
the Save series to folder button will be available. When series are saved in a folder, the
fused series will be skipped.

6. In the Saving series to the folder dialog box that pops up, provide the required param-
eters. The interface of the dialog box is identical with the interface of the dialog box for
saving studies to a folder (see Fig. 1.13).

7. Click the OK button to save or CANCEL to cancel.

The series saved in a folder can be viewed and then recorded on a CD with the OS soft-
ware.

1.7 Search Panel

The search panel is shown in Fig. 1.14.
To open or close the panel, click the button on the toolbar.

Figure 1.14: Search panel

A search query is executed in the text field (see «2» in Fig. 1.14). From the drop-down list
(«1» in Fig. 1.14), select one of the following search parameters:

• patient name (to search for a name that does not start with the entered characters, put
an asterisk at the beginning: «*John»);

• patient ID (similar to search by name);

• body part (Enter the name of a body part in the text field. Under the text field, you will
see some options that may be used for searching by body parts);

• accession number (similar to search by name);

• description.

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 1.7. SEARCH PANEL

To search for studies by modality, press the button for the respective modality. The buttons
for the selected modalities are highlighted. You can choose any modalities combination. To
delete a selected modality, press the button again.
The search panel also provides for search by date of birth, search by the date of study
performance or study import. Select one of the following options from the drop-down list (see
«3» in Fig. 1.14):
• by study date;

• by import date;

• by date of birth. In the search period drop-down list (see «4» in Fig. 1.14) only the Exact
date option is available.
You can perform search by the exact date, by the time interval specified or by the period
selected from the drop-down list. Choose a period from the drop-down list (see «4» in Fig. 1.14):
• all time;

• today;

• yesterday;

• last week;

• last month;

• last year;

• exact date;

• interval.
To search by date and interval enter the year: YYYY-**-**, year and month: YYYY-MM-**, or
the full date. The date can also be selected using the calendar.
After filling in the required fields, click the SEARCH button or press the Enter key on the
keyboard. If the SEARCH button is inactive, it means that the selected data source is not
available. To clear the search criteria, click CLEAR.
The search for studies on the PACS server with no period specified (option All time) may
take some time and increase the server load. Therefore, when you click the SEARCH button,
the warning dialog Search for all time. It may take some time. Would you like to continue?
will be displayed. To perform a search, click Yes, to cancel, click No.
If four or more characters are entered in the search field, the long search on the PACS
server warning message is not displayed, regardless of the specified search date.
The PACS Server may not support the search by some of the selected options and criteria.

1.7.1 Saving the Search Parameters

To simplify study search by commonly used parameters, the DICOM Viewer provides for an
opportunity to save study search parameters (presets).
To create a new preset with commonly used parameters, proceed as follows:
1. Open the search panel and specify the search parameters (for details see Section 1.7).

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2. Click the arrow on the right-hand side of the SEARCH button and select Save preset.

3. In the Preset creation dialog box (Fig. 1.15), enter the name of the new preset.

Figure 1.15: The Preset creation dialog box

Click OK, to create new preset, or CANCEL to cancel.

All the current search panel parameters will be saved as the preset.
To delete a preset, click the arrow on the right-hand side of the SEARCH button. Choose
the Remove preset option and select the preset to be deleted.

1.7.2 Searching for Studies by Preset Parameters

To search for studies by preset parameters, choose the preset you need in the SEARCH button
menu. The search will be performed automatically after you have selected the preset.
The current preset parameters are displayed on the search panel. The preset parameters
are specified with consideration for the storage selected. For example, if the search is per-
formed in a storage different from the local storage, it will be impossible to search by the date
of import. In this case, a warning will pop up (Fig. 1.16). The search panel does not display the
current preset parameters and the search will not be performed.

Figure 1.16: Warning that a search cannot be performed

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 1.8. SELECT SERVER PANEL

1.8 Select Server Panel

The server selection panel is shown in Fig. 1.17.

Figure 1.17: Server selection panel in the DICOM Viewer window

The server selection panel specifies the server server on which the search for data is
carried out.

1.9 Study Panel

The study panel is shown in Fig. 1.18 (highlighted in red).

Figure 1.18: Study panel in the DICOM Viewer window

The study panel displays the list of studies stored in the selected location (folder, disk, local
storage or PACS server).
To select multiple studies that are contiguous (next to each other):

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1. click on one study and then holding Shift click the last study or

2. move the cursor from one study to the last study holding the left mouse button.

To select multiple studies that are anywhere on the study list, click on each one holding
the Ctrl key (or the Command key for macOS).

1.9.1 Customize Study Panel

The DICOM Viewer allows you to customize columns and the font for the list of studies.
To select columns, right-click on the table header, a menu with a list of columns will be
displayed (Fig. 1.19). The displayed columns are marked with a flag. To check/uncheck a
column, left-click on its name on the context menu.

Figure 1.19: Context menu

Set size, family and font style to bold and/or italic (see Section 16.7.2).

1.9.2 Sort Studies

If two or more studies are displayed, they can be sorted by a certain parameter. To do this,
click on the header of the column the parameter is located in. For instance, to sort by date
and time, click on the area highlighted in red in Fig. 1.20.

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 1.9. STUDY PANEL

Figure 1.20: Date and time column header

Next to the column name, there is an arrow showing the sorting order (down arrow —
descending , up arrow — ascending ). To change the sorting order, click on the
column header again. Studies can be sorted only by one parameter at a time. The default
sorting order is ascending.

1.9.3 Edit Patient Name and Description in a Study

Editing the displayed patient name the description for this study are possible only for the
studies in the Local Storage or for those that are opened from a folder or from a CD. The
data itself will remain unchanged, and this information will not be saved on the PACS server.
By default, editing is disabled. To enable it, check the box Allow to edit patient name and
discription (Section 16.7.2).
If you change the patient’s name, another patient’s study may be mistakenly
used for establishing a diagnosis.
To edit the patient name or study description:

1. Right-click on the study on the study panel. The context menu shown in Fig. 1.21 will pop
up.

2. Select one of the menu items Edit Patient Name and Edit Description. The correspond-
ing field will become available for editing, and the cursor will be located in it.

3. Edit the text.

4. Press Enter key on the keyboard or click the mouse in the DICOM Viewer window in
any area except the edited text to apply the changes.

These commands are available as well from the Study context menu.
The commands from the context menu (Fig. 1.22) are available during editing. To open the
context menu, right-click on the edited text.

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CHAPTER 1. PROGRAM WINDOW ELEMENTS

Figure 1.21: Study context menu

Figure 1.22: Context menu to select editing action

The following commands are available:

• Undo: undo the changes;
• Redo: redo the last canceled action;
• Cut: delete the selected text and copy it to the exchange buffer;
• Copy: copy the selected text to the exchange buffer;
• Paste: paste the text from the exchange buffer;
• Delete: delete the selected text;
• Select all: select all edited text.

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 1.9. STUDY PANEL

To restore a patient name or description, right-click on the study and select the Restore
patient name or Restore description item.
If a command is unavailable, it is displayed in grey in the menu.
The edited patient name and description are displayed in italics after you select it on the
Study Panel.

1.9.4 Study List Export

To save the list of studies displayed in the Study Panel to a CSV file:

1. Select the Studies menu and the Export study list to CSV... item.

2. In the dialog (Fig. 1.23) that opens, check columns from which you want to export data
and click OK to confirm or CANCEL to cancel.

3. In the dialog that opens choose the folder and file name. Click Save to save data or
Cancel to cancel.

Figure 1.23: The dialog box for selecting fields for export to a CSV file

A study list file in CSV format is a text file with a table. The columns of the table are
separated by commas. The file may be opened in any text editor.
The software intended for working with spreadsheets (Microsoft Excel, LibreOffice Calc
etc.) is better suited for viewing and analyzing CSV files data.
To open a CSV file in a spreadsheet application undistorted, proceed as follows (as exem-
plified by LibreOffice Calc):
1. Run the spreadsheet application.

2. In the dialog box for opening a document, select the CSV file and click Open.

3. In the Text Import dialog box, provide the following parameters:

• in the Separator options section, select the field separator. In our case, it is a
comma;

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• in the Fields section, highlight all the columns in the imported data view window
and select the text column type from the dropdown list.

4. Click OK to open the document or Cancel to cancel.

1.10 Series Panel

The panel is shown in Fig. 1.24 (highlighted in red). Select the study from the study panel to
see the list of series for it. The first series is highlighted automatically.

Figure 1.24: Series panel in the DICOM Viewer window

Selecting series is analogous to the studies selecting (see Section 1.9). But if you want
to select multiple series by moving the mouse, start moving when cursor is not on the series
thumbnail.

1.11 Studies and Series Download/Upload Panels

The panels are shown in Fig. 1.25 (Studies Download/Upload Panel highlighted in green,
Series Download/Upload Panel highlighted in red). These panels are identical except that
the former is designed to work with studies, and the latter is for series.

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 1.11. STUDIES AND SERIES DOWNLOAD/UPLOAD PANELS

Figure 1.25: Studies and Series download/upload panels in the DICOM

Viewer window

Series import/export panel buttons:

The Download selected series to Local Storage button downloads the

selected series to the local storage.
The Upload selected series to remote server button uploads the selected
series to the remote PACS server.
The Add selected series to Local Storage button adds the selected series to
the local storage.
The Remove the selected series from the Local Storage button deletes the
selected series from the local storage.
The Add selected series to DICOM CD/DVD image button adds the selected
series to the CD/DVD Creator. For details on how to work with the creator,
see Chapter 15.

If the action corresponding to a button cannot be performed, the button looks pale and
cannot be pressed (inactive).
Managing the Studies Download/Upload Panel is completely analogous to the Series
Download/Upload Panel.
These actions are available as well from the context menu and the Studies menu item for
studies and from the Series menu item for series. To open it from the context menu, click the
right mouse button on the study.

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1.12 Information Panel

The panel is displayed in Fig. 1.26 (highlighted in red) and Fig. 1.27. Its left part displays the
status of the last operation performed. The right part displays the progress bar for the current
action and the data download/upload indicator while working with the PACS server or another
DICOM Viewer. Fig. 1.27 illustrates data download from the server.

Figure 1.26: Information panel in the DICOM Viewer window

Figure 1.27: Information panel. Download data from the server

When data are downloaded, an animated icon is displayed. When data are uploaded,

an animated icon is displayed. When no data are being downloaded or uploaded, no

icons or progress bar are displayed.

1.13 Uncompress series

The following functionality allows to uncompress data and save it. This makes it possible to
solve the problems with viewing and uploading compressed data on some remote servers.
Uncompressing is possible only for studies in the Local Storage.
To uncompress data:

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 1.14. TOOL CONTROL BUTTONS

1. Open a study containing compressed data;

2. Select the series that you want to uncompress. For details on how to work with series,
see Section 1.10.

3. Select the Series menu and Create uncompressed copy of series item. The selected
series will be uncompressed, saved to the Local Storage and marked uncompressed.

1.14 Tool Control Buttons

Starting with the version 2.0, you can use the left, the right and the middle mouse button,
which allows you to activate up to three tools at the same time. To activate a tool, click on the
tool button with the mouse button. There are two ways to deactivate a tool:

1. Activate another tool with the same button or

2. Click on the tool button with the same mouse button.

On the tool button, you will see a symbol representing the mouse with the respective
button selected (see Fig. 1.28).

Figure 1.28: The tools activated with the left, the middle and the right
mouse button respectively (from left to right)

If a tool is activated from the main menu, from the context menu or with a hot key, it is
automatically assigned to the left mouse button.
If a limited number of clicks is needed to create a graphic object (e.g. two clicks for a ruler,
three clicks for corner measurements), then the creation process will be completed after these
clicks. If you need an unlimited number of points to create a graphic object (e.g. a polygon
or an MPR curve), you have to double-click the button with which the tool was activated to
complete the creation process. The objects may be activated by mouse-over. When activated,
they may be moved or edited.
The objects created with a certain tool can be edited:

• with the button to which this tool is assigned;

• with the left mouse button, no matter whether the tool is activated or not.

If you mouse over the object and click the right button, the right-click menu will pop up.
The measurements and markers are activated if you mouse over them. It allows you to move
the marker or edit the measurement.

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CHAPTER 2. VIEW FLAT IMAGES

Chapter 2

View Flat Images

256 gray shades are used to show tissue density. As there are more than
256 density values, similar values are represented by the same colour. To be
able to distinguish between similar values, you need to decrease the
window width. In this case, a smaller range of values will be represented by
256 gray shades. If necessary, set the desired the window level value.

In Image Viewer window, diagnosis can only be established on the basis of

CT, MR, MG, and XA series.

2.1 Open Series

Select a study from the study panel. There are five ways to open a series:

• click the Image viewer button on the toolbar;

• double-click the left mouse button on the study title on the toolbar;

• double-click the left mouse button on the series icon on the series panel;

• drag the series icon to the study panel holding the left mouse button;

• right-click the mouse to call the context menu for the series icon, and select one of the
options in the Image viewer item.
The series will open in a new tab.
There are three ways to open a series from the explorer window:
• by dragging and dropping the folder with the series from the explorer window to the
study list tab. A new study list tab will be opened. The first series of the study will be
opened in the new flat image viewer tab;

• by dragging and dropping the folder with the series from the explorer window to the flat
image viewer tab stub. The first series of the study will be opened in a new window of
the current tab;

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 2.1. OPEN SERIES

• by right-clicking on the selected folder in the Explorer and selecting the Open with In-
obitec DICOM Viewer <Edition> <Version> from the context menu (see Section 1.5.4).
This function is only available on Windows.

ECG modality series (see Chapter 11) and series containing protocols (see
Chapter 18) are opened in the respective tabs. PDF documents are opened
in third-party software installed in the user’s OS. Series that do not conform
to the DICOM standard or series for which there are no special tabs to view
are opened in the DICOM tag viewer tab.
If nessesary, change the sorting order of images. To do it, right-click on the image to open
context menu, select the Image sorting item, and then select one of the displaying modes:

• No sorting;

• Sort by image number;

• Sort by image position and phase.

The current order is marked with flag. The defaulf sorting order is defined by the Sort by
parameter (see Section 16.7.1).
The series panel will be displayed on the left. To hide/show it select the main menu Image
and the Quick series list item or move the cursor to the panel border so that it would look like
this: and drag the border holding the left mouse button. The series panel is shown in
Fig. 2.1.

Figure 2.1: Series panel

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The DICOM Viewer allows you to open multiple series at a time or the same series multiple
times. All series are opened in separate windows of the same tab, and their position will
depend on the settings described in Section 2.10.
To open the selected series in the Volume Reconstruction or Multiplanar Reconstruction
window, click the Volume Reconstruction or MPR Reconstruction button on the
toolbar respectively.

2.2 Open Series with Current Settings

The DICOM Viewer allows you to open series of the opened study with the window level and
width set for the previously opened series. To do this:

1. Open any series and set the window level and width.

2. Select the study view window by clicking the left mouse button on the window header
(marked by the arrow in Fig. 2.2).

3. Open another series of this study. The series will be opened with the parameters of the
window level and width specified earlier.

4. Repeat Steps 2 and 3 if necessary. The settings for the first opened series will be used.

5. Change the window level and width for the first opened series if necessary.

Figure 2.2: The window header is marked by the arrow

2.3 Context Menu of the Image Viewer Tab

The Image Viewer tab is provided with a context menu (see Fig. 2.3). To bring up the context
menu, right-click on the Image Viewer window.

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 2.3. CONTEXT MENU OF THE IMAGE VIEWER TAB

Figure 2.3: The context menu of the Image Viewer tab

The context menu of the Image Viewer tab provides for:

• zooming, panning, and rotating tools (see Section 2.16);

• series arrangement settings (see Section 2.10);

• image arrangement settings (see Section 2.11);

• image sorting order settings (see Section 2.1);

• graphic label tools (see Section 2.33);

• measuring tools (see Section 2.19);

• command to open DICOM tag viewing tab for the current series (see Chapter 17);

• list of series from the current study containing images.

To see the list of series on the context menu of the Image Viewer tab, enable the Show
series list in context menu option in the program settings (see Section 16.7.1). The option is
enabled by default.
Series are shown on the list in the following format:
<Series number from DICOM tags> - <Series description> (<Number of images>).

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For example, 1000 - Anonymized (200). The current series is highlighted on the list.

To switch to the series required, left-click on its name on the list.

The list of series is only shown on the context menu if a window with images has been
selected. If a study window or an SR series window has been selected, the context menu will
be shown without the series list.

2.4 Working with Several Monitors and Split Screen

The DICOM Viewer allows you to split the screen into two parts or work with two monitors
connected to the same computer. For details on how to set up your monitor, see Section 16.5.

Let us assume that both displays are used, and each one is split (Fig. 2.4). In this case, the
DICOM Viewer will be running in four autonomous windows. To close the DICOM Viewer just
close any of its windows.

Figure 2.4: DICOM Viewer with two split screens. The right display is the
main one

In the illustration above, the right monitor is the main one, so the Study list tab is open in
its left window. To open this tab in any of the three remaining windows, select the File menu
and the Study list item in this window. The series panel on the right side displays the window
panel (Fig. 2.5).

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 2.4. WORKING WITH SEVERAL MONITORS AND SPLIT SCREEN

Figure 2.5: Window panel

Each window has a display icon corresponding to it.

• the first icon corresponds to the left window of the main display;

• the second icon corresponds to the right window of the main display;

• the third icon corresponds to the left window of the additional display;

• the fourth icon corresponds to the right window of the additional display.
The OS settings determine which display is the main one. The icon corresponding to the
current window is displayed against a light background. In Fig. 2.6, the Study list tab is open
in each window, and you can see the correspondence between the windows and the display
icons. The right display is the main one.

Figure 2.6: Correspondence between open windows and display icons

on series panels

To open a series in a certain window:

1. Load studies in any tab.

2. Select a study from the study panel.

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3. Hold the left mouse button and drag the series icon from the series panel to the display
icon corresponding to the window to open the series in.

4. Release the left mouse button. The series will open in the window corresponding to the
display icon.

If the cursor is not located on the display icon, it will look as follows: . This means
that dragging is impossible. As soon as the cursor is over the display icon, it changes to ,
and you can drag the icon.

2.5 Resampling filter

To change the Resampling filter, open the Image main menu, select the Resampling filter
menu item and in the submenu that opens, select a filter. The active filter is marked with a flag
(Fig. 2.7)

Figure 2.7: The Resampling Filter menu

The following filters are available:

• Bilinear;

• B-spline;

• Mitchel;

• Catmull-Rom;

• Lanczos3;

• Lanczos5;

• Lanczos7.

By default the Mitchel filter is active.

When filters are used (except for the Bilinear filter), distortions may occur. If
you see any dubious artifacts, select the Bilinear filter.

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 2.6. IMAGE FILTERS

2.6 Image Filters

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

A filter is an algorithm for transforming series images with various effects in the image
viewer window. The DICOM Viewer provides filters for blurring images, changing sharpness
and reducing visual noise.
Filters for image processing are available in the Image Viewer, MPR reconstruction, Ves-
sel analysis and Coronary artery analysis tabs.

2.6.1 Preset Filters

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

To choose and apply a preset filter in the Image Viewer tab, on the main menu, select
Image->Filters and from the filter list, select the desired filter.
You can choose preset filters with the following parameters:

• Blur 1 (Sigma=1);

• Blur 2 (Sigma=1.5);

• Blur 3 (Sigma=2);

• Sharpen 1 (Sigma=1; Sharpness weight=0.5);

• Sharpen 2 (Sigma=1; Sharpness weight=0.7);

• Sharpen 3 (Sigma=1; Sharpness weight=0.9);

• Median 1 (Radius=1);

• Median 2 (Radius=2);

• Median 3 (Radius=3).

In the Image Viewer tab, the filter is applied to the selected window. If you select a series
window, the filter is applied to the whole series. If you choose a study window, it is applied to
all the series of the study.
Only one filter may be applied to a selected series window. The current filter is highlighted
with blue on the list of filters, and marked with a flag. The name of the filter is shown in the
left-hand bottom corner of the window for which the filter is used.

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If you apply a filter to an image, you will see an asterisk «*» symbol in the ROI measurement
results and intensity value line. It informs the user that the measurement results are affected
by the filter applied.
An image to which a filter has been applied is not original, and the
measurement results may be inaccurate.
Preset filters are switched cyclically (see Section 2.6.3).
After the window is closed, the preset filter is reset and is not applied when the window is
opened again.

2.6.2 User Filters

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

The DICOM Viewer provides an opportunity to apply customized user filters. There are
three user filters on the main menu of the program:

• Blur;

• Sharpen;

• Median.

To set the parameters and apply a user filter, check one of the user filters on the list of
filters of the main menu.
In the dialog box that pops up, set the following parameters:

• for the Blur filter:

– Sigma parameter. The range of values is from 0.01 to 5.0. The pitch is 0.01. The
default value is 0.01;

• for the Sharpen filter:

– Sigma parameter. The range of values is from 0.01 to 5.0. The pitch is 0.01. The
default value is 0.01;
– Sharpness weight parameter. The range of values is from 0.01 to 0.99. The pitch
is 0.01. The default value is 0.01;

• for the Median filter:

– Radius parameter. The range of values is from 1 to 5. The pitch is 1. The default
value is 1.

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 2.6. IMAGE FILTERS

Fig. 2.8 shows the dialog box for customizing the Sharpen user filter.

Figure 2.8: Dialog box for customizing the Sharpen user filter

There are several ways to set the values of parameters in the dialog box for user filters:

• move the slider or scroll the mouse wheel while the cursor is on the track bar;

• enter the parameter value in the field on the right-hand side of the slider.

When parameters are changed in the dialog box for user filters, the changes are simulta-
neously reflected in the viewer window. When the dialog box is closed, the current user filter
is not reset.
The values of the parameters are saved and applied next time you select the user filter.

2.6.3 Actions with Filters

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

There are several ways to activate a filter:

• select a filter in the filter list of the main menu by marking it with the flag;

• press the hotkey for the filter. Hotkeys for filters are not provided by default. For details,
see Section 16.8;

• switch the current filter with the help of hotkeys or commands on the list of filters.

To go to the next or previous filter, proceed as follows:

• on the list of filters on the main menu, select Next filter to switch to the next filter or
Previous filter to switch to the previous filter;

• press the Ctrl+I key combination (the Command+I key combination for macOS) to switch
to the next filter or Ctrl+Shift+I (the command+Shift+I key combination for macOS) to
switch to the previous filter.

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Preset filters are switched cyclically. After the last preset filter on the list you go to the first
one. You do not switch to user filters.

There are several ways to reset the current filter:

• select the current filter in the filter list of the main menu. The flag next to the filter will
be removed;

• select the Reset filter command on the list of filters on the main menu;

• press the Shift+I key combination on the keyboard.

You can assign a hotkey to each filter (see Section 16.8).

2.7 View Images in a Series

When a series is opened, its first image is displayed in the series window.
The window for viewing series is shown in Fig. 2.9.

Figure 2.9: Series window

The data in the header of the series viewer windows of the Image viewer or CLUTs tab
are displayed as follows:
Series #<Sequence number of the series in the study> (<DICOM data series number>).
E.g.: Series #3 (201).
The value in the parenthesis is provided by the SeriesNumber(0020,0011) tag. If there is
no value provided for the SeriesNumber(0020,0011) tag, only the series sequence number will
be shown in the header of the series viewer window.

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 2.8. SWITCH BETWEEN SERIES

DICOM data series number are not shown for temporal series obtained as a
result of combining several series in a multiphase or merged series.
On the right-hand side of the window, you can see a scroll bar for scrolling images of the
series (marked by the green arrow). If the series contains several phases or is a multiframe
series, at the top of the window you will see an additional scroll bar (marked by the red arrow)
for switching between phases or frames. In the window, you will find the information on the
current image (see Section 2.30).
There are six ways to switch to other images:

• roll the mouse wheel up to switch to the previous image or down to go to the next one.
One click of the wheel changes the position by one image;

• use the scrollbar on the right side of the series window to move to the target image. To
change the position by one image, click the left mouse button on the arrow or the bar
above or below the scroll;

• click the left mouse button holding the Shift key. If the current image is the last in the
series, a click will switch you to the first image. Similarly, click the left mouse button
holding the Ctrl key (or the Command key for macOS) to move to the previous image;

• use the Scrolling tool. Activate the tool on the toolbar by clicking the left/right/mid-
dle mouse button. To continue work with this tool, use the button with which the tool
was activated. To learn more about tool control, see Section 1.14. If it is impossible to
switch between images, the tool may be used for scrolling frames;

• move the mouse up and down while holding the left mouse button. By default, the
Scrolling tool is assigned to the left mouse button and can be used without activating
the button on the toolbar. You can change the mouse buttons’ default settings
for the Slide images operation in the Controllers tab of the Image viewer module (see
Section 16.7.1);

• use the arrow buttons on the toolbar: , .

2.8 Switch between Series

There are two ways to switch between series in the series window:

• Use the arrow buttons on the toolbar: , ;

• Use the context menu: right-click on the image and select a series from the list for the
current study (see Section 2.3.

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2.9 View Several Studies at a Time

To open several studies simultaneously:
1. From the program window:
(a) Open a study by opening any of its series.
(b) Switch to the tab containing the study list.
(c) Select another study and drag one of its series to the tab with the opened study
(highlighted in red in Fig. 2.10).
2. From the explorer folder:
(a) Open a study by opening any of its series.
(b) Select the folder with the another study and drag one of its series to the tab with
the opened study (highlighted in red in Fig. 2.10). The first series of another study
opens in a new window of the current tab.
3. From the study list:
(a) Select several studies on the study list (see Section 1.9).
(b) Click the button on the toolbar or the key combination Alt+I (Option+I for
macOS). The selected studies will be opened in a new Image viewer tab. Series
are opened in compliance with the default series arrangement settings (see Sec-
tion 2.10).

Figure 2.10: Study view tab

Series are opened in the same tab, but in different viewer windows. The first series of each
study is opened in a separate tab window. You can open studies from any data source (e.g.,
local storage, folder, zipped file, CD, PACS server). You will find the information on selection
of the data source in Section 1.5.
ECG modality series (see Chapter 11) and series containing protocols (see
Chapter 18) are opened in the respective tabs. PDF documents are opened
in third-party software installed in the user’s OS. These series cannot be
opened in the Image viewer tab.
When opened from the PACS Server, SR series containing protocols are opened in the
window for viewing structured reports. To view protocols in the editor window, you need to
download the respective series or study to the local storage.
There are several ways to maximize any of the series windows to full screen and restore
its size:

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 2.9. VIEW SEVERAL STUDIES AT A TIME

• click on the Expand button in the right-hand upper corner of the series window;

• double-click with the left mouse button on the title of the series window;

• double-click with the left mouse button on the series window.

The series panel is displayed on the left, and the series are grouped by study (Fig. 2.11).
The arrows point to series panel stubs. The series panel at the top of the picture is ex-
panded, and the bottom series panel is folded. To unfold it, just click the left mouse button on
the header (marked by the arrow below). Only one series panel may be unfolded at a time,
the rest will be folded.

Figure 2.11: Series panel for several studies. Study titles are marked by
arrows. The top study is unfolded, and the bottom study is folded

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2.10 View Multiple Series

There are several modes for positioning series windows in the study window.
You can choose the mode for arranging series in the study window in the Series
arrangement button menu. There are three ways to open this menu:
1. Click the arrow on the right-hand side of the Series arrangement button on the toolbar
and select the arrangement mode from the drop-down menu (Fig. 2.12).

Figure 2.12: Series arrangement menu

2. Move the cursor to the window with the open series, right-click and select Series ar-
rangement command from the shortcut menu.
3. Select Series arrangement from the Image section of the main menu.
You can choose from the following series arrangement modes:
• Automatic — the default series arrangement mode (see Section 2.10.1);
• Stacked — only one series window may be opened in the study window (see Sec-
tion 2.10.2);
• 2 near — the study window is divided into two parts (see Section 2.10.3);
• 2x2 — the study window is divided into four parts (see Section 2.10.3);
• 2x3 — the study window is divided into six parts (see Section 2.10.3);
• Custom arrangement... — the user customizes the arrangement of series windows (see
Section 2.10.4)
The current series arrangement mode is highlighted in blue on the toolbar and on the
menu.
There are several ways to maximize any of the series windows to full screen and restore
its size:
• click on the Expand button in the right-hand upper corner of the series window;
• double-click with the left mouse button on the title of the series window;
• double-click with the left mouse button on the series window.

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 2.10. VIEW MULTIPLE SERIES

2.10.1 Auto Mode

This mode is active by default. If two or more series are open, they will be located in the
window and scaled automatically, occupying the entire window. Five series are displayed in
Fig. 2.13.

Figure 2.13: Automatic display of series

There are three ways to activate this mode:

• select the Automatic item in the Series arrangement button menu on the toolbar;

• locate the cursor to the window with the open series, right-click and select command
Series arrangement->Automatic on the context menu;
• on the main menu, select Image->Series arrangement->Automatic.

2.10.2 Stacked Mode

This mode allows you to open only one series in the study window. If you try to open another
series, the current series will be closed.
Activate this mode in several ways:

• select the Stacked item in the Series arrangement button menu on the toolbar;

• locate the cursor to the window with the open series, right-click and select command
Series arrangement->Stacked on the context menu; on the main menu, select Image-
>Series arrangement->Stacked.

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2.10.3 Grid Mode

In this mode the study window is split into parts, and a series window can be opened in each
of them.
To set up a 1x2, 2x2 or 2x3 grid, select the 2 near, 2x2 or 2x3 item in
the Series arrangement button menu.
These grid configuration types are available from the image context menu. Locate the cur-
sor to the window with the open series, right-click and select command Series arrangement.
Selection of 1x2, 2x2 or 2x3 grid is available on the main menu Image->Series arrange-
ment.
If the selected grid configuration has fewer cells than there are open series in the study,
a warning dialog box pops up (Fig. 2.14), in which the program asks for a permission to close
the open series.
Click OK to close the series, or CANCEL to cancel.

Figure 2.14: Warning dialog box

There are two ways to disable the warning dialog box:

• Check the Don’t show this dialog again box in the dialog (Fig. 2.14) and click the OK
button.

• On the main menu, select Options->Settings...->Modules->Image Viewer, then choose

the Image arrangement tab and uncheck the Confirm series closure on the arrange-
ment changing box. For more information on the module settings see Section 16.7.1.

Click OK to apply the settings or Cancel to cancel.

2.10.4 Custom Mode

A grid may have from 1 to 100 cells. The maximum number of rows and columns is 10. This
mode can be set by default (see Section 16.7.1).
Fig. 2.15 illustrates a 2*4 grid with three cells filled.

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 2.10. VIEW MULTIPLE SERIES

Figure 2.15: Displaying series in a 2*4 grid

To define your own grid configuration perform the following:

• select the Custom arrangement... item in the Series arrangement button menu;

• locate the cursor to the window with the open series, right-click and select command
Series arrangement->Custom arrangement... on the context menu;
• on the main menu, select Image->Series arrangement->Custom arrangement....
This mode can be set by default (see Section 16.7.1).
In the Row/Column setting dialog box (Fig. 2.16) enter the number of rows and columns of
the grid.

Figure 2.16: Row/Column setting dialog box

For customized grids, the DICOM Viewer allows for auto-fill of the cells with the current
study series. The auto-fill function is disabled by default. To enable it, on the main menu,

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select Options->Settings...->Modules->Image Viewer, then choose the Image arrangement

tab and check the Automatic fill with series box. For more information on the module settings
see Section 16.7.1.
When a series is opened in a new tab, the other series are opened in the cells available.
The cells are sorted by serial number.
When positioning series on the grid, the DICOM Viewer allows you to move the boundary
between cells. To do this, move the cursor to the panel border so that it would look like
or and drag the border holding the left mouse button. Setting the priority of horizontal
or vertical separator is described in Section 16.7.1.

2.11 View Multiple Images in the Same Series Simultaneously

To select the mode for viewing images of the same study, right-click on the image to open
context menu, select the Image arrangement... item, and then select one of the displaying
modes. In general, they are similar to the modes for displaying series.
Image displaying modes:

• Stacked. Set by default. A single image is displayed in the window.

• 2 below. Two images are displayed in the window, one above the other. The image
order is downward. The entire screen is scrolled at once (i.e. if Images 1 and 2 of the
same series are initially displayed, Images 3 and 4 will be displayed next), or one Image
is scrolled at once. Selection of the desired mode is described in Section 16.7.1). To apply
a new configuration, you should reopen the Flat Image View Tab.

• 2 near. This mode is similar to the previous one, but the images are positioned horizon-
tally, and the order is from left to right.

• 2x2. Two columns and two rows of images are displayed in the window. The order is
downward from left to right.

• 2x3, 3x2, 3x3, 4x4. Similar to the previous item.

• Custom arrangement. The number of columns and rows is set manually (from 1 to 10).
This configuration can be set by default (see Section 16.7.1).

Fig. 2.17 illustrates a 3x2 grid.

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 2.11. VIEW MULTIPLE IMAGES IN THE SAME SERIES SIMULTANEOUSLY

Figure 2.17: Images in a series displayed in a 3x2 grid

Multiple series may be displayed on the screen simultaneously, and each series window
may contain multiple images. In Fig. 2.18, three series windows are open, the first one displays
a single image, the second contains a 2x2 grid, and the third shows a 4x4 grid.

Figure 2.18: Displaying multiple series and multiple images in a series

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To set default viewing images modes for series of different modalities, add settings for
these modalities (see Section 16.7.1). Use only English letters to specify modality. The modality
designation should coincide with the designation on the icon of the series (Fig. 2.19).

Figure 2.19: Series modality designation is marked by the red arrow

2.12 Viewing Several Series as a Single Multiphase Series

Several series of a single study may be merged into a single multiphase series. Such a series
may be used for assessment of contrast distribution in tissues at regular time intervals, e.g.
for viewing it in the digital subtraction angiography (DSA) or perfusion parameters estimation
mode.
The following series may be merged:

• saved in the local storage. If the PACS server has been chosen as the DICOM data
source, save the series in the local storage;

• having the same modality;

• having the same FrameOfReferenceUID (0020, 0052) tag value.

To merge several series of the same study in a multiphase series, proceed as follows:

1. Select the study on the study panel to see the list of series.

2. Select several series on the list in one of the following ways:

• select the first and the last series you need while holding the Shift button;
• mouse over the series you need while holding the left mouse button;
• select several series placed in different parts of the list while holding the Ctrl key
(or the Command key for macOS).

3. Hover over the selected series, click the right mouse button and select the Image viewer
(open as a single series) option on the menu. Choose one of the three viewing options:

• Show at window 1 opens images in a new tab;

• Show as detached window opens images in a separate window;
• Show fullscreen opens images in the full screen mode. To exit the full screen mode,
press Esc or F11 on the keyboard.

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If the selected study series cannot be merged, a dialog box notifying of an error will pop
up. To learn about the cause of the error, click the SHOW DETAILS... button.
The merged multiphase series will be opened in the flat image viewer window. A merged
series may be opened from the Image viewer tab in the Volume reconstruction and MPR
reconstruction tabs.
The new merged series will be added to the list of series of the current study. The descrip-
tion of the merged series comprises a list of all the series included in it, separated by a space
followed by a Merged prefix. The series may be opened in the Volume reconstruction and
MPR reconstruction tabs. To delete a merged series from the list of series, click the Remove
the selected series from the Local Storage button on the series panel.
The following options are unavailable for a merged series:

• saving in a local storage;

• loading to the PACS server;

• adding to a CD/DVD image;

• viewing tags.

When the list of studies is updated, the merged series is deleted automatically.

2.13 Viewing Orthogonal Projections of Images

The DICOM Viewer provides the user an opportunity to change view for the series shown in
the Image Viewer tab.
The button for viewing orthogonal projections may appear as , or , de-
pending on the variant selected.
There are several ways to choose the view for the series in the selected window:

• click the orthogonal projection button or the arrow on the right-hand side of the button.
Select one of the options on the drop-down list (Fig. 2.20);

• press the Shift+A combination on the keyboard to switch to the axial projection, Shift+C
to switch to the coronal projection, or Shift+S to switch to the sagittal projection. These
hotkeys are assigned by default. You can assign new hotkey combinations in the Tools
section of the Hotkeys settings (see Section 16.8).

Figure 2.20: Orthogonal projection drop-down list

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The active projection for the selected window is highlighted in blue on the toolbar and on
the drop-down menu.
The default projection for the series is the same as the one used in which it was received
from the medical equipment. Other options are available for series that can be images sorted
by position and phase.
If only a part of the series has been loaded and the user chooses an orthogonal projection
different from the one used in which it was received from the medical equipment, the pro-
jection will be built on the basis of the data that have already been loaded. If the number of
images in the initial series has changed, the orthogonal projection is re-constructed when a
projection other than the one from the medical equipment is re-selected.
If you choose an orthogonal projection in the same viewer window for a second time, the
projection will be opened on the slice that was the last to be viewed.
All the operations available for the projection that was used in which it was received from
the medical equipment, e.g. measurements, viewing several series, synchronization etc., may
be performed with any orthogonal projection.
Images of series may be sorted and tags may be displayed only for the projections that
were used in which it was received from the medical equipment. To change the image sorting
type for all the series open in the viewer window, open the context menu by right-clicking on
the window header, choose the Image sorting section and one of the sorting options.
When you return to the orthogonal projection that corresponds to what we got from the
medical equipment, the image sorting does not change.
The Orthogonal projection drop-down list is not available for series:
• which cannot be sorted by Sort by image position and phase;
• having less than 2 pictures for at least one phase;
• consisting of images based on the RGB color model.
The series that were opened from the Image Viewer tab in the Volume Reconstruction,
MPR reconstruction tabs are only displayed in the projection used in which it was received
from the medical equipment.
The Calcium scoring tool works independently with each orthogonal projection of the
series.
When the window width and level parameters are customized, the thumbnail of the active
series in the chosen orthogonal projection is shown in the W/L settings dialog box.
The current series in the chosen orthogonal projection is shown in the histogram and the
CLUTs tab.

2.14 Play images

The DICOM Viewer allows you to automatically play back images of a series at a certain speed.
To set up playback, click on the right part of the Play and choose parameters.

1. If the series contains several phases or is multiframe, then the DICOM Viewer allows
you to switch between the playback of images, phases and frames. To switch ,
select the Play images, the Play phases or the Play frames item from the «Play» button
context menu. The selected item is marked with a flag. Only the items suitable for this
series are available on the context menu.

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 2.15. VIDEO RECORDING

2. Select the speed (5, 10, 20 or 25 frames per second). If you want to set a different
playback speed, select the User defined... item and in the dialog that opens, set the
value from 1 to 100. The selected speed will be marked with a flag.

3. If you want to play images cyclically, select the Loop item. The item will be marked
with a flag. To disable the cyclic playback, select this command again. The flag will be
removed.

To play the images click on the button on the toolbar. The button looks like .

To end playback, click on the Pause button.

2.15 Video recording

Functionality is available in the Pro edition

The DICOM Viewer allows you to record video for the selected image viewing window. If
you use the View Multiple Series mode (see Section 2.10), then video will be recorded only
from the selected window. If you are viewing multiple images in a series at the same time (see
Section 2.11), then video will be recorded only for the left bottom image area (highlighted in
red in fig. 2.21). The following objects will be recorded:

• tissues;

• measurements;

• annotations;

• scout lines;

• tags;

• orientation cube;

• ruler;

• synchronization crosshair.

The following objects will not be recorded:

• cursor;

• dialog windows.

Video recording will be stopped if:

• focus is moved to another window within this tab;

• window size is changed.

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Figure 2.21: Video recording area is highlighted in green

Video recording can be synchronized with playback (see Section 2.15). To start playback
when recording a video and stop it after completing a video recording, click on the arrow on
the right side of the button, select the Settings... item and in the dialog that opens
(fig. 2.22), check the Start playback after recording starts box. If this box is checked then
video recording will stop after the playback is stopped.

Figure 2.22: Video record settings dialog box

Chose one for the following options from the Encoder drop-down list:

• Auto. The choice of the encoder depends on the number of pixels in the window
recorded. If the number of pixels (width × height) is ≤ 9437184, the H264 encoder
will be used. For windows with more than 9437184 pixels, the MPEG4 encoder will be
used. By default, the encoder is selected automatically;

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 2.16. ZOOM. PAN. ROTATE

• H264. The encoder is used for recording videos when the number of pixels in the win-
dow (width × height) is ≤ 9437184. If the number of pixels in the window is greater,
a window suggesting that the MPEG4 encoder should be selected instead will pop up
when the user presses «OK»;

• MPEG4. The encoder may be used for recording videos in the windows of any size, but
the resulting video file will occupy more space on a disc compared to a file created with
the H264 encoder.

To set the frame rate, enter the value into the Frame per second field.
Click OK to apply the settings or CANCEL to cancel.
To start recording video:

1. Click on the Start video record button. The file save dialog opens.

2. Select the save path and the file name.

3. To start video recording, click Save and to cancel, click Cancel.

During video recording, the button looks like . To stop video recording, click the

button. After the video recording is completed, the Video record was stopped message
appears.
The video will be saved in a file with .mp4 extension.

2.16 Zoom. Pan. Rotate

2.16.1 Zoom
To zoom an image, use one of the following methods:

1. Roll the mouse wheel holding the Ctrl key (or the Command + scrolling key for macOS).
Roll the wheel up to zoom in or down to zoom out.

2. With the Zoom tool. Activate the tool by clicking on the button and zoom the
image, moving the cursor up and down. To select scale values, call the drop-down menu,
clicking on the arrow on the right side of the button and select the value. To set
the scale manually, select the Custom zoom... item from the drop-down menu. This tool
is also available from the image context menu and from the Image main menu item.

Images are scaled relative to the point the cursor is located at.

2.16.2 Pan
There are two ways to move the image in the view window:

1. Move the mouse holding the wheel and the Shift key on the keyboard. This key combi-
nation is set by default. You can disable or change the setting in the Controllers tab of
the Image viewer module (see Section 16.7.1).

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2. Activate the Pan tool on the toolbar by clicking the left/right/middle mouse button.
To continue work with this tool, use the button with which the tool was activated.To learn
more about tool control, see Section 1.14. To move an image, move the cursor around
the screen while holding down the mouse button.
This tool is also available from the image context menu and from the Image main menu
item.

2.16.3 Rotate
To rotate an image by an angle multiple of 90 degrees, click on the arrow on the right side of
the Rotate button on the toolbar, and select one of the four options:

• Set 0°;

• Set 90° clockwise;

• Set 180°;

• Set 90° counterclockwise.

To rotate an image by an arbitrary angle, activate the Rotate tool by clicking the
left/right/middle mouse button. To continue work with this tool, use the button with which the
tool was activated. To learn more about tool control, see Section 1.14. Rotate the image by
moving the mouse while holding down the button that activated the tool. When you finish,
click the Rotate button to deactivate the tool.
These commands are available from the image context menu. To open them, right-click
on the image and select the Rotate item from the context menu.
This tool is also available from the image context menu and from the Image main menu
item.

2.17 Set Window Level and Width

The current window level and width values are displayed in the top right-hand corner of the
window. If the Adjust W/L tool on the toolbar is active, these changes are made holding
the button which the tool was activated. To learn more about tool control, see Section 1.14.
In the Volume Reconstruction tab or Multiplanar Reconstruction tab, you can also activate
the tool from the right-click menu of the image. In the Flat Image Viewer tab, the tool is
available in the Image section of the main menu. In the Multiplanar Reconstruction tab, the
tool is available in the MPR section of the main menu. In the Volume Reconstruction tab, the
tool is available in the Volume section of the main menu.
To change the parameters, move the mouse in the study window, holding the button which
the tool was activated
• to increase the window level — down;

• to reduce the window level — up;

• to reduce the window width — left;

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 2.17. SET WINDOW LEVEL AND WIDTH

• to increase the window width — right.

If you haven’t activated any tools with the right mouse button, you can change the window
width and level by moving the mouse while holding the right button. In the Controllers tab of
the Image viewer module (see Section 16.7.1), you can choose the mouse button which will be
used by default to change the window parameters.
The terms «window width» and «window level» in digital images commonly refer to «con-
trast» and «brightness» respectively on your computer.
For certain types of tissues, the DICOM Viewer has preset width and level values. To
change the width and level settings, click the arrow on the right-hand side of the Custom W/L
button .

Figure 2.23: Menu of preset width and level values

The following preset values are available in the drop-down menu (see Figure 2.23):

• Recommended — the DICOM Viewer applies the values of the corresponding image
tags. They are used by default.

• Full dynamic — the mode where the window width and level depends on the image
parameters available. This mode is used when the window width and level is not men-
tioned in the study.

• Bones — for viewing bone tissues.

• Lung — for viewing lung tissues.

• Brain — for viewing brain tissues.

• Chest — for viewing chest tissues.

• Headneck — for viewing head and neck tissues.

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• Abdomen — for viewing abdominal tissues.

• Custom W/L... — the window width and level parameters are provided by the user in
the Window Level settings dialog box (see Figure 2.24) and are used for all the images
in the series.

To select one of the modes without the preview option, click on the arrow on the right side
of the button. You cannot edit the values predefined for specific tissues. To return to
the original settings, select the Recommended mode.
To customize the window width and level settings, click the Custom W/L button . In
the Window Level settings dialog box (Figure 2.24) that pops up, provide the window width
and level parameters or choose the preset values you need from the Preset dropdown list.
On the Preset list, you will find standard preset values, as well as presets saved by the user
earlier (see Section 2.17.2). Standard preset values are marked with icons.
In the Window Level settings dialogue box, you will see the hotkey and the window width
and level settings assigned to the selected preset.

Figure 2.24: Dialog box Window Level settings

Click OK to apply the settings or CANCEL to cancel.

2.17.1 User Presets for Window Width and Level

There are two ways to create a user preset for window width and level:

1. Manually specify the values in the Width, Center, Min and Max fields of the Window
Level settings dialog box. When a value is changed in one of the fields, the values in
the other fields are changed automatically according to the following formulas:

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 2.17. SET WINDOW LEVEL AND WIDTH

Width = Max — Min;

Center = (Max + Min)/2.

If the window width and level settings provided are different from the existing presets,
a <Custom W/L> value will be shown on the Preset dropdown list.

2. Change the window width and level settings with the Adjust W/L tool (see Sec-

tion 2.17). Open the Window Level settings dialog box by clicking the button on
the toolbar.
If the window width and level settings provided are different from the existing presets,
a <Custom W/L> value will be shown on the Preset dropdown list.
To save the provided window width and level settings as a new preset, click the Save
preset button in the Window Level settings window. In the New W/L preset dialog box
that pops up (see Fig. 2.25), provide the preset name and assign a hotkey to it. By default,
the name assigned is in the W<window width value>/L<window center value> format, and the
Hotkey box remains empty.

Figure 2.25: Creating a new preset

Provide a unique preset name. Assign a hotkey if required (see Section 2.17.2)
Click SAVE to save the preset or CANCEL to cancel.
After the new preset has been successfully saved, it will be shown in the Window Level
settings dialog box.

2.17.2 Actions with presets

Actions with hotkeys. To assign or change a preset hotkey, proceed as follows:

1. Open theWindow Level settings dialog box by clicking the key on the toolbar.

2. Choose the preset required from the Preset dropdown list.

3. Click the Set the hotkey button.

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4. In the Set the hotkey dialog box that pops up (Fig. 2.26), provide a value in the Hotkey
field. The permissible values are:
• any single key on the alphanumeric keyboard or a function key, such as A or F5;
• combinations of modifier keys Alt key (or the Option key for macOS), Ctrl key (or
the Command key for macOS), Shift and alphanumeric or function keys pressed
simultaneously, e.g. Ctrl+H (or the Command+H keys for macOS), Shift+F5, or
Alt+Ctrl+Shift+Q (or the Option+Command+Shift+Q keys for macOS).

Figure 2.26: Setting up a hotkey

If the value specified in the Hotkey box is already assigned to another action or tool, a
notification that the existing hotkey will be reassigned will appear in the dialog box. The
user can also reassign hotkeys for standard window width and level settings.
5. Click «OK» to save the hotkey or CANCEL to cancel.

When a hotkey is reassigned, the user may have to relaunch the program for
the changes to take effect. If the reassigned hotkey was assigned to
another W/L preset, no relaunch is required.
Deleting a user hotkey. To delete a user hotkey, proceed as follows:

1. Open the Window Level settings dialog box by clicking the key on the toolbar.

2. Choose the preset to be deleted from the Preset dropdown list.

3. Click the Remove the preset button.

4. In the dialog box that pops up, click REMOVE to delete the preset or CANCEL to cancel.

Only the presets that were created earlier by the user can be deleted.
Standard presets cannot be deleted.
After the selected preset has been deleted, the previous preset on the list will be used as
the current preset. The hotkey assigned to the deleted preset will be vacant.
User presets import and export. Window width and level presets will be exported and
imported with other program settings (see Section 16.9).

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2.17.3 Additional Width and Level Settings

To enable additional image viewer settings, proceed as follows:

1. Choose Settings... in the Options menu.

2. Choose Image viewer in the Modules list and click the Settings button.

3. From the Image viewer settings window, go to the W/L settings tab (Figure 2.27).

Figure 2.27: Image viewer settings dialog box

4. For the Flat Image Viewer mode, select the following options:

• To calculate the Recommended and Full dynamic values and apply them to all the
slices in the study, check the box Use the same W/L value for all images in Series.
If you do not select this option, the Recommended and Full dynamic values will be
calculated for each image separately.

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• If the window width and level values provided in the series tags are incorrect, check
the box Recalculate recommended W/L. The recommended values are calculated
on the basis of the image properties. The values provided in the series tags are
ignored.

• To set the default window width and level values for the DSA mode, check the
Default DSA W/L. Provide the required numerical values in the Width and Center
boxes.

Click OK to apply the settings or CANCEL to cancel.

The options Use the same W/L value for all images in Series and Recalculate recom-
mended W/L impact the window width and level values in the Recommended and Full dy-
namic modes.
To restore the default settings, click the DEFAULTS button.

2.17.4 Setting the Window Width and Level for Merged Series

To use the values provided in the Window Level settings dialog box (Figure 2.24) when view-
ing merged series, proceed as follows:

1. In the list of layers for the merged series, choose any except the first (base) layer. For
details on series fusion, see Chapter 4. In the Window Level settings dialog box (Fig-
ure 2.24), provide the window width and level parameters or choose the preset values
you need for this layer.

2. Open the merged series in the Volume Reconstruction or Multiplanar Reconstruction

tab by pressing the respective button on the toolbar.

The width and level parameters for the first (base) layer are taken from the series tags. For
the other layers, the width and level parameters are chosen by the user in the tab for merging
layers.

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 2.18. MAGNIFIER

2.18 Magnifier
This tool allows you to increase the tissue with a zoom increment of 2 to 32 (Fig. 2.28).
To magnify the tissue:

1. Activate the Magnifier tool on the toolbar by clicking the left/right/middle mouse
button. To continue work with this tool, use the button with which the tool was activated.
To learn more about tool control, see Section 1.14.
2. Move the cursor to the area you want to make out.
3. To increase the value of the zoom increment, click the mouse button with which the tool
was activated. To reduce value, click the mouse button with which the tool was activated
holding down the Alt key (or the Option key for macOS) on the keyboard.
4. The radius and the zoom increment of the tool are set in the Magnifier options dialog
box. To set these parameters, click on the arrow on the right side of the button
and select Options...

Figure 2.28: Tool Magnifier

2.19 Measurements
To avoid errors caused by the discrepancy between the image size and the
real size, Calibration tool should be used when working with projection
images (e.g. X-ray images) (see Section 2.37).
The measurement accuracy is up to one screen pixel. As a screen pixel is
smaller than a source image pixel, the true linear measurement accuracy is
up to one source image pixel. Errors may also occur in density
measurements. The most accurate measurements are performed with
bilinear interpolation (see Section 2.5).
The following tools are used to measure various parameters: Ruler, Polygonal ruler, An-
gle, Cobb angle, Point value, ROI rectangle, ROI ellipse, ROI polygon. To select one of

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these tools, click on the arrow on the right side of the tool selection button. The button will
look different depending on the selected tool:

Ruler (selected by default)

Polygonal ruler

Angle

Cobb angle

Point value

ROI rectangle

ROI ellipse

ROI polygon

Cardiothoracic ratioPRO

To activate or deactivate the tool that is currently selected, just click on the tool selection
button. If some tool is activated, the button is highlighted. The drawn objects will be displayed
in the window while it is open, and you can pan, zoom or rotate them together with the image.
If the series is open in multiple windows or tabs, the measurements made in any window,
appear in all the other windows.

2.19.1 Ruler
To measure distance in an image:

1. Activate the Ruler tool on the toolbar by clicking the left/right/middle mouse but-
ton. To continue work with this tool, use the button with which the tool was activated.
To learn more about tool control, see Section 1.14.

2. You can measure the distance in two ways:

• Mark the first point by clicking the mouse button. Drag the cursor over the screen.
The distance from the first point to the current point will be displayed beside the
line. To fix the current point, click the mouse button.
• Click on the mouse button at the starting point and move the cursor to the endpoint
while holding the mouse button. The distance from the first point to the current

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point will be displayed beside the line. To fix the endpoint, release the mouse
button.

3. To cancel an incomplete measurement, press Esc.

This tool is also available from the image context menu and from the Image main menu
item. Activation is only possible with the left mouse button.
The measurement results are not saved in the project file. To save the measurement
results, export the current image to a file (see Section 2.28) or use marker lines (see Sec-
tion 5.12.3).

2.19.2 Displaying angles between intersecting rulers

Functionality is available in the Pro edition

The DICOM Viewer provides an opportunity to see the base and the adjacent angle when
two Ruler tools cut each other in the Image Viewer, MPR reconstruction, Vessel anal-
ysis, Coronary artery analysis, PET analysis, and Cardiac function analysis tabs.
To see the angle between two intersecting Ruler tools, check the Show angles between
rulersPRO box in the Tool options dialog box. The box is checked by default. You can choose
whether only the base angle or both (the base and the adjacent) angles are to be shown (see
Section 2.19.9).
The base angle between the rulers is marked with a single arc, and the adjacent angle is
marked with a double arc. The angle value is shown in degrees as a separate note.

2.19.3 Polygonal Ruler

To perform plygonal linear measurements:

1. Activate the Polygonal ruler tool by clicking the left/right/middle mouse button. To
continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14.

2. Mark the first point on the toolbar by clicking the mouse button.

3. Drag the cursor over the screen. The distance from the first point to the current point
will be displayed beside the line.

4. To fix the current point, click the mouse button.

5. Repeat Steps 3 and 4 until the last but one point is fixed.

6. Fix the last point by double-clicking the mouse.

7. To cancel an incomplete measurement, press Esc.

To move the linear measurement point:
1. Locate the cursor on the point to be moved.

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2. Drag the point, holding down the left mouse button or the button to which this tool is
assigned;

3. Release the mouse button.

To delete a point:

1. Locate the cursor on the point to be deleted.

2. Right-click the mouse and select the Remove point command.

To insert a point:

1. Locate the cursor on the ruler where you want to insert a point.

2. Right-click the mouse and select the Insert point command.

This tool is also available from the image context menu and from the Image main menu
item. Activation is only possible with the left mouse button.
The measurement results are not saved in the project file. To save the measurement re-
sults, export the current image to a file (see Section 2.28) or use polygonal marker lines (see
Section 5.12.4).

2.19.4 Angle
To measure an angle:

1. Activate the Angle tool from the toolbar by clicking the left/right/middle mouse
button. To continue work with this tool, use the button with which the tool was activated.
To learn more about tool control, see Section 1.14.

2. Put two points on the image, clicking the mouse button. The second point is the angle
apex.

3. Move the cursor over the screen to set the other side of the angle.

4. Click the mouse button to fix the second side of the angle.

5. To cancel an incomplete measurement, press Esc.

The DICOM Viewer allows you to build as many angles as you need. To deactivate the
tool, click on the tool selection button.
This tool is also available from the image context menu and from the Image main menu
item. Activation is only possible with the left mouse button.
The measurement results are not saved in the project file. To save the measurement re-
sults, export the current image to a file (see Section 2.28) or use polygonal marker lines (see
Section 5.12.4).

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2.19.5 Cobb angle meter

To measure a Cobb angle:

1. Activate the Cobb angle tool from the toolbar by clicking the left/right/middle
mouse button. To continue work with this tool, use the button with which the tool was
activated. To learn more about tool control, see Section 1.14.

2. Draw a line that runs along the border of one of the vertebrae. To do this, click the mouse
button to set two points through which the line must pass.

3. Likewise, construct a line for the second vertebra.

4. To cancel an incomplete measurement, press Esc.

To display additional parameters, hover the mouse over the measurement tool or the mea-
surement value. Right-click the mouse and select the Tool options... item from the context
menu.
In the Tool options dialog box, provide the measurement name, as well as the color, the
line width, and the font size for the angle value. To join the measurement value to the angle
with a dashed line, check the Footnote line box.
To display the value of the adjacent angle, check the Adjacent angle box.
To show the angle value at the intersection of segments, check the Show intersection
box. If this function is disabled or the segments do not intersect, the angle value is shown
only at the intersection of normals. In Fig. 2.29 the option Show intersection is disabled, and
in Fig. 2.30 is enabled.

Figure 2.29: The Show intersection option is disabled

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Figure 2.30: The Show intersection option is enabled

To use these parameters by default, check the box Set as default.

To apply the settings, click OK. To cancel, click CANCEL.
To delete mesurement, locate the cursor on it, right-click the mouse and select the Remove
object. For more information see Section 2.19.12.
This tool is also available from the image context menu and from the Image main menu
item. Activation is only possible with the left mouse button.
The measurement results are not saved in the project file. To save the measurement re-
sults, export the current image to a file (see Section 2.28) or use polygonal marker lines (see
Section 5.12.4).

2.19.6 Measure Intensity at a Point

If non-bilinear interpolation filters are used, significant errors may occur
when intensity is measured in a certain point. In this case, the intensity
value will be marked by an asterisk. For more accurate measurements, use
the bilinear interpolation filter (see Section 2.5).
To measure intensity at some point:

1. Activate the Point value tool from the toolbar by clicking the left/right/middle
mouse button. To continue work with this tool, use the button with which the tool was
activated. To learn more about tool control, see Section 1.14.

2. Click the mouse button on the target point.

The point will be highlighted at the image, and the intensity value will be displayed next
to it. It is shown in the «k HU» format for original images and in «k», where k is the intensity
value at the point. If the value is inaccurate, you will see a «*» symbol next to it.
If you apply a filter to an image, you will see an asterisk «*» symbol next to the intensity
value. It informs the user that the measurement results are affected by the filter applied (see
Section 2.6).
An image to which a filter has been applied is not original, and the
measurement results may be inaccurate.

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To adjust the Point value tool, locate the cursor on the point or the mesurement results on
the image. Right-click the mouse and select the Tool options... item from the context menu.
In the Tool options dialog box enter the measurement name. Set the color and the font size.
To connect the block with the measurement results with a dotted line, the Footnote line box
must be checked. To use these parameters by default, check the box Set as default.
To apply the settings, click OK. To cancel, click CANCEL.
To delete mesurement, locate the cursor on it, right-click the mouse and select the Remove
object.
This tool is also available from the image context menu and from the Image main menu
item. Activation is only possible with the left mouse button.
The measurement results are not saved in the project file. To save the measurement re-
sults, export the current image to a file (see Section 2.28).

2.19.7 Measure the Intensity Average and Standard Deviation in an Area

To measure the average intensity value and standard deviation in a particular area:

1. Activate one of the ROI ... tools (rectangle , ellipse , or polygon ) from
the toolbar by clicking the left/right/middle mouse button. To continue work with this
tool, use the button with which the tool was activated. To learn more about tool control,
see Section 1.14.

2. You can draw a rectangle in two ways:

• Click the mouse button to mark the first corner of the rectangle. Move the cursor
to the place where the opposite corner of the rectangle should be located. The
rectangle will be displayed on the screen. To fix the second corner of the rectangle,
click the mouse button.
• Click the mouse button to mark the first corner of the rectangle and move the cursor
to the place where the opposite corner of the rectangle should be located while
holding the mouse button. The rectangle will be displayed on the screen. To fix
the point, release the mouse button.

3. To draw an ellipse, just draw the rectangle the ellipse is inscribed in.

4. To draw a polygon, click the mouse button to mark each apex and then double-click the
mouse to finish.

5. To cancel an incomplete measurement, press Esc.

These tools are also available from the image context menu and from the Image main
menu item. Activation is only possible with the left mouse button.
The following parameters will be displayed next to the highlighted area:
• minimum intensity value;

• maximum intensity value;

• average intensity value;

• standard deviation;

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• area perimeter;

• area space.

If you apply a filter to an image, you will see an asterisk «*» symbol in the ROI measurement
results line. It informs the user that the measurement results are affected by the filter applied
(see Section 2.6).
An image to which a filter has been applied is not original, and the
measurement results may be inaccurate.

2.19.8 Measuring the Cardiothoracic Ratio (CTR)

Functionality is available in the Pro edition

To measure the cardiothoracic ratio, proceed as follows:

1. Activate the Cardiothoracic ratio tool from the toolbar by clicking the left/right/mid-
dle mouse button. To continue work with this tool, use the button with which the tool
was activated. To learn more about tool control, see Section 1.14.

2. Measure the thoracic diameter by marking points on the inside of the ninth rib (points 1
and 2 in Fig. 2.31).

3. Build the vertebral column axis (points 3 and 4 in Fig. 2.31).

4. Measure the transverse cardiac diameter by marking the outermost points of the left
and the right contours (points 5 and 6 in Fig. 2.31).

5. To cancel an incomplete measurement, press Esc.

Next to the measurement, you can see the following results:

• transverse thoracic diameter (TTD)) in millimeters;

• transverse cardiac diameter (TCD) in millimeters;

• cardiothoracic ratio (CTR) as a percentage.

This tool is also available from the image context menu and from the Image main menu
item. Activation is only possible with the left mouse button.

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Figure 2.31: Measuring the cardiothoracic ratio

2.19.9 Drawing Parameters

To set the default drawing parameters for measurement tools:
1. Click on the arrow on the right side of the measurement tool selection button.
2. Select the item Default tool options....
3. In the dialog box that appears, set the color by clicking on the color box.
4. Set the line thickness and the font size.
5. Set length and area units (millimetres or centimetres).
6. To connect the footnote and the measurement of the dotted line, check the box Foot-
note line.
7. To see the angle between two intersecting Ruler tools, check the Show angles between
rulersPRO box. The box is checked by default.
8. Choose the angle display option:
• if you want only the base angle to be shown, chose the Only onePRO option;
• if you want the base and the adjacent angles to be shown, choose the Both (incl.
adjacent angle)PRO option. This option is selected by default.

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9. To apply the settings, click OK. To cancel, click CANCEL.

Drawing parameters are available as well from the image context menu and from the Image
main menu item.
The settings will be applied only to the measurements conducted in the flat image view
window. For multiplanar reconstruction, similar settings should be saved separately.
To edit the drawing parameters of an existing measurement:

1. Locate the cursor on the measurement to highlight a line or a point.

2. Right-click the mouse.

3. Select the Tool options... item from the context menu.

4. In the dialog box that appears, set the parameters in the same way as the default drawing
parameters.

5. To use these parameters by default, check the box Set as default. Set the measurement
name if necessary.

2.19.10 Move Measurements

To move a measurement:

1. Locate the cursor on the measurement to highlight the line or point or to magnify the
cross, marking the angular point. Do not locate the cursor on angle points.

2. Move the measurement, holding down the left mouse button or the button to which this
tool is assigned. To learn more about tool control, see Section 1.14.

2.19.11 Move Measurement Results

To move a measurement result:

1. Locate the cursor on the measurement so that it is highlighted by a dotted frame.

2. Move the measurement result, holding down the left mouse button or the button to
which this tool is assigned. To learn more about tool control, see Section 1.14.

If the cursor is located on the measurement, the corresponding measurement result will
be highlighted, and vice versa.

2.19.12 Delete Measurements

To delete annotations and measurements, locate the cursor on the measurement to highlight
a line or a point and press the Delete key on the keyboard, or right-click the mouse and select
the Remove object item from the context menu.
To delete all annotaions and measurements, click the Delete all annotations and mea-
surements button on the toolbar or select the corresponding item from the Image main

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menu. In the dialog box that appears, Click YES to delete or NO to cancel. If you want the DI-
COM Viewer to always delete annotations and measurements without this confirmation, check
the box Don‘t show this dialog again and click YES. If you want the DICOM Viewer to show the
confirmation dialog, check the box Ask before deleting all annotations and measurements
(see Section 16.7.1).

Please note that all other graphic objects created manually will be deleted
as well.

2.19.13 Measuring Dimensions and Area during Ultrasound Imaging

The Ruler, Polygonal ruler, ROI rectangle, ROI ellipse and ROI polygon tools may be used
for linear and area measurements on ultrasound images (series with US modality).
Ultrasound study series may contain data on the areas of images with a certain pixel size.
If measuring tools are applied to the area of the image for which the pixel size has been
determined, then the measurement units provided for in the tool parameters will be used for
linear and area measurements (see Section 2.19.9).
If a line or a part of the measuring area stretches beyond the area for which the pixel size
has been determined, linear and area measurements will be performed in pixels.
If the series does not contain any data on the areas for which the pixel size has been
determined, linear and area measurements will be performed in pixels.

2.19.14 Measuring the Time Interval and the Blood Flow Velocity during
Ultrasound Imaging

The Ruler and Polygonal ruler tools may be used for measuring the time interval and the
blood flow velocity when performing ultrasound examination (series with US modality) with
dopplergram.

For the Polygonal ruler tool, the values of the time interval and blood flow
velocity are only shown when the measurement is made by two points.

When measurements are performed, the measurement value is shown on the dopplergram
image next to the segment built, in the X: x s Y: y cm/s format,
where x is the value of the time interval in seconds (s) accurate up to hundredth;
y is the value of the blood flow velocity in cm/s, accurate up to hundredth.
If the measurement is fully or partly performed beyond the Doppler area, the linear dimen-
sion will be shown next to the segment built. In this case, the measurement units depend on
the current algorithm and program settings.
If no image areas are suitable for evaluation of the time interval and the blood flow velocity,
then when a measurement is made, the linear value will be shown next to the segment built.
In this case, the measurement units depend on the current algorithm and program settings.

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2.20 Perfusion Parameters Estimation

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

The following series are suitable for perfusion parameters estimation:

• multiphase MR series. The minimal recommended phase number for brain perfusion
parameters estimation is 40;

• multiphase CT series.

2.20.1 Open series in Perfusion Parameters Estimation mode

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

To open series in perfusion parameters estimation mode:

1. Open a series in the View Flat Images window.

2. Make sure that the series images are sorted by image position and phase (For details
on how to sort images see Section 2.1).

3. Select the main menu Image and the Perfusion item.

The perfusion parameters estimation panel will be displayed on the right side of the win-
dow (Fig. 2.32)
This panel has two tabs: General and Brain perfusion. The General tab allows for evalu-
ation of the parameters of general perfusion analysis for different types of tissue. The Brain
perfusion tab is used for evaluation of the cerebral parameters of brain tissue perfusion.

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Figure 2.32: Perfusion Parameters Estimation mode

If the time interval between phases has not been set automatically, when you open the
perfusion panel, you will see a dialog box (Fig. 2.33) where you need to specify the time
interval between phases (see Section 2.20.2).
If the series is not suitable for Perfusion Parameters Estimation, then the The current series
don‘t fit in perfusion message will be displayed on the Perfusion Parameters Estimation panel.

2.20.2 Setting the Time Interval on the Perfusion Panel

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

The time interval between phases is set automatically on the basis of the DICOM tags for
the series. The tags used for determining the time interval are listed below in order of priority:

• AcquisitionDate (0008,0022) and AcquisitionTime (0008,0032);

• AcquisitionDateTime (0008,002A);

• FrameAcquisitionDateTime (0018,9074);

• ContentDate (0008,0023) and ContentTime (0008,0033);

• TriggerTime (0018,1060).

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If the time interval between phases has not been set automatically, when you open the
perfusion panel, you will see a Perfusion settings dialog box (Fig. 2.33).

Figure 2.33: The Perfusion settings dialog box

Specify the time interval between phases in seconds in the Time interval ∆t (sec) field.
The value provided must be ≥0,01. Click OK to proceed with perfusion parameters estimation
or CANCEL to cancel. When you click CANCEL, the perfusion parameters estimation panel
becomes unavailable. To make another attempt to specify the time interval, relaunch the
perfusion parameters estimation panel.
To see the interval between phases, build a ROI for some tissue or a ROI AIF (see Sec-
tion 2.20.3). The minimum length of a time axis segment shown in the chart is equal to the
time interval between phases (Fig. 2.34).

Figure 2.34: The time interval between phases as shown in the chart

To change the given time interval between phases, click the Settings button on the
perfusion panel. In the Perfusion settings dialog box (Fig. 2.33), change the current value
shown in the Time interval ∆t (sec) field.
After the time interval between phases has been changed, all the parameters for tissue
ROI and maps are reevaluated.

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2.20.3 Brain Perfusion Parameters Estimation

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

To estimate brain perfusion parameters, go to the Brain perfusion tab.

To add a simulated artery input function (AIF), proceed as follows:

1. Click the Add AIF. To create a simulated AIF, choose Simulated in the drop-down list.

2. Provide the following AIF parameters:

• Appearance time (time before the commencement of the first bolus passage);
• Time to concentration peak;
• Concentration peak value;
• Sharpness.

The chart shows a simulated AIF built on the basis of the stated parameters.
Click OK to create a simulated AIF or Cancel to cancel.
To create an AIF with the help of ROI:

1. Find the image that shows the artery.

2. Click the Add AIF button, and choose ROI in the drop-down list.

3. Activate one of the following tools — ROI rectangle , ROI ellipse or ROI

polygon — on the perfusion parameters estimation panel with the left, right, or
middle mouse button. To continue work with the same tool, use the button with which
the tool was activated. For details on tool management, see Section 1.14.

4. Build ROI around the artery. Graphs of artery input fucntion for each ROI pixel will be
displayed at the bottom of the Perfusion Parameters Estimation panel. A ROI AIF graph
is an averaged graph based on the graphs for the selected pixels. By default, all the
pixels are selected.

5. To adjust the constructed ROI AIF, highlight several pixel graphs in ROI. To do that, select
the graphs by left-clicking on them while holding the Ctrl key (or the Command key for
macOS), or else you can move the mouse while holding the left mouse button. All the
pixel graphs are highlighted by default. If you change the ROI, the selected pixel graphs
will be reset. Click OK to build an AIF on the basis of the ROI, or Cancel to cancel.

6. To limit the interval of the phases for which the parameters are calculated, enter the
numbers of the first and the last phase in the respective fields, and press Enter key on
the keyboard. You may also move the interval limits on the chart. To do that, pause the
mouse pointer on the limit so that it appears as and move the limit while holding
the left mouse button.

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7. If the peak on the intensity graph is negative, you need to switch the Type of images to
T2-weighted (the default value). The other value is T1-weighted. The Type of images
setting is only used for MPT study series.

The AIF added will be displayed on the AIF list panel. If the AIF is based on a complete
model, its name will start with the word «Simulated», if it is created with the help of ROI, its
name will start with «ROI». To choose a name for an AIF, left-click the input box and print
the name. All the AIF graphs are shown in dotted line. To apply a certain AIF, click on the
respective AIF switch. To show or hide a certain AIF, check or uncheck the Show box. To
change the pixels selected in ROI, click Settings for the respective AIF. To go to the
image for which the AIF was created, click on the right-hand side of the name. To delete

the selected AIF, click the Delete button.

The charts may show:

• The intensity values (for AIF with ROI, tissue ROI);

• The concentration values (for all the AIF, tissue ROI);

• The response function values (for tissue ROI).

Select Intensity, Concentration, or Response in the drop-down list over the chart. The
Response chart is built for tissue ROI on the basis of the data for the AIF selected.
The X-axis shows the time, while the Y-axis shows the intensity, concentration, or relative
bolus concentration (depends on the chart selected).
To move the chart along the vertical axis, move the mouse up or down while holding the
left mouse button and the Shift key. To resize the chart, move the mouse up or down while
holding the left mouse button and the Ctrl key (or the Command key for macOS). If you check
the Fit to plot box, the graph will be fitted to the window size. This box is checked by default.
If you check the Show label box, the values will be shown in the point where the cursor is
placed. This box is also checked by default.
The concentration graph for ROI objects has the following key points:

• The point showing the commencement of the bolus passage through the tissue ROI (a
round point);

• The point showing the bolus peak concentration in the tissue ROI (a round point);

• The point showing the end of the first bolus passage through the tissue ROI (a round
point);

• The point showing the steepest slope of the concentration curve (a square point).

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Figure 2.35: The panel Brain perfusion

To build a ROI for evaluating the intensity, concentration, or response values, proceed as
follows:

1. Activate one of the following tools — Point value , ROI rectangle , ROI el-

lipse , or ROI polygon — with the left, right or middle mouse button. To
continue work with the same tool, use the button with which the tool was activated. For
details on tool management, see Section 1.14.

2. Build a ROI object for the area you need.

3. Configure the settings jn the General tab:

• In the Range of intensities section, set the minimum and the maximum value of the
intensity range for pixels. A pixel falls within this range if at least one of the values
of the respective graph of intensities built by phases falls within this range. The
following requirements must be met:

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– The values provided must be integers;

– The intensity value in the left field must be smaller than the value in the right
field.
The default values are from 100 to +∞ for MRI-series and from 0 to 300 for CT-
series.
If the ROI does not contain any pixels falling within this range, no graph will be built
for this ROI.
• In the Enable filtering section, you can enable/disable the use of the smoothing
filter for pixel intensity distribution graphs in order to set the signal-to-noise ratio.
By default, the filter is enabled.
– Choose the type of filter in the Filter type drop-down list. By default, the Me-
dian filter is enabled. At present, only one algorithm of raw data conversion
with the median filter has been implemented. The list of filters will be ex-
panded.
– Provide the value in pixels in the Filter radius field. Only integers ≥ 1 must be
entered. The filter radius determines the degree of smoothing for the graph of
intensities (the greater is the value, the higher is the degree of smoothing).
The default value of the filter radius is 1 for MRI series and 3 for CT series.
• In the Remove skin section, you can enable/disable the deletion of skin pixels. By
default, the filter is enabled. Provide integer values in the Opening radius and Di-
lation radius fields. The default values are 10 for Opening radius and 2 for Dilation
radius.

The ROI built will be shown on the Tissue ROI list.

At the top of the perfusion parameters estimation panel, the graphs depicting the changes
in intensity, concentration, or response values across time are shown. These graphs are pre-
sented as a solid line. To switch between the Intensity, Concentration, and Response param-
eters, choose the value you need from the Chart name drop-down list.
You may perform the following actions with the study subjects (AIF with ROI, simulated AIF,
or tissue ROI):

1. Rename.
2. Change a color. Click the color button to the right of the AIF or ROI name.
3. Change visibility. To make an AIF or ROI invisible, uncheck the box for the selected AIF
or ROI.
4. Move the phases. If the patient moves while scanning is being performed, the tissues
for which AIF and ROI are to be built are displaced, and the phases are changed. The
DICOM Viewer provides an opportunity to build AIF and ROI separately for each phase.
To move an AIF or ROI for the current phase, hold down the Ctrl key (or the Command
key for macOS) while moving; for the current and all the following phases hold down
the Shift key; for the current and all the previous phases hold down the Alt key (or the
Option key for macOS). You cannot resize the ROI for a particular phase. If you try to
resize the ROI for a particular phase or phase subset, the ROI for the other phases will
be resized accordingly. Tissue ROI resizing and relocation only affects the evaluation of
the parameters of the selected tissue area.

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5. Move to the next slice. To move an AIF or ROI to the next slice, choose Move ROI to
previous slice or Move ROI to next slice in the right-click menu.

6. Remove. Click the button for selected AIF or ROI.

To go to image containing AIF or ROI, click the button.

The values of the following parameters are shown for ROIs:
• Time to peak (TTP);
• Cerebral blood flow (rCBF);
• Cerebral blood volume (rCBV);
• Time to peak of response (Tmax);
• Mean transit time (MTT).

2.20.4 Map mode

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

To activate the map display mode, check the Enable box on the Map tab of the perfusion
panel. This box is unchecked by default.

a) b)

Figure 2.36: The Map tab of the perfusion panel

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In the Mode drop-down list, choose one of the preset map display modes. The following
map display modes are available:
• Conventional. One map for one selected perfusion parameter is displayed in the series
window. The option is shown in the Mode list as: <Full parameter name>, e.g. Time to
peak (Fig. 2.36a);

• Multimap. Several maps for different perfusion parameters of the same slice are dis-
played simultaneously in the same window. The option is shown in the Mode list as:
<Short name of parameter 1>…<Short name of parameter l>_n×m,
where l=n×m;
n is the number of lines, and m is the number of columns for displaying images in the
series window.
E.g. rCBF-rCBV-MTT-Tmax_2x2 (Fig. 2.36b). In the Map tab, an additional tab bar with
map parameters is displayed.
If you choose the multimap mode, maps are automatically displayed in the series window.
If the multimap mode is enabled, you cannot change the arrangement of the images via the
context menu. To escape from the multimap menu, choose the Conventional mode or disable
the map display function by unchecking the Enable box in the Map tab.
The following modes are available for the General tab:

• Time to peak;

• Area under curve;

• Maximal slope;

• TTP-Area-Slope_1x3.

If at least one AIF has been provided, the following modes are available for the Brain
perfusion tab:

• Time to peak;

• Area under curve;

• Maximal slope;

• TTP-Area-Slope_1x3;

• Cerebral blood flow;

• Cerebral blood volume;

• Mean transit time;

• Time to peak of response;

• rCBF-rCBV-MTT-Tmax_2x2.

If no AIF has been provided, you will only be able to use the modes that are available in
the General tab.
The following parameters are provided for a map:

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 2.20. PERFUSION PARAMETERS ESTIMATION

• CLUTs. A drop-down list of color tables that determine the map color spectrum. The
setting applies to all displayed maps. The «[WL]Map(spectrum)» color table is used by
default. Users may create their own color tables with the Perfusion tag. The user’s color
tables are added to the drop-down list.

• The Range of values table is used for setting the minimum and maximum map values.
If the Automatic selection box is checked, the input fields for the minimum and the
maximum map value percentile ranks are displayed. The minimum percentile rank de-
termines the percentage of pixels for which the parameter value is above the minimum
range value. The maximum percentile rank determines the percentage of pixels for
which the parameter value is below the maximum range value. When the percentile
ranks are set, the entered values are checked. The value range for each field is from 1
to 100. The sum of the minimum and the maximum percentile ranks must be more than
100. If the entered value is invalid, then after you press Enter key on the keyboard, the
previous valid value will be restored.
If the Automatic selection box is unchecked, the input fields for the minimum and the
maximum map values are displayed. The minimum and the maximum map values are
shown at the beginning and the end of the color range. By default, the Automatic se-
lection box is checked, with both percentile ranks at 95%.

• Opacity. By moving the slider, you can set the map opacity.

In the multimap mode, Range of values and Opacity settings are provided separately for
each map for the selected parameter available in this mode. You can select a map from the
tab bar (Fig. 2.36b).

When the map is activated, in the left-hand side of the window you see a color range
(Fig. 2.37). Above the range, you will see the short or abbreviated name of the parameter.
The parameter units are shown in parentheses.

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Figure 2.37: Color Range

To hide the range, uncheck the Show color range box on the Range of values panel. This
box is checked by default. In the multimap mode, the range visibility is set individually for each
parameter.
To change the range values, move your mouse over the upper or the lower bound, so that
it looks like . Then move the bound outwards to enlarge the range or inwards to shrink
it. The bound value will be displayed when moved. When you release the mouse button, the
range will be adjusted and the range values will be saved. The Automatic selection box on
the Range of values panel will be unchecked. In the input fields, you will see the minimum
and the maximum color range values.

2.20.5 Advanced Settings for Bayesian Estimation Algorithm

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

Select the algorithm by clicking the Bayesian estimation radio button in the Advanced tab
on the Brain perfusion panel (Fig. 2.38).

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 2.20. PERFUSION PARAMETERS ESTIMATION

Figure 2.38: Bayesian estimation algorithm selected in the Advanced tab

To set the algorithm parameters, click on the SETTINGS button.

In the Bayesian estimation dialog box (Fig. 2.39) set the following parameters:

Figure 2.39: Bayesian estimation dialog box

• The section Settings of the response function:

– To enable/disable oscillation amplitude regulation for the function graph, check-

/uncheck the Physiological box. Regulation is enabled by default.

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– Specify the oscillation factor value in the Oscillation factor field. Permissible values
are all non-negative real numbers. The default value is 0,01;
The oscillation factor provides for the maximum permissible ratio of the oscillation
amplitude value to the peak value of the response function graph. Figures 2.40
and 2.41 show response function graphs for the same ROI but different oscillation
factor values.

Figure 2.40: Oscillation factor 0,3

Figure 2.41: Oscillation factor 0,01

– The Finite option enables/disables transformations used to create response func-

tion graphs decreasing to zero over finite time after reaching the peak. The option
is enabled by default. Figures 2.42 and 2.43 show response function graphs for
the same ROI but different Finite option values.

Figure 2.42: Option Finite is enabled

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 2.20. PERFUSION PARAMETERS ESTIMATION

Figure 2.43: Option Finite is deactivated

• The following parameters are specified in the Domain parameters section:

– The minimum and maximum Range of the T values. The values provided must be
real numbers. The lower bound must be ≤ -4, while the upper bound must be ≥ 0.
The default range of values is -4 to 40.
– The minimum and maximum Regularization range values. The values provided
must be real numbers. The minimum range value must be ≥ 1. The maximum
range value must comply to the following formula:

αmax
ln( )/(lnα0 ) > 10, (2.1)
αmin

Where αmax is the maximum regularization range value,

αmin is the minimum regularization range value,
and α0 is the regularization factor.
The default range of value is 1 to 1e6 (1000000);
– Regularization factor. The value provided must be a real number more than 1 and
complying to the formula 2.1.
The default value of the regularization factor is set to 2;
– Density factor. The entered value must be an integer greater than 1. The default
setting is 4.

Click the OK button to apply the algorithm settings or CANCEL to cancel.

If any of the parameters is changed, the following values will be reevaluated in the Bayesian
estimation dialog box:

• Parameters for the tissue ROI provided.

• Parameters maps for rCBF, rCBV, MTT, and Tmax parameters (if a map display mode with
one of the listed parameters has been set).

To enable AIF smoothing, check the Fit the AIF data with the gamma-variate function box.
If you enable the smoothing function, the ROI and AIF graphs will be smoothed. Besides, the
TTP, rCBV, rCBF, MTT, and Tmax parameters for ROI and maps will be re-evaluated. Simulated
AIFs are not smoothed as they are initially built with the help of the gamma-variate function.

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To enable the smoothing of concentration charts, check the Fit the AIF tissue concentra-
tion data with the gamma-variate function box. If you enable this function, all the concen-
tration graphs for tissue ROI will be smoothed. Besides, the TTP, rCBV, rCBF, MTT, and Tmax
parameters for ROI and maps will be re-evaluated.
In most cases, if you enable AIF or concentration graphs smoothing, it does not affect the
TTP parameter value.

2.20.6 Deconvolution Advanced Settings

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

To choose a deconvolution algorithm on the basis of singular value decomposition (SVD)

and set its parameters, go to the Advanced tab on the Brain perfusion panel. SVD deconvo-
lution algorithm established by default

Figure 2.44: The Advanced tab of the perfusion panel

To apply one of the SVD deconvolution algorithms and set its parameters, click the respec-
tive option:

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 2.21. EVALUATION OF BLOOD FLOW PARAMETERS

• sSVD: a non-circular algorithm. The regularization method is TSVD, the parameters ad-
justment method is Stationary. The threshold (the default value of 0.2) is provided as
the numeric parameter.

• cSVD: a circular algorithm. The regularization method is TSVD, the parameters adjust-
ment method is Stationary. The threshold (the default value of 0.2) is provided as the
numeric parameter.

• oSVD: a circular algorithm. The regularization method is TSVD, the parameters adjust-
ment method is the oscillation method. The oscillation index (the default value of 0.05)
is provided as the numeric parameter.

• Custom SVD allows for setting individual combinations of regularization methods, pa-
rameters adjustment methods, and their values.

The standard sSVD algorithm is used by default.

To choose a circular custom algorithm, check the Circular box. This box is unchecked by
default.
In the Regularization method drop-down list, choose the regularization method: TSVD
or Tikhonov regularization. In the Parameters adjustment method drop-down list, choose
the adjustment method: Fixed or Oscillation method. The threshold value or the oscillation
method depends on the chosen parameters adjustment method. If you do not know what
value should be provided, leave the default value. If you change the deconvolution settings,
the perfusion parameters (rCBV, rCBF, Tmax, MTT) will be re-evaluated for tissue ROI and
maps. The principles of work of the smoothing functions Fit the AIF data with the gamma-
variate function and Fit the AIF tissue concentration data with the gamma-variate function
are described in Section 2.20.5. In most cases, if you enable AIF or concentration graphs
smoothing, it does not affect the TTP parameter value.

2.21 Evaluation of Blood Flow Parameters

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

The evaluation of blood flow parameters based on phase-contrast images provides for:

• obtaining the data concerned with the blood flow velocity and volume on the basis of
phase-contrast images;

• calculating the pulse-wave velocity (PWV parameter) on the basis of the data obtained.

To evaluate the blood flow parameters, you can use:

• multiphase series of magnitude images or a magnitude MRI (MAG MRI);

• multiphase series of phase-contrast images or a phase-contrast MRI (PC MRI).

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2.21.1 Opening a Series in the Blood Flow Parameters Evaluation Mode

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

To evaluate the blood flow parameters, proceed as follows:

1. Open a suitable magnitude MRI (MAG MRI) series and the respective phase-contrast
MRI (PC MRI) series in the flat image viewer window (Fig. 2.45). Make sure that the
images have been sorted by number and phase (for details see Section 2.1). Each pair
of series (MAG MRI and PC MRI) that can be used for blood flow analysis represents a
separate slice.

Figure 2.45: The windows for MAG MRI and PC MRI series have been
opened in the flat image viewer tab

2. On the Image main menu, choose the Flow analysis item.

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 2.21. EVALUATION OF BLOOD FLOW PARAMETERS

Figure 2.46: Input data for flow analysis dialog box

3. Provide the following parameters in the Input data for flow analysis dialog box (Fig. 2.46):

• the Available series list is automatically filled with the series that have been opened
in the window of the current tab. The search and the choice of a compatible MAG
MRI and PC MRI couple from the list of the series available are performed automat-
ically. The type of each series representing one of the detected slices is specified
as <series type><slice number>, e.g. PC1 or MAG1. The values in the Type column
are highlighted in red if:
– One of the series (MAG MRI or PC MRI) has not been specified for the slice.
– Not all the phase-contrast slice parameters have been provided.
– An attempt to read the sequence of phases from the tags of a phase-contrast
series has failed.
A sequence of phases is an ascending sequence of time values determined for
each slice separately. The first element of the sequence is the value of the Trigger-
Time (0018, 1060) tag of the phase-contrast series. If a value in the Type column is
highlighted in red, an error message will pop up as a balloon tip when you mouse
over this value. If a compatible pair has not been determined automatically, select
the series manually.

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MAG MRI and PC MRI compatibility criteria:

– the same number of phases (obligatory);
– section position and orientation compatibility (obligatory);
– the series must have the MR modality (recommended);
– the series must be multiphase (obligatory);
– the Manufacturer tag must comprise the SIEMENS value (recommended);
– the contents of the ReferencedImageSequence tag sequence must be the
same (recommended);
– the ImageType tag must start with ORIGINAL\PRIMARY\P (for PC MRI) or
ORIGINAL\PRIMARY\M (for MAG MRI) string expression (recommended).
When automatic search is being performed, all the listed criteria are to be taken
into account; if the search is performed manually, only the obligatory criteria must
be met. The series that can be selected manually do not belong to any slice (null
values are assigned to such series in the Type column). To select a compatible
pair of series manually, highlight the PC MRI series and click the PC button. Then
select the respective MAG MRI series and click the MAG button. For each slice, an
individual pair of PC MRI and MAG MRI series must be specified. The compatibility
of the selected series must be tested according to the obligatory criteria.
In the Type column, specify the type in the <series type><slice number> format for
each series representing one of the slices determined, e.g. PC1 or MAG1. If the
highlighted series belongs to a slice that has already been selected, then the PC
and MAG buttons will be unavailable.
If the selected series does not compliance with the obligatory criteria for PC MRI
and MAG MRI selection, a dialog box is displayed with a message that the selected
series cannot be set as PC MRI or MAG MRI.
To delete a slice, select the series corresponding to this slice and click the « — »
button. In the Type column, a null value is assigned to each series representing a
deleted slice. If the selected series does not belong to any of the slices, the « — »
button will be deactivated.
• Slice parameters are used to evaluate general blood flow parameters and are set
automatically on the basis of PC MRI tags:
– Minimum and maximum intensity;
– Minimum and maximum velocity encoding (cm/s). When you specify the pa-
rameter manually, the new value is set for all the slices for which this parameter
cannot be taken from the PC MRI series tags;
– Heart rate (beats/min);
– Max number of automatically detected ROI is used to restrict the maximum
number of vessels ROI set by default when the panel is opened. As the algo-
rithm for automatic recognition of vessel contours creates the list in the order of
descending accuracy, this parameter allows for excluding odd ROI from con-
sideration. The default value of the Max number of automatically detected
ROI parameter is 2 (if only one slice has been selected) or 1 (if two or more
slices have been selected). If the value of this parameter has not been pro-
vided, then the blood flow parameters will be estimated for all the vessels de-
tected automatically.

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 2.21. EVALUATION OF BLOOD FLOW PARAMETERS

Not all the required parameters may be set automatically, but only some of them.
In such a case, the rest of the parameters specified in the dialog box are to be set
manually.

4. Click the OK button to provide the data for blood flow analysis. Click the CANCEL button
to cancel the data input.

If you have not provided all the required parameters in the Input data for flow analysis
dialog box (Fig. 2.46), the OK button will be inactive.

The vessels ROI that are built in the MAG MRI series window are reproduced in the PC MRI
series window. The blood flow analysis panel where the obtained results for all the vessels
found will be presented as graphs and tables will appear on the right-hand side of the tab
(Fig. 2.47).
When one of the windows (MAG MRI or PC MRI) is closed, the blood flow analysis panel is
deactivated and all the vessels, as well as the evaluation results, are deleted.

Figure 2.47: Blood flow parameters evaluation mode

On the General tab, general blood flow results are analyzed for each vessel detected.
On the PWV tab advanced analysis of blood flow results is performed, which includes the
calculation of additional parameters, such as: pulse wave velocity (PWV) and pulse transit
time (PTT).

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2.21.2 Changing the Configuration Parameters for a PC MRI Series

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

To change the configuration parameters for a PC MRI series in the process of work, click
the PC MRI parameters button on the blood flow analysis panel. The current values of
the parameters are shown in the PC MRI parameters dialog box (Fig. 2.48).

Figure 2.48: he dialog box for changing the PC MRI parameters

Change the values of the parameters. If you have not provided all the required parameters
in the PC MRI parameters dialog box, the OK button will be inactive.
To reevaluate the blood flow parameters for all the vessels considered, click the OK button.
To cancel, click the CANCEL button.

2.21.3 Building and Editing Vessels ROI

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

To evaluate general blood flow parameters for each of the vessels detected, go to the
General tab.
To add ROI for the vessels that have not been included in the list by default, proceed as
follows:

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 2.21. EVALUATION OF BLOOD FLOW PARAMETERS

1. With the left, right or middle mouse button, activate the Detect vessel ROI by
point tool on the panel for blood flow parameters evaluation. Use the same button to
work with the tool. For details on working with tools, see Section 1.14.

Attention! The tool works only in the MAG MRI window selected in the
“Input data for flow analysis” dialog box (Fig. 2.46). If you choose a window
from a different series, you will be notified that the tool is not available for
the window selected.

2. Click on a magnitude image (MAG MRI), at a point where you expect to find a vessel.
The ROI for the vessel detected will be built for all the phases, with consideration for the
position and the size of the vessel section in each phase. A new vessel will be added
to the list placed on the blood flow parameters evaluation panel, and the parameters
evaluated will be presented as graphs and tables. If no vessel ROI is detected in the
point specified, you will be notified that there is no vessel ROI at this point.

The Detect vessel ROI by point tool may be used for restoring the vessels that were
deleted earlier.
To build or edit a vessel ROI with contour lines, proceed as follows:

1. With the left, right or middle mouse button, activate the Vessel ROI (contour) tool
on the panel for blood flow parameters evaluation. Use the same button to work with
the tool. For details on working with tools, see Section 1.14.

2. Press and hold the mouse button to create a contour. Release the button to finish the
process and to close the contour. A new vessel will be added to the list placed on the
blood flow parameters evaluation panel, and the parameters evaluated will be presented
as graphs and tables.

The Vessel ROI (contour) tool provides an opportunity to edit the ROI of automatically
detected vessels.
On the PWV tab, the Vessel ROI (contour) tool is only available for editing vessels ROI.
Edit the ROI for each phase. The following editing methods are available:

• changing the ROI shape. o change the ROI shape, mouse over the contour of the ROI
to be edited. The ROI contour line will be highlighted. Press the mouse button at the
point where you want to edit the contour and draw a new line while holding the button.
Release the mouse button to finish the editing process. All the blood flow parameters
for the vessel will be reevaluated. Press Esc on your keyboard while still holding the
mouse button to cancel the building or editing operations for the current contour;

• moving the ROI. o move a ROI, mouse over the contour of the ROI to be moved. Move
the mouse while holding the mouse button and the Shift key on the keyboard.

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2.21.4 Blood Flow Analysis Panel. Displaying the Results of General Blood
Flow Analysis

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

On the General tab, general blood flow results are analyzed for each vessel detected. The
results of general blood flow analysis are presented as graphs and tables.
On the coordinate plane (Fig. 2.49) graphical data for the parameter selected from the
drop-down list are presented:

• Mean velocity;

• Velocity dispersion;

• Area;

• Total flow.

Figure 2.49: Mean velocity parameters graphs for the vessels detected

The time values are shown on the x-axis, while the values of the parameter chosen from
the drop-down list are shown on the y-axis. The range of values for the time axis is formed by
combining the phase sequences for all the slices. The resulting sequence does not contain

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 2.21. EVALUATION OF BLOOD FLOW PARAMETERS

any matching values and is sorted in ascending order. The current phase position is marked
by a blue slider. In the series window, the phase that is the closest to the time value marked
by the slider on the graph is selected as the current phase. To change the current phase,
mouse over the slider so that the cursor is displayed as . While holding the left mouse
button, move the slider to the right or to the left. When you move the slider, the current phase
is changed in PC MRI and MAG MRI windows. When you change the current phase, the results
presented in the Current phase parameters table are also changed (Fig. 2.51).
To move the graph along the y-axis, move the mouse up and down while holding the left
mouse button and the Shift key on the keyboard. To scale the graph, move the mouse up and
down while holding the left mouse button and the Ctrl key (or the Command key for macOS)
on the keyboard.
To smooth the graphical data by cubic spline interpolation, check the Use smoothing box.
By default, this option is disabled. The Fit to plot box is used to adjust the graph to the size of
the window. The box is checked by default. The Show label box is used to show the position
of the point where the cursor is placed. By default, this option is disabled.
The Vessels table (Fig. 2.50) is used to adjust the display settings for the vessels ROI and
graphs. The table shows the number of the slice with the vessel. When you mouse over a cell
with a slice number, a balloon tip with the basic data on the slice pops up.

Figure 2.50: The Vessels table on the blood flow analysis panel

You can perform the following actions with the settings for vessels ROI and graphs:
• renaming. Double-click on the name of the vessel with the left mouse button. Type the
new name and press Enter n the keyboard. The new name of the vessel will be shown
in the respective cells of the tables displaying the blood flow parameters;
• changing the color. Click on the color icon next to the name of the vessel and select
the color in the dialog box. The color icon, the ROI contours for all the phases, and the
graphs for the selected vessel will be changed accordingly;
• adjusting visibility. To hide/show the ROI contours for all the phases, as well as the
graphs for the selected vessel, tick/untick the Show box;
• inverting the graph. To invert the graph values (reverse the sign), check the Invertbox.
By default, this box is only checked for the vessels with backward blood flow volume.
The graph values are inverted for Mean velocity and Total flow parameters;

• deleting. To delete a selected vessel, click the button. All the data for this vessel
will be deleted: the ROI for all the phases, the graph and the evaluation results from the
tables, the blood flow parameters.

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The deleted vessel may be restored with the Detect vessel ROI by point tool (see
Section. 2.21.3).
In the Current phase parameters table (Fig. 2.51), you will find the basic blood flow param-
eters:

• Mean velocity (v_mean);

• Velocity dispersion (Disp);

• Area;

• Total flow (F_total).

Figure 2.51: The Current phase parameters table on the blood flow
analysis panel

Tick the Show extended parameters box to display the following additional parameters in
the table:

• Min velocity (v_min);

• Max velocity (v_max);

• Positive flow (F_positive);

• Negative flow (F_negative).

The parameters shown in the Current phase parameters table are time-dependent and
change with the current phase.
In the Integral parameters table (Fig. 2.52), the values of the following parameters are
shown:

• Net volume (V_net);

• Forward volume (V_forward);

• Backward volume (V_backward);

• Cardiac output (CO).

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 2.21. EVALUATION OF BLOOD FLOW PARAMETERS

These parameters are not time-dependent and do not change with the current phase.

Figure 2.52: The Integral parameters table on the blood flow analysis
panel

2.21.5 Evaluating the General Blood Flow Analysis Parameters

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

The following parameters are calculated while performing general blood flow analysis:
• Phase parameters:

– Mean velocity (vmean , measured in cm/s). This parameter is calculated as the mean
value for all the velocity values evaluated for each point of the ROI. The velocity for
a particular ROI point is calculated according to the formula below:

(Ik –Imin )
Vk = V EN Cmin + ∗ (V EN Cmax –V EN Cmin ), (2.2)
(Imax –Imin )

where Vk is the velocity at the k-th point of ROI;

Ik is the intensity value at the k-th point of ROI;
Imin is the minimum intensity for the series;
Imax is the maximum intensity for the series;
V EN Cmin is the minimum velocity encoding value;
V EN Cmax is the maximum velocity encoding value;
– Velocity dispersion (Disp). This parameter is calculated as the velocity variance
for each point of the ROI;
– Area (Area, measured in cm2 ). This parameter is calculated as the area of the ROI;
– Total flow (Ftotal , measured in ml/s). The value is calculated according to the for-
mula below:

Ftotal = vmean ∗ Area (2.3)

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– Min velocity (vmin , measured in cm/s). The value is calculated as the minimum
velocity among all the points of the ROI;
– Max velocity (vmax , measured in cm/s). The value is calculated as the maximum
velocity among all the points of the ROI;
– Positive flow (Fpositive , measured in ml/s). The value is calculated according to the
formula below:

Fpositive = vmean positive ∗ Areapositive (2.4)

where vmean positive is the mean velocity for all the ROI points with positive velocity
values,
Areapositive is the area of all the points with positive velocity values;
– Negative flow (Fnegative , measured in ml/s). The value is calculated according to
the formula below:

Fnegative = vmean negative ∗ Areanegative (2.5)

where vmean negative is the mean velocity for all the ROI points with negative velocity
values,
Areanegative is the area of all the points with negative velocity values;

• Integral parameters:

– Net volume (Vnet , measured in ml). The value is calculated according to the formula
below:
∫ tn
Vnet = Ftotal dt (2.6)
t0

where Ftotal is the blood flow,

t0 is the time of the first phase,
tn is the time of the last phase;
– Forward volume (Vf orward , measured in ml). The value is calculated according to
the formula below:
∫ tn
Vf orward = Fpositive dt (2.7)
t0

where Fpositive is the positive blood flow,

t0 is the time of the first phase,
tn is the time of the last phase;
– Backward volume (Vbackward , measured in ml). The value is calculated according to
the formula below:

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 2.21. EVALUATION OF BLOOD FLOW PARAMETERS

∫ tn
Vbackward = Fnegative dt (2.8)
t0

where Fnegative is the negative blood flow,

t0 is the time of the first phase,
tn is the time of the last phase;
– Cardiac output (CO, measured in l/min). The value is calculated according to the
formula below:

CO = Vnet ∗ HR (2.9)

where Vnet is the blood flow volume,

HR is the heart rate.

2.21.6 Designing a Trajectory for the Pulse Wave

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

You need to build a trajectory for the pulse wave to calculate the Pulse wave travel dis-
tance auxiliary parameter, which is used for Pulse wave velocity parameter evaluation.
Attention! To build the pulse wave trajectory, the study must contain a
sagittal plane series.
If there is no sagittal plane series in the study, but the pulse wave travel distance is known,
it can be entered manually by the user in the PWV settings dialog box (Fig. 2.53). For details
see Section 2.21.7.
To design a pulse wave trajectory, proceed as follows:
1. Open the MAG MRI and PC MRI series in the blood flow parameters evaluation mode
(for details see Section 2.21.1).
2. Open a sagittal plane study series. To simplify the process of building the trajectory, we
advise you to enable the display of scout lines in the selected window (see Section 2.26).
3. Go to the PWV tab. When you first click on the PWV tab the PWV settings dialog box
is displayed (Fig. 2.53).
Any two sections of the same vessel placed on the same slice or on different
slices may be selected as the input and output vessels. The vessel
characterized by a smaller time to peak value of the blood flow graph is
selected as the input vessel. If the time to peak values are the same for both
vessels, the one placed higher on the Vessels table is selected as the input
vessel. The PWV tab will be available after such a pair of vessels has been
found.

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4. In the PWV settings dialog box (Fig. 2.53), you will see the list of the series opened in
the current study window, except for those that have been selected as the PC MRI and
MAG MRI. Select a sagittal plane study series.

Figure 2.53: The PWV settings dialog box

To proceed with building the pulse wave trajectory, click the OK button, to go back to
the General tab, click CANCEL.

If you have not chosen a series from the Sagittal MRI ist or entered the pulse wave travel
distance value (for details see Section 2.21.7), the OK button will be disabled.

5. Activate the Pulse wave travel path tool on the panel for blood flow parameters
evaluation with the left, right, or middle mouse button. Use the same button to work with
the tool. For details on working with tools, see Section 1.14.

Attention! The «Pulse wave travel path» tool may only be activated may if
the current tab is the «PWV» tab.

6. Press and hold the mouse button to build the trajectory. Release the button to finish the
process. The trajectory must connect the two different slices of the vessel (Fig. 2.54).
The pulse wave trajectory is smoothed to fend off aliasing which causes lengthening of
the curve.

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Figure 2.54: Designing a Pulse Wave Trajectory

7. To edit a trajectory, mouse over the line to be edited. The trajectory line will be high-
lighted. Press the mouse button at the point where you want to edit the trajectory and
draw a new line towards one of the ends of the trajectory while holding the button. Re-
lease the mouse button to finish the editing process. All the parameters for advanced
blood flow analysis will be reevaluated. Press Esc on your keyboard while still holding
the mouse button to cancel the trajectory building or editing operations.

You can change the Pulse Wave Travel Distance (PWTD) value in three ways:

• by editing the trajectory of the pulse wave;

• by clicking on the PWV settings button and enter a new value in the dialog box.
Previously constructed pulse wave trajectory is removed;

• by manually changing the value in the PWTD column of table Pulse wave parameters.
Previously constructed pulse wave trajectory is removed.

If after returning to the General tab, you delete one of the vessels considered in the pro-
cess of advanced blood flow analysis, the pulse wave trajectory and the pulse wave parame-
ters (PWTD, PTT, and PWV) will be deleted.
If you close the sagittal plane window, the pulse wave trajectory designed will be deleted,
but the PWTD, PTT, and PWV parameters will be saved.

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2.21.7 Getting the Results of Advanced Blood Flow Analysis without Build-
ing a Pulse Wave Trajectory

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

If there is no sagittal plane series in the study, but the pulse wave travel distance is known,
you may enter this value manually to display the results of advanced blood flow analysis.
To get the results of advanced blood flow analysis without building a pulse wave trajectory,
proceed as follows:
1. Open the MAG MRI and PC MRI series in the blood flow parameters evaluation mode
(for details see Section 2.21.1).
2. Go to the PWV tab. When you first click on the «PWV» tab the PWV settings dialog box
is displayed Fig. 2.55).
Any two sections of the same vessel placed on the same slice or on different
slices may be selected as the input and output vessels. The vessel
characterized by a smaller time to peak value of the blood flow graph is
selected as the input vessel. If the time to peak values are the same for both
vessels, the one placed higher on the Vessels table is selected as the input
vessel. The PWV tab will be available after such a pair of vessels has been
found.

3. In the PWV settings dialog box (Fig. 2.55), enter the pulse wave travel distance value
(in millimeters).

Figure 2.55: The dialog box for providing the pulse wave travel distance
value

To get the results of advanced blood flow analysis, click the OK button. To go back to the
General tab, click the CANCEL button.
you have not provided the pulse wave travel distance value in the dialog box (Fig. 2.55),
the OK button will be inactive.
You can change the Pulse Wave Travel Distance (PWTD) value in two ways:

• by clicking on the PWV settings button and enter a new value in the dialog box;

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• by manually changing the value in the PWTD column of table Pulse wave parameters.

2.21.8 Blood Flow Analysis Panel. Displaying the Results of Advanced

Blood Flow Analysis

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

The results of advanced blood flow analysis are displayed as graphs and tables.
Chart display settings are configured similarly to the settings of charts on the General tab
(see Section 2.21.4).

Figure 2.56: The graphs showing the blood flow parameters for the
selected pair of vessels

The Vessels table (Fig. 2.57) s used to customize the display settings for the vessels’ ROI
and graphs.

Figure 2.57: The Vessels table

The ROI display and vessels graph settings are described in the Section 2.21.4.

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In the Current phase parameters table are displayed the blood flow parameters. Similar
to the table on the General tab (see Section 2.21.4).
In the Integral parameters table integral blood flow parameters are displayed. Similar to
the table on the General tab (see Section 2.21.4).
In the Pulse wave parameters table (Fig. 2.58) you will see the results of the evaluation of
the following parameters:

• Pulse wave travel distance (PWTD).There are three ways to specify this parameter:

– manually, in the PWV settings dialog box (see Section 2.21.7);

– manually, in the PWTD column of the Pulse wave parameters table;
– by way of building a pulse wave trajectory (see Section 2.21.6).

• Pulse transit time (PTT);

• Pulse wave velocity (PWV).

Figure 2.58: The Pulse wave parameters table

If the PWTD parameter has not been specified, in the respective cell of the table, you will
see a No data sign instead of the assessment result. The PTT and PWV parameters will be
calculated automatically. If an error occurs during the calculation procedure, you will see a No
data sign in the cell for the respective parameter.
In the section named Calculation method of PTT, you choose the method of calculating
the pulse transit time:

• Foot-to-foot (the default value);

• Peak-to-peak.

The Use interpolation check box enables cubic spline interpolation of the data for PTT
calculation. When you check/uncheck this box, the PPT and PWV parameters will be reeval-
uated.

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2.21.9 Evaluation of the Parameters for Advanced Blood Flow Analysis

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

In advanced blood flow analysis for the vessel slices pair, the PWV parameter is calculated
based on two auxiliary parameters.
Advanced blood flow analysis implies the calculation of additional parameters, such as:
• Pulse wave travel distance (P W T D, measured in mm). This parameter is calculated as
the distance between a pair of vessel slices. The trajectory between the sections may
be built with the Pulse wave travel path tool;
• Pulse transit time (P T T , measured in ms). This parameter is calculated on the basis of
the blood flow graphs of vessel slices by two methods:
– Foot-to-foot. The value is calculated according to the formula below:

P T T = T T FOV − T T FIV (2.10)

where T T FOV is the time to the foot of the output vessel graph,
T T FIV is the time to the foot of the intput vessel graph;

Figure 2.59: Graphical interpretation of the Foot-to-foot method

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– Peak-to-peak. The value is calculated according to the formula below:

P T T = T T POV − T T PIV (2.11)

where T T POV is the time to the peak of the output vessel graph,
T T PIV is the time to the peak of the intput vessel graph;

Figure 2.60: Graphical interpretation of the Peak-to-peak method

• Pulse wave velocity (P W V , measured in m/s). The value is calculated according to the
formula below:

P W V = P W T D/P T T (2.12)

2.21.10 Blood Flow Parameters Evaluation for Two Slices

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

Each pair of series (MAG MRI and PC MRI) that can be used for blood flow analysis repre-
sents a separate slice. Besides the PWV parameter evaluation, work with two or more slices

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provides an opportunity to compare common blood flow parameters for sections of the ves-
sels placed on different slices.

To perform blood flow parameters evaluation for two slices, proceed as follows:

1. Open several pairs of series (MAG MRI and PC MRI) suitable for blood flow analysis. Each
pair of series represents a separate slice. Provide the missing parameters if required
(see Section 2.21.1).

Figure 2.61: The mode for blood flow parameters evaluation on the basis
of two slices

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Figure 2.62: The dialog box for changing PC MRI parameters for each
slice

2. To change the configuration parameters for a PC MRI series, click the PC MRI
parameters button on the blood flow analysis panel. in the PC MRI parameters dialog
box (Fig. 2.62) change the current parameter values for each slice. For more information
see Section 2.21.2.

3. Build or edit the vessel ROI for each slice (see Section 2.21.3).

On the General tab, general blood flow results are analyzed for each vessel detected.
The results of general blood flow analysis are presented as graphs and tables. For more
information see Sections 2.21.4 and 2.21.5).

4. To evaluate the PWV parameter, build a trajectory for the pulse wave between the se-
lected vessel sections Fig. 2.63, (see Section 2.21.6). If there is no sagittal plane series
in the study but the pulse wave travel distance is known, enter the value manually (see
Section 2.21.7).

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Figure 2.63: Trajectory for the pulse wave between the slices

In the PWV tab (Fig. 2.64) of the blood flow analysis panel, the results of advanced blood
flow analysis are shown as graphs and tables (see Sections 2.21.8 and 2.21.9).

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Figure 2.64: The results of advanced blood flow analysis for two slices

2.22 Image Stitching

Functionality is available in the Pro edition

If a study or several studies contain series obtained as a result of scanning different seg-
ments of a single longer area, these multiple images can be combined in the image stitching
mode. The result of image stitching can be exported to the current study, as well as to a new
series or file (see Section 2.22.7). It can also be printed (see Section 2.22.8).
The stitching option is only available for images meeting the following criteria:

• monochrome image. The permissible values of the PhotometricInterpretation (0028,

0004) tag are MONOCHROME1 or MONOCHROME2;

• square pixel image. The ratio of pixel side dimensions is determined by the values of
the PixelSpacing (0028,0030) or ImagerPixelSpacing (0018,1164) tags. If the pixel side
dimensions are not specified in the tags, the pixel is considered to be square.

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2.22.1 Opening a Series in the Image Stitching Mode

Functionality is available in the Pro edition

To open a series in the image stitching mode, proceed as follows:

1. Open the respective series in the flat image viewer tab (see Section 2.1).

2. Open the series with the images to be stitched. If you need to stitch images from series
related to different studies, add these series to the current tab. To do that, go to the tab
with the study list, select the respective study and drag the series related to this study
to the open Image viewer tab stub. The series for the selected study will be added to
the series panel for the current tab.

3. Select the window with the series that will be used as the first (basic) image. It is recom-
mended to choose the first image that will be placed in the center of the stitched image
and will overlap with as many other images as possible. Go to the respective image from
the selected series (see Section 2.7).

4. On the main Image menu, select the Image stitching option or press the Ctrl+Shift+X
key combination (Command+Shift+X for macOS).

Figure 2.65: Image Stitching mode

Activation of the Image stitching mode leads to deactivation of Perfusion,

Flow analysis or Image annotation modes that were active before.

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On the right-hand side of the Image viewer tab, the Stitching view window and the image
stitching functional toolbar (see Fig. 2.65) will appear. The image from the selected window
is automatically added to the Stitching view window. If several images of the series are dis-
played in the series window, the first image will be added to the Stitching view window.
There are several ways to exit the Image stitching mode:

• on the main Image menu, select the Image stitching option once again;

• press the Ctrl+Shift+X key combination (Command+Shift+X for macOS);

• close the Stitching view window.

If you exit the Image stitching mode, the Stitching view window and the image stitching
functional toolbar are closed without saving the stitching results.

2.22.2 Image Stitching Functional Toolbar

Functionality is available in the Pro edition

The image stitching functional toolbar is placed on the right-hand side of the Image viewer
tab (Fig. 2.65) and contains:

• the Stitching view window where images added for stitching or stitching results are
displayed;

• a vertical toolbar for working with images in the Stitching view window;

• a panel with the list of images added for stitching. The images added to the Stitching
view window are shown on the list as thumbnails. The order in which the images were
added to the Stitching view window is shown on the thumbnails in the form of numbers.
Next to each thumbnail in the Stitching view window, there is an opacity slider for the
respective image.

Tools on the image stitching functional toolbar:

The Add image button adds images from the selected series window to the
Stitching view window and to the list of images on the stitching panel
The Remove selected images button removes selected images from the
Stitching view window and from the list of images on the stitching panel
The Flip horizontally button flips the image selected on the stitching list in
the horizontal plane
The Flip vertically button flips the image selected on the stitching list in the
vertical plane

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The Manual image fusion button is used for moving, scaling, and rotating
images in the Stitching view window (see Section 2.22.4)
The Reset all transformations button resets all the transformations for the
selected images in the Stitching view window
The Reset zoom button resets the scaling changes for the selected images in
the Stitching view window
The Merge image automatically button automatically merges the image
selected on the list of images on the stitching panel with other images (see
Section 2.22.5)
The Recalculate intensities by W/L button sets the same intensity range for
all the images in the Stitching view window. It is recommended to use this
tool for stitching images with different intensity ranges
The Stitching mode button enables the stitching of images added to the
Stitching view window (see Section 2.22.6)

The user may assign a hotkey to each tool on the image stitching functional toolbar (see
Section 16.8).

2.22.3 Adding Images for Stitching

Functionality is available in the Pro edition

To add images to the Stitching view window, proceed as follows:

1. Open the respective series in the flat image viewer tab, activate the Image stitching
mode (see Section 2.22.1).
2. Select the window with the series containing the image to be stitched with the basic
image. Select the image (see Section 2.7).
3. Add the selected image by one of the following methods:

• click the Add image button on the image stitching toolbar;

• mouse over an image in the selected series window and drag it to the Stitching
view window while holding the left mouse button.

The value of the «PhotometricInterpretation» tag for the image added to the
Stitching view window must be the same as the value of the
«PhotometricInterpretation» tag for the first Image.
If the pixels of the images are all square, but their sizes are different, a message will pop
up notifying the user of this problem. The images will be added to the Stitching view window.
For the stitching function availability criteria, see Section 2.22.

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The image from the selected series window will be added to the Stitching view window.
A thumbnail for the image will be added to the list of images on the stitching panel.
To delete an image from the Stitching view window, select the image thumbnail and click
the Remove selected images button on the toolbar. The selected image will be deleted
from the Stitching view window and from the list of images on the stitching panel.

The first (basic) image cannot be deleted from the Stitching view window.

2.22.4 Merging Images Manually

Functionality is available in the Pro edition

To merge images manually, proceed as follows:

1. From the list of images on the stitching panel, select the thumbnail of the image to be
merged with the first (basic) image in the Stitching view window.

2. Click the Manual image fusion button with the left, right, or middle mouse button.
To continue work with the tool, use the same button you used to activate it. For details
on tool management, see Section 1.14.

3. Merge the selected image with the basic image in the Stitching view window. To do
that, proceed as follows:

• drag the selected image while holding the mouse button that was used for activat-
ing the tool;
• rotate the image while holding the Alt key (or the Option key for macOS) and the
mouse button which was used for activating the tool;
• zoom the image while holding the Ctrl key (or the Command key for macOS) and
the mouse button that was used for activating the tool.

You cannot change the position, scale, or orientation of the first (basic)
image.

4. To cancel all the transformations for the selected image, click the Reset all transforma-
tions button.

5. To cancel scaling for the selected image, click the Reset zoom button.

After the images have been merged, stitch them by clicking the Stitching mode
button on the image stitching functional toolbar (see Section 2.22.6).

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2.22.5 Merging Images Automatically

Functionality is available in the Pro edition

To merge images automatically, proceed as follows:

1. From the list of images on the stitching panel, select the thumbnail of the image to be
merged with the first (basic) image in the Stitching view window.

2. Click the Merge image automatically button on the image stitching functional
toolbar.

The automatic fusion function is not available for the first (basic) image.

Automatic fusion can be performed inaccurately. For better result, move the selected
image closer to the place of fusion (see Section 2.22.4), and then use the automatic fusion
function.
After all the images have been merged, stitch them by clicking the Stitching mode
button on the image stitching functional toolbar (see Section 2.22.6).

2.22.6 Stitching Merged Images

Functionality is available in the Pro edition

Stitching provides an opportunity to combine several images in a single panorama. To use

the stitching mode, proceed as follows:

1. Merge the images in the Stitching view window manually (see Section 2.22.4) or auto-
matically (see Section 2.22.5).

2. Click the arrow on the right-hand side of the Stitching mode button on the image
stitching functional toolbar and select one of the stitching options. The selected stitching
option will be used by default each time you click the Stitching mode button.

• Cut overlapped. The intensity value in the area of overlap is set equal to the inten-
sity value of the image whose position number is smaller. This option is checked
by default as the default stitching option;
• Mix overlapped. The intensity value in the area of overlap is set as the mean in-
tensity value for all the overlapping images.

3. Click the Stitching mode button on the image stitching functional toolbar. The
image in the Stitching view window will look similar to Fig. 2.66 (on the left, you can see
the merged images before stitching, on the right — after stitching).

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Figure 2.66: Changes after activation of the stitching mode (the stitched
image is displayed on the right)

When the stitching mode is activated (the Stitching mode button on the image
stitching functional toolbar is highlighted), the opacity settings are reset and the image opacity
sliders are locked.

2.22.7 Exporting Stitching Results

Functionality is available in the Pro edition

Stitching results can be exported to the current study, to a new series, or to a file with .png
or .jpg extension in a given directory (see Section 2.28).
Before exporting stitching results, select the Stitching view window and activate the stitch-
ing mode by clicking the Stitching mode button on the image stitching functional toolbar.

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2.22.8 Printing the Image Stitching Results

Functionality is available in the Pro edition

The DICOM Viewer provides an opportunity to print image stitching results on both, paper
and film (see Chapter 19).
Before adding stitching results to the print list, select the Stitching view window and ac-
tivate the stitching mode by clicking the Stitching mode button on the image stitching
functional toolbar.

2.23 Visualize Images

2.23.1 Select CLUT
Select the CLUT (colour look-up table) from the drop-down menu on the rendering setup panel
(Fig. 2.67).

Figure 2.67: Rendering setup panel

You can choose from the following groups of CLUTs:

• relative [WL];

• absolute CT and XA;

• special, Palette color. This type of CLUT is used for adequate display of the images be-
longing to series where there is at least one image with the
Photometric Interpretation (0028,0004) tag value equal to PALETTE COLOR.

If, when a series is opened, the first image displayed has the
Photometric Interpretation (0028,0004) tag value equal to PALETTE COLOR, the Palette color
CLUT will be automatically selected. If the first image displayed has a different Photometric
Interpretation (0028,0004) tag value, the relative [WL] CLUT will be selected for the group. In
this case, you will have to select the Palette color CLUT manually to view the images with the
PALETTE COLOR value of the Photometric Interpretation (0028,0004) tag.
When the Palette color CLUT is used, the Custom W/L button is unavailable.

2.23.2 Edit CLUTs List

To edit the list, open the CLUTs setup tab by clicking the CLUTs button. The tab is shown
in Fig. 2.68.

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Figure 2.68: CLUTs setup tab

CLUTs setup panel is located on the right-hand side of the window (Fig. 2.69).

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 2.23. VISUALIZE IMAGES

Figure 2.69: CLUTs setup panel

The CLUTs list edit buttons are located at the top of the panel.

Add a new CLUT as a copy of the current one adds a new CLUT as a copy of the
selected one

Add a new group adds a new group of CLUTs

Remove the selected CLUT/group deletes the selected CLUT or group.

Predefined groups and some CLUTs cannot be deleted
Reset the selected CLUT to its original state sets up default parameters for the
selected CLUT

Edit CLUT/group opens the CLUT or group setup dialog

The groups contain several CLUTs (e.g., WL, CT, XA) and are intended for structuring the
list. They are marked by the arrow (Fig. 2.70) on the drop-down menu (Fig. 2.67). For the
description of the process of assigning the group type to the user CLUTs, see Section 2.23.4.

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Figure 2.70: Group of CLUTs

To add a new group, set the following parameters in the dialog box (Fig. 2.71):

1. Name: any name of group;

2. Required tags: labels that must contain CLUTs to be included in the group.

Figure 2.71: Group setup dialog box

2.23.3 CLUT Parameters

To browse the settings for the selected CLUT, click the Rendering transfer function
button. The panel displaying the visualization transfer function graph will appear at the bottom
of the study window (see the example in Fig. 2.72).

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 2.23. VISUALIZE IMAGES

Figure 2.72: Rendering transfer function graph

You cannot change the setup parameters for predefined CLUTs.

Intensity will be displayed on the horizontal axis, while the number of points with a particu-
lar intensity will be shown on the vertical axis (blue line). The default scale may not allow you
to see the intensity distribution graph (blue) at once. To change the horizontal axis scale, move
the scroll under the axis or roll the mouse wheel while the cursor is located on the scrollbar.
The scale value will be displayed to the right of the scrollbar. To change the vertical axis scale,
roll the mouse wheel while the cursor is located on the visualization setup panel, but not on
the scrollbar. Fig. 2.73 shows the same graph as in the previous figure, but with a greater
intensity distribution scale (on the vertical axis).

Figure 2.73: Intensity distribution graph with a greater vertical axis scale

The color/transparency chart (white line) is superimposed on the intensity distribution scale.
The horizontal axis shows the intensity, and the vertical axis shows the transparency of the
color highlighting the points with this intensity. The color is displayed below the graph. The
horizontal axis scale changes for both graphs simultaneously, while the vertical axis scale for
the color/transparency chart does not change. To move the graph along the horizontal axis,
hold the left mouse button.

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Figure 2.74: Displaying the window level and width edges

To show the current edges of the window level and width (W/L) in the histogram window,
click the Adjust W/L button on the rendering transfer function panel. This mode is
switched on by default. The current edges of the window level and width are displayed as
blue vertical lines in the histogram window (Fig. 2.23.3).
The DICOM Viewer provides an opportunity to adjust the edges of the window level and
width in the histogram window. To do it, mouse over one of the edges so that the cursor is
displayed as . Move the edge while holding the left mouse button. On the flat image
viewer tab, the edges of the window level and width are only displayed for relative CLUTs (the
CLUTs with the [WL] group label). If the CLUT selected on the Image viewer tab is absolute
(and has a CT group label), the edges of the window level and width will not be shown in
the histogram. The Adjust W/L button on the rendering transfer function panel will
be disabled. On the MPR reconstruction and Volume reconstruction tabs, the edges of the
window level and width will be shown in the histogram for all the types of CLUTs.
To find out what percentage of tissue has a density in a given range, click on the Histogram
percentage button, move the cursor to the beginning of the range and move the cursor
to the end of the range, holding the left mouse button. The percentage of tissue that has a
density within the range is indicated in red (fig. 2.75). To edit a range, move the cursor to its
border and move the border with the left mouse button pressed. To move a range, move the
cursor on it so that the cursor would look as follows , and move the cursor, holding the
left mouse button. Multiple ranges can be built at the same time. To remove the built ranges,
click the Histogram percentage button again.
To export data on the distribution of densities, click on the button, in the dialog that
opens, specify the file name and folder, click Save to finish or Cancel for cancel.

Figure 2.75: Histogram percentage

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2.23.4 Create and Edit CLUT

To create your own CLUT:

1. Click the CLUTs button to open the CLUT setup tab.

2. Copy one of the existing CLUTs by selecting it from the list and clicking on the Add a
new CLUT as a copy of the current one button.

3. To rename a CLUT, double-click the left mouse button on it, enter the new name and
press the Enter key on the keyboard. In our example, in Figure 2.69, the table is renamed
«[WL]Example».
4. Specify the required parameters:
• Color. Select a point on the color/transparency chart. The color settings for this
point will become available. To set the color of the current point for all the points
of the chart, click the Apply to all chart points button.
• Density. Sets the position of the point on the horizontal axis. The alternative way to
set this parameter is to move the point along the horizontal axis using the mouse.
• Opacity. Sets the opacity of the color. 1 — maximum, 0 — minimum. The alternative
way to set this parameter is to move the point along the vertical axis using the
mouse.

5. To add a point, locate the cursor on the graph so that it looks like , right-click the
mouse and select the Add point item.

6. To delete a point, locate the cursor on the point so that it looks like , right-click the
mouse and select the Remove point item.
7. To restore the original settings for this CLUT, click the Reset the selected CLUT to its
original state button.

8. To assign a group type to the CLUT, click the Edit CLUT/group button at the top
of the CLUTs settings panel. In the CLUT dialog box (Fig. 2.76), select the group type to
which the table belongs from the drop-down list:

• Window, if the CLUT is relative and has a group label [WL];

• Absolute, if the CLUT is absolute and has a group label CT and XA.

Click OK to apply the settings or CANCEL to cancel.

9. To add the tags that the CLUT should contain, click the Edit CLUT/group button
at the top of the CLUTs panel. In the CLUT dialog box (Fig. 2.76), click the ADD TAG
button and enter the tag name in the input area. To rename a tag, double-click on the
tag name, enter the new name and press the Enter key on your keyboard. To remove a
tag, select it and click the REMOVE TAG button.
Click OK to apply the settings or CANCEL to cancel.

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Figure 2.76: CLUT dialog box

To delete a CLUT, click the Remove the selected CLUT/group button.

The DICOM Viewer allows you to add additional color/transparency charts. To add:

1. Click the Add chart button. A new chart will appear at the bottom part of the
window, and its name will be added to the drop-down chart menu. The opened menu
is shown in Fig. 2.77.

2. To rename the selected chart, click the Edit chart name button, type new name
and press Enter key on the keyboard.

3. To delete the selected chart, click the Remove chart button.

4. To move all the charts along the horizontal axis, locate the cursor so that it would not to
be on any chart and move it, holding the left mouse button.

5. To move any chart, select Auto detection from the drop-down chart menu, locate the
cursor on the some chart and move it, holding the left mouse button.

6. To move a certain chart, select its name from the drop-down chart menu, locate the
cursor on this chart and move it holdind the left mouse button. This mode is useful if the
charts overlap.

If the charts overlap, the colors are mixed.

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 2.24. SUV MEASUREMENT

Figure 2.77: Drop-down chart menu

2.23.5 User CLUTs Import

User CLUTs may be imported from one of the program versions to another. This function
provides an opportunity to use the CLUTs created by another user or in another DICOM Viewer
version. For details, see the Section 16.9.3.

2.24 SUV Measurement

Functionality is available in the Pro edition

SUV (Standardized Uptake Value) is a value reflecting the intensity of contrast accumula-
tion in tissues. To measure the SUV:

1. Open a series suitable for SUV measuring.

2. Select the Image main menu, select the SUV item and the Show SUV command. If
the selected series is not suitable for SUV measuring, then the Show SUV command
is disabled. If SUV measuring is already activated, then the Show SUV command is
marked with a flag.
3. If necessary, change the CLUT to [WL]PET by selecting it from the drop-down list or by
pressing the Shift+F8 key combination on the keyboard. For details, see Section 2.23.1.
4. If the data contained in the study is insufficient, then the dialog shown in Fig. 2.78 ap-
pears. Specify the following data:
• SUV Type. Choose one of four ways to measure SUV:
– by body weight: SUV Body Weight (SUVbw);
weight(g)
SU V bw(g/ml) = pixel(Bq/ml) ∗ (2.13)
dose(Bq)

– by body surface area: SUV Body Surface Area (SUVbsa);

( ) pixel (Bq/ml) weight(kg)0.425 ∗ 0.007184 ∗ 10000(cm2 /m2 )
SU V bsa cm2 /ml =
dose (Bq)
(2.14)

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CHAPTER 2. VIEW FLAT IMAGES

– by the body mass index according to the James method: SUV Lean Body Mass
(SUVlbm James); For men:

g pixel( Bq
ml
)(1.1 ∗ weight(kg) − 120.0(weight(kg) ∗ height(cm))2 )
SU V lbm( ) =
ml decayedDose
(2.15)
For woman:

g pixel( Bq
ml
)(1.07 ∗ weight(kg) − 148.0(weight(kg) ∗ height(cm))2 )
SU V lbm( ) =
ml decayedDose
(2.16)

– by the body mass index according to the Janmahasatian method: SUV Lean
Body Mass (SUVlbm Janmahasatian);

g pixel( kBq
ml
)
SU V lbm( ) = (2.17)
ml dose(M Bq) ∗ lbm(Kg)

weight(kg)
bmi(Kg/m2 ) = (2.18)
height(m)2
For men:

9270 ∗ weight(kg)
lbm(Kg) = (2.19)
6680 + 216 ∗ bmi(Kg/m2 )
For woman:

9270 ∗ weight(kg)
lbm(Kg) = (2.20)
8780 + 244 ∗ bmi(Kg/m2 )

• Patient weight (Kg) (optional for the method of calculating by body surface area);
• Patient height (cm);
• Injected dose (MBq);
• Injection date time;
• Acquisition date time;
• Half-life (min);
• Sex (optional for the method of calculating by body weight and by body surface
area);
• if it is necessary to display the SUV measurement results for ROI tools then check
the Use SUV for ROI tools box.
To measure the SUV, click OK, to cancel the operation, click CANCEL. If there is not
enough data to calculate (for example, the patient‘s weight or height is not specified
or is zero), then the OK button is disabled.

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 2.24. SUV MEASUREMENT

Figure 2.78: SUV Settings

5. To change the SUV calculation settings, select the Image main menu, select the SUV
item and the Settings... item.

6. When the SUV measurement is activated, the value at the point where the cursor is lo-
cated appears in the top left-hand corner of the window. For example:
SUVlbm: -0.092 g/ml. Move the cursor over the image to measure the SUV. Please
note that the Display information button must be pressed (see Section 2.27).

7. To calculate the SUV in a particular area or point, use the ROI tools (see Section 2.19.6).
Please note that the Use SUV for ROI box must be checked in the SUV settings.

If the time and the date of the series creation is greater than the time and the date of the
study, then the message Warning: This series may be post-processed in which date of series
creation unrelated to acquisition appears in the SUV Settings dialog.
To disable the SUV measurement, select the SUV on the main menu Image and select the
Show SUV command. The density information will be displayed for the built ROIs.

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2.25 Calcium Scoring

Functionality is available in the Pro edition

The DICOM Viewer allows you to measure calcium in the coronary arteries using the Cal-
cium scoring tool. The conditions on which the tool is available are listed below:

• the series modality is CT;

• the series contains information on the slices thickness;

• slices must be shown in the axial projection (see Section 2.13).

If a series does not meet these requirements, the Calcium scoring tool will not be available.
The tool selection button will look different depending on the tool that was used last:

Calcium scoring (ellipse) (selected by default)

Calcium scoring (polygon)

To switch between these tools click the arrow on the right side of the tool selection button
and select the desired tool.

2.25.1 Selection of measurement areas

Functionality is available in the Pro edition

To measure calcium:

1. Open a CT series suitable for activation of the calcium measurement tool (see Sec-
tion 2.25). Change the series view projection to axial if necessary (see Section 2.13).

2. Select the image to measure.

3. Activate the Calcium scoring (ellipse) tool or Calcium scoring (polygon).

These tools are similar to ROI ellipse and ROI polygon (see Section 2.19.6). If the study
does not contain information about the age and/or gender of the patient, the dialog
shown in Fig. 2.79 appears. Enter missing information and click OK to continue or CAN-
CEL to cancel the measurement. After clicking OK, this dialog no longer appears until
the Flat image viewer window is closed. To change the gender and/or age of the patient,
close the Flat Images View window and return to step 1.

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 2.25. CALCIUM SCORING

4. When the calcium scoring tool is active, a window shown in Fig. 2.80 is displayed on the
screen. Move the window if necessary. To do this, move the cursor over the window
title (highlighted in red in the figure) and move it, holding the left mouse button. In the
upper part of the window there are vessel selection buttons:

• LM — Left main coronary artery

• LAD — Left anterior descending coronary artery

• LCX — Left circumflex coronary artery

• RCA — Right coronary artery

Select the artery for measurement by clicking the corresponding button. The choice of
an artery does not affect the measurement result.

5. Build an ellipse or a polygon around the affected area. For details on how to build one,
see Section 2.19.6 (the ROI ellipse and ROI polygon tools). A block with the following
data is displayed near the measurement:

• The name of the artery (corresponds to the button pressed while building);

• Area of calcified lesion. If the measurement area contains several lesions then their
total area is displayed;

• Agatston score;

• Volume score.

Figure 2.79: Patient data entry dialog

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CHAPTER 2. VIEW FLAT IMAGES

Figure 2.80: Calcium scoring

When the projection is switched from axial to any other, the tool is
deactivated.

To deactivate the tool click the tool selection button Calcium scoring (ellipse) tool

or Calcium scoring (polygon) or close the Calcium scoring window. All the changes
made are saved until the Flat images view window is closed.

2.25.2 Actions with measurement areas

Functionality is available in the Pro edition

For details on how to move measurement areas, see Section 2.19.10, for how to move
measurement results, see Section 2.19.11.
To edit the drawing parameters:

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 2.25. CALCIUM SCORING

1. Activale the calcium scoring tool.

2. Locate the cursor on the measurement or the mesurement results to highlight them.

3. Right-click the mouse and select the Tool options... item from the context menu.

4. In the dialog box that appears, enter the measurement name.

5. Set the color by clicking on the color box.

6. Set the line thickness and the font size.

7. To connect the block with the measurement results with a dotted line, the Footnote line
box must be checked.

8. To display the block with the measurement results, the Show labels box must be checked.

9. To use these parameters by default, check the box Set as default.

10. To apply the settings, click OK. To cancel, click CANCEL.

2.25.3 Measurement results

Functionality is available in the Pro edition

The measurement results are displayed in the window shown in Fig. 2.80:

1. For each vessel separately and in total:

• total lesion area (for all lesions);

• lesion numder (N);
• Agatston score (AS);
• Volume score (VS).

2. Patient gender

3. Age group

4. Percentile

Formula for Agatston index scoring:

( )
∑
n
Tslice
Ics = Si F i (2.21)
i=1
3.00

Ics — Agatston index, n — lesion number, Si — i-lesion area, Fi — i-lesion density factor,
Tslice — slice thickness. The Fi value is determined by the maximum pixel density in the lesion
area:

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CHAPTER 2. VIEW FLAT IMAGES

Maximum pixel density Fi

130—199 HU 1
200—299 HU 2
300—399 HU 3
⩾ 400 HU 4

Formula for calcium scoring:

( )
∑
n
Vcs = Si Tslice (2.22)
i=1

Vcs — Agatston index, n — lesion number, Si — i-lesion area, Tslice — slice thickness.
Electron beam tomographic coronary artery calcium score percentiles for men and Women
within each age strata

Age
<40 40-44 45-49 50-54 55-59 60-64 65-69 70-74 >74
Man
3504 4238 4940 4825 3472 2288 1209 540 235
(25251)
25th
0 0 0 1 4 13 32 64 166
percentile
50th
1 1 3 15 48 113 180 310 473
percentile
75th
3 9 36 103 215 410 566 892 1071
percentile
90th
14 59 154 332 554 994 1299 1774 1982
percentile
Woman
641 1024 1634 2184 1835 1334 731 438 174
(9995)
25th
0 0 0 0 0 0 1 3 9
percentile
50th
0 0 0 0 1 3 24 52 75
percentile
75th
1 1 2 4 23 57 145 210 241
percentile
90th
3 4 2 55 121 193 410 631 709
percentile

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 2.26. SCOUT LINES

The measurement results are exported in the html format can be inserted into report edi-
tor (see Chapter 18) or in a text editors that support the html markup, for example, LibreOffice
Writer or Microsoft Word. To do this click the EXPORT TO CLIPBOARD button, create a doc-
ument in a text editor and paste the copied information into it.

2.26 Scout Lines

The Show series scout lines tool is used if two or more series are opened for a particular
study. The tool allows you to display the series image scout lines in images from other series
if they are synchronized.
By default, the current image scoute line is highlighted in green, and the boundary scout
lines are highlighted in yellow (Fig. 2.81). If the Show all scout lines mode is active, the inter-
mediate scout lines are highlighted by a dotted line, and current and boundary scout lines are
highlighted by solid lines.

Figure 2.81: The left-hand image scout line is displayed in the right-hand
image

The study series must have the same value of the FrameOfReferenceUID (0020,0052) tag.
If study series have different values of FrameOfReferenceUID (0020,0052) tag, then the scout
lines for these series are not displayed.

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CHAPTER 2. VIEW FLAT IMAGES

2.26.1 The Tool Menu

The Show series scout lines tool menu (fig. 2.82) contains the following items:

1. Mode Show all scout lines shows the scout lines of all series images, not just of the
current one.

2. The Show bound scout lines mode shows boundary scout lines in all the open windows.
The mode is set by default.

3. Mode Scout lines on selected view shows in the current window scout lines of images
opened in other windows.

4. Mode Selected view scout lines shows the scout lines of the current image in other
windows.

5. Line settings... opens the dialog to configure the scout lines settings (Fig. 2.83).

Figure 2.82: The menu for setting the scout lines display mode

To activate/deactivate the mode of this tool, click on the arrow on the right side of the
button and check/uncheck the corresponding item.
The modes are activated independently.
By default, the Show series scout lines tool is active and the Selected view scout lines
mode is checked. To activate/deactivate the tool, click the button on the toolbar.

2.26.2 Line Settings

To set the color and width og lines:

1. Click on the arrow on the right side of the button and select the Line settings...
item. A dialog box shown in Fig. 2.83 will be displayed.

2. Set the line color. To do this, click the color change button, select a color in the dialog
box and click OK.

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 2.27. SET UP VIEWER WORKSPACE

3. Set the line width.

4. Click OK to apply the changes or CANCEL to cancel the actions.

Figure 2.83: Line settings dialog box

2.27 Set Up Viewer Workspace

The Show labels tool allows you to display or hide the information about an image in the series
windows. The settings are applied to all the series opened in the current tab. By default, the
tool is active. To activate/deactivate the tool, click the Show labels button on the toolbar.
You can adjust the visibility of:
• Orientation cube. Located in the lower right corner of the window (for more information
see Section 2.30.1). To show (hide) the Orientation cube, click the arrow on the right side
of the Show labels and check (uncheck) the Show orientation cube box. Orientation
cube is active by default;
• Orientation letters. The letters are located on the sides of the window. To show (hide)
the Orientation letters, click the arrow on the right side of the Show labels and check
(uncheck) the Show orientation letters box. Orientation letters option is active by de-
fault. The option is only available for the MPR reconstruction tab;

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CHAPTER 2. VIEW FLAT IMAGES

• Point coordinates. The point coordinates are displayed under the cursor. To show (hide)
the Point coordinates,click the arrow on the right side of the Show labels and check
(uncheck) the Show point coordinates box. The point coordinates are shown in the
viewer window where the cursor is placed. The coordinates are displayed as the first
line in the left-hand bottom corner, in «X: px Y: px» format for original images and in «X:
vx Y: vx Z: vx» format for reconstructed images;
• Point value. To show (hide) the Point value, click the arrow on the right side of the Show
labels and check (uncheck) the Show point value box. The intensity value is displayed
as the second line in the left-hand bottom corner of the viewer window where the cursor
is placed. It is shown in the «Value: k HU» format for CT series and in «Value: k», where
k is the intensity value at the point under the cursor. If the value is inaccurate, you will
see a «*» symbol next to it. This can happen when you use an MPR reconstruction tab
or interpolation filters. For details see Sections 2.5 and 5.3;

Figure 2.84: Set visible labels dialog

• Visible labels. To customize the list of displayed labels, click the arrow on the right side

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 2.28. EXPORT IMAGES

of the Show labels button, select the Set visible labels... command.

By default, all the labels are displayed in the viewer window. The color of the labels is
white. In the Labels dialog box (Fig. 2.84), check the Visible boxes for the labels you
want to be displayed. In the Color column, you can see the color for each label. To
change the color, click on the respective square and select the color required. In the
tabs that were opened earlier, the color of the labels will be changed after the image is
refreshed.

The list of displayed labels depends on the series and the module in which
the Labels dialog was opened.

Click OK to apply the changes or CANCEL to cancel the actions.

To customize the labels text size, click the arrow on the right side of the Show labels button,
select the Set labels text size... command and in the dialog that opens, enter an integer or
fractional value. Click OK to apply the changes or CANCEL to cancel the actions.

2.28 Export Images

2.28.1 Export to DICOM

The export to DICOM allows you to export images to a series that is available while the current
study is open. To export:

1. Click on the arrow on the right side of the Quick export images button on the
toolbar and select the Export images... item or press Ctrl+E key (or the Command+E
key for macOS).

2. Select the Export to DICOM tab. The export window will look as shown in Fig. 2.85.

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CHAPTER 2. VIEW FLAT IMAGES

Figure 2.85: DICOM export window

3. Select the series to export. If no series has been exported yet, only the Create new
series item will be available. If an export has been conducted before, you can export
the data to the last created series by selecting the Use exists series option.

4. If you need to load the exported images to the DICOM server immediately, check the
option Upload image to the default server. If the default server is not set in the DICOM
Viewer this option will be inactive.

5. Select a set of images for export. Three options are available:

• Current image;
• Entire series;

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 2.28. EXPORT IMAGES

• Current phase images (only for multiphase series).

6. Select the capture type. Three options are available:

• View screenshot: the entire view window workspace is captured, including the
image information without conversions performed by the user;
• Image screenshot: only the image visible in the workspace (with conversions per-
formed by the user) is captured;
• Raw image data: the whole image is captured; of all the user’s conversions, only
mirroring is taken into account.

7. Set the image size if necessary.

8. To initiate export, click OK. To cancel the export, click CANCEL.

To continue exporting images to the DICOM format with the current settings, click on the
Quick export images button or press F5.
This tool is also available from the Image main menu item.
The results of image export to a DICOM series are affected by the filter applied (see Sec-
tion 2.6).
An image to which a filter has been applied is not original, and the
measurement results may be inaccurate.

2.28.2 Export to Image

The export to image allows you to export the current image to a .png or .jpg file. To export
data to an image:

1. Click on the arrow on the right side of the Quick export images button on the
toolbar and select the Export images button or press Ctrl+E key (or the Command+E
key for macOS).

2. Select the Export to image tab. The export window will look as shown in Fig. 2.86.

3. Set the path to the folder for export by entering it into the Path to export field or click
the button and select the path in the dialog box.

4. Enter the file name.

5. Select the file extension from the drop-down menu.

6. Select a set of images for export. Three options are available:

• Current image;
• Entire series;
• Current phase images (only for multiphase series).

7. Select the capture type. Three options are available:

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CHAPTER 2. VIEW FLAT IMAGES

• capture view area: the entire view window workspace is captured, including the
image information;
• capture visible image: only the image visible in the workspace is captured (scale-
sensitive);
• all image: only the image is captured, irrespective of scale.
8. Set the image size if necessary.
9. To initiate export, click OK. To cancel the export, click CANCEL.

Figure 2.86: Export image to file window

To continue exporting images to a file with the current settings, click on the Quick export
images button or press F5. The file names will be specified automatically. If you attempt

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 2.29. DSA MODE

to export the same image twice, the DICOM Viewer will return the «File with the same name
already exists. Do you want to overwrite it?» warning. To overwrite the image, click YES. To
cancel, click NO.
This tool is also available from the Image main menu item.
The results of image export to a file are affected by the filter applied (see Section 2.6).
An image to which a filter has been applied is not original, and the
measurement results may be inaccurate.

2.29 DSA Mode

Using the DSA mode you can process multiphase and multiframe series with a varying con-
centration of a contrast agent, subtracting images in such a way that the tissues containing
contrast are best seen. Applicable to series with CT, MRI and X-ray modalities.
The following outlines how to view multiframe series. Viewing multiphase series of studies
is done in the same way.
Hight-density tissue (e.g. bone) images may be subtracted from the images
of contrast-enhanced vessels, which will lead to data loss.

2.29.1 Single-image subtraction view

For studies containing multiframe series with a varying concentration of a contrast agent, one
of the frames is subtracted from all frames in the series. To apply the DSA mode:

1. Open the series of study in the View Flat Images window.

2. Click on the Digital Subtraction Angiography (DSA) button. The first frame of the
series has been subtracted from all the frames of this series.

3. Scroll through the frames by moving the slider or rotating the mouse wheel, hovering
the cursor over the scroll bar on the Frame Scroll Bar (Fig. 2.87).

4. If you want to subtract another frame from all the frames, select this image using the
scroll bar in the Frame Scroll Bar, click on the arrow on the right side of the button
and select the command Set the current frame as a key frame.

5. If the series frames are offset relative to each other, then correct it by selecting the com-
mand Auto adjust key image offset from the Digital Subtraction Angiography (DSA)
tool menu.

6. To manually correct the offset, select the command Manual Adjustment from the Digital
Subtraction Angiography (DSA) tool menu and change the location of the frames using
the buttons that appear in the image view window (Fig. 2.88) or using the
keys.

7. If necessary, change the window width and the window level.

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CHAPTER 2. VIEW FLAT IMAGES

Figure 2.87: Frame Scroll Bar

Figure 2.88: The button for manual adjustment is highlighted in red

Figure 2.89: View tissues with a varying concentration of a contrast agent

in DSA mode

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 2.29. DSA MODE

2.29.2 Series subtraction view

For studies containing at least two related series of frames and images with different con-
centrations of a contrast agent, the frames and images of one series are subtracted from the
corresponding frames and images of the other series. To apply the DSA mode:

1. Open the series of study in the View Flat Images window.

2. Choose a series whose images you want to subtract from the images of the other series.

3. Click on the button.

4. Click on the arrow on the right side of the Digital Subtraction Angiography (DSA)
button. If the series contains the necessary data, then the command Set the frame
series as key frames is available. Select this command.

5. Select another series of frames by rotating the mouse wheel or moving the slider on the
right side of the image view window.

6. Scroll through the images by moving the slider or rotating the mouse wheel, hovering
the cursor over the scroll bar on the Frame Scroll Bar (Fig. 2.87).

7. If necessary, change the window width and the window level.

This tool is also available from the Image main menu item.

2.29.3 Viewing Several Series of the Same Study Fused in One Multiphase
Series with Subtraction
A fused series may be viewed in the digital subtraction angiography (DSA) mode and used for
assessment of contrast distribution in tissues at regular time intervals.

1. Open a fused series in the flat image viewer mode (see Section 2.12).

2. Scroll the phases and images of the series by moving the sliders on the phases and
images scroll bars.

3. Activate the DSA mode by clicking the Digital Subtraction Angiography (DSA)
button.

4. Chose a phase whose images are to be subtracted from the images belonging to other
phases. Click the arrow on the right-hand side of the button and select the Set
the current frame as a key frame option on the tool menu.

5. Change the window width and level if required.

This tool is also available from the Image main menu item.

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CHAPTER 2. VIEW FLAT IMAGES

2.30 Image Information in the Series Window

2.30.1 Orientation Cube
The Orientation Cube is located in the bottom right-hand corner (Fig. 2.90). The markers on
the cube show the side the image is viewed from:

A — Anterior

R — Right

L — Left

P — Posterior

F — Foot

H — Head.

Figure 2.90: Orientation cube

If «F» is written on the cube face, it means that the image is viewed from below; if «R» is
written beside a rib, it means that the patient‘s right side is on this side of the image.
For details on the display settings for the orientation cube and letters (markers), see Sec-
tion 2.27.

2.30.2 Scale
A graduated 10-cm scale is displayed on the right side of the window.

2.30.3 Image Information

The image information is displayed in the bottom left-hand corner. It may include the following
parameters, depending on the study type:

• Image No — current image number in the series/total number of images in the series;

• Image size — image size (pixels);

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 2.31. VIEW DICOM TAGS

• FOV (field of vision) — image size (millimeters);

• Location — image location determined by the device;

• Thickness — interval between slices.

For details on customizing the data concerning the image, see Section 2.27.

2.30.4 Patient Information

The information about the patient is displayed in the top left-hand corner.
For details on customizing the data concerning the patient (the patient ID, name, age, date
of birth etc.), see Section 2.27.

2.31 View DICOM Tags

To view the DICOM tags of the image:

1. Open the image.

2. Open the image context menu by right-clicking on the image.

3. Select the Show image tags item. The DICOM tags will be displayed in a new tab (see
Section 17).

2.32 Viewing Structured Reports

Structured reports are used for transferring and storing structured medical documents.
A structured report contains information on the patient and the study. Series of structured
reports have SR modality.
To view a structured report, open an SR series (see Section 2.1).
A series is opened in a new flat image viewer tab, in a separate window (Fig. 2.91).

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CHAPTER 2. VIEW FLAT IMAGES

Figure 2.91: Window for viewing structured reports

In the structured reports viewer window, you can choose the mode for arranging series
(see Section 2.10). The automatic mode is selected by default.
At the top of the structured reports viewer window, you can see general information on
the patient, the study, and the report status. In the lower part of the window, you can see
structured information.
If an SR series comprises more than one document, you will see a horizontal scroll bar
at the top of the window. The order of the documents depends on the names of the files
containing such documents. There are several ways to switch between documents:

• by moving the slider;

• by hovering over the scroll bar and scrolling the mouse wheel;

• with the help of Switch to the previous image and Switch to the next image
buttons on the toolbar.

Structured reports cannot be edited. The data can be copied to the clipboard and then
inserted in the report editor (see Chapter 18) or in any text editor. There are two ways to copy
text from the structured reports viewer window to the clipboard:

• select the text, open the context menu by right-clicking on the text, and click Copy;

• select the text and press Ctrl+C (or the Command+C for macOS) on the keyboard.

There are several methods to select text in the structured reports viewer window:

• to select a word, double-click on that word with the left mouse button;

• to select a line, click three times on any word in that line with the left mouse button;

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 2.33. GRAPHIC LABEL TOOL

• to select a text fragment, place the cursor before the first word of the fragment, click
the left mouse button and drag the cursor to the end of the fragment while holding the
button;

• to select the complete text of the document, open the context menu by right-clicking
within the window and choose Select all. Alternatively, you can press the Ctrl+A (or the
Command+A for macOS) combination on the keyboard.

To maximize the report window and restore its size, proceed as follows:

• double-click with the left mouse button on the title of the series window;

• click on the Expand button in the right-hand upper corner of the series window.

To close the window with structured reports, click the Close button on the right-hand
side of the window header.

2.33 Graphic Label Tool

2.33.1 General
This tool allows you to create graphic labels (as arrows, ellipses, polygons, freeform lines and
text fields) on an image. The labels will be applied during the entire session of working with
the series. The labels are attached to specific points on the image and panned, scaled or
rotated together with the image.
The button design depends on the selected tool. The default tool is Arrow, and the tool
selection button looks like this: .
To activate/deactivate the selected tool, click on the graphic label tool selection button.
To select and activate one of the tools, click on the right side of the tool selection button and
select the tool (Fig. 2.92).

Figure 2.92: Graphic label tool menu

This tool is also available from the image context menu and from the Image main menu
item.

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The annotation tools are available on the MPR reconstruction, Vessel analysis, Coronary
artery analysis, Cardiac function analysis and PET Analysis tabs.

2.33.2 Create Labels

To create a label on an image:

1. Activate the Arrow tool by clicking the left/right/middle mouse button. The button will
look as follows: . To continue work with this tool, use the button with which the
tool was activated. To learn more about tool control, see Section 1.14.

2. You can draw a arrow in two ways:

• Click the mouse button at the point where the arrow tip is to be placed and, while
holding the mouse button, move the cursor to the opposite end of the arrow. To fix
the point, release the mouse button.
• Click the mouse button at the point where the arrow tip is to be placed. Click the
mouse button again where the opposite end of the arrow should be placed. The
arrow is shown in Fig. 2.93.

3. To cancel an incomplete creation, press Esc.

Figure 2.93: Arrow

To create a freeform shapes and lines on an image:

1. Activate the Pencil tool by clicking the left/right/middle mouse button. The button will
look as follows: . To continue work with this tool, use the button with which the
tool was activated. To learn more about tool control, see Section 1.14.

2. Click the mouse button at the point where you want the line to begin and, while holding
the mouse button, move the cursor. This displays a line that follows the cursor trajectory.
To complete the drawing, release the mouse button.

3. To cancel an incomplete creation, press Esc.

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To create a text label on an image:

1. Activate the Text tool by clicking the left/right/middle mouse button. The button will look
as follows: . To continue work with this tool, use the button with which the tool
was activated. To learn more about tool control, see Section 1.14.
2. Click the mouse button where the text should be located.
3. Enter text in the Edit text dialog box and click OK to add it to the image or CANCEL to
cancel the action.
To create a polygon on an image:
1. Activate the Polygon tool by clicking the left/right/middle mouse button. The button will
look as follows: . To continue work with this tool, use the button with which the
tool was activated. To learn more about tool control, see Section 1.14.
2. Click the mouse button where the first point of the polygon should be located.
3. Move the cursor to the location of the next point. The lines connecting the points of the
polygon will be displayed on the screen.
4. Click the mouse button to save the point.
5. Repeat Steps 3 and 4 until the last but one point is set.
6. Double-click the mouse to create the last point. The polygon is complete (Fig. 2.94).
7. To cancel an incomplete creation, press Esc.

Figure 2.94: Polygon labels

To create an ellipse on an image:

1. Activate the Ellipse tool by clicking the left/right/middle mouse button. The button will
look as follows: . To continue work with this tool, use the button with which the
tool was activated. To learn more about tool control, see Section 1.14.
2. To build an ellipse, just build the rectangle the ellipse is inscribed into. You can draw an
ellipse in two ways:

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• Click the mouse button to mark the first end of the ellipse and while holding the
mouse button move the cursor to the place where the opposite end should be
located. The ellipse will be displayed on the screen. To fix the point, release the
mouse button.
• Click the mouse button to mark the first end of the ellipse. Move the cursor to the
place where the opposite end of the ellipse should be located. The ellipse will
be displayed on the screen. To fix the second end of the ellipse, click the mouse
button. The ellipse is shown in Fig. 2.95.

3. To cancel an incomplete creation, press Esc.

Figure 2.95: Ellipse label

2.33.3 Actions with Labels

The DICOM Viewer allows you to perform the following actions with labels:

• Drag. Locate the cursor on the figure line or text and drag the object, holding down the
left mouse button or the button to which this tool is assigned.

• Drag a point (an apex for an arrow or polygon and a rectangle apex for an ellipse). Locate
the cursor on a point and drag the point, holding down the left mouse button or the
button to which this tool is assigned.

• Delete. Locate the cursor on the label border and press the Delete key on the keyboard,
or right-click the mouse and select the Remove object item from the context menu.

• Set render params. Locate the cursor on the label border, right-click the mouse and
select the Tool options... item from the context menu. In the dialog box that appears,
set the line color and thickness for a figure or the font color and size for text. If the box
Set as default checked, these settings will be applied by default when creating new
annotations. Click OK to apply the changes or CANCEL to cancel the actions.

• Edit text label. Locate the cursor on the text, right-click the mouse, and select the Edit
text command from the context menu.

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To set the default render parameters, click on the right side of the button and select
the command Default tool options...
To delete all objects, click the Delete all annotations and measurements button.
In the dialog box that appears, Click YES to delete or NO to cancel. If you want the DICOM
Viewer to always delete annotations and measurements without this confirmation, check the
box Don‘t show this dialog again and click YES. If you want the DICOM Viewer to show the
confirmation dialog, check the box Ask before deleting all annotations and measurements
(see Section 16.7.1).
Attention! All measurements and other objects created manually will be
deleted.

2.34 Synchronize Images

Synchronization is applied if two or more series are opened for the same study. This function
allows you to scroll images in several series synchronously. By default the option is enabled.
To set up the synchronization options you need, proceed as follows:

1. Click on the arrow on the right side of the Sync series button on the toolbar. This
tool is also available from the Image main menu item.

2. In the drop-down menu for the button (Fig. 2.34), choose the synchronization types
and modes:

Figure 2.96: Activating the image synchronization types and modes

• Sync scroll. Provides an opportunity to scroll images from the series with the same
frameOfReferenceUid tag values simultaneously in the By patient coordinates mode.
If the frameOfReferenceUid tag values are different for different series, scrolling will
not be synchronized in the By patient coordinates mode. To synchronize series with
different frameOfReferenceUid tag values, select the Manual mode.
Synchronization is performed for the sections parallel to the synchronizing section;

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• Sync W/L. Window width and level (W/L) synchronization is performed for the series with
CT modality. For series with other modality types, synchronization will only be performed
if the recommended window width and level (W/L) values are the same. The mode
chosen does not impact this synchronization type;

• Sync zoom and position. Provides an opportunity to synchronize image scaling and
moving. This option will work differently depending on the mode chosen.

– In the By patient coordinates mode:

* image scaling and moving is synchronized for the images from the series with
the same frameOfReferenceUid tag values. If the frameOfReferenceUid tag
values are different, synchronization will not be performed;
* the real size of the image is taken into account. For sections of the same size,
objects are displayed in the same way;
* the centers of the windows are synchronized. In the window center, you see
the projection of the center point of the synchronizing window on the synchro-
nized window section;
* if the Synchronize scale and position of slices in different projections option
on the Tools tab of the Image viewer module (for details see Section 16.7.1)
is disabled, synchronization will only be performed for the sections parallel to
the synchronizing section. If this option is enabled, parallel orientation of the
sections will not be taken into account for scaling and position synchronization.
– In the Manual mode:

* the real size of the image is taken into account. For sections of the same size,
objects are displayed in the same way;
* if the position of the synchronizing window center is changed, the position of
the synchronized window center is changed accordingly;
* if the Synchronize scale and position of slices in different projections option
on the Tools tab of the Image viewer module (for details see Section 16.7.1)
is disabled, synchronization will only be performed for the sections parallel to
the synchronizing section. If this option is enabled, parallel orientation of the
sections will not be taken into account for scaling and position synchronization.

• Sync phases. The image phases are synchronized by number. If the phase number for
the synchronizing series is greater than the total number of phases in the synchronized
series, then the phase with the greatest number will be selected for the synchronized
series. The mode chosen does not impact this synchronization type.

If there are several images in the window, then the properties of the first image will be
used for scaling and movement evaluation.
Image synchronization is performed automatically. To disable synchronization, click on the
Sync series button.
To disable the default synchronization on the DICOM Viewer startup, uncheck the Turn on
sync image by default box in the image viewer setup dialog box (see Section 16.7.1).

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2.35 Synchronization by a Point

To choose the slices in all the windows that are the closest to the point selected, use the Sync
by point tool. To synchronize, choose a reference point in one of the viewer windows.
You will see crosshairs at this point. The synchronized windows will show the slices that are
the closest to the point chosen; you will see crosshairs at the closest point of the synchronized
slice.
If the reference point is not present on the synchronized slice, the crosshairs
shown will have a black spot in the centre
The slice thickness is determined by the modality.

2.36 Mirror Image Horizontally/Vertically

This tool allows you to mirror images. The button will look different depending on the mode
that was used last ( — horizontal, — vertical). The horizontal mode is used by
default.
To activate/deactivate the tool, click on the button. If several series are opened in the view
window, the mirroring is activated for each series independently.
To change the mirroring mode, click on the arrow on the right side of the button and check
the required mode. Both modes can be activated simultaneously.
This tool is also available from the Image main menu item.

2.37 Calibration sizes

X-ray image sizes are increased as compared with the real size of the tissues (Fig. 2.97).

Figure 2.97: The green arrow shows the actual size of the tissues and red
arrow shows the size of the image

Hence, the size determined by X-ray modality may be incorrect. If a picture contains an
object whose size is known (e.g., a catheter), it is possible to calibrate the image size. To
calibrate the size:

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1. Select the Images main menu and the Calibration tool.

2. A calibration segment can be built in two ways:

• Mark the first point by clicking the left mouse button. Drag the cursor over the
screen. The distance from the first point to the current point will be displayed be-
side the line. To fix the second point, click the left mouse button.

• Click the mouse button at the first point of the calibration segment and move the
cursor to the endpoint while holding the mouse button. The distance from the first
point to the current point will be displayed beside the line. To fix the endpoint,
release the mouse button.

3. In the dialog box that appears, type the real length of the interval constructed (Fig. 2.98).
To calibrate the size, click OK, to calcel, click Cancel.

Figure 2.98: Calibration size

If you cancel the calibration, the calibration interval remains in the image. To hide the
calibration interval, put the cursor on it and press the Delete key on the keyboard, or right-
click the mouse and select the Remove object item on the context menu. This calibration will
remain.
To deactivate the Calibration tool, select it again in the Image main menu. This calibration
will remain.
Calibration is factored in for measurements that depend on linear dimensions. After cali-
bration, previously made measurements are automatically adjusted.
Calibration is maintained until the window containing the current series is open.

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2.38 Apparent diffusion coefficient

Functionality is available in the Pro edition

DICOM Viewer allows to show parametric maps for diffusion-weighted images. To activate
the ADC mode, click on the Apparent diffusion coefficient (ADC) map button.

The mode is available for MRI study series containing information on the
«b» value (Diffusion sensitization factor).
To set values factor, click on the arrow on the right side of the button and select the Set
values factor... item.

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Chapter 3

Volume Reconstruction

In Volume Reconstruction window, diagnosis can only be established on the

basis of CT, MR, MG, and XA series.

The DICOM Viewer supports 16-bit images. If the source data width is
significant, data may be partially lost.
It is recommended to use a render device supporting the CUDA technology (preferable) or
the OpenCL technology to build a volume model. The settings are described in Section 16.7.3.
On macOS 10.15 and later, it is recommended to use a visualization device that supports
Metal polygonal and voxel rendering. The settings are described in Section 16.7.3.
Color tables are needed for displaying voxels representing different density
values in different colors for improved perception. The shades on the screen
are different from the real shades.

3.1 View Images

To open a study in the volume reconstruction window:

1. Load the studies to the DICOM Viewer.

2. Select the study from the study panel.

3. Click the Volume Reconstruction button on the toolbar. To select the tab location
(in the current window, in a separate window, or in the full screen mode), click on the
arrow on the right side of the button. To open the volume reconstruction window in a
new tab in the current window, click on the button. This process may take some time.

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Fig. 3.1 illustrates the volume reconstruction window. The right side of the screen displays
the toolbar with the volume edit tools and the windows for viewing the axial, frontal and sagittal
sections. You can work with the sections in the 3D cursor mode described in Section 5.5.1.

Figure 3.1: Volume reconstruction tab

The right side of the screen displays the toolbar with the volume edit tools and the windows
for viewing the axial, frontal and sagittal sections. You can work with the sections in the 3D
cursor mode described in Section 5.5.1.
The volume reconstruction of tissues is located on the left side of the screen.
To move the cursor in MPR reconstruction windows, to move the cursor to a point on the
model, activate the Select model point tool and click the mouse button to select the

desired point. To deactivate the tool, click the button again. For details on setting and
operating the Select model point tool, see in Section 3.5.
The tool is also available in the Volume section of the main menu.

3.2 Model Projection

The DICOM Viewer creates an opportunity to show the model in the perspective (Fig. 3.3)
and parallel (Fig. 3.2) projection. The button will look different depending on the projection
selected:

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Switch to parallel projection. The perspective projection is now selected

(selected by default)

Switch to perspective projection. The parallel projection is now selected

Figure 3.2: Parallel projection of the Figure 3.3: Perspective projection

3D model of the 3D model

The Clipping Box tool in Fig. 3.2 and Fig. 3.3 is included for clarity and described in detail
in Section 3.10.

3.3 Actions with Model

The DICOM Viewer allows you to perform the following actions with a model:

• Pan leftward and rightward using the keys.

• Zoom the 3D image by rolling the mouse wheel or using the keys.

• Rotate by moving the mouse holding the wheel or using the Rotate tool (see Section 3.4.2).

On the left-hand side of the window, you can see a standard space orientation panel
(Fig. 3.4). To jump to a different space orientation option, click the buttons on the panel. To

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open additional options for the «LAO» and «RAO» buttons, click the arrow on the right side
of the corresponding button. By clicking the buttons on the panel, you can only work with the
window in which the panel is placed.

Figure 3.4: Space orientation selection buttons

The panel with space orientation selection buttons (Fig. 3.4) is available in the Volume
reconstruction and 3D view windows of the MPR reconstruction, Vessel analysis and Coro-
nary artery analysis tabs. You can set the visibility of the standard space orientation panel in
the UI tab. To do that, go to the 3D reconstruction and Vessel analysis module settings (see
Sections 16.7.3 and 16.7.4).

3.4 Model Positioning Tools

3.4.1 Model Shift
There are two ways to move the model in the volume reconstruction window:

1. Move the mouse holding the wheel and the Shift key on the keyboard. This key combi-
nation is set by default. You can disable or change the setting in the 3D controllers tab
of the 3D reconstruction module (see Section 16.7.3).

2. Activate the Pan tool on the toolbar by clicking the left/right/middle mouse button.
To continue work with this tool, use the button with which the tool was activated.To learn
more about tool control, see Section 1.14. To move a model, move the cursor around the
screen while holding down the mouse button.

This tool is also available from the image context menu.

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3.4.2 Model Rotation

Activate/deactivate the Rotate tool by clicking the left/right/middle mouse button. By
default, the tool is active. To continue work with this tool, use the button with which the tool
was activated. To learn more about tool control, see Section 1.14.
Note that the initial point of the cursor does not affect the rotation. If the cursor is moved
vertically, the image is rotated round the horizontal axis. If the cursor is moved horizontally,
the image is rotated round the vertical axis. That is, the image follows the cursor. If the cursor
moves along a slanting line, the image slants the same way.
This tool is also available from the image context menu and from the Volume main menu
item. Activation is only possible with the left mouse button.

3.4.3 Model Scaling

The tool allows you to zoom the model with the mouse, holding the button. Move the cursor
up to zoom in or down to zoom out.
Activate/deactivate the Zoom tool by clicking the left/right/middle mouse button. To
continue work with this tool, use the button with which the tool was activated. To learn more
about tool control, see Section 1.14.
This tool is also available from the image context menu and from the Volume main menu
item.

3.5 «Select Model Point» Tool

The Select model point tool is available on the toolbar in the Volume reconstruction
and MPR reconstruction tabs. In the MPR reconstruction tab, the tool becomes available
when the 3D view mode is chosen. Besides, the tool is available in the Volume section of the
main menu of the Volume reconstruction tab.
Activate the Select model point tool by clicking the left/right/middle mouse button.
To continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14.
Mouse over the volume model and choose a point. The point of intersection of the cutting
planes in the MPR Reconstruction windows is moved to the specified point on the volume
model. The point specified may be used as the initial point for measuring and editing the
model volume.
Attention! For more precise choice of the point on the volume model,
provide the correct value of the opacity threshold for the «Render settings»
tool (see Section 3.14).

3.6 The Play Tool

The DICOM Viewer allows you to automatically rotate a volume model around one of the
three orthogonal axes relative to the center, or play phases. The center of the model can be
changed using the Center tool (see Section 3.9). To configure playback, click the arrow on

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the right side of the Play button and specify the necessary parameters in the button
context menu.
1. If the series contains several phases, then the DICOM Viewer allows you to switch be-
tween the model rotation and the phase playback. To switch between these modes,
select the Play phases or the Volume rotation item from the Play button context menu.
The selected item is marked with a flag. Only items suitable for this series are available
on the context menu.
2. Select the speed (5, 10, 20 or 25 frames per second only for the phase playback). If you
want to set a different playback speed, select the User defined... item and in the dialog
that opens set the value from 1 to 100. The selected speed will be marked with a flag.
3. If you want to play phases cyclically, select the Loop item. The item will be marked
with a flag. To disable the cyclic playback, select this command again. The flag will be
removed.
4. To select the rotation axis of the model, select the Settings... command; in the dialog
that opens, select the axis from the Axis drop-down list and click OK to apply the setting
or CANCEL to cancel.
5. To adjust the rotation speed of the model select the Settings... command; in the dialog
that opens, enter a value in the Degrees per second field and click OK to apply the
setting or CANCEL to cancel.
To start playback, click on the Play button on the toolbar. During playback, the button

looks like . To end playback, click the button.

3.7 Video recording

Functionality is available in the Pro edition

The DICOM Viewer allows you to record video for the volume model view window. The
following objects will be recorded:
• base volume and segmented structures tissues;
• measurements;
• annotations;
• markers;
• clipping box;
• tags;
• orientation cube;
• the Select model point tool label.
Other features of the tool are similar to those described in Section 2.15.

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3.8 Cutting Tools

There are several cutting tools on the right toolbar.

3.8.1 Polygon Cut

The Polygon Cut tool allows you to build a polygon or an area with smooth borders that
the cut area is projected on.
To build a polygon:

1. Activate the Polygon Cut tool by clicking the left/right/middle mouse button. To continue
work with this tool, use the button with which the tool was activated. To learn more about
tool control, see Section 1.14.

2. Click the mouse button to set the apices of the polygon marking the figure to be cut,
except the last point.

3. Fix the last point by double-clicking the mouse.

4. To cancel an incomplete building, press Esc.

To build an area with smooth borders (Lasso mode):

1. Activate the Polygon Cut tool by clicking the left/right/middle mouse button. To continue
work with this tool, use the button with which the tool was activated. To learn more about
tool control, see Section 1.14.

2. Press and hold the Shift key on the keyboard.

3. Circle the area to be cut, holding down the mouse button.

4. To complete the building, release the mouse button or click another mouse button.

5. To cancel an incomplete building, press Esc.

The part of the model to be projected on the area will be cut.

3.8.2 Inverse Polygon Cut

The tool is similar to the previous one, except that the part of the model not to be projected
on the area will be cut. To activate/deactivate the tool, use the button on the toolbar.

3.8.3 Cut object

The tool allows you to delete an area of a 3D model not associated with its other parts.
Activate/deactivate the tool by clicking the left/right/middle mouse button. To con-
tinue work with this tool, use the button with which the tool was activated. To learn more about
tool control, see Section 1.14.

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3.8.4 Cut all except object

The tool is similar to the previous one, except that all areas excluding the selected area are
deleted. To activate/deactivate the tool, use the button on the toolbar.

3.8.5 Cutting Tools Parameters

For the Cut object and Cut all except object tools, the following parameters can be set:

1. Grow from surface (mm). The tissue surrounding the deleted area will be deleted
too. This parameter specifies the distance from the surface on which the tissue will
be deleted. If this parameter is set to zero, the model surface may look rough, so use a
value of zero only if necessary.

2. Min object thickness (mm). If the value is greater than zero, the tissue with a thickness
less than the set value will be ignored during deletion.

The parameters for each tool are set separately.

To set these parameters, click on the arrow on the right side of the appropriate tool button
and select the Parameters... item and in the dialog box that appears, specify the required
values.

3.8.6 Brush Tools for Editing Volume

Functionality is available in the Pro edition

The Brush cut , Brush restore and Restore by mask tools allow to remove
tissue within a sphere or cylinder and restore the tissue deleted by cutting tools.
The Brush opening and Brush closing tools are aimed for smoothing tissues
and deleting hollows in the tissues of the model.
The brush tools for editing volume are assigned to the same button. To select a tool,
click on the arrow on the right side of the tool selection button. The button looks different,
depending on the tool selected:

Brush cut (is selected by default)

Brush restore

Brush opening

Brush closing

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Restore by mask

To select one of modes (Sphere, Cylinder), click the arrow on the right side of the tool
buttons. The same mode is used for all the brush tools for editing volume.
The cursor will look different depending on the mode that is selected. The cursor for the
Sphere mode is shown in Fig. 3.5, and the cursor for the Cylinder mode is shown in Fig. 3.6.

Figure 3.5: The cursor for Sphere Figure 3.6: The cursor for Cylinder
mode mode

To activate/deactivate the tool, click on the tool button. If any tool is activated, the button
is highlighted.
To cut tissue:

1. Activate the Brush cut tool by clicking the left/right/middle mouse button. To
continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14.

2. Select the tool mode from the menu.

3. Set the tool diameter, moving the mouse while holding the Alt key (or the Option key
for macOS). The Brush cut, Brush restore, Brush opening and Brush closing tools are
set to the same diameter value.

4. For the Cylinder mode, set the height if it is necessary. To do it, click the arrow on the
right side of the tool button and select the Cylinder options... item. In the dialog box
that appears, set the cut height.

5. Click the mouse button in the place where you want to cut tissue. Part of the tissue
will be cut. The green dot indicates where the great circle of the sphere (the base area
of the cylinder) touches the surface of the model. The great circle passes through the
center of the sphere and is parallel to the plane of the screen.

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6. Repeat steps 3 and 5 if necessary.

The Brush restore tool allows you to perform the reverse process of brush cutting.
The Brush opening tool is used for removing random elements (noise) and smooth-
ing tissues on the model. It implies successive erosion and dilatation within the region limited
by the tool.
The Brush closing tool is used for deleting small hollows in the model. It implies
successive dilatation and erosion within the region limited by the tool.
To set the radius for the brush opening/closing morphological operation, click the arrow
on the right-hand side of the tool button and select the Morphological operation radius...
option. In the dialog box that pops up, provide the radius in millimeters or voxels. The same
morphological operation radius is set for the Brush opening and Brush closing tools.
The Restore by mask tool allows you to restore tissue by mask (this tool is used
for segmentation). If mask is not set, this mode is analogous to the Brush restore mode. For
details how to set mask, see Section 6.2.4.

3.8.7 Tools for intelligent volume editing

Functionality is available in the Pro edition

The Grow (dilation), Shrink (erosion), Fill and Cut invisible volume tools allow to edit
tissue within special algorithms. The Multi-segment growing (Voronoi diagram) tool allows
you to edit segmented structures. To select one of these tools, click the arrow on the right
side of the tool buttons. The button will look different depending on the tool that was used
last:

Grow (dilation) (set by default)

Shrink (erosion)

Remove noise (opening)

Remove holes (closing)

Multi-segment growing (Voronoi diagram)

Fill

Cut invisible volume

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The Grow (dilation) tool allows you to increase the volume by a certain value from the
surface in one iteration. This value is specified in the Settings menu of this tool (parameter
Growing radius). The increase is possible only within the original volume, for example, after
the use of cutting tools. When you use this tool to edit a segmented structure, an increase
is possible only within the mask. The tool is used to fine-tune the structure if, initially, the
required volume was not obtained.
The Shrink (erosion) tool performs the opposite action. The reduction value is specified
by the parameter Growing/Shrinking radius.
The Remove noise (opening) tool allows to remove noise from the volume. This tool is
equivalent to the consistently applied tools Shrink (erosion) and Grow (dilation).
The Remove holes (closing) tool allows to remove little holes from the volume. This tool
is equivalent to the consistently applied tools Grow (dilation) and Shrink (erosion).
Each time the Grow (dilation), Shrink (erosion), Remove noise (opening), and Remove
holes (closing) tools are used, a dialog box (Fig. 3.7), in which the operation radius should be
set in millimeters or voxels is displayed.

Figure 3.7: Operation radius dialog box

The Multi-Segment Growing (Voronoi diagram) tool allows you to simultaneously build
several structures and base volume. It is used to edit segmented structures (see Section 6.8.6).
If the tool is applied only to the base volume, then it works like the Grow (dilation) tool.
The Fill tool allows you to fill the voids in the volume. If you are working with segmented
structures, the tool is used to improve structures, built on a «grainy» mask. Such masks are
typical, for example, for kidneys.
The Cut invisible volume tool sets the mask according to the visible volume. On the 3D
model, the voxels that are not shown for the selected color table or the set window width and
level (W/L) values are deleted. If the color table or the window width and level (W/L) values are
changed later, the deleted voxels are not restored. The Cut invisible volume tool is available
in the Volume reconstruction tab and in the 3D view window of the MPR reconstruction tab.

3.8.8 Remove Table

The tool allows you to delete areas resembling the medical equipment table. To delete, click
the button on the toolbar.

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Some objects that have been misrecognized as the modality table may be
deleted by mistake.

To undo or redo the last action associated with cutting, use the Undo and Redo
buttons.

3.9 Center
The tool allows you to set the center point. The model rotates and scales with respect to
this point. This may be necessary if the model is altered with cutting tools. The tool has two
modes: auto and intaractive (manual). To select mode, click on the arrow on the right side of
the Center button on the toolbar and select the mode. The current mode is marked
with a flag.
Centering is performed in space. Depth centering can be disabled. To enable/disable
depth centering, click on the arrow on the right side of the Center button and select the
Center depth item. If depth centering is enabled, the item is marked with a flag. Centering in
a plane parallel to the screen plane is always performed.
To activate the tool, click on the Center button. If the auto mode is selected, activate
the tool by clicking the left/right/middle mouse button. To continue work with this tool, use the
button with which the tool was activated. To learn more about tool control, see Section 1.14. If
the auto mode is selected, centering will be performed immediately after the tool is activated.
If the interactive mode is selected, the cursor takes the form of a crosshair. Set the center
point by clicking on it with the left mouse button.
To center the model without activating the tool, press Alt + middle mouse button. To do
this, click the middle mouse button while holding the Alt key (or the Option key for macOS)
on the keyboard. When you click on a selected point, the visible model will be centered with
respect to this point. When you click on the screen beyond the model, the model will be
centered with respect to the center of the visible part.

3.10 Clipping Box

The clipping box allows you to cut off all tissues outside it. To build a box, click on the Clipping
Box button on the toolbar by clicking the left/right/middle mouse button. To continue
work with this tool, use the button with which the tool was activated. To learn more about tool
control, see Section 1.14.
To build a minimum box not cutting the model, click on the arrow on the right side of the
Clipping Box button and select the Fit to model command.
To build a box by the image borders, click on the arrow on the right side of the Clipping
Box button and select the Reset clipping box command.
To cut off parts of tissues, move the box face so that it intersects the 3D model. To do this,
locate the cursor on the box face so that its borders are highlighted in green (Fig. 3.8).

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Figure 3.8: Editing the Clipping Box. The active face ready for moving is
highlighted in green

Next, move the face using the mouse while holding the left button. Only the faces located
in the foreground (highlighted in white) can be moved. The faces unavailable for moving are
highlighted in grey. To be able to work with the faces that are unavailable for moving, rotate
the image. The box is rotated synchronously with the image.
To zoom the box symmetrically, move the mouse, holding the mouse button with which the
tool was activated and Ctrl key (or the Command key for macOS).
To pan the box, move the mouse, holding the mouse button with which the tool was acti-
vated and Shift key.
To rotate the box, move the mouse, holding the mouse button with which the tool was
activated and Alt key (or the Option key for macOS).
If the Clipping Box tool is deactivated, the sections made using the tool will be saved. To
restore the initial look of the model, use one of the following options:

1. Activate the Clipping Box tool and move the faces to make the model visible.

2. Click on the arrow on the right side of the Clipping Box button and select any of the
building options. If the Clipping Box tool is inactive, the box will not be visualized, but
the section will still be reset.

This tool is also available from the Volume main menu item.

3.11 Measurements
The tool allows you to make linear and polygonal linear measurements of distances in an
image.

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The measurement accuracy is up to one screen pixel. As a screen pixel is

smaller than a source image pixel, the true linear measurement accuracy is
up to one source image pixel. Errors may also occur in density
measurements. The most accurate measurements are performed with
bilinear interpolation (see Section 2.5).

3.11.1 Ruler
To make linear measurements:

1. Activate the Ruler tool by clicking the left/right/middle mouse button. To continue
work with this tool, use the button with which the tool was activated. To learn more about
tool control, see Section 1.14.
2. You can measure the distance in two ways:
• Mark the first point by clicking the mouse button. Drag the cursor over the screen.
The distance from the first point to the current point will be displayed beside the
line. To fix the current point, click the mouse button.
• Click on the mouse button at the starting point and move the cursor to the endpoint
while holding the mouse button. The distance from the first point to the current
point will be displayed beside the line. To fix the endpoint, release the mouse
button.
3. To cancel an incomplete measurement, press Esc.
To move the ruler border:

1. Locate the cursor on the point to be moved so that it would look like this .

2. Drag the point, holding the left mouse button.

3. Release the left mouse button.
To delete a ruler:

1. Locate the cursor on the line to be deleted so that it would look like this .

2. Press the Delete key on the keyboard or right-click the mouse and select the Remove
ruler command.
This tool is also available from the model context menu and from the Volume main menu
item. Activation is only possible with the left mouse button.

3.11.2 Polygonal Ruler

To perform plygonal linear measurement:

1. Activate the Polygonal ruler tool by clicking the left/right/middle mouse button. To
continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14.

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2. Mark the first point on the toolbar by clicking the mouse button.

3. Drag the cursor over the screen. The distance from the first point to the current point
will be displayed beside the line.

4. To fix the current point, click the mouse button.

5. Repeat Steps 3 and 4 until the last but one point is fixed.

6. Fix the last point by double-clicking the mouse.

7. To cancel an incomplete measurement, press Esc.

To move the linear measurement point:

1. Locate the cursor on the point to be moved so that it would look like this .

2. Drag the point, holding the left mouse button.

3. Release the left mouse button.

To delete a point:

1. Locate the cursor on the point to be deleted so that it would look like this .

2. Right-click the mouse and select the Remove point command.

To insert a point:

1. Locate the cursor on the ruler where you want to insert a point so that it would look like
this .

2. Right-click the mouse and select the Insert point command.

To resume a completed polygonal linear measurement:

1. Locate the cursor on the point from which you want to continue the measurement, so
that it would look as follows: .

2. Right-click the mouse and select the Resume ruler command.

3. Perform the polygonal linear measurement.

To delete a completed polygonal linear measurement:

1. Locate the cursor on the measurement to be deleted so that it would look like this
.

2. Press the Delete key on the keyboard or right-click the mouse and select the Remove
ruler command.

This tool is also available from the model context menu and from the Volume main menu
item. Activation is only possible with the left mouse button.

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3.11.3 Surface ruler

Functionality is available in the Pro edition

A distance on the surface of a visible volume may only be measured in the Volume recon-
struction tab.
To measure a distance on the surface of a visible volume or a surface, proceed as follows:

1. Activate the Surface ruler tool by clicking the left/right/middle mouse button. To
continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14.

2. Mark the first point on the toolbar by clicking the mouse button.

There may be a delay before the first point is displayed as it takes some time
to bind the first point to the segmented structure.

3. Drag the cursor over the screen. The next point number is displayed next to the cursor.

4. To fix the current point, click the mouse button.

5. Repeat Steps 3 and 4 until the last but one point is fixed.

6. Fix the last point by double-clicking the mouse.

The line reflecting the change is built along the shortest path between the points on the
surface of only one segmented structure. The distance is measured on the surface of the
segmented structure where the first point is placed.
Selecting a segmented structure to place the first point is based on the Point projection
setting of the Render settings tool. For details on render setting tool management, see Sec-
tion 3.14.
If more than one segmented structure is created in the project that satisfies the criterion
for placing the first point, the point is placed on the structure located in the foreground. You
can measure the distance on the surface of the structure in the background in several ways:

• rotate the volume model so that there are no other structures in front of the selected
structure;

• turn off the visibility of the structure in the foreground;

• change the opacity value of the foreground structure.

If the path cannot be built, an Unable to find the path message pops up, and the last path
that was successfully built is restored. The measurement path is highlighted when you hover
over it, and the numbers of the points are shown.
It is impossible to measure a distance on the surface of a imported or copied
surface.

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Imported and copied surfaces are structures without a 3D model. If the user attempts to
make a measurement on the surface of an imported/copied surface, a warning message will
pop up.
If a measurement path is built on the surface of a segmented structure (base volume, or
surface) that is invisible, a warning will pop up if a user attempts to edit the path.
In the merged series opened in the Volume reconstruction tab, the distance on the sur-
face of the segmented structure is measured in the same way. The first measurement point
along the surface of the structure is placed on the layer that is in the foreground. To mea-
sure the distance on the surface of the structure located on the background layer, decrease
transparency of the foreground layers.
In addition to commands, the context menu of the Surface ruler (Fig. 3.9) contains infor-
mation concerning the layer and the segmented structure on which the measurement path to
be edited was built. To open the context menu for the tool, right-click on a point, the path or
the text describing the path length.

Figure 3.9: The Surface ruler context menu

To move a point of a measurement path, proceed as follows:

1. Locate the cursor on the point to be moved so that it would look like this .

2. Drag the point, holding the left mouse button or the button, with which the tool is acti-
vated.
To add a point in order to proceed with building a measurement path, proceed as follows:
1. Locate the cursor over the first or the end point of the measurement path so that it would
look like this .

2. Right-click the mouse and on the context menu select the Add surface point command.

3. Proceed with building the measurement path.

To add a new point to a path between two existing points, proceed as follows:
1. Hover the cursor over the place on the path where you want to add a point so that it
would look like this .

2. Right-click the mouse and on the context menu select the Insert surface point com-
mand.

3. Drag the cursor over the screen. To fix the new point, click the mouse button.

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 3.11. MEASUREMENTS

To delete a point:

1. Locate the cursor on the point to be deleted so that it would look like this .

2. Right-click the mouse and on the context menu select the Remove surface point com-
mand.

The deletion of a single point does not lead to rebuilding the measurement path com-
pletely. Only the segment between the two neighboring points will be rebuilt.
To rebuild the edited measurement path, hover the cursor over the path or the text de-
scribing the path length so that it would look like this . Right-click and select the Rebuild
the entire ruler option on the context menu.
There are several ways to delete a measurement:

1. To delete an incomplete measurement, press Esc.

2. To delete a measurement path, hover the cursor over the path, a point, or the text de-
scribing the path length so that it would look like this . Press the Delete key on
the keyboard or right-click and select the Remove surface ruler option on the context
menu.

3. To delete all measurements, click the Delete all Measurements button on the
toolbar. In the dialog box that appears, Click YES to delete or NO to cancel. If you
want the DICOM Viewer to always delete annotations and measurements without this
confirmation, check the box Don‘t show this dialog again and click YES. If you want the
DICOM Viewer to show the confirmation dialog, check the box Ask before deleting all
annotations and measurements (see Section 16.7.1).

The Surface ruler tool is also available from the model context menu and from the Volume
main menu item. Activation is only possible with the left mouse button.

3.11.4 3D Angle
To measure an angle on the model:

1. Activate the 3D Angle tool by clicking the left/right/middle mouse button. To

continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14.

2. Make two points on the model clicking the mouse button. The second point is the angle
apex.

3. Move the cursor over the screen to set the other side of the angle.

4. Click the mouse button to fix the second side of the angle.

5. To cancel an incomplete measurement, press Esc.

To move the 3D angle point:

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1. Locate the cursor on the point to be moved so that it would look like this .

2. Drag the point, holding the left mouse button.

To remove the 3D angle:

1. Locate the cursor on the line of the 3D angle to be deleted so that it would look like this
.

2. Press the Delete key on the keyboard or right-click the mouse and select the Remove
3D angle command.

This tool is also available from the model context menu and from the Volume main menu
item. Activation is only possible with the left mouse button.

3.11.5 Customizing the Text Size for Measuring Tools

To change the text size for a measurement that has already been displayed, right-click on the
point, line or text referring to the measurement result. On the context menu that pops up,
select the Options...

Figure 3.10: Dialog box for customizing the text size for a measuring tool

In the dialog box (Fig. 3.10), set the text size in millimeters. The minimum size is 1. If you
want the new settings to be applied to all the new measurements by default, check the Set
as default box.
Click OK to apply the settings or CANCEL to cancel.

3.12 Markers
Working with markers is mostly similar to the procedure described in Section 5.12. The differ-
ences are as follows:

• To drag a marker, locate the cursor on the circle in the middle of the marker. If the image
scale is relatively small, the circle size may exceed the marker size.

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 3.13. EXPORT MODEL

• If the marker is on a surface currently hidden behind other tissues, only the circle in the
middle of the marker will be visible, and the marker itself will be hidden. If you drag the
marker, it will be moved to the model surface that is currently visible. The line marker in
this situation is not visible.

3.13 Export Model

Functionality is available in the Pro edition

All the tabs may not fit in the box, in this case, scroll through the tabs, using the left and
right arrows .
The export of a model to DICOM or to an image is similar to the image export described
in Section 2.28.

3.13.1 Export Rotation to Series

To export a rotation to series:

1. Set the series description.

2. Specify the rotation axis (the default is Y).

3. Set the rotation angle (the default is 90 degrees).

4. Set the rotation step (the default is 5 degrees).

5. If you need to load the exported series to the server at once, check the option Upload
exported series to the default server. If the default server is not specified in the DICOM
Viewer this option will be inactive.

6. Specify the image size if necessary.

7. To export the rotation, click OK. To cancel, click CANCEL.

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3.13.2 Export Rotation to Images

To export a rotation to images:

1. Set the path to the folder for export.

2. Enter the file name.

3. Select the file extension from the drop-down menu. Other parameters are described in
the previous section.

4. To export the rotation, click OK. To cancel, click CANCEL.

This tool is also available from the Volume main menu item.

3.14 Render settings

The Render settings tool allows for setting the rendering quality of the 3D model and
the opacity threshold. The tool is available on the toolbar of the Volume reconstruction tab,
MPR reconstruction tab, Vessel analysis tab, Coronary artery analysis tab and in the Volume
section of the main menu. The tool allows you to set the quality of the model both in dynamic
and static state.
The opacity threshold allows to ignore relatively transparent tissue when performing mea-
surements and creating segments. That is, the tissue whose transparency level is below a
predetermined value will be visible, but the points of the measuring tools will be projected on
the tissue with a higher level of transparency. Such tissue will not be included in the segment.
To set quality:

1. Click on the Render settings button on the toolbar. The dialog shown in Fig. 3.11
will be displayed.

2. Move the sliders to set the quality of the model in dymanic state (Dynamic quality) and
in static state (Static quality). Move the slider to the right for maximum quality.

3. Provide the opacity threshold value for measuring tools as percentage (the Point pro-
jection parameter). The ability to change the threshold value makes it easier to work
with linear and angular measurement tools, markers and Select model point tool (Sec-
tion 3.5).
The tools for editing the volume (Cut object, Cut all except object and Brush cut) delete
the tissues whose opacity is below the threshold value. For details on volume editing
tool management, see Section 3.8.

4. Provide the opacity threshold value in the Segmentation field. The value provided in
this field affects the voxel opacity level in the Segmentation mode.

5. Click the CLOSE button.

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 3.15. RECONSTRUCTION BY SERIES WITH VARYING DISTANCES BETWEEN SLICES

Figure 3.11: Render settings dialog box

If the quality is high, the update image may be delayed because of low computer resources.

3.15 Reconstruction by Series with Varying Distances between

Slices

If a series contains images made with a varying step, volume reconstruction by the standard
algorithm is impossible. There are two solutions to this problem.

1. The missing images are interpolated (recreated). In this case, the reconstruction will not
be accurate. The DICOM Viewer will return a warning like Series slice distance varies
too much: most unique distance: 7.5 mm; min distance: 7.5 mm; max distance: 22.5
mm. Model may be innacurate.

2. The reconstruction is made within the part of the series where the distances between
slices are the same. In this case the reconstruction will be incomplete. The DICOM
Viewer will return a warning like Series slice distance varies too much. Only slices
1-22 of 28 are used.

The first method is used by default. For details on how to specify the preferable recon-
struction method, see Section 16.7.3.

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3.16 Subtraction of Volumes for Fused Series

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

The DICOM Viewer provides an opportunity to subtract the volume of one layer from the
volume of another layer in a fused series. The result of subtraction is exported in the current
study as a new series.
This function allows the user to perform subtraction for series with arbitrary relative position
of slices, with or without contrast.
Fig. 3.12 shows the results of subtracting a series with contrast from a series without con-
trast for the same body part.

Figure 3.12: Volume subtraction for a fused series has been performed

Some tissues may be deleted by mistake. This function should only be used
as an auxiliary. The diagnosis should be established on the basis of the
original images.
To subtract the volume of one layer from the volume of another layer in a fused series,
proceed as follows:
1. Open a fused series in the MPR reconstruction or Volume reconstruction tab. For this
purpose, in the Series fusion tab, click the or button on the toolbar or select
the respective command in the View section of the main menu.

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 3.16. SUBTRACTION OF VOLUMES FOR FUSED SERIES

2. On the segmentation panel, select the layer from which you want to subtract the volume.
If the fused series comprises series for the same body part with and without contrast,
select a layer with contrast as a layer from which the volume is to be subtracted.

3. Click the Subtract volumes button on the toolbar with editing tools.

4. In the dialog box that pops up (Fig. 3.13), add the description of the created series. By
default, the description is generated automatically on the basis of the following template:
<Name of the first layer>(subtracted). Check the information on the initial layer and
select the layer to be subtracted.

Figure 3.13: Creating a fused series for volume subtraction

5. Click OK to perform subtraction and export the new series to the current study or CAN-
CEL to cancel. The subtraction and export procedure may take some time.

The exported series is saved in the local storage as a new series. A thumbnail for the
new series will be added to the series panel.

6. Go to the Local storage tab. In the current study, open the new series in the Volume
reconstruction or MPR reconstruction tab. For this purpose, click the or
button on the toolbar or select the respective command in the View section of the main
menu.

7. If required, change the current CLUT on the rendering setup panel (see Section 2.23)
and edit the image by deleting unwanted fragments with editing tools.

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3.17 Remove Bone Tissue

3.17.1 Remove Bone Tissue Manually (Interactive)
Interactive bone tissue removal is performed by watershed method. To enable the interactive
mode, click on the arrow on the right side of the Remove Bones button on the toolbar
and check the Interactive box.
To remove bone tissue:
1. Open the series containing bone tissue in the volume reconstruction window.

2. Activate the Remove bones tool by clicking the left/right/middle mouse button. To
continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14. The tool initiation process may take some time.
3. Set markers on the tissue that should not be deleted. To do that, click the mouse but-
ton with which the tool was activated on the tissue while holding the Ctrl key (or the
Command key for macOS).
4. To delete bone and other tissue, click the mouse button with which the tool was activated
on this tissue. The deletion process may take time.

5. To undo this action, click the Undo button; to redo the action, click the Redo
button.
To set the tool parameters, cLick the arrow on the right-hand side of the Remove bones
button and select Options....

3.17.2 Removing Bone Tissue Manually (Automatic)

You can remove the bone tissue for any series specifying the required parameters manually.
To do that, you need to disable the interactive mode of the tool. Click the arrow on the right
side of the Remove bones button on the toolbar and uncheck the Interactive box.
To remove bone tissue manually:
1. Open the series containing bone tissue in the volume reconstruction window.

2. Click the Remove bones button on the toolbar. A dialog box (Fig. 3.14) will pop up.

Figure 3.14: Configure bone remove parameters dialog box

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 3.17. REMOVE BONE TISSUE

3. Set the Min bones density(HU) value in the dialog box. All tissues whose density ex-
ceeds this value will be deleted. If you set the minimum bone density value equal to the
surface layer density, some tissues other than bones may be removed as well.

4. Set the Grow bones (voxels) value. This value allows you to set the thickness of the soft
bone surface layer in voxels.

5. Click the OK button to remove bones or CANCEL to cancel.

6. As a result of the operation, bone tissues are removed. Other tissues adjacent to bone
tissue, such as vessels, are not deleted.

All these values should be adjusted experimentally. The default values are not optimum.
To remove bone tissues with a lesser density, click the Remove bones button and
reduce the minimum bone density value. If the value turns out to be too small, undo the last
removal using the Undo button, and increase the minimum bone density value during
the next removal.
Some tissues that are different from bone structures may be deleted by
mistake. This function should only be used as an auxiliary. The diagnosis
should be established on the basis of the original images.
This tool is also available from the Volume main menu item.

3.17.3 Remove Bone Tissue for Fused Series

Functionality is available in the Pro edition

This tool is used for angiographic and other studies containing at least one series with
contrast and one series without it for the same body area.
To remove the bone tissue:

1. Fuse the series with contrast and without it in the Series fusion tab (see Chapter 4). The
series fusion is stored in the local storage in the same study.

2. Open the fused series in the Volume reconstruction or MPR reconstruction tab. To do
this click the or button on the toolbar or select the corresponding command
in the View section of the main menu.

3. In the layer list select the series with contrast. By default, the first series is selected.

4. Click the Subtract bones (Choose layer to subtruct from first) button on the
toolbar.
In the dialog box (Fig. 3.15) that opens, enter the name of the new series. By default, the
new series is named <Name of the first layer>(Bones subtracted). Under the name of
the new series, the names of the layers for the created series are displayed. Click OK
to create a new series or CANCEL to cancel. The process may take some time. Upon
completion, a series without bones will appear on the series panel for this study.

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Figure 3.15: Creating a fused series for subtracting bones

5. Go to the Local storage tab. Open the new series in the Volume reconstruction or MPR
reconstruction tab. To do this click the or button on the toolbar or select
the corresponding command in the View section of the main menu.

6. Change the current CLUT to the CT-Bones on the visualization setup panel (see Sec-
tion 2.23).

Figure 3.16: The bone tissue has been removed

If required, edit the image removing bone tissue with editing tools.

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 3.17. REMOVE BONE TISSUE

Some tissues that are different from bone structures may be deleted by
mistake. This function should only be used as an auxiliary. The diagnosis
should be established on the basis of the original images.

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CHAPTER 4. SERIES FUSION

Chapter 4

Series Fusion

There are certain peculiarities associated with fused series depending on

the type of the rendering device:

• On a CPU-based renderer, the display of merged series may not be

accurate in the Volume reconstruction tab.

• For the CUDA renderer, no more than four fused series may be
displayed in the Volume reconstruction tab.

• For OpenCL and Metal rendering devices, no more than four fused
series may be displayed in the Volume reconstruction tab and no more
than eight fused series may be displayed in theMPR reconstruction
tab.

To be suitable for fusion, series must comply with the following requirements:

• the images in the series must be monochrome;

• there must be an opportunity to sort the images by the position and the phase;

• for multiphase series, the number of phases must be equal. Yet, it is possible to fuse a
single-phase series with a multiphase series.

The series obtained as a result of fusion cannot be fused again.

The procedure of viewing fused series is the same as viewing series in the flat image
viewer tab. It is described in Section 2.7.

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 4.1. CREATE SERIES FUSION

4.1 Create Series Fusion

Functionality is available in the Pro edition

To create a series fusion:

1. Open the study.

2. Select the series.

3. Click the Series fusion button on the toolbar or select the View menu and the
Series fusion item.

4. In the Available series section of the Series fusion tab (Fig. 4.1), choose the series you
want to fuse with the selected series.

In the Available series section, you can see the thumbnails for the series available for
fusion. Each thumbnail provides the following information: the icon for the data source
(in the left-hand top corner), the number of images (in the right-hand top corner), and the
series modality (in the right-hand bottom corner).

5. To add a selected series, click the Add series as a new fusion layer or select the
Fusion menu and the Add new layer item. The added series is displayed on the panel
Layers list (Fig. 4.1).

On the Layers list panel, you can see thumbnails for the series that have been fused.
Each thumbnail provides the following information: the icon for the data source (in the
left-hand top corner), the number of images (in the right-hand top corner), and the series
modality (in the right-hand bottom corner).

If the fused series has already been opened in the MPR reconstruction or Volume re-
construction tab, a new layer will also be added to the series in such a tab.

6. To delete a slice from the Layers list panel select it and click the Remove fusion layer
button or select the Fusion menu and the Remove layer item. If the series fusion is
already open in the MPR reconstruction or Volume reconstruction tab, then the series
will also be removed in these windows.

The first (base) layer on the Layers list panel cannot be deleted.

7. If nessesary, open the series fusion in the Volume reconstruction, MPR reconstruction
or Virtual endoscopy tab by clicking the corresponding button on the toolbar.

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CHAPTER 4. SERIES FUSION

Figure 4.1: The layers list and the available series list

The series fusion will appear on the current study series panel and may as well be opened
from there.
This tool is also available from the image context menu.

4.2 Merge Series from Different Studies

Functionality is available in the Pro edition

To merge series from different studies:

1. Select the first study from the study panel.

2. Select one of the series from this study.

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 4.3. MERGE LAYERS

3. Click the Series fusion button on the toolbar or select the View menu and the
Fusion item.

4. In the Series fusion tab, on the Layers list panel, you can see the selected series. The
Layers list panel shows the series that have been fused.

5. Switch to the previous tab.

6. Select another study from the study panel.

7. Select the series to be merged with the selected series from the first study.

8. Drag the series to the Series fusion tab. The second series will be added to the Layers
list (Fig. 4.1).

9. To delete a slice from the Layers list panel select it and click the Remove fusion layer
button or select the Fusion menu and the Remove layer item.

The first (base) layer on the Layers list panel cannot be deleted.

10. Set the visualization mode for the second slice (see Section 2.23.1).

The order of selecting series is important. The first (basic) series of images is located
behind the second series in the flat image view window. The volume model is based on the
first series, and even if the second series covers a larger volume of tissue, only those images
are used in the reconstruction, the location of which is the same in both series, and the others
are ignored.
Merged series can be opened in the Volume Reconstruction, Multiplanar Reconstruction
and Virtual Endoscopy windows.

4.3 Merge layers

Functionality is available in the Pro edition

Fused layers do not always coincide, particularly in cases when two different studies are
fused (Fig. 4.2). In this case, you need to merge layers.
To merge layers:

1. Open the fused series in the Multiplanar Reconstruction window by clicking the MPR
reconstruction button on the toolbar.

2. In the Multiplanar Reconstruction tab, open the segmentation panel by clicking the Seg-
mented structure panel button. There is the Fusion of layers panel at the bottom
of the Segmentation panel (Fig. 4.3).

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3. Select the layer which must be merged with the base one. If the selected layer has the
same «FrameOfReferenceUID» tag value as any other layer, then you will see a
button on the Fusion of layers. You will find more information on merging layers with a
locked system of coordinates in Section 4.3.1.

4. Merge layers automatically (see Section 4.3.2), manually (see Section 4.3.3) or by points
(see Section 4.3.4).

Figure 4.2: Not merged layers

Figure 4.3: Fusion of layers panel

To reduce the Fusion of layers panel, click the Hide button. To expand the reduced
panel, click the Show button.

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To customize the fusion mode settings, click the Options button on the Fusion of
layers panel. The respective dialog box is shown in Fig. 4.4.

Figure 4.4: Layer fusion mode settings dialog

4.3.1 Locking the Frame of Reference for a Layer

Functionality is available in the Pro edition

The position of series of the same study is normally specified in the same frame of ref-
erence. The identifier of the frame of reference is provided in the «FrameOfReferenceUID»
DICOM tag. Series with the same «FrameOfReferenceUID» tag value have the same frame of
reference.
If the selected layer has the same frame of reference as any other layer, you will see
the button on the fusion of layers panel. This button is not shown for the first (basic)
layer.
When layers are fused, layers with a locked frame of reference change their position si-
multaneously with the other layers that have the same frame of reference. If a layer with a
locked frame of reference has the same frame of reference as the basic (first) layer, it cannot
be merged without unlocking.
To merge layers with a locked system of coordinates, proceed as follows:
1. Select the layer whose coordinate system you want to unlock for merging. You will see
a button on the Fusion of layers panel.

2. Click the Unlock layer frame of reference button on the Fusion of layers panel.
The button for a layer with unlocked coordinate system appears as .

3. Merge layers automatically (see Section 4.3.2), manually (see Section 4.3.3) or by points
(see Section 4.3.4).

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4. If needed, unlock the coordinate system of the other layers and merge again.

The frame of reference is locked and unlocked for each layer separately. Layers with an
unlocked frame of reference can be moved independently. When you customize the position
of layers with a locked frame of reference, it has no impact on the layers with an unlocked
frame of reference.
To restore the original frame of reference for a layer, click the Lock layer frame of refer-
ence button on the fusion of layers panel. After unlocking, the layer restores the position
it had before the Lock layer frame of reference button was pressed.
The settings concerning the position of layers and the information on locking are saved in
the segmentation project (see Section 6.11.1) and when matrices are exported to DICOM (see
Section 4.3.5).

4.3.2 Merge layers automatically

Functionality is available in the Pro edition

To merge layers automatically:

1. Click the Merge layers automatically button on the Fusion of layers panel (Fig. 4.3).
This starts the merging process, the Optimizing correlation dialog will open.

2. To cancel the merging process, click the CANCEL button in the Optimizing correlation
dialog.

3. When the merging process is completed, click the DONE button.

4. Merging quality can be poor if the tissue density on the merged layers is very different.
In this case, check the Gradient correlation box on the Fusion mode settings dialog
(see Section 4.3, Fig. 4.4) and repeat steps 1-3.

5. To change the merge accuracy, move the Accuracy of automatic fusion slider on the
Fusion mode settings dialog (see Section 4.3, Fig. 4.4). Move the slider to the right for
maximum quality. High accuracy requires more time to merge.

To merge layers by part of their volume:

1. Choose a layer you need to merge with the base layer.

2. Create a segmented structure for this layer. The mask of the structure should conform to
the volume to be merged. The merge is performed by mask rather than by the created
segmented structure volume.

3. Click the Merge layers automatically button.

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4.3.3 Merge layers manually

Functionality is available in the Pro edition

To merge layers manually:

1. Activate the Manual layer fusion tool by clicking the left/right/middle mouse but-
ton. To continue work with this tool, use the button with which the tool was activated.
To learn more about tool control, see Section 1.14.

2. Match the images in three projections. To do this:

• drag the selected slice, holding the left mouse button or pressing the cursor man-
agement keys , , and ;

• rotate the selected slice, holding the Alt key (or the Option key for macOS) and the
left mouse button;
• zoom the selected slice in and out, holding the Ctrl key (or the Command key for
macOS) and the left mouse button.

3. To cancel all transformations, click the Reset layer transformations button.

4. To cancel zoom, click the Reset layer zoom button.

5. To set the displacement step, set the desired value in the Keyboard move step field of
the Fusion mode settings dialog box (see Section 4.3, Fig. 4.4).

6. When the slices are matched satisfactorily, close the MPR reconstruction tab. The Se-
ries fusion tab will reappear on the screen.

7. Browse the series fusion images to see the result. If the result is unsatisfactory, repeat
the merging proccess.

4.3.4 Merge layers by control points

Functionality is available in the Pro edition

To merge layers by control points:

1. Make all the layers transparent except the base one. To do this, move the transparency
slider for the MPR windows of the corresponding layer to the left. The transparency
slider is highlighted in red in Fig. 4.5.

2. Select the base layer on the segmentation panel.

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3. Activate the Mark the points tool by clicking the left/right/middle mouse button.
To continue work with this tool, use the button with which the tool was activated. To
learn more about tool control, see Section 1.14.
4. Put at least three control points on the image. Each point has its own colour and number.
5. Select the layer that you want to fit with the base. Make all the layers transparent except
this one.
6. Put on this layer the same number of control points in the same places as on the base
layer. Point numbering starts over again. The colours of the corresponding points are
the same.
7. If necessary, adjust the position of points on all three orthogonal planes. When you
locate the cursor on a point, it is highlighted on all three orthogonal planes.
8. To delete point, locate the cursor on it, right-click the mouse and select the Remove
point item.
9. To switch to slices containing a point, move the cursor to this point, right-click the mouse
and select the Go to point item. The point on the current slice is brighter than others.

10. To delete all points, click on the Remove all points button on the Fusion of layers
panel. In the dialog box that opens, click YES to confirm the deletion, or click NO to
cancel.
11. To change the point diameter, open the Fusion mode settings dialog (see Section 4.3,
Fig. 4.4). Set the diameter of the points.

12. Click on the Fit layers by points button on the Fusion of layers panel. The second
layer will be moved in such a way that the corresponding points are as close to each
other as possible.
13. If necessary, adjust the position of the points and repeat the previous step again.
14. If necessary, add the same number of points on all the layers.

Figure 4.5: Control layer slider

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 4.3. MERGE LAYERS

Fig. 4.6 illustrates the example of control points location. Red dots (#1) are located on the
tip of the nose, green (#2) on top, blue (#3) on the right eye.

Figure 4.6: Control points

If the points are set correctly, they match with little margin of error. If the points are set
inaccuratly, the result looks something like in Fig. 4.7.

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Figure 4.7: Control points are matched with a large margin of error due to
location errors

4.3.5 Export and Import Matrices of Merge Layers

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer exports and imports matrices of merge of layers into DICOM Spatial
Registration IOD (modality REG).
To export merge of series, click the Export series registration to DICOM object
button on the Fusion of layers panel (Fig. 4.3).
In the dialog box Export to DICOM Registration (Fig. 4.8) add the description of the ex-
ported merged series. By default, the series description is «Registration». Click OK button to
export series or CANCEL to cancel.

Figure 4.8: The dialog box «Export to DICOM Registration»

The exported merged series will be saved in the local storage as a new series with REG
modality. A thumbnail for the new series will be added to the series panel in the study con-
taining the base layer.

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 4.4. IMAGE REGISTRATION

To import a matrix merged layers:

1. Make a series fusion from the series for which the object was exported DICOM Regis-
tration. Pay attention to the order of the series selection. Select the first (base) layer.

2. Click the Import series registration from DICOM object button on the Fusion of
layers panel (Fig. 4.3).

3. In the dialog box Import from DICOM Registration (Fig. 4.9) select a REG modality series
to import. Click OK button to import series or CANCEL to cancel.

Figure 4.9: The dialog box «Import from DICOM Registration»

The layers are merged relative to the first (base) layer.

4.4 Image registration

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

This tools allows you to deform the images so that their coincidence is maximal. If the
inconsistencies of the series are too large (for example, the patient turned), you must first
merge the layers manually or automatically (see Section 4.3) and then register the images.
Images can be registered for:

• series with the same modality;

• phases of one series.

If a study contains images with a varying density over time (for example, due to the intro-
duction of contrast), then registration may not be performed correctly. To do this, exclude the
tissue with varying density.

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• Set the maximum value of the density for which registration is performed. In this case,
the tissues with a density higher than the specified value do not participate in the regis-
tration, and their deformation is performed according to another algorithm.

• Check the Use image gradient in the Series registration settings dialog. This mode
requires a large amount of video card memory. If the registration failed due to a lack
of video card memory of the video card, turn off this mode or select a CPU(software)
render device (see Section 16.7.3).

If the images contain air outside the patient’s body, then the density of such areas for
CT examinations is usually less than or equal to -1024. It makes no sense to register these
sections of images. Hence, for CT studies, the default minimum density value is -1023.
If the registration failed due to a lack of video card memory, select a CPU(Software) render
device (see Section 16.7.3). In this case, the registration takes more time, but it is performed
regardless of the amount of GPU memory.

4.4.1 Series registration

Functionality is available in the Pro edition

To register two series:

1. Create a fused series of at least two series.

2. Open the fused series in the Multiplanar Reconstruction window.

3. If the inconsistencies between the series are too large (for example, the patient turned
over), you must first merge the layers manually or automatically (see Section 4.3). More
accurate merging of layers enables faster registration.

4. Open the segmentation panel by clicking the Segmented structure panel button.

5. Select a base layer on the layers panel (fixed layer). Its images will not be changed.

6. Click the Volumes registration button. The dialog shown in Fig. 4.10 appears. If
more than two series are fused, then the list from which you must select one series for
registration (Choose moving seris layer).

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 4.4. IMAGE REGISTRATION

Figure 4.10: Series registration settings dialog

7. The Output series description field will be automatically filled in based on the name
of the series being registered, and it will contain the «registered» mark. If necessary,
change the description.

8. Select the desired registration options, checking the Affine registration, Non rigid reg-
istration and Use image gradient boxes.

9. Set the minimum size of the parts that will affect registration. The default size is 20
voxels. The smaller the value is, the more minor details are registered, but the risk of
incorrect registration increases.

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10. Set the percentage of voxels that are used during the registration. The larger the value
is, the higher the accuracy is, but the lower the registration rate gets.

11. If it is necessary to perform registration for a specific range of densities, then set the
minimum and/or maximum values. To do this, set the appropriate flag and enter a nu-
meric value. If the flag is set, but the value is not set, then the OK button is unavailable.
For CT series, the minimum default value is -1023.

12. Click OK to export the series or CANCEL to cancel. Registration may take a long time
depending on the amount of RAM and the speed of the computer.

4.4.2 Phases registration

Functionality is available in the Pro edition

To register the phases of one series:

1. Open the multiphase series in the Multiplanar or Volume Reconstruction window.

2. Open the segmentation panel by clicking the Segmented structure panel button.

3. Click the Volumes registration button. The dialog shown in Fig. 4.11 appears.

4. The Output series description field will be automatically filled in based on the name
of the series being registered, and it will contain the «registered» mark. If necessary,
change the description.

5. Select the base phase that should not be changed (fixed phase).

6. Select the desired registration options, checking the Affine registration, Non rigid reg-
istration and Use image gradient boxes.

7. Set the minimum size of the parts that will affect registration. The default size is 20 vox-
els. The smaller the value the more minor details are registered, but the risk of incorrect
registration increases.

8. Set the percentage of voxels that are used during the registration. The larger the value
is, the higher the accuracy is, but the lower the registration rate gets.

9. If it is necessary to perform registration for a specific range of densities, then set the
minimum and/or maximum values. To do this, set the appropriate flag and enter a nu-
meric value. If the flag is set, but the value is not set, then the OK button is unavailable.
For CT series, the minimum default value is -1023.

10. Click OK to export the series or CANCEL to cancel. Registration may take a long time
depending on the amount of RAM and the speed of the computer.

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Figure 4.11: Phases registration settings dialog

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4.5 Actions with the fused series

Functionality is available in the Pro edition

Action buttons on the toolbar:

The Scrolling tool is described in Section 2.7

The Image stitching mode tool is described in Section 4.6

The Rotate tool is described in Section 2.16

The Zoom tool is described in Section 2.16

The Pan tool is described in Section 2.16

The Adjust W/L tool is described in Section 2.17

The Ruler tool is described in Section 2.19

The Angle tool is described in Section 2.19

The Cobb angle tool is described in Section 2.19

The Point value tool is described in Section 2.19

The ROI rectangle tool is described in Section 2.19

The ROI ellipse tool is described in Section 2.19

The ROI polygon tool is described in Section 2.19

The Delete all annotations and measurements tool is described in

Section 2.19

The Quick export images tool is described in Section 2.28

The Add to print list tool is described in Section 19

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 4.6. IMAGE STITCHING MODE

4.6 Image stitching mode

Functionality is available in the Pro edition

If a the study contains several series that are the results of scanning sections of an ex-
tended area, then such series can be fused into one in the «stitching» mode. The mutual
arrangement of images from different series is determined automatically according to the
scanner data.
To «stitch» images:

1. Open the study containing the series that need to be «stitched» in the series fusion
window.

2. Make a series fusion. If the image does not fit in the window, use the image positioning
tools Zoom and Pan (see Section 4.5).

3. Click the Image stitching mode button on the toolbar. The image will change as
shown in Fig. 4.12 (the right-hand image is the image after «stitching»).

Figure 4.12: Changes in the «stitching» mode (the right-hand image is the
image after stitching)

In the «stitching» mode, the Adjust W/L tool applies to the entire series.

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4.7 Volume Stitching

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

The DICOM Viewer provides an opportunity to export several fused series to the current
study as a new series. The fused series will be stitched as one layer.

Figure 4.13: The layers are fused, and the new series is ready for stitching

To export a fused series to the current study as a new series, proceed as follows:

1. Open the series in the MPR reconstruction tab.

2. Click the Export button on the segmented structure panel and select the Export volume
stitching option on the dropdown menu (Fig. 4.14).

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 4.7. VOLUME STITCHING

Figure 4.14: Export menu

3. In the Volume stitching options (Fig. 4.15) dialog box that pops up, add a description of
the series created. By default, the description is generated automatically according to
the following template:
stitching of <description of the 1st layer series> and … <description of the N layer series>

Figure 4.15: Dialog box for customizing the volume stitching parameters

4. Specify the position and the boundaries of the exported area in the coordinates of the
voxel model of the first (basic) layer. The size of the exported area will be calculated
automatically and may be changed by the user. The position and the boundaries of the
exported area are shown in the windows of the MPR reconstruction tab and may be
changed when editing the numeric values.

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The acceptable range of values for the coordinates of the exported area position is from
-8192 to 8192, for the coordinates of the boundaries — from 1 to 8192.

The boundaries of the exported area along the X and Y axes are determined
by the volume of the basic layer.

5. On the Intensity rescale method drop-down list, select the intensity rescale method for
the stitched volumes:

• No rescale;
• By visible intensity. If you use this method, the same intensity range will be set for
all the volumes for the current window width and level (W/L) values.

If all the volumes have the same intensity range and the same modality, then the No
rescale method will be set by default. If volumes with different modalities and different
intensity ranges are stitched, the By visible intensity method is set by default.

6. On the Volume stitching weight computing method, select the computing method for
weights:

• Shared weights. Voxels for all the volumes have the same weight;
• By volume opacity. Voxel weight for each volume depends on the opacity value
of the layer basic volume for the selected window type (MPR or 3D model);
• By volume geometry. Voxel weight for each volume is proportional to the distance
from the closest boundary of this volume.

If volumes with the same modality are stitched, the By volume geometry method is
selected by default. Otherwise, the Shared weights method is selected by default.
The default values of the intensity rescale method and the volume stitching
weight computing method are set when the Volume stitching options dialog
box pops up for the first time. The methods selected by the user will be
saved when the dialog box is opened again.

7. Click OK to stitch the layers of the fused series and export the new series to the current
study, or click CANCEL to cancel. The stitching and export procedure may take some
time.

Make sure that all the volume required has been exported.

The exported series is saved in the local storage as a new series. A thumbnail for the new
series will be added to the series panel.
If one or several original series are multiphase series, the stitching and export procedures
are only performed for the current phase.

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Chapter 5

Multiplanar Reconstruction (MPR)

In Multiplanar Reconstruction window, diagnosis can only be established on

the basis of CT, MR, XA and MG series

5.1 Open Study in Multiplanar Reconstruction window

To open a study in the multiplanar reconstruction window:

1. Load the studies to the DICOM Viewer.

2. Select the target study from the study panel.

3. Click the MPR reconstruction button on the toolbar. To select the tab location (in
the current window, in a separate window or in the full screen mode), click on the arrow
on the right side of the button. To open the multiplanar reconstruction window in a new
tab in the current window, click on the button. The process may take some time.

Fig. 5.1 illustrates the multiplanar reconstruction window.

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Figure 5.1: MPR reconstruction tab

5.2 MPR View Elements

The tab will display three image view windows. The top left window displays the axial sec-
tion, the right window shows the coronal section, the bottom left window contains the sagittal
section .
This template for the arrangement of section windows is activated by default. The informa-
tion regarding the choice of other window arrangement templates is provided in Section 5.2.1.
You can maximize any of the sectional plane windows from the MPR reconstuction tab
and restore its size in several ways:

• click on the Expand button in the right-hand upper corner of the series window;

• double-click with the left mouse button on the title of the series window.

You can maximize and restore the size of the 3D view window using the first or second
method.
The DICOM Viewer provides the user an opportunity to swop section windows. To do that,
choose the window you want to move, place the cursor on the window header, and press the
left mouse button so that the cursor changes to . While holding the left mouse button,
drag the window to the spot you have chosen for it, and it will change places with the window
that is currently in that spot.
The DICOM Viewer allows you to move the borders between the image view windows. To
do it, locate the cursor on the border so that it would look like or , and drag the
border, holding the left mouse button.
For details, on how to save the image view window configuration, see Section 16.7.3.

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 5.2. MPR VIEW ELEMENTS

The top part displays the toolbar on the left (Fig. 5.2) and the image setup panel on the
right (Fig. 5.3).

Figure 5.2: Toolbar

Figure 5.3: Image setup panel

To open a study in the 3D view window of the MPR reconstruction tab, click the 3D
button on the toolbar. A 3D view window will pop up, in which you will see a 3D model and a
standard space orientation panel (for details see Section 3.3).

5.2.1 Customizing the Section Windows Arrangement

Functionality is available in the Pro edition

The DICOM Viewer provides the user an opportunity to customize the section windows
arrangement in the MPR reconstruction tab. You can choose the template from the menu of
the button used for section windows arrangement customization.
Depending on the template chosen, this button may appear as: , , ,
, , , , or .
To select a windows arrangement template, press the button for section windows arrange-
ment customization or the arrow on the right-hand side of the button. On the drop-down menu
(Fig. 5.4) select one of the following options:

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Figure 5.4: Choosing the windows arrangement template

• 2 columns (2, 1). There are two columns for section windows. Two windows are
placed in the left column and one in the right one. This template is chosen by default;

• 1 row. The three section windows are placed in a single row;

• 1 column. The three section windows are placed in a single column;

• 2 columns (1, 2). There are two columns for section windows. One window is
placed in the left column and two in the right one;

• 2 rows (1, 2). There are two rows for section windows. One window is placed in
the upper row and two in the lower one;

• 2 rows (2, 1). There are two rows for section windows. Two windows are placed
in the upper row and one in the lower one;

• 1 row (3D). The three MPR reconstruction section windows and the 3D view win-
dow are placed in a single row;

• 2x2 (3D). There are two columns for windows arrangement. In the left column,
there are two section windows, and in the right column, there is one section window
and the 3D view window;

• 3D + 3MPR rows. The 3D view window is placed in the left column. The three
section windows are in the right column.

The current windows arrangement template is highlighted on the toolbar and the menu in
blue.

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 5.3. RESAMPLING FILTER

To change the current windows arrangement template for 2x2 (3D) , click the 3D
button on the toolbar. To get back to the previous windows arrangement template, click the
3D button on the toolbar again.
To set the default windows arrangement template, click the arrow on the right-hand side
of the button for windows arrangement template selection, and then select the Set default
layout template... option.

Figure 5.5: Dialog box for selecting the default windows arrangement
template

In the dialog box that pops up (see Fig. 5.5), select the default arrangement option. Click
OK to apply the settings or CANCEL to cancel.
Next time the series is opened in the MPR reconstruction tab, the default windows ar-
rangement template will be applied.
If you switch to the curvilinear reconstruction mode, the windows arrangement templates
will be replaced by the curvilinear reconstruction windows arrangement templates (see Sec-
tion 5.7.6).

5.3 Resampling filter

To change the Resampling filter, open the MPR main menu, select the Resampling filter menu
item and in the submenu that opens, select a filter. The active filter is marked with a flag.
The following filters are available:

• Bilinear;

• B-spline;

• Mitchel;

• Catmull-Rom;

• Lanczos3;

• Lanczos5;

• Lanczos7.

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By default the Bilinear filter is active.

When filters are used (except for the Bilinear filter), distortions may occur. If
you see any dubious artifacts, select the Bilinear filter.

5.4 Image Filters

Functionality is available in the Pro edition

This function cannot be used for establishing a diagnosis

Work with filters in the MPR reconstruction tab is similar to work in the Image viewer tab
(see Section 2.6) with two exceptions:

• to apply a filter in the MPR reconstruction tab, on the main menu, select MPR->Filters
and select the desired filter on the list of filters on the main menu. The current filter is
highlighted with blue on the list of filters, and marked with a flag;

• in the MPR reconstruction tab, a filter is applied to all the cutting plane windows and
the involute curve window.

5.5 Working with Orthogonal Planes

5.5.1 View Modes
Click the Switch navigation mode button and select one of the three view modes:

1. The 3D cursor mode. It allows you to drag and rotate orthogonal cutting planes using
the mouse. The Switch navigation mode button will look as follows: .

2. The on click 3D cursor mode. It allows you to move orthogonal cutting planes similarly
to the 3D cursor mode, but the plane lines are visible only during the dragging (while the
left mouse button is pressed). The Switch navigation mode button will look as follows:
.

3. The planes cursor mode. The cutting planes are displayed permanently. Their moving is
described in the next section. The rotation of planes is similar to the 3D cursor mode and
is described in Section 5.5.2. The Switch navigation mode button will look as follows:
.

In all the view modes the current plane can be moved in several ways:

• scroll the mouse wheel. If you scroll the wheel forward, the plane will withdraw, if you
scroll it backward, the plane will move nearer. One click of the mouse wheel changes the
plane position by the distance equal to the thickness of the slice from the initial series;

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 5.5. WORKING WITH ORTHOGONAL PLANES

• by use the scrollbar on the right side of the section view window to move the section;

• use the Scrolling tool. Activate the tool on the toolbar by clicking the left/right/mid-
dle mouse button and move the cursor up to withdraw the plane or down to move it
nearer, holding down the button with which the tool was activated. To learn more about
tool control, see Section 1.14.

5.5.2 Working with Planes in 3D Cursor Mode

To move orthogonal planes, click the left mouse button at the point you want to move the
planes to, or move the mouse, holding the left button. When the button is released, the posi-
tion of the planes is fixed. To rotate a plane while maintaining orthogonality:
1. Locate the cursor on the radial bidirectional arrow on the plane line (see red arrows in
Fig. 5.6). The bidirectional arrow will be highlighted.
2. Move the cursor, holding the left mouse button to rotate the plane by the required angle.
The images on the other planes will change.
3. Release the left mouse button to fix the current position of the plane.

Figure 5.6: Rotate an orthogonal plane

To rotate a plane without maintaining orthogonality, follow the steps above, holding the
Shift key while performing the step 2.
To undo the rotation of all planes, click the Undo rotation button on the toolbar .

Note that all the other view changes will be undone as well.

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5.5.3 Working with Planes in the Cutting Plane Mode

The DICOM Viewer allows you to move planes one by one in the image view modes. To do
this:

1. Locate the cursor on the plane line to highlight it.

2. Move the line, holding the left mouse button.

Scroll the images in some window to see how the target plane is moving in the other
windows.
For convenience, zoom the image in and out by rolling the mouse wheel, holding the Ctrl
key (or the Command key for macOS).
There are two ways to move images in the window for viewing cutting planes:

1. Move the mouse holding the wheel and the «Shift» key on the keyboard. This key
combination is set by default. You can disable or change the setting in the Controllers
tab of the Image viewer module (see Section 16.7.1).

2. Activate the Pan tool on the toolbar by clicking the left/right/middle mouse button.
To continue work with this tool, use the button with which the tool was activated.To learn
more about tool control, see Section 1.14. To move an image, move the cursor around
the screen while holding down the mouse button.

This tool is also available from the image context menu and from the MPR main menu item.

5.6 Series Synchronization in MPR Reconstruction Tabs

Series synchronization is used for viewing series of one or several studies simultaneously.
The opportunity to compare series created at different times allows the user to evaluate the
changes and improves diagnostic accuracy. Series can be compared in MPR reconstruction
tabs.
To compare series, open them in MPR reconstruction tabs. The tabs may:

• be placed in the main program window or be unattached to it;

• be placed on the same or on different monitor screens. The monitors may be different
in size and have different settings (e.g. scaling, resolution, brightness, contrast etc.).

To enable synchronization, click the Sync series button. Synchronization provides

the user an opportunity to change window width and level (W/L) settings, move, scale and
scroll images from different series in section plane windows. Synchronization is disabled by
default. If synchronization is enabled and the user opens a new tab, the new tab will be
synchronized with the one that was opened earlier.
To set synchronization types and modes, proceed as follows:

1. Click the arrow on the right-hand side of the Sync series button on the toolbar.

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2. Select the synchronization types and modes from the drop-down menu (Fig. 5.7):

Figure 5.7: Sync series button menu

• Sync planes. Planes and rotation angles of orthogonal planes are synchronized in
MPR reconstruction tab windows (Axial plane, Coronal plane and Sagittal plane).
Other MPR reconstruction tab windows are not synchronized;
– in the By patient coordinates mode, synchronization is only performed for se-
ries with the same frameOfReferenceUid tag value. If synchronization is en-
abled, the orthogonal planes of the new tab are synchronized with the planes
of the tab that was opened earlier;
– in the Manual mode, synchronization is performed for series with different
frameOfReferenceUid tag values. In this case, the same changes regarding
scrolling the synchronized and the synchronizing viewer window will be ap-
plied in the patient’s coordinate system. Planes in synchronized windows will
be turned around the line of intersection of orthogonal planes through the
same angle;
• Sync W/L. Changes in the window width and level (W/L) will be synchronized for se-
ries with the CT modality. For series with other modalities, synchronization will only
be performed if the modalities of the series and the recommended width and level
(W/L) values are the same. Series with different modalities cannot be synchronized.
The chosen mode has no impact on this synchronization type.
If synchronization has been enabled, the window width and level (W/L) values of
the tab opened will be synchronized with those of the tab that was opened earlier.
Merged series are synchronized layer by layer. Layers are synchronized by their
respective numbers (the first layer is synchronized with the first one, the second
layer is synchronized with the second one etc.);
• Sync zoom and position. The scaling and position changes are synchronized in
MPR reconstruction tab windows (Axial plane, Coronal plane, and Sagittal plane).
Other MPR reconstruction tab windows are not synchronized. Merged series are
synchronized on the basis of the data for the first layers of the series. This synchro-
nization type functions differently depending on the mode chosen.
– in the By patient coordinates mode:

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* synchronization is only performed for series with the same frameOfRefer-

enceUid tag value;
* the actual image size is taken into account. For sections of the same size,
objects are displayed in the same way;
* window centers are synchronized. In the window center, the user sees the
projection of the center point of the synchronizing window on the synchro-
nized window section;
* if synchronization is enabled, the scale and the position of the image in the
new tab will be synchronized with the scale and the position of the image
in the tab that was opened earlier;
– in the Manual mode:
* the actual image size is taken into account. For sections of the same size,
objects are displayed in the same way;
* if the position of the synchronizing window center is changed, the position
of the synchronized window center is changed accordingly;
* if synchronization is enabled, the scale of the new tab will be synchronized
with the scale of the tab that was opened earlier. The position will be syn-
chronized in compliance with the changes in the synchronizing section po-
sition;
• Sync phases. The image phases are synchronized by number. If the phase num-
ber for the synchronizing series is greater than the total number of phases in the
synchronized series, then the phase with the greatest number will be selected for
the synchronized series. This synchronization type does not depend on the chosen
mode.

5.7 Curvilinear Reconstruction

5.7.1 Build Surface

Functionality is available in the Pro edition

Curvilinear reconstruction is a section of tissues by a curvilinear surface whose configura-

tion is set by the trajectory passing through the middle of this surface. This trajectory is called
a curve.
To activate the Curvilinear reconstruction mode, click the Curve mode . To get back

to the Multiplanar reconstruction mode, click the Curve mode button again. The curve
built in the Curvilinear reconstruction mode is not shown in the MPR reconstruction mode.
To build a surface:

1. Select the plane in which it would be convenient to start building a curve.

2. Roll the mouse wheel to select the slice where the first point will be located.

3. Fix the first point on the image by clicking the left mouse button.

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4. If necessary, move to another slice by rolling the mouse wheel.

5. Move the mouse to select the location of the next point. Fix the point by clicking the left
mouse button. The point will appear in the current slice.

6. Repeat Steps 4 and 5 until the last but one point is fixed.

7. Fix the last point by left-clicking the mouse twice. While building the curve, the cur-
rent section will be displayed in the bottom right-hand window. The other windows will
display the projections of the curve on the corresponding planes (Fig. 5.8).

8. If necessary, correct the projections of the curve on the two other planes. For details on
how to correct, see the section 5.7.4.

Figure 5.8: Reconstruction by a curve

You can maximize any of the sectional plane windows from the MPR reconstuction tab
and restore its size in several ways:

• click on the Expand button in the right-hand upper corner of the series window;

• double-click with the left mouse button on the title of the series window.

You can maximize and restore the size of the Involute window using the first or second
method.

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5.7.2 Choosing a Display Mode for an Involute of a Curve

Functionality is available in the Pro edition

Click the arrow on the right-hand side of the Curve mode button and choose the
display mode for the involute of the curve from the button menu (Fig. 5.9). The current mode
is ticked.

Figure 5.9: Curve mode button menu

• Straightened involute. The mode is set by default. In the straightened involute curve
window (Fig. 5.10), the curve built by the user is transformed into a straight line. The
distortions of space along the curve are marginal and increase with distance from the
curve. We recommend this mode when the region of interest is placed near the curve.
This option provides for the highest possible level of detail along the curve.

Figure 5.10: Straightened Involute curve mode

• Involute curve in orthogonal planes (Fig. 5.11). Unlike the Straightened involute mode,
this mode provides for a lower distortion degree at a distance from the curve, but the

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level of detail along the curve is also lower. Unlike the Involute curve from first to last
point, this mode is less dependent on the position of points on the curve. It is used when
you need an involute similar to an orthogonal projection. The orthogonal projection is
chosen automatically to provide for the highest possible level of detail along the curve.
Still, the level of detail along the curve is lower compared to other curve modes.

Figure 5.11: Involute curve in orthogonal planes

• Involute curve from first to last point (Fig. 5.12). Compared to the Straightened involute
mode, the distortion degree at a distance from the curve is lower, but the level of detail
along the curve is also lower. The involute is highly dependent on the position of the
first and the last point on the curve. The level of detail along the curve is greater than in
the Involute curve in orthogonal planes mode.

Figure 5.12: Involute curve from first to last point

The selected curve mode will be applied the next time the Curvelinear Reconstruction
mode is activated.

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In the Straightened involute mode, the Ruler, Polygonal Ruler, Angle, and Kobb angle
tools cannot be used in the window with the involute.

5.7.3 Curve settings

Functionality is available in the Pro edition

The parameters of the curve can be set in the Curve options dialog box (Fig. 5.13). The
appearance and the functions of the Curve options dialog box depend on the way you call
for it. There are two ways to call for the Curve Options dialog box:

1. Click the arrow on the right-hand side of the Curve mode button on the toolbar
and then select Default curve options... from the button menu. You will see the dialog
box shown in Fig. 5.13a.

2. Right-click on the curve or a point on the curve and select Curve options... from the
menu that pops up. You will see the dialog box shown in Fig. 5.13b.

a) b)

Figure 5.13: Curve options dialog box

You can set up the following parameters:

• color;

• line width in pixels;

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• point radius in pixels.

Setting the curve visibility mode:
• Always. When the curve is being built, it is shown in all the windows of the tab with
plane projections, as well as in the involute window. After the curve has been built, it
is always shown in all the windows of the tab with plane projections, as well as in the
involute window. This mode is set by default.
• Do not display on the involute. When the curve is being built, it is shown in all the win-
dows of the tab with plane projections, except for the involute window. After the curve
has been built, it is always shown in all the windows of the tab with plane projections,
except for the involute window.
• Hover. When the curve is being built, it is shown in all the windows of the tab with plane
projections, as well as in the involute window. After the curve has been built, it is shown
in all the windows of the tab with plane projections, as well as in the involute window if
the cursor is placed on the curve.
• Never. When the curve is being built, it is shown in all the windows of the tab with plane
projections, as well as in the involute window. After the curve has been built, it is hidden.
Choose another visibility mode to see the curve.
If you open theCurve options window from the Curve mode button menu (Fig. 5.13a), the
settings will always be applied to the curve by default.
If you tick the Set as default box in the Curve options dialog window opened from the
curve context menu (Fig. 5.13b), the settings will be applied by default when a curve is built.
To apply the settings, click OK. To cancel, click CANCEL.

5.7.4 Actions with a Curve

Functionality is available in the Pro edition

Actions with a curve can be performed only if the curvilinear reconstruction mode is active.
The following actions are available:
• Drag a point. Locate the cursor on the point so that it enlarges, and drag the point
holding down the left mouse button or the button to which this tool is assigned. Then
release the mouse button.
• Add a point. Locate the cursor on the curve where the point should be added. Right-click
the mouse and select the Add point item.
• Delete a point. Locate the cursor on the point. Right-click the mouse and select the
Remove point item.
• Continue a curve. Locate the cursor on one of the border points of the curve. Right-click
the mouse and select the Resume curve item. Then, perform Steps 3 and 4 of the curve
building algorithm.
• Delete a curve. Locate the cursor on any position on the curve or on a point. Right-click
the mouse and select the Remove curve item.

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5.7.5 Position of a Curve, Its Nodes and Surface in Space

Functionality is available in the Pro edition

By the color of the curve, you can determine which part of the curve is located in front of
the current image in space. This part of the curve is brighter than the part behind the image.
In Fig. 5.14, the central part and the third point are a brighter color. This means they are
located in front of the current section.

Figure 5.14: Reconstruction by a curve

To make it easier to find a node on the curve on all the projections, locate the cursor on
this node. The node will be magnified on all the projections.
To rotate the surface relative to the curve, move the cursor to the bottom right-hand win-
dow (Surface by curve) and roll the mouse wheel.
To move the cutting planes to the selected point of the curve, move the mouse cursor to
the selected point on the curve in the selected window. Left-click while holding down the Ctrl
key (or the Command key for macOS) on the keyboard. The point of intersection of the cutting
planes is moved to the specified point on the curve in all the windows.

5.7.6 Curved Reconstructions Cross Sections Mode

Functionality is available in the Pro edition

The curved reconstruction cross section mode is aimed for viewing the planes that are
perpendicular to the curve and evenly spaced.

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You can view curve slices if Curvelinear reconstruction mode is activated and a curve has
been built. To activate the Curvilinear reconstruction mode, click the Curve mode button
.
To select the window arrangement template, click the arrow on the right-hand side of the
button or the Switch layout template button and choose one of the options provided
(see Figure 5.15):

Figure 5.15: Switch layout template

• Curve 2x2. In the MPR reconstruction tab, you see three windows with multiplanar
reconstruction cutting planes and a Involute window. This mode is selected by default.

• Curve slices 1x2. The tab is divided into two windows. The Involute window is
placed at the top, and the Curve slices window is at the bottom.

• Curve slices 2x1. The tab is divided into two windows. The Involute window is
placed on the left-hand side, and the Curve slices window is on the right-hand side.

• Curve slices 2x2. The tab is divided into four windows. The Axial projection and
the Volume reconstruction windows are placed on the left-hand side, while the Involute
and the Curve slices windows are placed on the right-hand side.

The window arrangement template settings will be applied next time you choose the Curve
mode.
You can maximize any of the sectional plane windows from the MPR reconstuction tab
and restore its size in several ways:

• click on the Expand button in the right-hand upper corner of the series window;

• double-click with the left mouse button on the title of the series window.

You can maximize and restore the size of the Involute, 3D view and Curve slices windows
using the first or second method.
If you see the Volume reconstruction window or the segmentation panel in the tab, the
volume editing tools are available.

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Figure 5.16: Curve slices 2x2 mode

In the Involute window, a straightened curve and perpendicular cutting planes projections
are shown. When you mouse over a cutting plane in the Involute window, the respective plane
and projection will be highlighted. The point in which the cutting plane crosses the curve will
be marked with a crosshair in the slices window.
To rotate the surface round the curve, mouse over the Involute window and scroll the
mouse wheel or move the slider in the slices window.
To move the cutting planes along the curve, mouse over the slices window and scroll the
mouse wheel or move the slider in the slices window.
To move the cutting planes automatically, activate the Play tool (see Section 5.10).
To set the curve slices parameters, click the arrow on the right-hand side of the button or
the Switch layout template button and choose the Curve slices options... (Figure 5.17).

Figure 5.17: Activating the dialog box for curve slices properties

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A dialog box will pop up (Fig. 5.18), in which you can set the following parameters:
• the size of the slices window grid. Choose the suitable number of rows and columns
(5x2 or 3x3);
• the distance between slices (in millimeters);
• the scrolling increment. Choose one of the two variants: Auto (the increment is equal
to one voxel) or specify the increment in millimeters;
• the color of the cutting plane lines;
• the thickness on the cutting plane line and the crosshair in pixels;
• the color of the selected cutting plane line and the frame of the slices window;
• the crosshair space in pixels. Set the distance from the lines forming the crosshair to its
virtual center;
• the size of the crosshair in pixels.
If you have checked the Set as default box, these settings will be used by default when
you switch to the Curve slices mode.

Figure 5.18: Curve slices options

There are two ways to activate the Curve slices options dialog box from the right-click
menu:

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1. Mouse over one of the cutting planes in the Involute window. Right-click and choose
Set curve slices options...

2. Mouse over the crosshair of one of the slices in the slices window. Right-click and
choose Set curve slices options...

Rotate, Zoom, Pan and Adjust W/L tools are simultaneously activated for all the slices.

DICOM Viewer records videos, exports and prints images from the Involute window or the
slices window, whichever is active.

In the slices window, only the image from the top left-hand cell will be printed. To print or
export the slice you need, move the cutting planes along the curve, so that the slice you need
appears in the top left-hand cell. You can move the cutting planes by scrolling your wheel or
moving the slider in the slices window.

In the slices window, video is recorded for the top left-hand cell. To record a video for the
slice you need, move the cutting planes along the curve, so that the slice you need appears
in the top left-hand cell.

To record a video, activate the Start video record tool (see Section 5.11).

To escape from the curve slices mode, click the Curve mode button.

5.8 Displaying Section Planes on 3D Models

The MPR planes on 3D view tool is used for setting up and displaying section planes
on 3D models in the 3D view window.

The tool is available on the toolbar in MPR reconstuction, Vessel analysis and Coronary
artery analysis tabs only when a 3D reconstruction is displayed in the 3D view window. In
the Fig. 5.19, , you can see an example of section planes displayed on a 3D model in the 3D
view window of the MPR reconstuction tab.

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Figure 5.19: Section planes displayed in the 3D view window

To enable the mode for displaying section planes, click the MPR planes on 3D view
button on the toolbar.

The tool is only available when a 3D reconstruction is displayed in the 3D

view window. To enable the 3D reconstruction display mode, click the 3D
button on the toolbar.

To enable the planes display, click the arrow on the right-hand side of the MPR planes on
3D view button and select the display mode on the button menu (see Fig. 5.20):

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Figure 5.20: MPR Planes on the 3D View button menu

Planes of open windows. In the 3D view window, the section planes that are shown in
the open windows of the tab are displayed. This mode is enabled by default.
To enable the display of certain cutting plains, disable the Planes of open windows mode.
You can enable the display of the following planes:

• Axial plane;

• Coronal plane;

• Sagittal plane;

• Curved surfacePRO . A curvilinear surface may be displayed in the 3D view window after
a curve is built (see Section 5.7.1). On the curvilinear surface plane, the centerline is
shown in dark red;

• Curved slice planePRO . The curve slices are displayed when the curve slices window is
opened for the first time (see Section 5.7.6). In the 3D view window, the plane of the first
slice is displayed.

All the planes are displayed by default.

Borders of the planes. The mode is used to enable/disable the display of borders of the
cutting planes on a 3D model. The display of borders of the planes is enabled by default.
Transparency settings. In the dialog box that pops up (Fig. 5.21), move the slider to set up
the planes transparency. The extreme right position equals maximum opacity. The maximum
opacity level is set by default.

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Planes transparency is not supported:

• if the CPU has been chosen as the visualization device;

• if the program is installed on Linux;

• if the program is installed on macOS and any device different from

Metal is used as the visualization device.

To make the background visible, uncheck the Transparent background box. The box is
checked by default. To close the transparency settings dialog box, click the CLOSE button.

Figure 5.21: Dialog box for setting cutting planes transparency

Figure 5.22: Displaying cutting planes on a 3D model in the 3D View

window

The colors of the plane borders are the same as the colors of the windows of the respective

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cutting planes. On the curvilinear surface plane, the centerline is shown in dark red. The
borders of the curve slice plane are shown in blue.

5.9 «Render settings» Tool

The Render settings tool allows for setting the rendering quality of the 3D model and
the opacity threshold in the 3D view window. The tool is available on the toolbar only when
a volume reconstruction is displayed in the 3D view window. The operation of the tool is
described in Section 3.14.
To enable the volume reconstruction mode, click the 3D button on the toolbar of the
MPR reconstruction tab.

5.10 The Play Tool

The DICOM Viewer allows you to automatically play slices and phases in the MPR View win-
dows and the Volume Reconstruction window. To configure the playback, click the arrow on
the right side of the Play button and specify the necessary parameters in the button
context menu.

1. If the series contains several phases, then the DICOM Viewer allows you to switch be-
tween the slice and phases playback. To switch select the Play phases or the Play slices
item from the Play button context menu. The selected item is marked with a flag. Only
the items suitable for this series are available on the context menu.

2. Select the speed (5, 10, 20 or 25 frames per second). If you want to set a different
playback speed, select the User defined... item and in the dialog that opens set the
value from 1 to 100. The selected speed will be marked with a flag.

3. If you want to play phases and slices cyclically, select the Loop item. The item will be
marked with a flag. To disable the cyclic playback, select this command again. The flag
will be removed.

To start playback, click on the Play button on the toolbar. During playback, the button

looks like . To end playback click the button.

5.11 Video recording

Functionality is available in the Pro edition

The DICOM Viewer allows you to record video for the volume model view window. The
following objects will be recorded:

• tissues;

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• measurements;

• annotations;

• markers;

• tags;

• orientation cube;

• the Select model point tool label.

The other features of the tool in the MPR View windows are similar to those described
in Section 2.15 and the features in the Volume Reconstruction window are similar to those
described in Section 3.7.

5.12 Markers
5.12.1 General
A marker is a point, line or polygonal line in space, associated with a model. The DICOM
Viewer allows you to display the length of the marker line and the polygonal marker line and
the angles of the polygonal marker line.
The following tools are used to add markers: Marker, Line marker and Polygonal Line
marker. To select one of these tools, click on the arrow on the right side of the tool selection
button. The button will look different depending on the selected tool:

Marker (selected by default)

Line marker

Polygonal Line marker

Activate/deactivate the currently selected tool by clicking the left/right/middle mouse but-
ton. To continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14.
The added markers are located in the displayed slice.

5.12.2 Add Markers

To add a marker as a point:

1. Activate the Marker tool by clicking the button on the toolbar.

2. Mark a place on an image by clicking the left mouse button. The marker will appear in
all three windows.

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After adding all the markers, deactivate the Marker tool.

This tool is also available from the image context menu and from the MPR main menu item.
Activation is only possible with the left mouse button.

5.12.3 Add Line Markers

To add a Line marker:

1. Activate the Line marker tool by clicking on the button on the toolbar. To continue
work with this tool, use the button with which the tool was activated. To learn more about
tool control, see Section 1.14.

2. A marker line can be built in two ways:

• Mark the first point by clicking the mouse button. If required, go to the next section
by rotating the mouse wheel. Move the cursor over the screen to the second point
of the marker line. To fix the current point, click the mouse button.
• Click the mouse button at the first point of the marker line and move the cursor
to the endpoint while holding the mouse button. To go to the next section, rotate
the mouse wheel while holding the mouse button. To fix the endpoint, release the
mouse button.

3. To cancel an incomplete addition, press Esc.

When building a marker line, the start and the end points are chosen on the selected sec-
tions. This allows for performance of measurements between the points placed on different
sections. You can tell by the color of the marker line which part of it is in front of the cur-
rent image. This part of the line will be brighter than the part placed behind the image (see
Fig 5.23).
After adding all the line markers, deactivate the Line marker tool.
This tool is also available from the image context menu and from the MPR main menu item.
Activation is only possible with the left mouse button.
Length measurements made with marker lines are saved in a file project.

5.12.4 Poilygonal Marker line

To add a Poilygonal Marker line:

1. Activate the Polygonal Line marker tool by clicking on the button on the toolbar.

2. Roll the mouse wheel to select the slice where the first point will be located.

3. Mark a point by clicking the mouse button.

4. If necessary, move to another slice by rolling the mouse wheel.

5. Move the mouse to select the location of the next point. Fix the point by clicking the
mouse button.

6. Repeat steps 4 and 5 until the last but one point is fixed.

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7. Fix the last point by double-clicking the mouse.

8. To cancel an incomplete addition, press Esc.

When building a polygonal marker line, the start and the end points, as well as the inter-
mediate points, are chosen on the selected sections. This allows for performance of mea-
surements between the points placed on different sections. You can tell by the color of the
marker line which part of it is in front of the current image. This part of the line will be brighter
than the part placed behind the image (see Fig 5.23).
After adding all the polygonal line markers, deactivate the Polygonal Line marker tool.
To continue the polygonal marker line, move the cursor to the end point of the line, right-
click and select the Continue line item.
This tool is also available from the image context menu and from the MPR main menu item.
Activation is only possible with the left mouse button.
The length and angle measurements made with polygonal marker lines are saved in the
project file.

5.12.5 Actions with Markers

The following actions are available:

• Drag a point or line and polygonal line marker points. Locate the cursor on the marker
or point so that it would look like , and drag it, holding down the left mouse button
or the button to which this tool is assigned. The location of the marker will change
accordingly in all the windows. The marker will be moved parallel to the displayed slice.

• Remove. Locate the cursor on the marker so that it would look like . Press the
Delete key on the keyboard or right-click the mouse and select the Remove marker
item.

• Remove all the markers. If you need to delete all the markers, locate the cursor on any
marker so that it would look like this: , right-click the mouse and select the Remove
all markers item or select the corresponding item from the Marker tool menu.

5.12.6 Marker Properties

You can set the following properties:

• Text;

• Text size;

• Diameter or Line width;

• Color;

• Show length (for Line Markers);

• Show angle (for Polygonal Line Markers).

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To set properties for previously added marker, locate the cursor over the marker, right-click
and select the Set marker properties... item.
To set the default marker properties, click the arrow on the right side of the Marker button
and select one of the Default marker options..., Default marker line options... or Default
marker polygonal line options... items.
The parameters provided will be applied by default when new markers are added or new
marker lines are built.

5.12.7 Position of Markers in Space

If the marker is in or near the current slice, it is displayed as a circle; otherwise, it is displayed
as a ring with a dot in the center. The further the marker slice is from the current slice, the
darker the marker is.
You can determine how the marker line is located relative to the plane of the current image,
judging by the color of the marker line. The line (or its part) located in front of the plane is
brighter than the line (or its part) behind the plane. In Fig. 5.23, the bottom part of the line is
located behind the image.

Figure 5.23: Position of Line Marker in Space

5.13 Reconstruction Modes. Slice Thickness

5.13.1 Render Modes
To switch between modes, the Switch render mode button on the toolbar is used.
Four render modes are available:

1. The MPR mode. Sections are available for viewing. Set by default.

2. The MIP mode . A slice of a particular thickness is viewed instead of a section. A point
with maximum intensity in the slice is projected on each point in the image. For details
on how to set the thickness, see the next section.

3. The MinIP mode . Similar to the previous mode, but points with minimum intensity are
projected on the image.

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4. The AIP mode. Similar to the previous mode, but the intensity of each point equals the
average intensity of the points projected on this point in the image.
This tool is also available from the MPR main menu item.

5.13.2 Slice Thickness

In the MIP, MinIP and AIP render modes, the slice thickness is set using the Thickness
button on the toolbar. Click the button and select the predefined values from the list, or click
the User defined button to specify your own value. In the projection window, the slice borders
are marked by lines (the red arrows in Fig. 5.24).
To set the thickness of solely the slice which is projected on a sertain plane, move the
cursor to any line, marked by the arrows in Fig. 5.24, for the corresponding slice and move it,
holding the left mouse button.

Figure 5.24: Slice borders

Setting the thickness is also available from the MPR main menu item.

5.14 Rotate Image in the Section Plane

To rotate an image by an angle multiple of 90 degrees:
1. Activate the window in which the target image is located. To do this, click the left mouse
button on the window area or header (marked by the arrow in Fig. 5.25).

2. Click on the arrow on the right side of the Rotate button and select the angle from
the drop-down menu.

3. To restore the initial image position, select the Set image rotation angle 0° item.

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4. To rotate an image by an arbitrary angle, activate the Rotate tool by clicking the
left/right/middle mouse button. To continue work with this tool, use the button with which
the tool was activated. To learn more about tool control, see Section 1.14. Rotate the
image by moving the mouse while holding down the button that activated the tool.

Figure 5.25: Window header

To cancel the rotation of all the images, click the Reset views orientation button on the
toolbar .

Note that all the other view conversions will be undone as well.

This tool is also available from the image context menu and from the MPR main menu item.

5.15 Mirror Image Horizontally/Vertically

The tool is described in Section 2.36.

5.16 Show labels tool

The tool is described in Section 2.27.
This tool is also available from the MPR main menu item.

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5.17 Export Images

The export of a model to DICOM or to an image is similar to the image export described in
Section 2.28.

5.18 Reslice

Functionality is available in the Pro edition

The reslice functionality allows you to export the series generated in the multiplanar re-
construction window, setting the area, size, step images and other parameters.

The MPR window doesn’t show the source data, it shows 3D structure
slices. That is why tweening errors may occur. To avoid tweening errors,
when creating a series, you should use the MPR reconstruction based on
the series obtained from the modality, rather than the series that was
created before.

To reslice:

1. On the fused series segmentation panel, select a layer series to be exported to a new
series.

2. Select the plane whose sections should be exported to the series. To do this, click the
left mouse button on the corresponding window.

3. Open the image export window by clicking on the Reslice button. The window
will look as shown in Fig. 5.26.

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Figure 5.26: Reslice

4. Enter the series description in the dialog shown in Fig. 5.27.

Figure 5.27: Reslice dialog box

5. Set the step to generate images in the series.

6. Set the images number.
7. If you need to load the exported images to the DICOM server at once, check the option
Upload image to the default server. If the default server is not specified in the DICOM
Viewer, this option will be inactive.

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8. To set additional parameters for the series, click on the ADVANCED... button. The dialog
box with additional parameters is shown in Fig. 5.28.

If you want the reconstruction mode and the slice thickness to be taken into account
while capturing images, check the Use MIP settings box. For details on reconstruction
modes, see Section 5.13.1.

9. Set the image size if necessary.

10. The image area that is to be exported is highlighted by a white frame positioned sym-
metrically with respect to the intersection point of the cutting planes. To resize the area,
drag the white frame, holding the left mouse button.

11. To rotate the reslice area, rotate the cutting planes. The cutting planes are described in
Section 5.5.2.

12. The other two planes display projections of the exported slices. If necessary, move or
rotate them in the same way.

13. Click OK to export the series or CANCEL to cancel.

A new series is formed for the selected layer series and exported in the coordinate system
of the basic layer series with consideration to level-to-level fusion. The FrameOfReferenceUID
tag value for the exported series is the same as the FrameOfReferenceUID tag value for the
basic layer. The exported series is saved in the current study as a new series.

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Figure 5.28: Reslice dialog box with additional parameters

This tool is also available from the MPR main menu item.
The Reslice button is not available for the Involute and Curve slices windows in the
MPR reconstruction tab.

5.19 Measurements
The MPR window doesn’t show the source data, it shows 3D structure
slices. That is why tweening errors may occur

As the images in MinIP, MIP, and AIP modes are the results of original
images processing, tweening errors may occur. The measurements
performed in these modes may be erroneous
The measurement accuracy is up to one screen pixel. As a screen pixel is
smaller than a source image pixel, the true linear measurement accuracy is
up to one source image pixel. Errors may also occur in density
measurements. The most accurate measurements are performed with
bilinear interpolation (see Section 5.3)

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 5.20. ANNOTATIONS

The MPR mode is not meant to be used for PET studies, use the specialized
module (see Section 9).

Errors may occur when intensity is measured in a certain point. In this case,
the intensity value will be marked by an asterisk. For accurate
measurements, use the bilinear interpolation filter (see Section 5.3).
The measurements are conducted in the same way as for flat images (Section 2.19).

5.20 Annotations
Annotations are described in Section 2.33.

5.21 Volume Reconstruction window

In the Multiplanar Reconstruction window, you can view and edit a 3D model. To open it, click
the 3D button on the toolbar. The model will be displayed in the bottom right-hand
window. The following tools are available for working with the model:

• Clipping box;

• MPR planes on 3D view;

• Center;

• Select model point;

• Ruler and Polygonal ruler;

• all the tools fot editing the model and creating segmented structuresPRO .

The Volume Reconstruction window is described in Chapter 3.

5.22 Diffusion Tensor Imaging (DTI) Mode

Functionality is available in the Pro edition

Tractography results cannot be used for establishing a diagnosis

The DICOM Viewer allows you to show the result of the fiber tractography for the series
of Diffusion MRI. Fig. 5.29 shows tracks which are the result of brain tractography.

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Figure 5.29: Result of brain tractography

The tracks which are the result of tractography are refered to as fibers in the DICOM Viewer
interface and in the User Manual.

5.22.1 Open series in DTI Mode

Functionality is available in the Pro edition

The tractography will be performed automatically for the series made in the DTI mode
when you open it in the Multiplanar Reconstruction Mode. To display fibers over the images
not made in the DTI mode (for the same study):
1. Open the series not made in the DTI mode.

2. Click the DTI button on the toolbar.

3. In the dialog that appears, select the series made in the DTI mode.

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4. Click SELECT to display fibers over the images or CANCEL to cancel.

5.22.2 Select Visible Fibers

Functionality is available in the Pro edition

If you want to make only some fibers visible, specify the areas through which the fibers
pass as visible or invisible. Use the ROI tools from the Fibers panel. The operation of these
tools is similar to using ROI from the toolbar at the top of the window (see Section 2.19.6). Note
that you cannot use the ROI tools from the top toolbar to adjust the visibility of the fibers.
To make some fibers visible:

1. Open the series made in the DTI mode or display fibers over the series not made in the
DTI mode.

2. Select the plane and the image in which you want to specify the area through which the
target fibers pass.

3. Open the Segmented Structure panel by clicking the Segmented structure panel
button. The Fibers panel will be located at the bottom.

4. Specify the desired area using the ROI tools (Rectangle , Ellipse , Poly-

gon ) on the Fibers panel. The similar tools from the toolbar at the top of the
window cannot be used to adjust the visibility of the fibers. After making the ROI, only
the fibers passing through the region specified by the ROI will be visible. A new group
appears on the Fibers panel. This group includes the new ROI.

5. To delete ROI select it and click the Remove ROI button on the Fibers panel.

6. To make fibers which pass through the area invisible, check the Inverse box for this ROI
on the Fibers panel.

7. To hide ROI, check the Hide ROI box for this ROI (marked with number «1» in Fig. 5.31).
To hide all the ROIs in the group, check the Hide ROIs box for this group (marked with
number «2» in Fig. 5.31). To hide all the ROIs, check the Hide ROIs box in the header of
the table (marked with number «3» in Fig. 5.31). The visibility of the ROI does not affect
the visibility of the fibers.

8. Make new ROIs until you see only the target fibers. Only the fibers which pass through
all the ROIs are visible (or invisible if you check the Inverse box).

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Figure 5.30: The Fibers Panel

Figure 5.31: ROIs visibility

When you create the first ROI, a group is automatically created for it. New ROIs are added
to the same group.
The flag to the left of the name of the ROI group and the Base fibers group allows you
to display or hide the relevant fibers. If the box is checked, then the fibers are displayed.
This flag does not affect the visibility of fibers, it only allows you to temporarily hide them, for
example, to adjust the visibility of other fiber groups.
To make other fibers visible without changing the visibility of the fibers previously made
visible:
1. If necessary, hide the previously displayed fibers by unchecking the box to the left of
the fiber group name.

2. Show the base fibers by checking the box on the left of the Base fibers group.

3. Add a new group by clicking the Add ROI group on the Fibers panel.

4. Add a new ROI to make only the target fibers visible. To ensure that the ROI is in the
right group, this group must be selected before making a ROI.

5. If necessary, show some other fibers by checking the boxes to the left of the other group
names.
To show the image containing a certain ROI, select this ROI in the table and click the Find
ROI button on the Fibers panel.

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5.22.3 Fiber Color

Functionality is available in the Pro edition

By default, fibers are colored in accordance with the DEC (Direction Encoded Color) scheme.
It means that the color of a fiber depends on its direction. You can set color for each group
manually. Color is indicated by the pictogram in the DEC mode and by the single-colored
pictogram if the color is set manually.
To set color manually, uncheck the DEC box for the group, double-click the left mouse
button on the color pictogram and in the dialog button that appears, select the color or leave
the default color.
To switch to the DEC scheme, check the DEC box.

5.22.4 Scalar Maps

Functionality is available in the Pro edition

The DICOM Viewer allows to display scalar maps for series made in the DTI mode. The
following types of maps are available:

• Fractional Anisotropy (FA);

• Mean Diffusivity (MD);

• Axial Diffusivity (AD);

• Radial Diffusivity (RD).

By default, the maps are not displayed. To display the map, select the target map on the
drop-down list Scalar map type (Fig. 5.32). To hide the map, select an empty value from the
list.

Figure 5.32: Select scalar map

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5.22.5 Building a Surface

Functionality is available in the Pro edition

DICOM Viewer allows for building fiber surfaces in the Multiplanar reconstruction window.
Select a group of fibers or a ROI for the selected group of fibers. A polygon surface is built
for a group of fibers. If you change the ROI visibility for the group of fibers, it won’t have any
impact on the surface to be built.
Each fiber is represented by a solid cylinder-shaped figure. The polygonal surface is built
on the basis of such parameters as the cylinder diameter and the number of points on the
cylinder circumference.
To set the parameters for the surface model surface, click the button Convert tracks to
polygonal mesh on the Fibers panel. In the dialog box for the surface model parameters
(Figure 5.33), provide the following parameters:

1. Fiber contour points, from 3 to 360. In most cases, six points are enough to ensure
decent accuracy. The accuracy of the model, the time required for estimation and the
memory space required increases with the number of points on the contour.

2. Fiber diameter, from 0.01 to 10 mm.

Figure 5.33: The dialog box for surface model options

Click OK to apply the settings or CANCEL to cancel.

A surface is created for the chosen group of fibers and added to the list on the Segmented
structure panel. The name of the surface, as well as the name of any structure without a
volume model, is shown in italics. The name of the surface is copied from the name of the
group on the Fibers panel.
You can view the built surface in the MPR reconstruction tab. To open a volume recon-
struction, click the 3D button on the toolbar. The volume reconstruction will be displayed
in the right-hand bottom window.
The work with the structures from the segmented structure list is described in Section 6.4.
The surfaces created can be exported or imported. For details on surface and structure export
and import, see Section 6.7. The procedures of saving and opening segmentation projects
and DTI projects are described in Section 6.11.

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5.22.6 Creating a Voxel Model of Fibers

Functionality is available in the Pro edition

DICOM Viewer allows for building voxel models of fibers in the Multiplanar reconstruction
window.
Select a group of fibers or a ROI for the selected group of fibers. A voxel model is built
for a group of fibers. If you change the ROI visibility for the group of fibers, it won’t have any
impact on the model to be built.
To build a voxel model, click the Voxelize tracks button on the Fibers panel.
A voxel model is created for the chosen group of fibers and added to the list on the Seg-
mented structure panel. The name of the structure is copied from the name of the group on
the Fibers panel.
To create a voxel model based on all the fibers, select the Base fibers group and click the
Voxelize tracks button on the Fibers panel.
The voxel model is created for the chosen group of fibers (Base fibers) and added to the
list on the Segmented structure panel under the name DTI tracktography.
You can view the model built in the MPR reconstruction tab. To open a volume reconstruc-
tion, click the 3D button on the toolbar. The volume reconstruction will be displayed in
the right-hand bottom window.
The work with the structures from the segmented structure list is described in Section 6.4.
The surfaces created can be exported or imported. For details on structure export and im-
port, see Section 6.7. The procedures of saving and opening segmentation projects and DTI
projects are described in Section 6.11.

5.22.7 Saving data in a file

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer provides an opportunity to save ROI and groups in files with .spj ex-
tension. The procedure for saving and opening files is described in Section 6.11. When a file
is opened, the data contained in it is added to the data from the Fibers panel.

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Chapter 6

Segmentation

Functionality is available in the Pro edition

Segmentation is the division of an object into its component parts to facilitate research and
modelling.
The tasks that segmentation solves:

• researching separate tissue parts with a certain density range. Usually, such parts have
a complicated form and are hidden inside other tissues, hence it is impossible or difficult
to highlight them with the cutting tools, e.g.: teeth and thir roots, tumors, bones, vessels;

• calculating the volume of tissue, such as tumors;

• studing mutual disposition of tissues that can notbe visible simultaneously;

• fusing a segment and a whole model to see its location within the tissue;

• exporting the structure surface for further use, such as 3D-printing;

• importing the objects used in the treatment to simulate their location in the tissues;

• dividing tissues into separate fragments for better visualization.

• cutting tissue by a mask created from a segmented structure.

To solve these problems, the DICOM Viewer allows you to build segmented structures
both automatically and manually.
The segmentation of tissues is possible in the Volume Reconstruction window and the Mul-
tiplanar Reconstructions window. In both modes you work with the same segmented structure
(structures), thereby for its/their construction you can use the benefits of both modes, switch-
ing between them.
Fig. 6.1 illustrates the segmented root of a tooth hightlighted in yellow. Fig. 6.2 illustrates
segmented kidneys highlighted in red and blue. The base volume is highlighted with the CLUT
so that the bones can be seen best and the other organs are not visible.

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Figure 6.1: Segmented root of tooth

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Figure 6.2: Segmented kidneys

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6.1 The Segmented Structures Panel

Functionality is available in the Pro edition

To open the segmented structure panel in the MPR reconstruction and Volume recon-
struction tabs, click the Segmented structure panel button on the toolbar.
The segmented structures panel for the MPR reconstruction tab is shown in Fig. 6.3. This
panel is identical in the Volume reconstruction tab, except that the MPR MPR nested element
is not displayed for the base volume.
The panel contains the Control buttons:

The Parameters button is used to call up the popup menu for surface creation
parameters setup and export/import parameter setup (see Section 6.7).
The Save segmentation project to file button is used to call up the dialog box for
saving a segmentation project in a file (see Section 6.11).
The Open segmentation project from file button is used to call up the dialog box
for opening a segmentation project saved in a file (see Section 6.11).

The Add a new structure button creates a new structure with an empty mask.

The Create surface for current segment button creates a surface for a selected
structure or for the base volume.
The Import masks from DICOM RT mask set... button imports a mask of
segmented structure from DICOM RT (see Section 6.7.5).
The Import surface(s) button imports a segmented structure from ply, obj or stl
file formats.
The Duplicate structure/Duplicate mask/Duplicate surface button, depending
on the element selected on the segmentation panel, makes a copy of the whole
structure, the mask of structure, or the surface in a separate structure (see
Section 6.3.1).
If the Structure or Base volume option has been selected, the structure Mask
and the Surface (when built) are copied to the new structure.
If the MPR, Base volume, or structure Mask option has been selected, only the
structure mask is copied to the new structure.
If the Surface option has been selected, only the surface is copied to the new
structure.
The Restore base volume by mask makes the main volume the same as the
selected segmented structure. For the MPR reconstruction tab, the 3D view
window must be activated.

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The Remove structure/Remove surface button deletes either the whole structure
or the surface depending on the option selected on the hierarchical list. When a
structure is deleted, a confirmation dialog box pops up.

The Export button opens export menu for surfaces and masks.

The Hide all masks/Show all masks button is used to hide/display the masks for
the base volume and the structures on the segmentation panel. When all the
masks are hidden, the icon is replaced by a crossed out version .

The Hide all surfaces/Show all surfaces button is used to hide/display all the
surfaces for the base volume and the structures on the segmentation panel.
When all the surfaces are hidden, the icon is replaced by a crossed out version
.

The Optimal view button is used to display all the elements of the list up to the
third nesting level and hide all the elements from the third nesting level.
The Collapse all button collapses all the elements of the list on the segmentation
panel except layer items.
The Expand all button shows all the elements of the list on the segmentation
panel.
The Surface positioning button changes spatial orientation and scale of the
imported surface. (only for the 3D reconstruction window). The tool may be
activated with the left, right, or middle mouse button. To continue work with the
tool, use the button with which the tool was activated. For details on tool control,
see Section 1.14.

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Figure 6.3: The Segmented Structures Panel

The hierarchical list of items on the segmented structures panel consists of the list of layers
and the list of segmented structures for each layer.
By default, the optimal view of the list is presented (the items up to the third nesting level
are shown). To see all the items, click the Expand all button on the segmented structures
panel. To see some particular items, press the arrow on the left-hand side of the name of the
item.
In the line referring to the layer, you can see a description of the layer, a thumbnail for the
layer series, and a button for customizing visibility of the layer and all the child items for
this layer. The layer includes the base volume and a list of segmented structures. The layer
consists of:
• Base volume. In this line, the visibility button for the base volume and all the child
items is shown. If a surface has been created for the base volume, then the symbol
is shown in the line. The color of the surface is the same as the color of the initial model.

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Alternatively, the user may select the color (see Section 6.4).
The Base volume item comprises the following elements:

– MPR (shown only in the MPR reconstruction tab). It comprises a visibility but-
ton for the item and child items, as well as a field showing the current opacity value
for MPR windows. When you mouse over the respective line, a slider is shown. To
change the opacity value, move the slider or enter the required numeric value in a
percentage.
The MPR comprises the following items:

* a CLUT settings control element for the MPR reconstruction tab;

* Statistics. This item provides for the results of base volume measurements.
Besides the visible voxel volume, the minimum, maximum, and average inten-
sity values are shown, as well as the standard intensity value deviation. When
tissues are cut off with the Clipping Box tool, only the statistics for the base
volume is affected. It has no impact on the statistics for segmented structures;
– Volume model. It comprises a visibility button for the base volume, as well as
a field showing the current opacity value for the 3D view window and the Volume
reconstruction tab. When you mouse over the respective line, a slider is shown.
To change the opacity value, move the slider or enter the required numeric value
in a percentage;
The Volume model comprises the following items:

* a CLUT settings control element for the 3D view window and the Volume re-
construction tab;
* Statistics. This item provides for the results of base volume measurements.
Besides the visible voxel volume, the minimum, maximum, and average inten-
sity values are shown, as well as the standard intensity value deviation. When
tissues are cut off with the Clipping Box tool, only the statistics for the base
volume is affected. It has no impact on the statistics for segmented structures;
– Surface (if created). It comprises a visibility button for the surface, as well
as a field showing the current opacity value. When you mouse over the respective
line, a slider is shown. To change the opacity value, move the slider or enter the
required numeric value in a percentage.
The Surface comprises the following items:

* a field for changing the number of triangles forming the surface;

* the Change surface creation parameters button used to call up the

dialog box for customizing the surface parameters;
* Details. This item provides the information about the volume of voxels around
which the surface was built, the number of vertices and the surface area.

In the Structure line for the segmented structure, you see the name of the structure, color
control elements, and a visibility button for the structure and its child items. The Struc-
ture comprises the following items:

• Mask. This element is used for control of the segmented structure voxel model, and its
structure is similar to the Volume model element. It comprises a visibility button
for the structure mask. When you mouse over the respective line, you see the current

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structure mask opacity value. To change the opacity value, move the slider or enter the
required numeric value in a percentage.

• Surface. This element is used for customizing the surface settings, and its structure is
similar to the Surface element for the layer.

6.2 The Mask

6.2.1 Creating a new structure and mask

Functionality is available in the Pro edition

1. Click the Add a new structure button. The dialog shown in Fig. 6.4 appears.

Figure 6.4: Set mask for a new structure

2. Enter the name of the new structure in the Name field. By default, the name of the struc-
ture is automatically generated by the <Structure X> template, where X is the counter
with the increment of one point. The first value is 1.

3. Set the tissue density values for the mask. You can do it in one of the three ways:

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• using the Threshold mode. In this mode the mask is set for the tissue whose density
is greater or less than the specified threshold value. To set the mask for the tissue
with a density less than the threshold, select the Low intensity setting, and vice
versa. Set the threshold;
• using the Interval mode. In this mode the mask is set for the tissue whose density
is in the range from minimum to maximum;
• using color tables. In this mode the mask is set for the tissue displayed for the
selected color table.

4. Click OK to create a new structure and mask or CANCEL to cancel.

6.2.2 Changing the structure mask using CLUTs

Functionality is available in the Pro edition

You can change the mask of the current structure in several ways:

1. Using the Adjust W/L tool:

(a) Select the target structure on the panel of segmented structures.

(b) Click the Adjust W/L button on the toolbar.

(c) Change the window width and level for the editing mask (see Section 2.17). The
green editing mask changes in real time in the MPR window.

2. Selecting the color table from the dropdown list (see Section 2.23.1) or with the Custom
W/L tool (see Section 2.17).

3. For the properties tree on the Segmented structure panel (Figure 6.5):

(a) Unfold the list of the segmented structure properties.

(b) In the drop-down list, select the editing mask mode or the color table you need:
• The High intensity and Low intensity mode provides the editing mask for tis-
sues whose density is above or below the threshold value.
• The Interval mode provides the editing mask for tissues whose density is within
the set value range.
• The CLUT mode provides the editing mask for the tissues displayed for the
chosen color table.
(c) To change the interval or the density threshold, click with the left mouse button on
the values (see the red box in Figure 6.5). Provide the values you need and press
Enter key on the keyboard.

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 6.2. THE MASK

Figure 6.5: Editing the mask

The editing mask parameters (the color table, the intensity threshold value and the inter-
val) are changed for each segmented structure separately. The color table type and the
editing mask mode for the segmented structure selected is shown on the visualization
setup panel.

4. For the Volume Reconstruction window only: using the Set mask tool (see Section 6.2.4).

You can change the editing mask visibility for the current structure using the editing mask
setup panel (see Section 6.2.3).

6.2.3 The Editing mask

Functionality is available in the Pro edition

The editing mask is a pattern beyond which the structure mask is not visible.
The editing mask is not visible in the volume reconstruction window, and it is displayed in
green in the MPR window. If necessary, the editing mask can be inverted. In this case, the
tissues not under the editing mask are displayed in green. To invert the editing mask, set the
flag Invert edit mask on MPR (see Section 16.7.3).
The editing mask can be changed at any time (see Section 6.2.2). If the editing mask is
reduced and the structure goes beyond the editing mask, then this part of the structure be-
comes invisible and is not taken into account in the calculations. However, it is not removed
and when the editing mask is increased, it becomes visible again.

You can change the editing mask visibility for the current structure using the editing mask
setup panel (Fig. 6.6). The panel is placed at the bottom of the segmented structures panel
and is only available in the MPR reconstruction tab.

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Figure 6.6: Editing mask panel

There are two ways to change the visibility of the editing mask:

• move the slider or roll the mouse wheel while the cursor is placed on the slider;

• enter the opacity value in the field on the right-hand side of the slider.

The editing mask opacity value is expressed as a percentage.

To see the outline of the editing mask, check the Outline box.

To conceal the editing mask, click the Hide mask button on the editing mask setup
panel. To display the editing mask, click the Show mask button.
The Hide mask button is unavailable if at least one tool for segmentation or volume
editing has been activated.
To minimize the editing mask setup panel, click the Hide button. To display the
hidden panel, click the Show button.

6.2.4 Set Mask Tool

Functionality is available in the Pro edition

The tool is only available for the Volume reconstruction tab. To set a structure as a mask
for another structure or base volume, proceed as follows:

1. On the list of structures, select the structure (base volume) for which you want to change
the mask.

2. Click on the Set Mask button. The dialog shown in Fig. 6.7 will be displayed.

3. On the list of structures, select the structure (base volume) you want to set as the mask.

4. Click OK to confirm or CANCEL to cancel the action.

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Figure 6.7: Select mask dialog

6.3 Creating segmented structure

6.3.1 Creating a structure by copying

Functionality is available in the Pro edition

When you create a structure by copying, a new structure is created. Depending on the
selected element, the current structure is copied to the new structure as a whole (the mask of
the current structure and the surface, if it was built), only the mask of the structure or only the
surface. To create a structure:

1. Open the segmentation panel by clicking the Segmented structure panel button.

2. Choose the base volume or the structure created earlier as the initial volume.

3. Click the Duplicate structure button on the segmented structure panel or place
the cursor over the structure, click the right mouse button and choose the Duplicate
structure point in the right-click menu. Depending on the option selected, the whole
structure or just the surface is copied to a separate structure.

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If the Structure or Base volume option has been selected, the structure
mask and the surface (when built) are copied to the new structure.
If the MPR, Volume model, or Mask option has been selected, only the
structure mask is copied to the new structure.
If the Surface option has been selected, only the surface is copied to the
new structure.

6.3.2 Creating a Structure with a Empty Mask

Functionality is available in the Pro edition

To create a structure with a empty mask, proceed as follows:

1. Open the segmentation panel by clicking the Segmented structure panel button.

2. Click the Add a new segmentation structure button. Set the mask in the dialog
that opens (see Section 6.2.1). A structure is created with an empty structure mask and
an editing mask with the specified parameters.
3. Fill out the structure using volume editing tools (see Section 6.8).

6.4 Actions with structure

Functionality is available in the Pro edition

The DICOM Viewer allows you to perform the following actions with structures:
• Renaming. Can be done in two ways:
– double left-click the structure name. Enter a new name and press the Enter key on
the keyboard;
– place the cursor over the structure, click the right mouse button and choose the
Rename structure point in the right-click menu. Enter a new name and press the
Enter key on the keyboard.
• Disabling visibility. The visibility button (Fig. 6.8) turn off visibility of structure mask
and surface for this structure. This action is also available for the base volume. The
button for the invisible element appears as .
If you change the visibility status for any element from the list, it will not affect the status
of the visibility buttons of its parent elements. If you disable visibility for the parent
element, the child elements will also become invisible. In this case, the visibility buttons
for the child elements that were not switched off by the user will appear as .
When projects are saved, the visibility status is also saved on the segmentation list for:

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– base volume;
– MPR;
– layers;
– structures.

Figure 6.8: Button to change the visibility of mask and structure surface

• Color change. To do this:

1. To set the user’s color, check the box in the line representing the structure (see the
red arrow in Fig. 6.9). To change the color, click the colored rectangle in the line
representing the structure and choose the color you need.
2. To use the color of the initial model, uncheck the box. The color of the mask and
the surface of the structure takes on the color of the initial model.
• Deletion. Can be accomplished in two ways:
– on the segmented structure panel, select the surface you want to delete. Click
the Remove structure/Remove surface button on the segmented structure
panel;
– place the cursor over the structure, click the right mouse button and choose the
Remove structure/Remove surface point in the right-click menu. In the dialog box
that pops up, click REMOVE to delete the structure or CANCEL to cancel.

Figure 6.9: Custom color check box

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If you want the DICOM Viewer to always delete structure without this confirmation, check
the box Don’t show this dialog again. If you want the DICOM Viewer to show the confirmation
dialog, check the box Confirm on the structure removing (see Section 16.7.3).

6.5 Building surface

Functionality is available in the Pro edition

The DICOM Viewer allows you to create a surface for segmented structures and base
volume in the Volume Reconstruction window and in the Multiplanar Reconstruction window.
In multiphase series, you can build a surface for base volume of the each phase.

Attention! Surfaces transparency is not supported if:

• a CPU has been chosen as the render device;

• the software was installed on macOS lower operating system than

10.15.

On macOS 10.15 and later, it is recommended to use a visualization device

that supports Metal polygonal and voxel rendering. The settings are
described in Section 16.7.3.

On the segmented structures list, select the base volume or the structure for which you
want to build a surface.

To customize the parameters used by default when building a surface, click the Parame-
ters button on the segmented structures panel and select the Default surface parame-
ters... option. In the dialog box that pops up (Fig. 6.11), provide the required default parameters
for building surfaces.

To build a surface, click on the Create surface for current structure button on the
segmented structures list. The surface is built according to the current settings.

To customize the parameters for each of the surfaces built, unfold the surface properties
tree on the segmented structure panel (see Fig. 6.10). Click the Change surface creation
parameters button.

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Figure 6.10: Surface parameters

Set the surface parameters in the dialog box that pops up (see Fig. 6.11).

Figure 6.11: Surface creation parameters

• The smoothness of the surface is defined by the Smoothing pass count parameter. With
this parameter set at zero value, the form of the surface is as close as possible to the

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structure. With an increase in the value, the surface roughness disappears.

• If the Interpolate vertex positions box is checked (checked by default), the surface is
smoothed at the border of the volume.

• To create the surface only for the largest structure, check the Remove secondary vol-
umes box.

• To fill the cavities and hollows, check the Fill cavities. box. As an alternative, you can
use the Fill tool (see Section 3.8.7).

• To fill small cavities, check the Perform morphological closing box. As an alternative,
you can use the Remove holes (closing) tool (see Section 3.8.7). The volume of
the model is first increased and then decreased by the operation radius provided (in
millimeters or voxels). The shape of the surface and the external dimensions are not
changed.

• To eliminate visual surface defects, check the Perform morphological opening box. As
an alternative, you can use the Remove noise (opening) tool (see Section 3.8.7).
The volume of the model is first decreased and then increased by the operation radius
provided (in millimeters or voxels). The shape of the surface and the external dimensions
are not changed.

• If the Apply current clipping box box is checked, then the surface is built only for that
part of the structure which is inside the cube.

To apply the settings, click OK. To cancel, click CANCEL.

When the segmentation project is saved, all the surface building parameters are saved in
the file. For details on saving projects, see Section 6.11.
The surface is represented by a polygon model made of triangles.
The program automatically determines the maximum possible number of triangles required
for creating a surface imitating the volume surface. The number of the triangles making up
the surface may be changed on the Segmented structure panel.
To change the number of the triangles making up the surface, unfold the surface properties
tree on the Segmented structure panel (Figure 6.10).
Double-click with the left mouse button on the value in the field with a triangle icon. Change
the value showing the number of triangles and press Enter key on the keyboard.
If the number of triangles entered is too small or too large to build a surface, the DICOM
Viewer will use the value from the permitted range which is the closest to the value provided
by the user.
If the entered value equals 0, the program will build a surface using the maximum possible
number of triangles which will be shown in the field with a triangle icon.
If visibility for this structure or surface is disabled, you cannot use the cutting tools, as well
as the Segmentation from point by mask, Region growing and Vessel tree segmentation
tools.
You can only edit hidden structures with intelligent volume editing tools, such as Grow
(dilation), Shrink (erosion), Remove noise (opening), Remove holes (closing) (for details see
Section 3.8.7) , as well as with the Union, Subtract, Subtract dilated, and Intersect tools (for
details see Section 6.9). In this case, the following message pops up: «The target structure

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is hidden. Are you sure you want to apply the operation to it?» Click Yes to proceed or No
to cancel.

6.6 Copying a Surface

Functionality is available in the Pro edition

The DICOM Viewer provides for copying segmented structure surfaces in the MPR Re-
construction and Volume Reconstruction windows. You can copy a segmented structure
surface:

• in one study series;

• in a merged study series.

To make a copy of a segmented structure surface in a single study series, proceed as

follows:

1. On the segmented structure panel, select the surface you want to copy.

2. Click the Duplicate surface button on the segmented structure panel or place
the cursor over the structure, click the right mouse button and choose the Duplicate
surface point in the right-click menu.

On the segmented structure list, you will see a copy of the surface with a «surface copy»
note. The name of the surface copy, as well as the name of any structure without a structure
mask, is shown in italics.

Figure 6.12: Surface copy

To make a copy of a segmented structure surface in a merged series, proceed as follows:

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1. On the segmented structure panel, select the surface you want to copy.

2. Click the Duplicate surface button on the segmented structure panel or place
the cursor over the structure, click the right mouse button and choose the Duplicate
surface point in the right-click menu.

3. In the Layer selection (see Fig. 6.13), select from the drop-down list the layer where you
want to place the surface copy.

Figure 6.13: Layer selection dialog box

4. Click OK to copy the surface to the selected layer or CANCEL to cancel.

On the segmented structure panel for the layer selected, you will see a copy of the surface
with a «surface copy» note. The name of the surface copy, as well as the name of any structure
without a structure mask, is shown in italics.
To move the copied surface manually, activate the tool Surface positioning by click-
ing the left/right/middle mouse button. To continue work with this tool, use the button with
which the tool was activated. To learn more about tool control, see Section 1.14. Move the sur-
face on the plane of the screen, holding the mouse button with which the tool was activated.
To scale the surface, move the mouse up and down while holding the Ctrl key (or the
Command key for macOS) and the button with which the tool was activated.
To rotate the surface around its center, move the mouse while holding the Alt key (or the
Option key for macOS) and the button with which the tool was activated.
To create a segmented structure for a surface, place the cursor over the copy of the surface,
click the right mouse button and choose the Create mask by surface point in the right-click
menu.
The things you can do with the surfaces and structures on the segmented structure list are
described in Section 6.4. The surfaces you have built or copied may be exported or imported.
For details on export and import of surfaces and structures, see Section 6.7. The procedures
of saving and opening segmentation and DTI projects are described in Section 6.11.

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6.7 Import and Export

6.7.1 Export surface

Functionality is available in the Pro edition

To customize the parameters used by default when exporting a surface, click the Param-
eters button on the segmented structures panel and select the Export/Import parame-
ters... option. In the dialog box that pops up (Fig. 6.14), provide the required default parameters
for exporting surfaces.

• to move the reference point (the point relative to which the model can be deformed in
the Vector graphics editors) to the geometrical center of the surface, in the dialog box
check the Center surface box. The option is disabled by default;

• to use the patient’s coordinates when exporting, check the Import and export surfaces
using patient coordinates box. Check box is set by default;

Figure 6.14: Surface export and import parameters

To apply the settings, click OK. To cancel, click CANCEL.

To export a segmented structure surface, proceed as follows:

1. On the segmented structures panel, select the surface to be exported.

2. Call up the popup menu with the export options in one of the following ways:

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• click the Export button on the segmented structures panel and choose the
type of export from the popup menu;
• mouse over the structure on the list, right-click and choose the Export option from
the right-click menu. Then select the type of export.

There are three options for exporting a surface:

• Export selected surface. Only the surface that is currently chosen is exported. It may
be exported in .ply, .obj, .stl or .glb format. In the dialog box that appears, select the file
type and save the surface;

• Export all visible surfaces. All the visible surfaces for which visibility in the segmented
structures panel is enabled are exported. They may only be exported in .glb format;

• Export all surfaces. All the surfaces on the segmented structure panel are exported.
They may only be exported in .glb format.

Figure 6.15: Export menu

If export is performed for several layers, the hierarchy is retained: layers (with the name of
the respective series) occupy the first level, while the second level is occupied by surfaces.
When surfaces are exported from the same layer, only one hierarchy level (surfaces) is re-
tained.
The name, the color of the apices and the transparency are retained for each surface.
When several surfaces are exported, their relative position which is the same as the relative
position in the DICOM Viewer at the time of export is retained.

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You need to be aware that when the surface is printed by a 3D printer, errors
may occur for the following reasons:

1. The surface accuracy depends on the voxel size; the margin of error
cannot be higher than the voxel size.

2. The boundaries of the structure mask for which the surface is created
depend on the color palette for the initial volume. If a wrong palette is
chosen, some tissues that are needed may become invisible, while
some negligible tissues may become visible.

3. The boundaries between tissues characterized by different density

values may be blurred because of the physical principles behind the
tissue scanning technology. The margin of error may be up to several
voxels.

4. The surface accuracy is subject to antialiasing and depends on the

triangles count.

6.7.2 Import surface

Functionality is available in the Pro edition

To customize the parameters used by default when importing a surface, click the Param-
eters button on the segmented structures panel and select the Export/Import parame-
ters... option. In the dialog box that pops up (Fig. 6.16), check the following boxes:

• to use the patient’s coordinates, check the Import and export surfaces using patient
coordinates box;

• to align the centers of the imported surface and the model when importing, check the
Add to the center box;

• to merge the vertices of the triangles when importing a surface in (stl) format, check the
Merge imported STL vertices box. This box is checked by default.

Click OK to apply the settings or CANCEL to cancel.

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Figure 6.16: Surface export and import parameters

There are two ways to import surfaces:

• click the Import surface(s) button. In the dialog box that pops up, select the files
and click Open;

• mouse over the structure on the list, right-click and choose the Import->Import sur-
face(s)... option from the right-click menu. In the dialog box that pops up, select the
files and click Open.

The name of the imported surface, as well as the name of any structure without a structure
mask, is shown in italics. In Figure 6.17 you see an imported surface Surface_example-1. You
cannot change the number of triangles for the imported surface.
To move the imported surface manually, activate the tool Surface positioning by
clicking the left/right/middle mouse button. To continue work with this tool, use the button
with which the tool was activated. To learn more about tool control, see Section 1.14. Move
the surface on the plane of the screen, holding the mouse button with which the tool was
activated.
To scale the surface, move the mouse up and down while holding the Ctrl key (or the
Command key for macOS) and the button with which the tool was activated.
To rotate the surface around its center, move the mouse while holding the Alt key (or the
Option key for macOS) and the button with which the tool was activated.
To create a segmented structure for a surface, place the cursor over the copy of the surface,
click the right mouse button and choose the Create mask by surface point in the right-click
menu.

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 6.7. IMPORT AND EXPORT

Figure 6.17: Imported surface

6.7.3 Export a structure to the current study

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer allows for exporting masks of segmented structures to the current
study as a new series or as DICOM RT Structure Set IOD.
To export a structure mask to the current study as a new series, proceed as follows:

1. Select the structure mask you need on the Segmented structure panel.

2. Export the structure mask to the current study in one of the following ways:

• click the Export button on the segmented structures panel and choose the
Export mask as new series option from the popup menu;
• mouse over the structure on the list, whose mask you want to export right-click and
choose the Export option from the right-click menu. Then select the Export mask
as new series option.

The exported structure mask will be saved in the local storage as a new series of the
current study. A thumbnail for the new series will be added to the series panel.
The structure mask of the selected layer is exported in the coordinate system of the basic
layer series with consideration to level-to-level fusion. The FrameOfReferenceUID tag value
for the exported series is the same as the FrameOfReferenceUID tag value for the basic layer.
The exported structure mask can be opened in the flat image viewer, volume reconstruc-
tion, or MPR reconstruction tab.

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The position of slices in a new series is in compliance with the window that was selected
when the Export mask as new series command was given. If a 3D view window is selected,
then the position of the planes will be in compliance with the position of the slices in the Axial
plane window.

6.7.4 Export a structure to DICOM RT

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To export a structure mask of the segmented structure to DICOM RT, proceed as follows:

1. On the segmented structures panel, select the structure whose mask to be exported to
DICOM RT.

2. Call up the popup menu with the export options (Fig. 6.18) in one of the following ways:

• click the Export button on the segmented structures panel and choose the
type of export to DICOM RT from the popup menu;
• mouse over the structure on the list whose mask you want to export, right-click and
choose the Export option from the right-click menu. Then select the type of export
to DICOM RT.

Figure 6.18: Export drop-down menu

There are three ways to export a mask of structure to DICOM RT:

• Export selected mask to DICOM RT.... Only the mask of the currently selected structure
is exported;

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• Export visible masks to DICOM RT.... All the visible masks of structures from the seg-
mented structures panel (for which the visibility button has been activated) are exported;

• Export all masks to DICOM RT.... All the masks of structures structures from the seg-
mented structures panel are exported.

In the Export to DICOM RT (Fig. 6.19) dialog box that pops up, add a description of the
exported RTSTRUCT series. The default series description is «Segmentation».

Figure 6.19: Export to DICOM RT

Click OK button to export mask of structure or CANCEL to cancel.

The exported mask of structure will be saved in the local storage as a new series with
RTSTRUCT modality. A thumbnail for the new series will be added to the series panel.
If a series has several phases, the mask of structure will only be exported for the current
phase. If no mask was exported during the export procedure (e.g. no voxels are visible under
the editing mask), an error message will pop up.

6.7.5 Importing a Structure from DICOM RT

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

There are two ways to import a mask of segmented structure from DICOM RT:

• click the Import masks from DICOM RT... button on the segmented structures
panel;

• mouse over the structure on the list, whose mask you want to import right-click and
choose the Import option from the right-click menu. Then select the Import masks from
DICOM RT... option.

In the Import from DICOM RT dialog box (Figure 6.20), select an RTSTRUCT modality
series to import.

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Figure 6.20: Import from DICOM RT

Click OK button to import structure mask or CANCEL to cancel.

In the Structures to import section of the dialog box (Figure 6.21), check the box next to
the structure whose mask you want to import. To import all the masks of the structures from
the list, check the upper box. By default, the boxes are not checked.

Figure 6.21: Structure selection dialog

Click OK to import structure mask or CANCEL to cancel.

6.8 Changing the structure mask with segmentation tools

Functionality is available in the Pro edition

When working with segmented structures, pay attention to which structure or volume is
selected. All the editing operations are performed with a selected visible structure mask or

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volume. If the visibility button (Fig. 6.22) hides the visibility of mask and surface for this
structure editing is not possible because the cutting tools (Segmentation from point by mask,
Region growing and Vessel tree segmentation) are deactivated.

Figure 6.22: Button to change the visibility of all masks and structure
surfaces

Invisible structures can be edited with smart volume editing tools, such as Grow (dila-
tion), Shrink (erosion), Remove noise (opening), Remove holes (closing) (for details see Sec-
tion 3.8.7), as well as Union, Subtract, Subtract dilated, and Intersect tools see Section 6.9.
In this case, the dialog box is displayed: The target structure is hidden. Are you sure you
want to apply the operation to it? Click Yes to proceed or No to cancel.
If the volume model is open (see Section 5.21), then the created structure appears simul-
taneously on the model. This causes additional load on the processor. If you want to reduce
the load, click the arrow on the right side of the Growing Region button and uncheck
the Interactive 3D Update item. After this, the structure on the volume model will be updated
after the next structure creation phase is completed.
If a base volume or mask of segmented structure is edited, the respective surfaces are
automatically rebuilt.
To edit a structure mask, use specialized tools (described below) and volume editing tools:

• Polygon Cut (see Section 3.8.1);

• Inverse Polygon Cut (see Section 3.8.2);

• Delete Area (see Section 3.8.3);

• Delete All Areas except Selected Area (see Section 3.8.4);

• Brush Cut (see Section 3.8.6);

• Brush Restore (see Section 3.8.6). The use of the tool is possible only if a part of the
structure is already created;

• Contour segmentation (see Section 6.10);

• Grow (dilation) (see Section 3.8.7);

• Srink (erosion) (see Section 3.8.7);

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• Remove noise (opening) (see Section 3.8.7);

• Remove holes (closing) (see Section 3.8.7);

• Multi-segment growing (see Section 3.8.7);

• Fill (see Section 3.8.7).

• Cut Invisible Volume (see Section 6.9);

• Vessels Tree Segmentation (see Section 6.8.4);

• Segmented structures regions growing (see Section 6.8.7);

• Union (see Section 6.9);

• Subtract (see Section 6.9);

• Subtract dilated (see Section 6.9);

• Intersect (see Section 6.9).

6.8.1 Tools for automatic segmented structure mask filling

Functionality is available in the Pro edition

The Segmentation from point by mask tool allows you to create a structure mask for a
bound area. It is necessary that the structure mask for this area does not touch the structure
masks of the neighboring areas. To create a structure mask:

1. Activate the Segmentation from point by mask tool by clicking the left/right/mid-
dle mouse button. To continue work with this tool, use the button with which the tool
was activated. To learn more about tool control, see Section 1.14.

2. Click on the bound area.

3. If the structure mask was created for a larger area than required, undo the action by
clicking the Undo button. Change the window width and level so that the editing
mask for this area is not in contact with the masks of the neighboring areas and create
the mask again.

If it is impossible to get a bound area completely separated from other tissues, then if you
use the tool Segmentation from point by mask, there will be leaks (segmentation beyond the
required area). To create a segment quickly and with minimal leaks, use the Region growing
tool:

1. Activate the Region growing tool by clicking the left/right/middle mouse button. To
continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14. The tool modes are described in Section 6.8.3.

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2. Select the point on the editing mask roughly in the center of the region you want to
segment.

3. Move the cursor in any direction, holding the mouse button. The structure mask will
grow. The growth occurs faster in those directions in which the curvature of the surface
is less (in thin sections the growth is slower to avoid leaks). The direction of the cursor
movement does not matter, the distance from the starting point of the movement is
important. When the cursor moves in the opposite direction, the structure mask does
not decrease.

4. If the structure is completely created or if any further growth leads to leaks, stop the
growing process by releasing the left mouse button.

5. If necessary, repeat the growing process for the tissue not yet segmented.

6. To undo an action, click the Undo button, to redo the canceled action click the

Redo . However, keep in mind that the tool will operate at regular intervals, so with
a single click on the Undo button, you can only delete that part of the structure mask
that was added as part of the previous execution or a series thereof, but not along.

6.8.2 Brush restore tool

Functionality is available in the Pro edition

To fill out the structure mask using the Brush restore tool:

1. Activate the Brush restore tool by clicking the left/right/middle mouse button. To
continue work with this tool, use the button with which the tool was activated. To learn
more about tool control, see Section 1.14.

2. Set the tool diameter. To do this, move the mouse cursor up and down, holding the Alt
key (or the Option key for macOS) on the keyboard.

3. Move the mouse cursor to the area for which you want to create a structure mask.

4. Click the mouse button. The tissues that are under the editing mask and inside the
sphere will be added to the mask. The tissue color changes to the one set for the
structure.

5. To undo the action, click the Undo button, to repeat the canceled action, click the

Redo button.

6. To add a large area to the structure, move the Brush restore tool, holding the
mouse button. However, keep in mind that the tool will operate at regular intervals, so
with a single click on the Undo button you can only delete that part of the structure mask
that was added as part of the previous execution or a series thereof, but not along.

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7. To remove a part of the tissue from the structure, activate the Brush cut tool. The
tool works in the same way as to the Brush restore tool, but unlike the Brush restore
tool, it removes the tissue from the structure.

8. To disable or enable the editing mask, click the visibility button on the Editing mask
panel.

In the Volume Reconstruction window, the tool is used for structure mask growth regard-
less of the editing mask. To grow a structure mask, use Restore by mask tool. Note that to fill
the structure mask, you need some volume (base volume or the structure) to be visible. The
visibility button (see the red arrow in Fig. 6.23) turn on visibility of all masks and surfaces for
this structure. Otherwise, you won’t be able to grow another mask.

Figure 6.23: Button to change the visibility of all masks and structure
surfaces

6.8.3 Region growing tool

Functionality is available in the Pro edition

When using the Brush restore tool, there may be leaks (structure mask beyond the re-
quired area). The Region growing tool takes into account the shape and density of the
segmented areas and allows users to minimize leaks. The tool has two modes: EDT Method
and Level Set Method. To switch the mode, click the arrow on the right of the button
and select the desired mode. The current mode is marked by the flag.
The EDT Method mode allows you to create a structure mask in the editing mask space.
To create a structure mask:

1. Activate the Region growing tool in the EDT Method mode by clicking the left-
/right/middle mouse button. To continue work with this tool, use the button with which
the tool was activated. To learn more about tool control, see Section 1.14.

2. Select the point on the editing mask roughly in the center of the region you want to
segment.

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3. Move the cursor in any direction, holding the mouse button. The structure mask will
grow. The growth occurs faster in those directions in which the curvature of the surface
is less (in thin sections the growth is slower to avoid leaks). The direction of the cursor
movement does not matter, the distance from the starting point of the movement is
important. When the cursor moves in the opposite direction, the structure does not
decrease.

4. If the structure mask is completely created or if any further growth leads to leaks, stop
the growing process by releasing the left mouse button.

5. If necessary, repeat the growing process for the tissue not yet segmented.

6. To undo an action, click the Undo button, to redo the canceled action, click the

Redo button. However, keep in mind that the tool will operate at regular intervals,
so with a single click on the Undo button you can only delete that part of the structure
mask that was added as part of the previous execution or a series thereof, but not along.

If the Level Set Method is selected, the tool uses its own editing mask created according
to a special algorithm. Hence, the created structure mask can go beyond the standard editing
mask, and when you change the mask boundaries, it will be visible. To create a structure
mask:

1. Activate the Region growing tool in the Level Set Method mode by clicking the
left/right/middle mouse button. To continue work with this tool, use the button with which
the tool was activated. To learn more about tool control, see Section 1.14.

2. Select the point on the mask roughly in the center of the region you want to segment.

3. Press and hold the mouse button. A separate blue tool editing mask appears in the
window in which you are working. If the mask is poorly visible against the background
of the standard editing mask, reduce the opacity of the editing mask. To do this, reduce
the opacity value in the Editing Mask panel (see Section 6.2.2).

4. Access the coverage of the tissues by the blue editing mask. The density of the tissues
that are under the blue editing mask depends on the density under the cursor. If the blue
editing mask is not built correctly, then release the left button, cancel the mask creation
by clicking the Undo button or deleting the mask; move the cursor to the tissue
section with the desired density, and repeat this step.

5. The red circle around the cursor shows the curvature of the areas that will be segmented
(the smaller the diameter of the circle is, the greater curvature is allowable, that is, the
thinner tissues will be segmented). To change the diameter of the circle, move the cursor
up or down, pressing the Alt key (or the Option key for macOS) on the keyboard.

6. Move the cursor in any direction, holding the mouse button. The structure mask will
grow under the blue editing mask. If the blue editing mask goes beyond the standard
editing mask, the mask can be built beyond the standard editing mask, but it will be
visible only within the standard editing mask.

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7. If the structure mask is completely created or if any further growth leads to leaks, stop
the growing process by releasing the mouse button.

8. If necessary, repeat the growing process for the tissue not yet segmented.

9. To undo an action, click the Undo button, to redo the canceled action click the

Redo button. However, keep in mind that the tool will operate at regular intervals,
so with a single click on the Undo button you can only delete that part of the structure
mask that was added as part of the previous execution or a series thereof, but not along.

If the volume model is open (see Section 5.21), then the created structure appears simul-
taneously on the model. This causes additional load on the processor. If you want to reduce
the load, click the arrow on the right side of the Growing Region button and uncheck
the Interactive 3D Update item. After this the structure on the volume model will be updated
after the next structure creation phase is completed. The visibility of the surface does not
affects the ability to edit the structure mask. The segmentation tools work if visibility for the
structure and/or surface mask is enabled.

6.8.4 Vessel tree segmentation tool

Functionality is available in the Pro edition

The tool is used for blood vessels segmentation.

Segmentation is performed only for the visible part of the structure (base volume). Before
using the tool, delete the parts of the image you don‘t need with the help of cutting tools. For
lung vessels you can use the lung vessels area selection tool. To do that, click on the arrow in
the right-hand part of the Vessel tree segmentation button and choose Extract lung vessels
area. It may take time. After the lung vessels area has been selected, a colour lookup table
«[WL]High Intensity» is assigned. For details on CLUTs see Section 2.23.
The Extract lung vessels area tool works correctly only on studies with
contrast.
To perform segmentation:

1. Select the target structure (the base volume). The visibility button turn on visibility
of structure mask.

2. Activate the Vessel tree segmentation tool by clicking the left/right/middle mouse
button. To continue work with this tool, use the button with which the tool was activated.
To learn more about tool control, see Section 1.14.

3. Specify the following parameters in the dialog box:

• Max vessel diameter (cm). The higher is the value of this parameter, the larger
vessels are detected. At the same time, the risk of misrecognition of other tissues
and mistaking a group of vessels for one vessel increases. If a smaller value is

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provided, the vascular tree is divided into several trees, as large vessels connecting
smaller trees are excluded.
• Vessel tree structures count. The parameter limits the maximum number of vessel
tree structures. The structures are only created for the largest trees.
After segmentation has been completed, the tool remains active for work with the trees.
The segmentation panel shows the structures created. To select a vessel, move the cursor to
the vessel. To select a vessel and its subtrees, move the cursor while holding the Shift button.
Figure 6.24 shows a vessel that has been selected.

Figure 6.24: The vessel selected

To join a vessel to another tree, select the respective tree structure on the segmentation

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panel, choose the vessel with the cursor, so that it is highlighted, and click on it. The vessel
and the structure will be the same colour.
The vessels that are not related to any trees are considered invalid. To disconnect a vessel
from one tree without connecting it to any other trees, you just need to mark it as invalid. To
do that, select the vessel with the cursor and double-click it or click holding down the Ctrl key
(or the Command key for macOS) on the keyboard. Use the button with which the tool was
activated. You can choose an incorrect vessel on the base volume holding down the Alt key
(or the Option key for macOS) on the keyboard and join it to any tree.
After the tool has been deactivated, you can no longer select vessels, join them or mark as
invalid. To proceed with the trees created, click the Vessel tree segmentation button.
A warning will appear on the screen: The vessels are already computed for that volume. Do
you want to recompute them using current structure mask? click No in the dialog box.
To perform vessels segmentation without deleting the results of the previous segmenta-
tion, choose the structure (base volume), for which you need to perform segmentation, click
the Vessel tree segmentation button and click Yes in the dialog box. The vessels that
have been created after you used the tool for the last time will be selected.

6.8.5 Watershed segmentation tool

Functionality is available in the Pro edition

The tool is used for segment volume using the watershed method and allows you to split
the volume into several non-overlapping parts.
The tool has two modes (directions for basin filling):
1. low dencity for the separation of soft tissues surrounded by more dense tissues: organs
containing air, as well as the brain. In this case, the filling of the basins progresses from
a lower tissue density to a greater one. The minimum density of tissues (Min dencity)
is the point from which the filling of the basins begins, and the Max dencity value limits
the density of the tissues to be segmented from above.

2. high dencity for separation of dense tissues surrounded by less dense tissues: bones
and contrasted organs. In this case, the filling of the basins begins with the maximum
density (Max dencity) and progresses in the direction of its reduction. The minimum
density of the tissues to be segmented is limited from below by the Min dencity value.
To speed up the segmentation process and avoid the creation of unnecessary segments,
exclude unnecessary tissues from the segmented volume, using the cutting tools.
To perform the Watershed segmentation:
1. Select the volume to be segmented.

2. If necessary, cut off the tissues that do not need to be segmented.

3. Activate the Watershed segmentation tool by clicking the left/right/middle mouse

button. To continue work with this tool, use the button with which the tool was activated.
To learn more about tool control, see Section 1.14.

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4. In the dialog that opens, set the following parameters:

• Min dencity;
• Max dencity;
• Min depth: the minimum depth of basins which can be combined;
• Max basins: the maximum number of created structures (no more than 31);
• Select the mode (Low dencity, High dencity);
• Select the source structure for segmentation from the Source drop-down list.
• To set this structure as default, check the Remember selected structure box.
• To hide the source structure, check the Hide source structure box.
• To hide the structures which will not be changed after segmentation, check the
Hide other structures box.

5. Click OK to perform segmentation or Cancel to cancel action. The process takes some
time.

After the segmentation is complete, you can manually distribute the tissue into the basins,
using the markers of the segmented structures. If the tissues do not fall into the required
structure, it is necessary to install the markers corresponding to the structure on this tissue.

Warning! The structure changes made using markers cannot be undone!

To perform the watershed segmentation using markers:

1. Select a structure on the list.

2. Activate the Segment marker tool by clicking the left/right/middle mouse button.
To continue work with this tool, use the button with which the tool was activated. To
learn more about tool control, see Section 1.14.

3. Add one or more markers in the required places by clicking the mouse.

4. If necessary repeat steps 1-3 for the other structures.

5. Click the Watershed segmentation button.

6. Make sure the Use structure markers box is checked.

7. Select the source structure for segmentation from the Source drop-down list.

8. To set this structure as default, check the Remember selected structure box.

9. To hide the source structure check, the Hide source structure box.

10. To hide the structures which will not be changed after segmentation, check the Hide
other structures box.

11. Click OK to perform segmentation or Cancel to cancel action. The process takes some
time.

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If the markers of different structures are put in one basin then the segmentation fails.
The source structure is not modified. The structures without markers are not modified.
To show/hide markers for the selected structure, click on the right side of the Segment
marker button and check/uncheck the Show current structure markers box in the
button menu (Fig. 6.25). The selected item is marked with a flag.
To show/hide marker numbers for the selected structure check/uncheck the Show current
structure marker numbers box. The option is disabled by default. This function simplifies
work with structures having many markers. E.g., if a watershed segmentation attempt results
in an error, this function helps you find out the number of the marker that caused this error.
The selected item is marked with a flag.

Figure 6.25: «Segment marker» button menu

To show/hide markers for all segmented structures, click on the right side of the Segment
marker button and select the Show all structure markers or Hide all structure markers
respectively.
To remove markers from the current segmented structure select the Remove current struc-
ture markers.
To change marker parameters of the selected structure, select the command Current
structure markers options....
The other features of the segment markers are similar to those described in Section 5.12.
If segmentation is performed for a fused series, then only markers for the selected layer
are displayed. Markers are editable regardless of which structure is selected.

6.8.6 Multi-segment growing tool

Functionality is available in the Pro edition

This tool is used when it is necessary to increase masks of several structures so that they
do not intersect. It is similar to Grow (dilation) (see Section 3.8.7), but can be applied simulta-
neously to an arbitrary number of structures and to the base volume. To use the tool:

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1. Build the required number of structures whose masks you want to increase without in-
tersection.

2. Activate the Multi-segment growing tool (see Section 3.8.7). The dialog shown in
Fig. 6.26 will be displayed.

3. The currently selected structure (base volume) is marked with a flag in the dialog. Check
all the structures (base volume) whose masks you need to simultaneously increase with
flags. If only one structure (volume) is checked, then the tool works similarly to the Grow
(dilation) tool.

4. Set the maximum growing radius in the Growing radius (mm) field.

5. Click OK to apply the tool or Cancel to cancel action. The process takes some time. If
the building is incomplete, repeat steps 2-4.

6. To undo or redo the action, use the Undo and Redo buttons for each structure
you have built up.

Figure 6.26: Multi-segment growing settings dialog

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6.8.7 Segmented structures regions growing Tool

Functionality is available in the Pro edition

This tool is used when several masks of segmented structures are to be grown in one
iteration (including within editing mask) so that they do not meet. To use this tool, you need
at least one structure that is not empty.
Proceed as follows:

1. Click the Segmented structures regions growing button. The dialog box shown
in Fig. 6.27 will pop up.

2. In this dialog box, choose the structures whose masks to be grown.

3. If required, choose a structure or the main volume as the editing mask. You cannot
choose the same structure for growing and as the editing mask.

4. Click OK to grow the structure or Cancel to cancel the operation. The process may take
some time.

To undo this action, click the Undo button, to redo the action, click the Redo
button.

Figure 6.27: Dialog box for setting segmented structures regions growing

In the tab for viewing the volume reconstruction, the mask is grown within the color table
assigned to this structure; in the tab for viewing the multiplanar reconstruction — within the
green editing mask.
The growth speed has exponential relationship with the distance to the boundaries of the
editing mask within which the structure is grown. It allows for effective division of the areas
linked by narrow connectors.

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6.9 Union, subtraction and intersection of structures

Functionality is available in the Pro edition

This tool allows you to create the unions, intersections and subtractions structures masks.
The button will look different depending on which instrument was last used:

Union (selected by default)

Subtract

Subtract dilated

Intersect

To use a tool that is already selected, simply click on the tool buttons. To select another
tool, click on the arrow on the right of the button and select an appropriate item from the list.

6.9.1 Union

Functionality is available in the Pro edition

The unification structures masks is the addition of one structure mask to another. The
structure mask added structure remains unchanged. To unite structures masks of structures:

1. Select the current structure on the Segmented Structure Panel (e.g., the left lung).

2. Click on the Union button. The dialog box shown in Fig. 6.28 will be displayed.

3. Select the structure with the mask of which you want to merge the mask of the current
structure. (e.g., the right lung). If you want to make the right lung invisible after the
merging process, check the Hide selected structure box. To make it visible later, enable
its visibility with the change structure visibility button on the segmented structure panel.
If you want to hide the base volume, check the Hide selected layer base volume box. If
you want the base volume to be displayed, enable its visibility with the change structure
visibility button on the segmented structure panel.

4. If the Place the result in a new structure box is checked, a new structure is created, in
which mask the procedure result is placed. The current structure is not changed.

5. To merge masks of structures, click OK, to cancel, click CANCEL.

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After the merging process, the original structure tissue will consist of the tissues contained
in both structures.

Figure 6.28: Union

6.9.2 Subtraction

Functionality is available in the Pro edition

The subtraction structures masks is the removal of voxels present in the mask of another
structure from the original structure mask. To subtract structure masks:

1. Select the current structure on the Segmented Structure Panel (e.g., the lungs).

2. Click on the Subtract button. The dialog box, similar to the one shown in Fig. 6.28,
will be displayed.

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3. Select the structure whose mask you want to subtract from the current one (e.g., the
rigth lung). If you want to make the right lung invisible after subtraction, check the Hide
selected structure box. To make it visible later, enable its visibility with the change
structure visibility button on the segmented structure panel.
If you want to hide the base volume, check the Hide selected layer base volume box. If
you want the base volume to be displayed, enable its visibility with the change structure
visibility button on the segmented structure panel.

4. If the Place the result in a new structure box is checked, a new structure is created, in
which mask the procedure result is placed. The mask of current structure is not changed.

5. To subtract, click OK, to cancel, click CANCEL.

After subtraction, the right lung tissue will be removed from the original structure (Lungs).

6.9.3 Intersection

Functionality is available in the Pro edition

The intersection structures masks is the removal of all voxels from the one structure mask
except those present in the masks of both structures. To intersect structures masks:

1. Select the current structure on the Segmented Structure Panel.

2. Click on the Intersect button. The dialog box, similar to the one shown in Fig. 6.28,
will be displayed.

3. Select the structure whose mask you want to intersect with the current one. If you want
to make the second structure invisible after intersection, check the Hide selected struc-
ture box. To make it visible later, enable its visibility with the change structure visibility
button on the segmented structure panel.
If you want to hide the base volume, check the Hide selected layer base volume box. If
you want the base volume to be displayed, enable its visibility with the change structure
visibility button on the segmented structure panel.

4. If the Place the result in a new structure box is checked, a new structure is created, in
which mask the procedure result is placed. The mask of current structure is not changed.

5. To intersect, click OK, to cancel, click CANCEL.

After intersection, the current structure will consist of the tissues contained in both struc-
tures.

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6.9.4 «Subtract dilated» Tool

Functionality is available in the Pro edition

The Subtract dilated tool performs the morphological opening operation for the radius
provided after subtraction. The morphological opening procedure is performed for the voxels
corresponding to the voxels obtained as a result of dilation of the structure mask with the
same radius. The radius is provided by the user in millimeters or voxels.

Figure 6.29: Editing structures dialog

To subtract structure mask:

1. Select the current structure on the Segmented Structure Panel (e.g., «Structure 1»).

2. Click on the Subtract dilated button. The dialog box shown in Fig. 6.29.

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3. Select the structure whose mask you want to subtract from the current one (e.g., the
«Structure 2»). If you want to make the Structure 2 invisible after subtraction, check the
Hide selected structure box. To make it visible later, enable its visibility with the change
structure visibility button on the segmented structure panel.
If you want to hide the base volume, check the Hide selected layer base volume box. If
you want the base volume to be displayed, enable its visibility with the change structure
visibility button on the segmented structure panel.

4. In the Place the result in a new structure box is checked, a new structure is created, in
which mask the procedure result is placed. The mask of current structure is not changed.

5. Click the OK button to apply the settings or CANCEL to cancel.

6. In the dialog box (Fig. 6.30), set the operation radius in millimeters or voxels.

Figure 6.30: Operation radius dialog box

7. To subtract, click OK, to cancel, click CANCEL.

6.10 Building Mask with Contours

Functionality is available in the Pro edition

6.10.1 General Information

Contours are used for segmentation of the organs whose density is comparable with the den-
sity of the surrounding tissue, e.g the heart, the liver, and joints. In such cases, it is hard to
see the boundaries of the region. Hence, the automatic segmentation procedure cannot be
applied.
Contours are built on sections in the MPR reconstruction tab. If the 3D view window is
opened in the tab, the structure mask created is simultaneously shown on the volume model.
To customize the contours display, click the arrow on the right-hand side of the Contour
segmentation button and provide the required parameters in the menu.

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• To enable/disable the contours display on the volume model, check/uncheck the box
next to the Show contours in 3D option. By default, the option is enabled.

• To enable/disable the synchronization point display when the user hovers over the con-
tour, check/uncheck the box next to the Show syncpoint option. By default, the option
is disabled.

• to enable/disable automatic rebuilding of a structure mask in alignment with the con-

tours, check/uncheck the Interactive voxelization box. By default, this option is en-
abled. If the interactive voxelization option is disabled, use the Voxelize unction on the
tool context menu to rebuild the mask manually. For details, see Section 6.10.3.

6.10.2 Building a Structure Mask with Contours

To build a structure mask with contours, proceed as follows:

1. Open the study in the MPR Reconstruction tab. Create a structure with an empty mask
and configure the editing mask by setting the tissue density. For the details on editing
mask creation, see Section 6.2.1.

2. Activate the Contour segmentation tool by clicking the left/right/middle mouse

button. To continue work with this tool, use the button with which the tool was activated.
To learn more about tool control, see Section 1.14.
Build the contour in one of the following ways:

• Building contours manually. Build a contour around the chosen area while hold-
ing the mouse button with which the tool was activated. To finish the procedure,
release the mouse button. To cancel the contour that has not been closed, press
Esc on the keyboard while holding the button.
• Building contours with an isoline. Move the cursor around the selected area while
holding the Shift button on the keyboard. Under the cursor, you will see an isoline
characterized by even points density. You can only see an isoline on the surfaces
where a contour can be built. To build a contour with an isoline, click the left mouse
button or the mouse button with which the tool was activated.

3. Go to the next slice and draw a contour around the selected area. Contours are only
built on parallel planes. Contours are used to create a mask with regard for the editing
mask. You need at least two contours to build a structure mask.

Structure mask may not be shown on the sections with the first and the last contour.
Building contours automatically with segmented structure sections. Contours are built
on the current section of the structure mask. The structure mask on which contours are built
may be built with any tools. The following conditions must be met in order to build a contour
on a structure mask:

• the current section must be placed in parallel with other contours;

• there must be no other contours of the same structure mask on the current section;

• the structure mask must be visible on the current section.

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Mouse over a section parallel to the structure mask contours. The mask should be visible in
the current slice. Click the right mouse button and select the Create contour X option from the
menu, or press X on the keyboard. The contour will be built on the current section (indicated
by the red arrow in the fig. 6.31) around the perimeter of the visible part of the current structure
mask (indicated by the black arrow in the fig. 6.31). If a contour (or several contours) already
exists on the current section, no other contour will be built.
To undo an action, click the Undo button, to repeat the canceled action, click the

Redo button. You can use the Undo and Redo buttons to delete or restore the contours
that were built in one click.
Contours projections are shown on perpendicular sections of the MPR reconstruction tab,
in the 3D view window and on the sections where they were built. If a slice is not perpendicular
to the contour plane, the projection of this contour is not shown.
When you hover over the contour line, it is highlighted in all the windows of the tab.

Figure 6.31: Building contours automatically with segmented structure

sections

If the Show syncpoint option is enabled and the user hovers over the contour in any of
the cutting plane windows or in the 3D view window, the crosshair under the cursor and the
synchronized crosshairs on the contours in other windows of the tab are displayed.
If you click the mouse button while the cursor is on the contour line in the 3D view window,
you will go to the section with this contour in the MPR reconstruction window.

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6.10.3 Work with Contours

DICOM Viewer provides for the following actions with contours:

• Editing. To edit a contour, place the cursor over it. When you hover over the contour
line, it is highlighted in all the windows of the tab. Place the cursor over the area that
needs editing and click the mouse button. Draw a new contour while holding the button.
To finish the editing procedure, release the mouse button.
To undo an action, click the Undo button, to repeat the canceled action, click the

Redo button. You can use the Undo and Redo buttons to delete or restore the
parts of the contour that were built in one click (from the moment you press the mouse
button to the moment the button is released);

• Rebuilding a mask manually. This function is used when the automatic structure mask
rebuilding function is disabled in the Contour segmentation button menu. To do it,
you need to mouse over the contour line, click the right mouse button and choose the
Voxelize option on the context menu. If the contour is built for a structure mask created
with the help of other tools, you will not be able to undo an action after voxelization.
Before voxelization is performed, a dialog box pops up informing you that the change
history will be lost (Fig. 6.10.3);

Figure 6.32: A message warning that the change history will be lost

To accept the changes, click the CONTINUE button. To cancel voxelization, click the
CANCEL button.

• Deleting. Place the cursor over the contour line, press the Delete key on the keyboard
or click the right mouse button and choose the Remove contour option in the right-click
menu.
To undo an action, click the Undo button, to repeat the canceled action, click the

Redo button. You can use the Undo and Redo buttons to delete or restore the
parts of the contour that were built in one click (from the moment you press the mouse
button to the moment the button is released).

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6.10.4 Setting the Contour Display Parameters

You can customize the contour display parameters in the Tool options dialog box (Fig. 6.33).
The appearance and the functions of the Tool options dialog box depend on the way
you call for it. There are two ways to call for the Tool Options dialog box:

1. Place the cursor over the contour line, click the right mouse button and choose
the Tool options... point in the right-click menu. The dialog shown in Fig. 6.33a
appears.
2. On the volume editing panel, click the arrow on the right-hand side of the Contour
segmentation button and select Default options... from the button menu.
The dialog shown in Fig. 6.33b appears.

a) b)

Figure 6.33: Contour parameter settings dialog box

In the dialog box that pops up (see Fig. 6.33), in the Display section select the color
and the contour line thickness in pixels. From the Interpolation drop-down list in the
Voxelization section, select the interpolation type for the segmented structure built with
contours. The interpolation types available are:

• Linear;

• Hermitian spline (set by default).

The interpolation type chosen will be displayed next time you open the structure selection
dialog box.
The parameters selected in the dialog box Fig. 6.33a will be applied to the contours of
the current structure mask. If you check the Set as default box, the settings will be used by
default when building the contours of a new structure mask.

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The parameters set in the dialog box shown in Fig. 6.33b are applied by default to the
Contour segmentation tool. The changes are not applied to the built contours of masks. To
restore the initial tool parameters, click the DEFAULT button.
Click OK to apply the settings or CANCEL to cancel.

6.11 Saving and Opening Segmentation Projects and DTI Projects

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer allows for saving segmentation projects and DTI projects in a file. One
project may contain structures and DTI data from different series, as well as source DICOM
data. If a project was saved without source DICOM data, it cannot be opened without down-
loading the corresponding series first.
Save segmentation project to file and Open segmentation project from file
buttons (shown with the red frame in Fig. 6.34) are located on the segmented structures panel.

Figure 6.34: Project management buttons

6.11.1 Saving a Project

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To enable/disable the saving of source DICOM data, on the main menu, select Options-
>Settings...->Modules->3D reconstruction, then choose the Project tab and check/uncheck
the Save DICOM data of series box. This option is activated by default.

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Figure 6.35: 3D reconstruction settings

The DEFAULTS button restores the checkbox Save DICOM data of series.
Click OK to apply the settings or CANCEL to cancel.
To save a project, click the Save segmentation project to file button on the seg-
mented structures panel. In the dialog box that pops up, provide the path to the file and the
file name. Click OK to save or Cancel to cancel. The project file has (spj) extension.
When a project is saved, the data regarding the visibility and minimization status of all the
elements on the segmentation panel list, as well as the data regarding the model orientation
and projection are saved. When the project is opened again, the visibility and minimization
status of the elements on the segmentation panel list, as well as the model orientation and
projection will be restored. If you open a project created by a user of the DICOM Viewer 2.14
or inferior, the status of the elements on the segmentation panel list will be determined in
compliance with the status of the Collapse new structure on creation setting which can be
found on the Segmentation tab, 3D Reconstruction module settings (see Section 16.7.3).
If the project is opened in the MPR reconstruction tab, the following characteristics are
restored:

• cutting planes turn and arrangement;

• model position;

• model scale.

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The turn of the model slice in the MPR reconstruction tab is not restored.
If the project is opened in the Volume reconstruction tab or in the 3D view window of the
MPR reconstruction tab, the following characteristics are restored:

• model turn;

• model position;

• model scale;

• projection type.

If the project was saved in the MPR reconstruction tab and opened in the Volume recon-
struction tab, the parameters that can be applied only to the 3D view window are restored.
The markers — Marker, Line marker, or Polygonal line marker — are saved in the project
for each layer. The length and angle measurements performed with polygonal marker lines
are saved in the project file. The work with markers is described in Section 5.12.

6.11.2 Saving Projects Automatically

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Segmentation projects are saved automatically to prevent loss of data as a result of a

program crash caused by a technical failure or the user’s actions. Autosave and data recovery
are available in MPR reconstruction and Volume reconstruction tabs.
If the license for the extended segmentation module is active and it is the first time the
user adds, deletes or edits

• a segmented structure or base volume;

• a surface for a segmented structure or base volume;

• a group of ROI DTI, or individual ROI DTI;

• a marker (except for segmented structure markers),

in the MPR reconstruction or Volume reconstruction tab, then a dialog box for segmentation
projects autosave activation (Fig. 6.36) will pop up.

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 6.11. SAVING AND OPENING SEGMENTATION PROJECTS AND DTI PROJECTS

Figure 6.36: Dialog box for segmentation projects autosave activation

Click YES to enable segmentation projects autosave or NO to cancel.

To enable/disable segmentation projects autosave, on the main menu, select Options-
>Settings...->Modules->3D reconstruction, then choose the Project tab (Fig. 6.35) and check-
/uncheck the Enable autosaving box. By default, segmentation projects autosave is disabled.
On the Timeout dropdown list, select autosave frequency. The default value is five minutes.
Autosave option is available only when the extended segmentation module
is activated. If the extended segmentation module is not activated, the
Enable autosaving option is automatically disabled.
Segmentation projects are automatically saved in the background mode without blocking
the interface. Autosave frequency may be selected on the Timeout dropdown list.
When a segmentation project is saved automatically, a file with .autospj extension is cre-
ated in a temporary system folder. This file contains:
• segmentation results;

• visibility status of structures on the segmentation panel list:

– base volume visibility is saved as visibility of a separate structure;

– 3D model visibility is saved as visibility of a structure mask;

• collapsed status of elements on the segmentation panel list, including:

– nested elements of the mask and the surface;

– base volume elements which are saved as separate structures;

• DICOM data source information.

The DICOM data source may be:
• a local storage;

• a folder with DCM files;

• a DICOMDIR file;

• an XML file;

• a third-party SPJ file;

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• an archive with DCM files.

The data concerning the changes in the base volume in different tabs working with the
current segmentation project are saved as separate segmented structures. If the user works
with the same segmentation project in several MPR reconstruction or Volume reconstruction
tabs, the data are automatically saved in the same file.
If a segmentation project is saved manually with the help of the Save segmentation project
to file button on the segmented structures panel (see Section 6.11.1), the .autospj file is
deleted automatically.
When the user closes the last tab of a segmentation project with unsaved changes, a dialog
box for saving the project changes (Fig. 6.37) will pop up.

Figure 6.37: Dialog box for saving the changes in a segmentation project

Click SAVE to save the changes in the project or DISCARD to close the tab without saving
the changes. To resume work on the project, click CANCEL. After the project has been saved
or the changes have been discarded, the .autospj file is deleted automatically.

6.11.3 Resuming Work with Segmentation Projects

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

If the segmentation projects autosave option is enabled, an .autospj file is created and
saved in a temporary folder.
The name of the .autospj file is generated as follows:
<patient name>_<description of the 1st layer series>_…_<description of the n layer series>_
<project #>_<time and date>.autospj,
where <project #> — is the unique number that is automatically assigned to a segmentation
project for a series or a fused series,
and <time and date> — is the time and date of the file creation in hhmmssddMMyyyy format,
where «hh» stands for hours, «mm» — for minutes, «ss» — for seconds, «dd» — for the day,
«MM» — for the month, and «yyyy» — for the year.
The maximum length of the autospj file name is 100 characters. If this limit is exceeded, the
name will be cropped and a «∼» symbol will be placed before _<project #>_<time and date>.

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 6.11. SAVING AND OPENING SEGMENTATION PROJECTS AND DTI PROJECTS

Figure 6.38: Dialog box with crash recovery settings

In case of the program crash, the project file is restored automatically when the DICOM
Viewer is launched again. If there is an .autospj file in the temporary folder, it is decided that
the project must be restored, and a dialog box for resuming work with the last autosaved
version of the segmentation project pops up (Fig. 6.38).
In the Disaster recovery settings dialog box, check the autosaved files for the projects
that have to be restored. If none of the files has been selected, the OK button is inactive. You
can choose the mode in which the restored project will be opened: 3D, MPR or Both. Click
OK to open the selected segmentation project in the mode specified or CANCEL to cancel.
If there are several projects, work with them will be resumed in the order in which .autospj
files are listed in the Disaster recovery settings dialog box. If any of the projects cannot be
restored, it does not affect the other projects.
When you renew work with an automatically saved file, the visibility and collapsed status
of the structures on the segmentation panel list will depend on the status of these structures
at the time of the .autospj file creation.

If you click CANCEL, .autospj files are deleted from the temporary folder.

An .autospj file contains only the information on the third-party DICOM data source. If this
source cannot be accessed, the segmentation project cannot be restored.
If the user cannot resume work with any of the segmentation projects as the DICOM data
for the series are unavailable, a dialog box will pop up advising to save the data from the
autosave file to a separate .spj file on the disk. After the user confirms that the data must be
saved, a standard Save As dialog box pops up. The name of the file and its location are to be
specified by the user.

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After the file is saved or the user chooses not to save it, the .autospj file is
deleted from the temporary folder.

6.11.4 Opening a Project with Source DICOM Data

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

When a project is opened, the DICOM Viewer shows it in the Volume Reconstruction
or Multiplanar Reconstruction tab. To choose a default tab, on the main menu, select Op-
tions->Settings...->Modules->3D reconstruction, then choose the Project tab (Fig. 6.35), and
choose the 3D, MPR or Both opening mode. The 3D mode is chosen by default.
The DEFAULTS button restores the checkbox Save DICOM data of series.
Click OK to apply the settings or CANCEL to cancel.
Orientation and projection data on the model are saved in the project. The orientation
and projection of the model is restored when the project is opened. For more information,
see Section 6.11.1.
There are three ways to open a project containing source DICOM data in the default tab:

1. Choose the Open project... option in the File menu. Select the project file in the window
that pops up. Click Open to open the project or Cancel to cancel.

2. Double-click with the left mouse button on the project file in the Explorer window. This
function is available by default only on Windows OS. On macOS and Linux, you have to
use the system functions to create a link between (spj) format and the DICOM Viewer
software.

3. Drag and drop the project file to the DICOM Viewer shortcut (this option is only available
on Windows and macOS). If you drag and drop several project files to the DICOM Viewer
shortcut, each file will be opened in a separate tab.

To open a part of the project and specify the tab in which it is to be opened, proceed as
follows:

1. On the main menu, select File->Open project as.... A window will pop up, in which you
will have to choose the file containing the project for this series. Click Open to open the
project or Cancel to cancel the action. The dialog box shown in Fig. 6.39 will pop up.

2. Choose the tab in which you want to open the project (3D, MPR or Both). The selected
mode will be set by default.

3. Select the series in the Series list box that need to be opened. By default, all series of
the project are selected. Uncheck the box against the series if you don’t want it to be
opened in the project.

4. The order in which the series are displayed is important for working with the project.
By default, the series are displayed in the Series list in the same order as when the
segmentation project was saved. To change the series order, highlight a series in the

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 6.11. SAVING AND OPENING SEGMENTATION PROJECTS AND DTI PROJECTS

Series list box. Use Move up and Move down buttons (indicated by the red
frame in Fig. 6.39) to move the selected series up or down.

5. Click OK to open the project or CANCEL to cancel the operation.

6. The first series on the Series list is considered to be the basic series.

• The basic series on the MPR tab is displayed as the background layer behind the
other layers. The background layer is fixed. The center of the background layer
coincides with the center of the window. You can move the layers about the back-
ground layer or each other with the help of the tools you see on the Fusion of layers
panel. The procedure of merging layers is described in Section 4.3.
• The project opened in the volume reconstruction window is displayed as 3D mod-
els created independently of each other. The basic series of the project is dis-
played as a 3D model fixed at the point of origin which is at the same time the
center of the model. The models from other series are located in space with re-
spect to the first layer model. The change of the order of the layers at the time of
opening the project does not affect the mutual arrangement of the models.

If the project does not contain any source DICOM data, when you attempt to open it, an
error notification will pop up: Cannot find DICOM data in the project file. The procedure of
opening projects without DICOM data is described in Section 6.11.5.

Figure 6.39: Dialog box for selecting the project opening parameters

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CHAPTER 6. SEGMENTATION

6.11.5 Opening a Project without Source DICOM Data

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To open a project without source DICOM data, you first need to open the source data in
the Volume Reconstruction or Multiplanar Reconstruction tab.
To open a project that does not contain any source data:

1. Open the initial series for which the project was saved in the Volume Reconstruction or
Multiplanar Reconstruction tab.

2. Open the segmented structure panel by clicking the button.

3. Click the Open segmentation project from file button on the segmented structure
panel. A window will pop up, in which you will have to choose the file containing the
project for this series. Click Open to open the project or Cancel to cancel the operation.

Orientation and projection data on the model are saved in the project. The orientation
and projection of the model is restored when the project is opened. For more information see
Section 6.11.1.
The segmented structures and DTI data for this series contained in the project are added
to the segmented structure panel. When the project is opened for the second time, the data
are added again without replacing the old data. When the structures are edited on the seg-
mentation panel, the file contents are not changed. If a project file contains data for several
series, only the data referred to the series that is currently open on the volume or multiplanar
reconstruction tab will be added.

6.12 Histograms

Functionality is available in the Pro edition

The sections with color tables described in Section 2.23.3 are available for segmented
structures. The difference is that in the Flat images view mode a histogram is built for the
entire density range, and for the structure it is built only for the range of the density that
corresponds to the structure mask.

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 6.12. HISTOGRAMS

6.12.1 Rendering a Histogram for a Structure

Functionality is available in the Pro edition

The DICOM Viewer provides for rendering histograms for the base volume and selected
segmented structures.
To view a histogram for a selected segmented structure in the MPR Reconstruction win-
dow, click the Rendering transfer function button on the toolbar.
At the bottom of the tab, you will see the panel of the rendering transfer function with the
histogram for the selected segmented structure. The color of the histogram for the selected
segmented structure will be the same as the user color of the segmented structure. The name
of the segmented structure is provided in the histogram legend.
If you have chosen the base volume on the segmentation panel, then only the base volume
histogram will be displayed on the panel of the rendering transfer function. The changes in
the visibility and transparency of the selected segmented structure or the base volume do not
affect the histogram rendering.

Figure 6.40: Histogram of segmented structure

When you hover over a point of the base volume or the selected segmented structure
histogram, a tip pops up.
The pop-up tip provides the following parameters:

• Chart — the name of the histogram;

• Density (HU) — the Hounsfield density value;

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• Value — the number of points characterized by the density value provided;

• Normalized value — is calculated by the following formula:

y − ymin
(6.1)
ymax − ymin

where:
y — the present histogram value;
ymin — the minimum histogram value;
ymax — the maximum histogram value.
The base volume and the name of the segmented structure is stated in the histogram
legend.
If the 3D view window is active in the MPR Reconstruction tab, then the histogram for the
base volume and the transfer function for the current color table will be displayed on the panel
of the rendering transfer function.
When you hover over a point of the rendering transfer function graph, a tip pops up.
The pop-up tip provides the following parameters:

• Density (%) — the density measured as percentage of the window width/level (W/L). The
parameter is calculated by the following formula:

100
D% = (D − M inW /L ) ∗ (6.2)
M axW /L − M inW /L

where:
D — the density value;
M inW /L — the minimum window dimensions;
M axW /L — the maximum window dimensions;

• Opacity — the opacity value from 0.0 to 1.0.

The opacity value shown in the pop-up tip is rounded off to 0.001.

6.12.2 Histogram for a ROI

Functionality is available in the Pro edition

A histogram for a ROI is a graph for the density range of the points within the ROI. The
DICOM Viewer displays histograms for ROI in the Image Viewer tab, MPR Reconstruction
tab, and PET Analysis tab.
To view a histogram for a ROI in the selected window, click the Rendering transfer
function button on the toolbar. At the bottom of the study tab, you will see the rendering
transfer function panel with the histogram for the ROI and the rendering transfer function over
it.

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 6.12. HISTOGRAMS

In the Flat Image Viewer tab, the histogram is built for all the ROI displayed in the selected
tab window. When you add a new ROI, scroll or switch windows, the histogram for the ROI is
changed accordingly.
If you have chosen a mode where several images of the same series are displayed si-
multaneously, e.g. 2x2, 2x3 etc., then the histogram for the ROI is built in the top left-hand
corner.
In the MPR Reconstruction tab, histograms for ROI are shown in the Axial plane, Sagit-
tal plane, Coronal plane, and Involute windows. If the MPR Reconstruction tab is open for
merged series, then, when you switch layers, the ROI histogram is changed in accordance
with the density values for the current section of the layer selected.
In the PET Analysis tab, the histogram is built for all the ROI of the current image in the
selected window: PT, CT, or Fusion (PET+CT). In the Fusion (PET+CT) window, the histogram
is built for the PET layer.

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CHAPTER 7. VESSEL ANALYSIS MODULE

Chapter 7

Vessel analysis module

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

In Vessel Analysis window, diagnosis can only be established on the basis of

CT and MR series. The anomalies detected should be studied using the
original images in the Image Viewer window.
Errors may occur when intensity is measured in a certain point. In this case,
the intensity value will be marked by an asterisk. For accurate
measurements, use the bilinear interpolation filter (see Section 5.3).
The DICOM Viewer allows you to open CT, MR and XA modality series in the Vessel anal-
ysis module.
The DICOM Viewer contains the Vessel analysis module (universal) and the Coronary
artery analysis module (adapted for the analysis of the coronary arteries). Both of these mod-
ules are licensed separately. Their functionality basically coincides, and the differences are
based on the location of the coronary arteries.
This chapter describes the Vessel analysis module. Differences related to the Coronary
artery module are described in Section 7.8.

7.1 Open Studies in Vessel Analysis Module

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To open a study:
1. Load studies to the DICOM Viewer.
2. Select the angiographic study and the series with contrast.

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 7.1. OPEN STUDIES IN VESSEL ANALYSIS MODULE

3. Click the Vessel analysis button on the toolbar. To select the tab location (in the
current window, in a separate window or in the full screen mode), click on the arrow on
the right side of the button. To open the virtual endoscopy window in a new tab in the
current window, click on the button. The process may take some time.

If you open a CT study, then the DICOM Viewer promt you to select a series without con-
trast to remove bones.
The dialog box for selecting a non-contrast-enhanced series pops up
automatically only if the series is opened for the first time. When the same
series is opened again, the dialog box does not pop up, but you can open it
manually in the menu of the «New vessel» button.
The following series are not shown in the dialog box for selecting non-contrast-enhanced
series (Fig. 7.1):

• Series with a modality other than CT;

• Series incompatible with 3D;

• The current series (opened in the Vessel analysis tab).

Figure 7.1: he dialog box providing an opportunity to select a

non-contrast-enhanced series for deleting bones

In the dialog that opens, select the seris without contrast and click OK to remove bones or
CANCEL to cancel deletion.

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If the study does not contain any series with an opportunity to delete bones, the dialog
box does not pop up.
To open the bone removal dialog (Fig. 7.1) manually, click the arrow on the right side of the
New vessel button and select the Subtract bones item. The command is only available
for series with CT modality. If there are no suitable series, a notification will pop up when the
user selects the Subtract bones command.
This process takes some time.
To enable/disable the function of displaying a dialog box requesting a non-contrast-enhanced
series for bones deletion when opening a study, on the main menu select the Options->Settings...-
>Modules->Vessel analysis, UI tab and check/uncheck the Request a non-enhanced series
to remove bones on window opening box. The dialog box is displayed by default.
The vessel analysis window is shown in Fig. 7.2.

Figure 7.2: The Vessel analysis window

The windows display the axial, coronal, sagittal sections and a 3D view. In the 3D view
window, you see a 3D model and a standard space orientation panel (for details see Sec-
tion 3.3). These windows are used to build the centerline. Vessel sweep is displayed in the
Involute curve window.
Cutting planes can be moved in the same way as they are moved in the MPR reconstruc-
tion tab (see Section 5.5.1.
To cancel rotation of all the images and the involute curve, click the Reset views orienta-
tion button on the toolbar.

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 7.1. OPEN STUDIES IN VESSEL ANALYSIS MODULE

7.1.1 Vessels list

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The built centerlines can be saved on the list of vessels until the window is closed. To
save the built line select the vessel category from the drop-down list Categories in the panel
shown in Fig. 7.3; next, select the vessel below and click the BIND button. The pictogram
appears to the right of the selected vessel on the list. To switch to the previously saved cen-
terline, select the vessel on the list and click the SWITCH TO button. To remove the centerline
from the list, click the UNBIND button. The pictogram disappears.

Attention! If the current centerline is not bound to any of the vessels on the
list, then when you built another line, it will be lost.

Figure 7.3: Vessel list

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7.2 «Render settings» Tool

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The Render settings tool allows for setting the rendering quality of the 3D model
and the opacity threshold in the 3D view window. The tool is available on the toolbar of the
Vessel analysis tab and Coronary artery analysis tab. The operation of the tool is described
in Section 3.14.

7.3 The Play Tool

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The tool in the MPR View windows is similar to that described in Section 2.15 and the tool
in the Volume Reconstruction window is similar to that described in Section 3.7.

7.4 Video recording

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer allows you to record video for the MPR view, the surfaces view and
the volume reconstruction view windows. The following objects will be recorded:

• tissues;

• measurements;

• annotations;

• markers;

• tags;

• orientation cube;

• the center line.

The other features of the tool in the MPR View windows are similar to those described
in Section 2.15 and the features in the Volume Reconstruction window are similar to those
described in Section 3.7.

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 7.5. IMAGE FILTERS

7.5 Image Filters

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

This function cannot be used for establishing a diagnosis

Work with filters in the Vessel analysis and Coronary artery analysis tabs is similar to work
in the Image viewer tab (see Section 2.6) with two exceptions:

• to apply a filter in the Vessel analysis and Coronary artery analysis tabs, on the main
menu, select MPR->Filters and select the desired filter on the list of filters on the main
menu. The current filter is highlighted with blue on the list of filters, and marked with a
flag;

• in the Vessel analysis and Coronary artery analysis tabs, a filter is applied to all the
cutting plane windows and the involute curve window.

7.6 Centerline building mode

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

For analysis, it is necessary to build a centerline which is automatically located in the no-
tional center of the vessel. Only one centerline can be built at a time. To save the built line
and build a new one, bind it to a specific vessel from the list in the left part of the window (see
Section 7.1.1).
You need to control the process of building the centerline and make
corrections, if needed.

7.6.1 Building the centerline

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

You can build the centerline in two methods. To select a method click the arrow on the
right side of the New Vessel button and select the appropriate method (Fig 7.4). The
current method is marked with a flag.

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CHAPTER 7. VESSEL ANALYSIS MODULE

Figure 7.4: Select a method to build the centerline

1. Building by one point. In this mode the line is built in both directions from the starting
point for a maximum distance. If the vessel splits along the construction line, then the
line is built in an arbitrary branch. To build the line, click the left mouse button at the
starting point. To extend a vessel line, left-click in the right spot. The line will be built
from the closest existing point and will pass through the new point.

2. Building by two points. In this mode, the line is built from the starting point to the end
point. To build the line, click at the starting and end points. The DICOM Viewer adds the
required number of intermediate points to set the centerline. If the line is not completely
built, then select the point up to which you want to extend the line and click in at it. The
line will be built from the nearest existing point.

If the centerline for the selected points cannot be built, then the message Unable to trace
vessel centerline from this point(s) appears.
If the line is not built correctly, then start building it again by clicking on the New vessel
button or edit the line.

• Drag a point. Locate the cursor on the center line of the vessel. The points are displayed
when you hover the cursor over the center line of the vessel. Select a point on the curve
you need to move. The selected point is centered in the cutting planes windows. While
holding the left mouse button, move the point in the cutting planes windows. To escape
from the Drag a point mode, left-click near the curve.

• Add a point. Locate the cursor on the center line of the vessel. The points are displayed
when you hover the cursor over the center line of the vessel. To add a point, move the
cursor to the place where you want to add a point, right-click and on the context menu
and select the Add point command. The centerline will change so as to pass through a
new point. A new point may be added to extend the centerline of a vessel.

• Continue curve to the end of the vessel. Locate the cursor on the center line of the
vessel. The points are displayed when you hover the cursor over the center line of the
vessel. To extend a curve, select the end point on the curve, right-click and select the
Trace from this tip command on the context menu. The curve will be extended to the
end of the vessel.

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 7.6. CENTERLINE BUILDING MODE

• Delete part of a curve (segment). To delete part of the line, delete a segment. The
segment is deleted along with the shorter part of the line adjacent to the point. To
delete a segment, right-click on the first point of the segment and select the Remove
segment item. The shorter part of the centerline is removed from one side of the point
and the section between this and the next point from the other side.

• Delete a point. Locate the cursor on the center line of the vessel. The points are dis-
played when you hover the cursor over the center line of the vessel. To delete a point,
move the cursor over this point so that all the points are highlighted, right-click and on
the context menu and select the Remove point command.

The initial research data or the volume reconstruction data can be used for building. To
select the data source, click the arrow on the right side of the New vessel button and
select the appropriate source.
The centerline is shown in Fig. 7.5.

Figure 7.5: The centerline

To choose the vessel centerline visibility mode, click the arrow on the right-hand side of the
New vessel button and choose the Centerline visibility mode option (see Figure 7.6).
The same command is available in the right-click menu. The current centerline visibility mode
is ticked.

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CHAPTER 7. VESSEL ANALYSIS MODULE

Figure 7.6: Select the vessel centerline visibility mode

• Always. The vessel centerline is always displayed in the Cutting planes windows, as
well as in the Volume reconstruction, Involute curve, and Straightened vessel win-
dows. If you mouse over the centerline, you will see the points.

• Hover. The vessel centerline is always displayed only in the Volume reconstruction
window. The vessel centerline is displayed in the Cutting planes windows, as well as in
the Straightened vessel and Involute curve windows if you mouse over it or select one
of the points.

• Never. The vessel centerline is always displayed only in the Volume reconstruction
window. It is not displayed in any other windows.

The vessel centerline visibility settings will be applied next time you open the Vessel anal-
ysis window.

7.7 Vessel Analysis Mode

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

After building the necessary centerlines, switch to the Vessel analysis mode by clicking on
the Analysis mode button. The window in the Vessel analysis mode is shown in Fig. 7.7.

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 7.7. VESSEL ANALYSIS MODE

Figure 7.7: The vessel analysis mode

The volume reconstruction is shown in the 3D view window, the curved surface is shown
in the Involute curve window. The vessel sweep following the straightening of its centerline
and the marking of its borders is shown in the Straightened vessel window. The sections by
the planes that are perpendicular to the centerline are shown in the Section window.
You cannot edit the centerline in the Vessel analysis mode. To do it swith to Centerline
building mode by clicking the Analysis mode button.

7.7.1 Vessel borders

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer calculates the inner and outer borders of a vessel and the border of
calcifications inside a vessel (Fig. 7.9). If no calcifications are found, then the corresponding
value remains empty.
If the Adaptive box is checked, threshold density values will be evaluated for each vessel
section individually. This ensures more accurate display of contours of vessels and calcifica-
tions. The box is checked by default.
To see the tissues that correspond to the density ranges, click the Show vessel tissue
button. In the Section views window the tissues with an intensity between the inner border
and the calcium border (vessel lumen) are highlighted in green, the tissues with an intensity
between the outer and inner border (vessel wall) are highlighted in brown, and the tissues
with an intensity higher than the calcium border (calcifications) are highlighted in white. The

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borders of the vessel are built in accordance with the threshold values, but due to certain
smoothing they do not exactly correspond to the threshold values. In the Straightened vessel
window, the green line indicates the inner border of the vessel, the red line indicates the outer
border (fig. 7.10).
If the Adaptive box is checked on the threshold value panel, then threshold density values
are only highlighted in the Section views window as in this case threshold density values are
evaluated for each vessel section individually. If the Adaptive box is unchecked, threshold
density values are also highlighted in the Straightened vessel window.
The central line is shown as a straight line.
To edit borders, activate the Edit vessel contours tool, click the left mouse button at
an arbitrary place near the border, the border will pass through the selected point. When you
move the mouse while holding the left button, the border repeats the path of the cursor.
You need to control the process of boundaries creation, as well as the
threshold boundary and calcification values. If needed, change the
boundaries and the threshold values manually.
To choose a visibility mode for vessel contours, press the arrow on the right-hand side of
the Analysis mode button and select the Contours visibility mode command (Fig. 7.8).
The same command is available in the right-click menu if the vessel analysis mode is active.
The current contours visibility mode is ticked.

Figure 7.8: Select the contours visibility mode

• Always. Vessel contours are constantly displayed in Section views and Straightened
Vessel windows. The mode is selected by default.

• Hover. Vessel contours are displayed in Section views and Straightened Vessel win-
dows when the user hovers over the contours.

• Never. Vessel contours are not displayed in any windows of the tab.

To change the threshold values, uncheck the Adaptive box and enter new values in the
appropriate fields and click the APPLY button. The border will be rebuilt in accordance with
the new values. To return to the threshold values calculated automatically, click the RESTORE
button.

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 7.7. VESSEL ANALYSIS MODE

Figure 7.9: Threshold value panel

To undo the all changes and return to the initial borders, click on the arrow on the right
side of the Analysis mode button button and select the Rebuild edges command.
At the bottom of the Straightened Vessel window, there is a graph showing changes in
the vessel lumen. The areas in which stenosis is possible are highlighted in red on the graph,
the remaining sections are highlighted in green.

Figure 7.10: Highlighted density thresholds

7.7.2 Section analysis

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To add a section, move the cursor to the centerline in the Involute curve, Straightened
vessel or 3D view window, right-click and select the Add section command or Add reference
to add a reference section.
To delete a section, select the Remove section command on the context menu of the
section or click on the cross in the upper right-hand corner of the current section window
(Fig. 7.11).
The position of the cross on the section corresponds to the position of the centerline.
The borders are outlined by the green and red lines. When editing borders in the current
section window (Fig. 7.11), the Edit vessel contours tool can be deactivated.

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The yellow line in the current section window shows the cutting plane for the current sec-
tion shown in the Straightened vessel window. To rotate the cutting plane, move the cursor
over it so that a bidirectional arrow appears, hold the left mouse button and move the mouse.
The following parameters are calculated in the section view windows:

• Lumen

• Short diameter

• Long diameter

with the percentage of stenosis.

If you set one section as a reference, then the diameter and lumen values for the other
sections are relative to the corresponding values for the reference section. If you set two
sections as a reference, then the values for the other sections are relative to the average
values for the reference sections. It is recommended to locate the reference sections on both
sides of the section of interest if the vessel narrows. To set the type of the section, select it
from the drop-down list in the upper left-hand corner of the section view window (Fig. 7.11).

Figure 7.11: Section view window

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7.7.3 Curved surface analysis

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

A vessel sweep is diaplayed in the Involute curve and Straightened vessel windows.
The Straightened vessel window displays the distance from the beginning of the vessel
to the cross section.
To analyze the vessel interval, select this interval in the Straightened vessel window. To
do this, move the cursor to the beginning of the interval and move the mouse to the end of
the interval, holding down the left mouse button, then release the button. The built interval is
shown in Fig. 7.12. The borders of the interval are diplayed as white sections.

Figure 7.12: Vessel interval

The following parameters are calculated for the interval:

• Length;

• Avg lumen;

• Min lumen;

• Avg SD;

• Min SD.

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To move the interval border, move the cursor to the corresponding white section in any
of the 3D view, Involute curve or Straightened vessel windows and move it with the mouse
while holding down the left button. To delete an interval, click the left mouse button at an
arbitrary place in the Straightened vessel window. To build multiple intervals, build them
holding down the Ctrl key (or the Command key for macOS) on the keyboard.

7.7.4 Export vessel surface mesh

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To export the vessel surface to a file, click on the Export vessel surface mesh button,
in the dialog that opens, select the file type (ply, obj or stl) and save the surface.
To close the ends of the vessel, click on the arrow on the right side of the Export vessel
surface mesh button, select the Export parameters... item and in the dialog that opens,
check the Close sides box.

7.8 Coronary Artery Analysis

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

In Coronary Artery Analysis window, diagnosis can only be established on

the basis of CT series. The anomalies detected should be studied using the
original images in the Image Viewer window.
The DICOM Viewer contains the Coronary Artery Analysis Module to analyze the coronary
vessels. Its functionality is basically the same as that of the Vessel Analysis module.
An advantage of the Coronary Artery Analysis module is the automatic detection of the
aorta. The central line of the coronary artery is cut off at the entrance to the aorta.
The features of the Coronary Artery Analysis module are:

1. Only the CT series are suitable for analysis.

2. The module does not contain the bone subtraction functionality.

3. Only coronary arteries are available on the vessel list.

To open a series in the Coronary Artery Analysis window, click the Coronary Artery Analy-
sis button on the toolbar. To select the tab location (in the current window, in a separate
window or in the full screen mode), click on the arrow on the right side of the button. To open
the Coronary Artery Analysis window in a new tab in the current window, click on the button.
The process may take some time.

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The Coronary artery analysis tab comprises the windows with Axial, Coronal, and Sagittal
plane sections, as well as the 3D view window. In the 3D view window, you see a 3D model
and a standard space orientation panel (for details see Section 3.3). In the Involute curve
window, the vessel involute is displayed.

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Chapter 8

Cardiac function analysis

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The module is intended for providing ventricular function quantification on the basis of a
set of short axes by way of contouring the region of interest (ROI). Contours may be built in
the manual and the semi-automatic mode. The ventricular parameters are evaluated on the
basis of the contours built.
Left ventricular function analysis based on Simpson’s rule is performed for
MR modality series with images oriented along the short axis of the heart.

8.1 Opening Studies in the Cardiac Function Analysis Module

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To open a study in the cardiac function analysis module, proceed as follows:

1. Choose a study and select MR series with images oriented along the short and long axis
of the heart.In some cases, you don’t have to select series with images oriented along
the long axis of the heart. For details on selecting series, see Section 1.10.

2. Click the Cardiac function analysis button on the toolbar. To select the tab location
(in the current window, in a separate window, or in the full-screen mode), press the arrow
on the right-hand side of the button. To open the cardiac analysis window in a new tab
in the current window, press the button. The process may take some time.
The Cardiac function analysis tool is also available in the View section of the main
menu.

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3. When the cardiac function analysis module is activated, the Input data for cardiac func-
tion analysis dialog box pops up (see Fig. 8.1), where the DICOM Viewer automatically
arranges the selected series in groups. A group consists of one or several series united
by planes parallelism. If there is more than one series in a group, series are merged.
For each series group, the type is automatically defined: with images oriented along the
short axis of the heart SAX (Short axis series) or with images oriented along the long
axis of the heart LAX (Long axis series). Sometimes the series type cannot be defined
automatically. In this case, you will see the — symbol as the axis type.

Figure 8.1: «Input data for cardiac function analysis» dialog box

The user may change the type of axis for the group. To do that, select the group and click
the Set as SAX or Set as LAX button. You don’t need the series with images oriented
along the long axis of the heart (LAX) series to analyze certain cardiac functions.
To reset the type of axis for the group, select it on the list and click Reset selected
series — .
To continue work, you need at least one series or group to have the SAX
type of axis.

4. In the lower part of the dialog box, you can see the information about the patient that is
loaded automatically. Sometimes only a part of the information is filled in automatically.
In this case, other parameters referring to the patient must be provided manually:
• heart rate (beats/min);
• height (cm);
• weight (kg).
5. Click OK to enter the data required for cardiac function analysis or CANCEL to cancel.

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If you haven’t provided all the required parameters in the Input data for cardiac function
analysis dialog box (see Fig. 8.1), the OK button will be deactivated.
In the Cardiac function analysis tab, you can see two windows, with the SAX merged
series and the LAX merged series (Fig. 8.2). The toolbar for cardiac function analysis is on the
right-hand side of the tab.
Under the SAX and LAX windows, you can see the contours panel aimed for navigation
between images and contour management (for details see Section 8.3.5). By default, the
panel is expanded.

Figure 8.2: Cardiac function analysis tab

8.2 Tools for Cardiac Function Analysis

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The toolbar for cardiac function analysis is on the right-hand side of the Cardiac function
analysis (Fig. 8.2).
Tools:

The Endocardial LV contour button is aimed for building and editing the
inner contour of the left ventricle manually (the contour is shown in red)

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 8.3. BUILDING CONTOURS

The Epicardial LV contour button is aimed for building and editing the outer
contour of the left ventricle manually (the contour is shown in yellow)
The Endocardial RV contour button is aimed for building and editing the
inner contour of the right ventricle manually (the contour is shown in
dark-blue)
The Epicardial RV contour button is aimed for building and editing the outer
contour of the right ventricle manually (the contour is shown in light-blue)
The LV extension boundaries button is aimed for manual determination of
the left ventricle extension boundaries along the long axis (see Section 8.3.2)
The Auto contouring button activates the process of automatic contouring of
the left ventricle endocardium end epicardium (see Section 8.3.3)
The Contours panel button is used to expand/minimize the contours panel
that is used for navigation between images and for contour management
(see Section 8.3.5)
The Start analysis button triggers the analysis process and opens a panel
with all the results of functional parameters evaluation (see Section 8.4)
The Edit button closes the panel with the results and opens the toolbar for
cardiac function analysis to provide an opportunity to build and edit contours

8.3 Building Contours

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The functional parameters of the left and the right ventricles are calculated on the basis of
the contours built. Contours can be built separately for each slice and phase in the window
with the SAX merged series. The contour boundaries are shown as points on the slices in
the window with the merge LAX series. If two or more contours were built for one phase, the
points can be connected by segments. You cannot build contours in the window with a LAX
merged series.
To simplify the process of building contours, we recommend enabling the display of slices
scout lines in the window selected (see Section 2.26).

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8.3.1 Building Contours Manually

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

You can use the following tools to build contours manually:

• Endocardial LV contour ;

• Epicardial LV contour ;

• Endocardial RV contour ;

• Epicardial RV contour .

The choice of the tool depends on the region of interest and the results of the analysis
required.
To build a contour, proceed as follows:

1. Open the study in the Cardiac function analysis tab (see Section 8.1).

2. Activate one of the contour building tools with the left, right, or middle mouse button.
To continue work with the same tool, use the button with which the tool was activated.
For details on tool management, see Section 1.14.
Build the contour in one of the following ways:

• building contours manually. In the window with the SAX merged series, build
a contour around the selected area while holding the button with which the tool
was activated. To complete the contour, release the mouse button. To cancel the
contour that has not been closed, click Esc on the keyboard while holding the
mouse button;
• building contours with an isoline. Move the cursor around the selected area while
holding the Shift button on the keyboard and the mouse button with which the tool
was activated. Under the cursor, you will see an isoline. You can see an isoline
only on the slices where a contour can be built. To build a contour with an isoline,
release the mouse button with which the tool was activated.

3. Go to the next slice and contour the selected area.

4. After you have built the required contours, click the Start analysis button to go to
the results of parameters assessment (see Section 8.4).

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 8.3. BUILDING CONTOURS

Figure 8.3: The Left ventricle epicardium and endocardium contours are
shown in the SAX window, and the contour boundaries on the slices are
shown in the LAX window

If there is a contour built with the current tool on the current slice, you cannot build a new
contour here. You can only edit or delete the existing contour (see Section 8.3.4).

8.3.2 Evaluating the Left Ventricle Extension

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To evaluate the left ventricle extension, you need the SAX and the LAX merged series to
be loaded to the Cardiac analysis tab (see Section 8.1).
To evaluate the left ventricle extension, proceed as follows:
1. Open the study in the Cardiac function analysis tab (see Section 8.1).

2. Activate the LV extension boundaries tool with the left, right, or middle mouse
button. To continue work with the same tool, use the button with which the tool was
activated. For details on tool management, see Section 1.14.
3. In the window with the SAX merged series, choose the slice for the upper plane of the
mitral valve and mark a point in the center of the mitral valve.
4. Go to the slice corresponding to the left ventricular apex and mark a point in the center
of the apex.

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When you mouse over a point in the window with the SAX merged series, you see a pop-up
tip with the type of the point, Mitral or Apex.
In the window with the LAX merged series, the left ventricle extension is marked with a
line (Fig. 8.4).

Figure 8.4: Left ventricle extension shown in the window with the LAX
merged series

In multiphase series, the left ventricle extension may be determined for each phase.

8.3.3 Contouring the Left Ventricle Endocardium and Epicardium

Automatically

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To contour the left ventricle endocardium and epicardium automatically, proceed as fol-
lows:

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 8.3. BUILDING CONTOURS

1. Open the study in the Cardiac function analysis tab (see Section 8.1).
2. Determine the left ventricle extension (see Section 8.3.2) for the End Diastole (ED) and
End Systole (ES) phases.

3. Click the Auto contouring button on the toolbar for cardiac function analysis.
Automatic contouring of the left ventricle endocardium and epicardium are performed in
the window with the SAX merged series for all the phases with the left ventricle extension
and all the slices within the extension. The contour boundaries are shown on the slices in the
window with the LAX merged series (Fig. 8.5).
The program algorithm builds the epicardium contour on the basis of the left ventricle
endocardium contour. If the program fails to build the endocardium contour on a slice or if an
error is made while contouring, it will be impossible to build the epicardium contour on this
slice or a similar error will be made.
Attention! If a part of the atrium is present on the mitral valve slice, it may
be captures while contouring.

Figure 8.5: Automatic contouring of the left ventricle

To rebuild all the contours, press the arrow on the right-hand side of the Auto contour-
ing button and select Rebuild contours.
During automatic contouring, it is possible that tissues may be captured by
the contour in error. Check that the contours are drawn correctly and edit
the contours manually if necessary.
To go to the results of parameters assessment, click the Start analysis button (see
Section 8.4).

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8.3.4 Actions with Contours

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer provides an opportunity to perform the following actions with contours
in the SAX window:
• editing. Mouse over the selected contour. When the cursor is placed on the contour,
the contour is highlighted. Click the mouse button in the place where you want to edit
the contour and build a new contour while holding the mouse button. To complete the
contour, release the mouse button;

• deleting a contour. Mouse over the selected contour, click the right mouse button, and
select the Remove contour option on the context menu;

• deleting the extension boundaries. Place the cursor on one of the points used for
evaluating the LV extension. The point will be highlighted. Click the right-hand mouse
button and select the Remove extension boundaries option on the context menu.
Contours and LV extension boundaries can also be deleted from the contours panel (see
Section 8.3.5).

8.3.5 Contours panel

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The contours panel (Fig. 8.6) is expanded/minimized with the «Contours panel» but-
ton on the cardiac analysis toolbar. By default, the contours panel is expanded.

Figure 8.6: Contours panel

The contours panel provides for navigation between images and for contour management.
The contours panel is presented as a phase and slice contingency table. The column header

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 8.3. BUILDING CONTOURS

shows the phase number, and the line header shows the slice number. The cells contain
information on contours and LV extension boundaries in the form of conventional signs:
• endocardial LV contour is ;

• epicardial LV contour is ;

• endocardial RV contour is ;

• epicardial RV contour is ;
• LV extension boundaries passage through the slice is .
To go to the selected slice image and phase in the SAX window, left-click on the respective
cell. The cell corresponding to the image in the SAX window is highlighted.

The DICOM Viewer provides an opportunity to perform the following actions with contours:
• Deleting contours on the selected slice. Right-click on the selected cell and on the
context menu, select:
– Remove LV endocardial contour (<slice number; phase number>);
– Remove LV epicardial contour (<slice number; phase number>);
– Remove RV endocardial contour (<slice number; phase number>);
– Remove RV epicardial contour (<slice number; phase number>).
• Deleting a certain type of contours on all the images for the selected phase. Right-
click on the column header (phase number) and on the context menu, select:
– Remove LV endocardial contours (<phase number>);
– Remove LVepicardial contours (<phase number>);
– Remove RV endocardial contours (<phase number>);
– Remove RV epicardial contours (<phase number>).
In the dialog box that opens, click YES to confirm the deletion, or click NO to cancel.
• Deleting a certain type of contours on all the images for the selected slice. Right-click
on the line header (slice number) and on the context menu, select:
– Remove LV endocardial contours (<slice number>);
– Remove LV epicardial contours (<slice number>);
– Remove RV endocardial contours (<slice number>);
– Remove RV epicardial contours (<slice number>).
In the dialog box that opens, click YES to confirm the deletion, or click NO to cancel.
• Deleting all the contours of the same type. Click the arrow on the right-hand side of
the Remove all cardiac contours button. On the menu, select the type of contours
you want to delete from all the slices. In the dialog box that opens, click YES to confirm
the deletion, or click NO to cancel. The selected contour type is removed from all slices
and phases in the SAX window.

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• Deleting all the contours. To delete all the contours, click the Remove all cardiac con-
tours button. In the dialog box that opens, click YES to confirm the deletion, or
click NO to cancel. All the contours on all the slices in the window with the SAX merged
series will be deleted.

• Deleting LV extension boundaries for the selected phase. Right-click on the column
header (phase number) and on the context menu, select: Remove lv extension bound-
aries (<phase number>).

The program automatically detects and highlights the end phases with the maximum and
the minimum ventricle cavity volume at the time of relaxation (diastole) and contraction (sys-
tole). The final phase of contraction (ES) is highlighted with green, and the final phase of
relaxation (ED) — with red.
To lock the end phases, click the Lock end phases button on the contours panel.
After the end phases are locked, the button will take the shape of . In this case, the end
phases cannot be detected automatically after creating, editing, and deleting contours. To
enable automatic detection of the end phases, click the Unlock end phases button on
the contours panel. The button will take the shape of .
The user may manually set and lock the selected end phase as ES or ED. To do that,
right-click on the column header (phase number) and on the context menu, select Set <phase
number> as ES or Set <phase number> as ED.

8.4 Evaluating Functional Parameters of the Heart

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To evaluate functional parameters of the heart, proceed as follows:

1. Open the study in the Cardiac function analysis tab (see Section 8.1).

2. Build the required contours manually or automatically (see Section 8.3).

3. Click the Start analysis button on the toolbar for cardiac function analysis.

The results of functional parameters evaluation and the information on the patient are
presented as a table. The following basic parameters for the left and the right ventricle are
evaluated:

• EDV (end diastolic volume), the maximum ventricle cavity volume at the end of diastole,
measured in ml. To evaluate the parameter, you need to build the endocardial contours;

• ESV (end systolic volume), the minimum ventricle cavity volume at the end of contraction
(systole), measured in ml. To evaluate the parameter, you need to build the endocardial
contours;

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 8.4. EVALUATING FUNCTIONAL PARAMETERS OF THE HEART

• SV (stroke volume), the volume of blood ejected with each heart beat, measured in ml
and calculated by the SV = EDV — ESV formula. To evaluate the parameter, you need
to build the endocardial contours;

• EF (ejection fraction), the percentage of blood ejected with each heart beat calculated by
the EF = SV/EDV formula. To evaluate the parameter, you need to build the endocardial
contours;

• CO (cardiac output), the amount of blood pumped in a minute, measured in l/min by

the CO = SV * heart rate formula. To evaluate the parameter, you need to build the
endocardial contours and know the heart rate;

• CI (cardiac index), the cardiac output related to the body surface area (BSA). The parame-
l
ter is measured in (m2 ∗min) and calculated by the CI = CO/BSA formula. The body surface
area (BSA) is calculated by the following formula:
BSA = 0.007184 ∗ W 0.425 ∗ H 0.725 , where W is the patient’s weight in kilos and H is
the patient’s height in centimeters. To evaluate the parameter, you need to build the
endocardial contours and know the patient’s weight and height;

• Myocardial mass, shows the difference in the epicardium and endocardium volumes at
the end of diastole (ED) and systole (ES) multiplied by a factor of 1.05, measured in g. To
evaluate the parameter, you need to build the endocardial and epicardial contours for
the ED and ES phases.

The results of functional parameters evaluation can be copied to the clipboard and then
inserted in the report editor (see Chapter 18) or in any text editor. To copy the results of func-
tional parameters evaluation to the clipboard, click the EXPORT TO CLIPBOARD button.

The coordinate system (Fig. 8.7) shows the functional parameters for all the phases as
graphs. On the x- axis, you can see the time in milliseconds while on the y- axis the blood
volume is shown in milliliters.
Attention! Graphs are built on the basis of the contours created for each
slice of each phase in the window with the SAX merged series.
The coordinate system shows the heart functional parameters as graphs:

• left ventricle endocardium volume LV blood (red line);

• left ventricle myocardium volume LV myocardial (yellow line);

• right ventricle endocardium volume RV blood (dark blue line);

• right ventricle myocardium volume RV myocardial (light blue line).

The measurement results are shown as a table on the right-hand side of the coordinate
plane. The values of the parameters reflect the measurement results for the current point.

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Figure 8.7: Heart functional parameters shown as graphs

The position of the current phase is marked with the yellow slider. To change the current
phase on the graph, mouse over the slider so that the cursor takes the shape. Holding
the left mouse button, move the slider to the left or to the right. When you move the slider, the
current phase in the window with the SAX merged series is changed simultaneously. When
the current phase is changed, the measurement results shown in the table next to the graphs
are also changed.
To move the graph along the y-axis, move the mouse up and down while holding the left
mouse button and the Shift key on the keyboard. To scale the graph, move the mouse up and
down while holding the left mouse button and the Ctrl key (or the Command key for macOS)
on the keyboard.
To edit the information on a patient, click the EDIT PATIENT INFO button and make the
necessary corrections in the dialog box (Fig. 8.8). Click OK to apply the new data or CANCEL
to cancel. After you click the OK button, the results of functional parameters analysis will be
reevaluated.

Figure 8.8: Dialog box for editing the information on a patient

To get back to the contour building and editing mode, click the Edit button.

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Chapter 9

PET analysis

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

9.1 Open Studies in PET Analysis tab

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To open a study:

1. Load studies to the DICOM Viewer.

2. Select a study containing at least one CT and one PET series.

3. Select one CT and one PET series by clicking the left mouse button while holding down
the Ctrl key (or the Command key for macOS) on the keyboard.

4. Click the PET analysis button on the toolbar. To select the tab location (in the
current window, in a separate window or in the full screen mode), click on the arrow on
the right side of the button. To open the study in a new tab in the current window, click
on the button PET analysis. The process may take some time.

5. Choose a windows arrangement template for the required number of series (see Sec-
tions 9.2.1 and 9.2.2).

The DICOM Viewer displays data in the following modes:

• 3D MIP (Maximum Intensity Projection) for the PET series (3D MIP mode);

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• Original CT series (CT mode);

• Original PET series (PET mode);
• Fused CT + PET series (Fusion (PET+CT) mode). The image displayed in the window is
the same as in the fused series window (see Chapter 4).
The PET analysis window is shown in Fig. 9.1.

Figure 9.1: PET analysis window

9.1.1 Fuse series from the same study in the PET analysis tab

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To fuse series of one study, proceed as follows:

1. Open the study in the PET analysis tab (see Section 9.1).
2. On the series panel of current study select the series required by left-clicking on them
while holding down the Ctrl key (or the Command key for macOS).
3. Drag the series to the window you need. If the series may be dragged to this window, the
cursor will have the shape of . If it is impossible to drag the series to this window,
the cursor will have the shape of . In this case, choose another window or change
the display mode in this window (Section 9.2.1). Release the mouse button. The series
(fused series) will be opened in this window.

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 9.1. OPEN STUDIES IN PET ANALYSIS TAB

4. If needed, repeat the actions described in points 2-3 for other series.

9.1.2 Fuse series from different studies in the PET analysis tab

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer allows you to fuse series from different studies in the PET analysis tab,
e.g. to monitor the changes. If the studies differ in the following parameters:
• the patient’s name (not case sensitive) (tag (0010,0010));
• the patient’s ID (tag (0010,0020));
• the patient’s sex (tag (0010,0040));
• the date of birth (tag (0010,0030))
such studies are considered to be carried out for different patients. If you attempt to open
them in the same tab, the following notification will pop up: Seems that you are trying to add
studies of different patients. Would you like to continue? To add the study, click YES, to
cancel click NO.
To fuse several series from different studies, proceed as follows:
1. Open the series of the first study in the PET analysis tab.
2. Go to the second tab with the list of studies and choose the second study.
3. Select the studies required by left-clicking on them while holding down the Ctrl key (or
the Command key for macOS).
4. Holding down the left mouse button, drag the series to the PET analysis tab (surrounded
by the red frame in Fig. 9.2). Do not release the button. The PET analysis tab is displayed
above other tabs.
5. Drag the series to the window you need. If the studies may be dragged to this window,
the cursor will have the shape of . If it is impossible to drag the studies to this
window, the cursor will have the shape of . In this case, choose another window or
change the display mode in this window (Section 9.2.1). Release the mouse button. The
series (fused series) will be opened in this window.
6. If needed, repeat the actions described in points 2-5 for other series.

Figure 9.2: PET analysis tab stub

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9.1.3 Viewing Images of a Series in the PET Analysis Tab

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The procedure of viewing images of a series in the PET analysis tab is similar to viewing
series in the flat image viewer tab, which is described in Section 2.7.

9.2 PET Analysis Tab Elements

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

9.2.1 PET Analysis tab Windows

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The PET analysis tab may contain 1-6 image viewing windows:

• One window;

• Two windows side by side;

• 2X2 grid;

• 2X3 grid.

The mode may be changed by pressing the respective button on the toolbar. The button
will look different depending on the current mode:

3D MIP mode. The mode may be switched to Mono PET

Mono-PET mode. The mode may be switched to 3D MIP

Mono-KT mode

Fusion PET+KT mode. The mode may be switched to Mono CT

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 9.2. PET ANALYSIS TAB ELEMENTS

To switch the mode, activate the respective window by left-clicking on it, click the mode
button and choose the mode you need from the menu. The current mode is highlighted in
blue. The procedure of setting the template for each mode is described in Section 9.2.2.
On the left, you can see the Series List panel showing all the series for the study. To open
the required series in the PET Analysis window, drag it into the window. The MIP window may
only be used for PET series, but you can drag PET, CT or fused series to other windows.
Double-click any of the four windows with the left mouse button to unfold it. Please, note
that you shouldn‘t activate any of the measuring tools, annotation tools or the magnifier with
the left mouse button.

9.2.2 Setting the templates for windows arrangement in the PET analysis
tab

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To set the windows arrangement templates, click the mode selection button ( , ,

or depending on the mode) and select Settings... A dialog box shown in Fig. 9.3
will pop up.

Figure 9.3: Dialog box for setting window arrangement templates

Choose a template from the drop-down menu (One, Two near, 2x2, 2x3).
To use this template as default, tick the Use current template as default box.

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To set a template window, select this window with the mouse. It will be highlighted (in
Fig. 9.3 the upper left window is selected). Then proceed as follows:

1. Choose the modality from the drop-down menu (Unspecified, CT, PT or PT+CT). If the
Unspecified modality has been chosen, the cell will be empty.

2. The DICOM Viewer allows you to open either only the corrected PET series or only those
that haven’t been corrected. To choose the series to be opened, check either Corrected
or Uncorrected in the Data box. The default value is Uncorrected. If a series does not
comply with this parameter, it will not be shown.

3. Check the MIP box for the PET series to display the maximum intensity projection.

To restore the default settings for the current template, click the DEFAULT button. In the
dialog box that pops up, click YES to restore the settings or NO to cancel. By default, the
following template settings are provided:

1. One Template: PET+CT combination is shown.

2. Two near Template: 3D MIP for the corrected PET series in the left window, Fusion
(PET+CT) — in the right window.

3. 2x2 Template: from left to right, downwards: 3D MIP for the corrected PET series, cor-
rected PET series, CT series, Fusion (PET+CT).

4. 2x3 Template: from left to right, downwards: 3D MIP for the corrected PET series, cor-
rected PET series, CT series, Fusion (PET+CT), two empty windows.

Click OK to apply the settings or CANCEL to cancel the operation.

The changes in the template do not affect the tabs that had been opened before such
changes were introduced.

9.3 MIP mode

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer allows you to change the section thickness for flat images, i.e. the
image is actually shown in MIP (Maximum Intensity Projection) mode. To change the section
thickness, you need to sort the images by phases and frames (the default setting for the sorting
procedure; for details see Section 2.1). The changes are possible within 0-50 mm range. You
cannot make the section thinner than the source image.
To change the thickness, use the tool shown in Figure 9.4, which you will find on the right-
hand side of the window in Mono-CT, Mono-PET and Fusion PET+CT modes (see Section 9.2).
In the centre you can see the current section thickness. The sliders adjusting the thickness
are marked with arrows. To change the thickness, you need to move either of the sliders by
pressing the left, right or middle mouse button. To make the section thicker, move the slider
outwards, to make it thinner — inward.

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 9.4. THE PLAY TOOL

The thickness set with the help of the tool is used when exporting and adding to the print
list.

Figure 9.4: The section thickness tool for MIP

When you are working with such tools as Point value, ROI rectangle, ROI ellipse and ROI
polygon, the data shown are for MIP mode images. When the thickness is changed, the value
is automatically scaled. All the other measurements are performed for the source data.

9.4 The Play Tool

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The tool is similar to that described in Section 5.10.

9.5 Video recording

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The tool is similar to that described in Section 2.15.

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CHAPTER 9. PET ANALYSIS

9.6 PET Window settings

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

For details see Section 16.7.9.

9.7 Image Positioning

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Use the following tools for image positioning:

The Reset views tool cancels all the actions made with the Rotate, Zoom,
Pan tools

The Rotate tool is described in Section 2.16

The Zoom tool is described in Section 2.16. It allows to zoom images. If the
other windows displays images in the same projection, they are scaled
synchronously
The Pan tool is described in Section 2.16. It allows to pan images. If the other
windows displays images in the same projection, they are moved
synchronously
The Axial projection tool displays images in the axial plane. To change the
projection of the selected window to axial, click on the button on the
toolbar or press the Shift+A combination on the keyboard
The Coronal projection tool displays images in the coronal plane. To change
the projection of the selected window to coronal, click on the button on
the toolbar or press the Shift+C combination on the keyboard
The Sagittal projection tool displays images in the sagittal plane. To change
the projection of the selected window to sagittal, click on the button on
the toolbar or press the Shift+S combination on the keyboard
The Sync series scroll tool allows you to simultaneously scroll the images in
the PET, CT and PET+CT windows
The Select model point tool displays in the PET, CT and PET+CT windows
the images corresponding to the point selected in the MIP window

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 9.8. VISUALIZE IMAGES

The MIP projection rotates around a vertical axis. To rotate move the cursor right and left
holding the left button, or move the scroll slider.

9.8 Visualize Images

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Color tables are needed for displaying pixels and voxels representing
different density values in different colors for improved perception. The
shades on the screen are different from the real shades.
Image visualization is described in Section 2.23. To change the CLUT for a specific window,
first select this window with a mouse click. In the PET+CT window you can change the CLUT
for the PET layer only.
To change the PET layer opacity in the PET+CT window, move the slider at the top of the
PET+CT window (marked with number «1» in Fig. 9.5).
The PET+CT window contains the scale of the CLUT for the PET layer (marked with number
«2» in Fig. 9.5). If the SUV mode is disabled, the scale borders coincide with the minimum and
maximum window values for the PET layer. If the SUV mode is enabled, then the scale borders
coincide with the minimum and maximum values of the SUV in the current image of the PET
layer.

Figure 9.5: The PET+CT window

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Changing the window width and the window level using the Adjust W/L tool is
described in 2.17. To change the window width and the window level for CT images in the CT
and PET+CT windows, select the CT window with the mouse. To change the values for all PET
images, select any window with the mouse, except for the CT window.
Attention! You can change only the upper window limit in the PET+CT and
PET windows for the PET layer, using the «Adjust W/L» tool.
The default upper window level value is determined by the Window upper limit setting.
There are two ways to adjust the upper limit:

1. Max SUV value. In this case, the default window upper limit is set equal to the corre-
sponding value in the SUV mode.

2. Max window percent. In this case, the default window upper limit is set equal to the
specified percentage of the recommended window width. Since the default lower limit
for PET is zero, the window width is numerically equal to the upper limit, and the percent-
age is actually calculated from its value. If different recommended upper limits are set
for different images of the series, then the percentage is calculated from the maximum
of these values.

9.9 Measurements and Annotations

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Use the following tools to measure:

The Ruler tool is described in Section 2.19

The Polygonal ruler tool is described in Section 2.19

The Angle tool is described in Section 2.19

The Point value tool is described in Section 2.19

The ROI rectangle tool is described in Section 2.19

The ROI ellipse tool is described in Section 2.19

The ROI polygon tool is described in Section 2.19

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 9.10. MEASURE THE INTENSITY AVERAGE AND STANDARD DEVIATION IN SPACE

The VOI Sphere tool is described in Section 9.10

The Delete all annotations and measurements tool is described in

Section 2.19

The Show SUV tool is described in Section 2.24

The Arrow tool is described in Section 2.33

The Pencil tool is described in Section 2.33

The Text tool tool is described in Section 2.33

The Polygon tool is described in Section 2.33

The Ellipse tool is described in Section 2.33

To open the SUV settings dialog click the arrow on the right side of the Show SUV
button and select the Settings... item.
To display the SUV value after opening a study in the PET analysis window, set the Enable
SUV mode automatically (see Section 16.7.9). If there is not enough data to calculate SUV,
then a dialog for entering parameters is displayed. For details, see Section 2.24.

9.10 Measure the Intensity Average and Standard Deviation

in Space

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The VOI Sphere tool is similar to the ROI tools described in section 2.19, but the measure-
ments are performed in the space bounded by a sphere.

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9.10.1 Create sphere

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To create a sphere:

1. Select a series to measure, go to the image in which the center of the sphere should be
located.

2. Activate the VOI sphere tool by clicking the button on the toolbar. To continue
work with this tool, use the button with which the tool was activated. To learn more about
tool control, see Section 1.14.

3. The VOI sphere can be built in two ways:

• Move the cursor to the point where the center of the sphere should be located.
Click mouse button. Choose the desired sphere diameter by moving the mouse.
To complete the drawing, click the mouse button.
• Click the mouse button at the point where the center of the sphere should be lo-
cated and set the desired sphere diameter while holding the mouse button. Re-
lease the mouse button to fix the sphere diameter.

4. To cancel creation, press the Esc button on the keyboard.

The following parameters are displayed near the sphere (Fig. 9.5):

• minimum intensity value;

• maximum intensity value;

• average intensity value;

• standard deviation;

The results only for the corresponding series are displayed in the CT and PET windows,
the results for both series are displayed in the PET+CT window.

9.10.2 Sphere location in space

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

All spheres are always displayed in the MIP window. The line of the intersection of the
sphere with the image plane and the measurement results are displayed in the other windows.
As the distance from the center of the sphere increases, the diameter of this circle decreases.

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 9.10. MEASURE THE INTENSITY AVERAGE AND STANDARD DEVIATION IN SPACE

If the sphere does not intersect with the image plane, the measurement results for the sphere
are not displayed in this window.
If the center of the sphere is in the current image and the VOI Sphere tool is activated,
crosses are displayed in the center of the sphere and on its border.

9.10.3 Actions with the sphere

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To edit a sphere:

1. Go to the image that contains the center of the sphere. To do this, slide the images until
the crosses appear in the center and on the border of the sphere.

2. To move the sphere, move the cursor over the cross in its center and move the mouse
holding down any mouse button. When you locate the cursor over the cross it increases.

3. To change the radius, move the cursor over the cross on the sphere border and move
the mouse, holding down any mouse button. When you locate the cursor over the cross
it increases.

To move the block with the measurement results, locate the cursor over it and move the
mouse, holding down the left mouse button or the button to which this tool is assigned. For
this, it is not necessary that the center of the sphere be on the current image.
To remove a sphere move the cursor over the block with the measurement results or on the
cross in the center or on the border of the sphere and press the Delete key on the keyboard,
or right-click the mouse and select the Remove object command.

9.10.4 Drawing Parameters

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To change the drawing parameters:

1. Locate the cursor over the block with the measurement results or on the cross.

2. Right-click.

3. Select the item Tool options... on the context menu.

4. In the dialog box that appears, set the color by clicking on the color box.

5. Set the object name, the line thickness and the font size.

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CHAPTER 9. PET ANALYSIS

6. To connect the block with the measurement results and the sphere of the dotted line,
check the Footnote line box.

7. To use these settings by default, check the Set as default box.

8. To apply the settings, click OK. To cancel, click CANCEL.

9.11 Synchronization in the PET analysis tab

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Synchronization will be applied if several images from the same study are opened in the
PET Analysis tab. This function provides an opportunity to scroll images from different series
simultaneously. By default, image scrolling is synchronized for the same study.
All the series are panned and zoomed simultaneously, including the series from different
studies.
To enable synchronization:

1. Click on the arrow on the right side of the Sync series scroll button on the toolbar.

2. Check one of the following items:

• Sync series (Same study). This option provides an opportunity to scroll images
from the series with the same values of the frameOfReferenceUid tag simultane-
ously. If the values of the frameOfReferenceUid tag are different for different series,
synchronization will not be performed;
• Sync from current position. This option provides an opportunity to scroll images
simultaneously from the current position.

3. If this button is not pressed, press it.

Synchronization is performed for the sections parallel to the synchronizing section.

To disable synchronization, click on the Sync series scroll button.

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Chapter 10

Virtual Endoscopy

10.1 Open Studies in Virtual Endoscopy window

Functionality is available in the Pro edition

To open a study in the virtual endoscopy window:

1. Load studies to the DICOM Viewer.

2. Select the target study from the study panel.

3. Click the Virtual endoscopy button on the toolbar. To select the tab location (in
the current window, in a separate window or in the full screen mode), click on the arrow
on the right side of the button. To open the virtual endoscopy window in a new tab in
the current window, click on the button. The process may take some time.

The virtual endoscopy window is shown in Fig. 10.1.

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CHAPTER 10. VIRTUAL ENDOSCOPY

Figure 10.1: Virtual endoscopy window

If the camera is in dense body tissues, there will be no image on the left side of the screen.
In this case, you need to move the camera to a body cavity manually. For details on how to
move the camera, see Section 10.3.

10.2 View Elements. Customize MPR Panel

10.2.1 View Elements

Functionality is available in the Pro edition

The toolbar is displayed in the top left part of the tab (Fig. 10.2).

Figure 10.2: Toolbar

The MPR navigation panel is on the right side of the tab.

The view setup panel is in the top right part of the tab (Fig. 10.3).

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 10.2. VIEW ELEMENTS. CUSTOMIZE MPR PANEL

Figure 10.3: View setup panel

Once you start auto-moving (see Section 10.3.1), the cavity surface sweep will appear at
the bottom of the window (Fig. 10.4).

Figure 10.4: Surface Sweep panel

Cavity surface sweep should only be used for navigation purposes. You
cannot make a diagnosis on its basis. To establish a diagnosis, open the
respective series in the Image Viewer window.

10.2.2 Customize MPR Navigation Panel

Functionality is available in the Pro edition

The MPR (multiplanar reconstruction) panel consists of three parts, each displaying a body
section by one of the three orthogonal planes.
To hide/display the MPR navigation panel, click the MPR navigation button on the
toolbar.
To change the panel size, move its border. To do this, move the cursor to the panel border
so that it would look like this: , and drag the border holding the left mouse button.
To change the size of the panel parts displaying the sections by various planes, move the
borders dividing the panel parts.

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10.3 Move Camera

10.3.1 Move Camera Automatically

Functionality is available in the Pro edition

If the camera is moved automatically, there is a danger to overlook

important areas. Use this option only in combination with manual control.
To move the camera automatically:

1. Drag the camera to a body cavity, using the MPR navigation panel. If the left side of the
screen displays the red cavity surface, it means that the camera is in the cavity. If not,
the camera is located in dense tissues. In this case, correct its position.

2. Start auto-moving by clicking the Space key or the Fly-through camera button on
the toolbar.

The camera can be stopped in a similar way.

After you activate automatic movement, the central line appears. The camera moves along
the central line. The color of this line is green. The vertical line on the sweep panel corre-
sponds to the camera position.
If the image quality is poor, the central line may be drawn incorrectly. You
need to make sure that it is drawn correctly.
To increase the movement speed, press + on the keybord, to decrease the speed, press -.

10.3.2 Manage Camera Manually

Functionality is available in the Pro edition

You can manage the camera manually, using the cursor management keys. Key functions:

move the camera forward

move the camera back

rotate the camera anticlockwise

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 10.4. VIDEO RECORDING

rotate the camera clockwise

To manage the camera, using the mouse and the keyboard:

1. To change the camera rotation angle, move the mouse, holding the wheel. The camera
turns in the same direction as the cursor. The camera direction vector will be displayed
on the MPR navigation panel.

2. To move the camera over the image plane, move the mouse, holding the wheel and the
Shift key. The camera turns in the same direction as the cursor.

3. To move the camera at random, use the MPR navigation panel. Click the left mouse
button at the target place in any projection window or move the mouse, holding the left
button. The camera will move in the same direction as the cursor.

4. To move tha camera along the central line, move the surface sweep, holding the left
button. The vertical line on the sweep panel corresponds to the camera position.

5. To point the camera at the point on the surface, click the right mouse button on this point
on the sweep panel.

10.4 Video recording

Functionality is available in the Pro edition

The DICOM Viewer allows you to record video for the surface view window. The following
objects will be recorded:

• tissues;

• the center line.

• measurements;

• markers;

• tags;

• orientation cube;

The other features of the tool in the MPR View windows are similar to those described in
Section 2.15.

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10.5 Customize Image

Functionality is available in the Pro edition

To increase of decrease the camera angle, turn the mouse wheel backward or forward
respectively. To change the view configuration, use the visualization setup panel in the top
right part of the tab. For details on how to work with the panel, see Section 5.5.

10.6 Measurements and Markers

Functionality is available in the Pro edition

The DICOM Viewer allows you to place markers on an image and conduct linear measure-
ments. For details on working with the Marker tool, see Section 3.12. The use of the Ruler and
Polygonal ruler tools is described in Section 2.19 and Section 3.11.2. However, in the virtual
endoscopy window you should switch between the Polygonal ruler and Ruler tools, using the
menu that opens by clicking on the arrow on the right side of the button (or in the
polygonal ruler mode).

10.7 Multiplanar Reconstruction

Functionality is available in the Pro edition

To switch to multiplanar reconstruction, click the MPR reconstruction button. Re-

construction will open in a new tab. Multiplanar reconstruction is described in Chapter 5.
The camera position is synchronized with the cursor position in MPR, and navigation is
performed synchronously. For convenience, you can open MPR in a separate window and
position it next to the virtual endoscopy window.

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 10.8. SURFACE RECONSTRUCTION

10.8 Surface Reconstruction

10.8.1 Create Surface

Functionality is available in the Pro edition

For reconstruction, click the Surface reconstruction button on the toolbar.

The process may take some time.
A sample reconstruction is shown in Fig. 10.5.

Figure 10.5: Surface reconstruction

To display/hide the camera orientation in the surface window, click the Show camera ori-
entation button. The camera orientation on the surface is synchronized with the virtual
endoscopy tab. For convenience, you can open surface reconstruction in a separate window
and position it next to the virtual endoscopy window.
The camera position is highlighted by the blue marker.
The yellow vector shows the view direction, and the green one points upward from the
camera (Fig. 10.6).

Figure 10.6: Camera orientation view elements

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10.8.2 Surface Orientation and Navigation

Functionality is available in the Pro edition

• To rotate the surface, move the mouse, holding the wheel. To select one of the prede-
fined orientations, use the buttons on the orientation panel. (Fig. 10.7).

Figure 10.7: Surface orientation panel

• To move the camera, activate the camera orientation view and click the left mouse button
on the 3D surface reconstruction. The camera will move to the selected place in the
center of the cavity. If there are overlapping body cavities, the camera will be located in
the cavity nearest to the user.

• To change the camera vector, right-click the mouse at any point on the surface. The
vector will be directed to this point.

• To change the model transparency, move the Model transparency scroll.

• To drag the surface, move the mouse, holding the wheel and the Shift key.

• To zoom the surface, move the mouse, holding the wheel and the Ctrl key (or the Com-
mand key for macOS).

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 10.9. EXPORT

10.9 Export

Functionality is available in the Pro edition

The export of images is similar to the image export described in Section 2.28, but you
cannot export an entire series.

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CHAPTER 11. ECG VIEWER

Chapter 11

ECG Viewer

The diagnosis can only be established for body-surface ECG.

11.1 Select Data Source

Select the data source. The source selection algorithm is described in Section 1.5.

11.2 Open Series in ECG View window

Load studies to the DICOM Viewer and select the target study. There are five ways to open a
series:

1. Click the ECG Viewer button on the toolbar. To select the tab location (in the
current window, in a separate window or in the full screen mode), click on the arrow on
the right side of the button. To open an ECG in a new tab in the current window, click
on the button.

2. Double-click the left mouse button on the study title on the study bar.

3. Double-click the left mouse button on the series icon on the series panel.

4. Drag the series icon to the study panel, holding the left mouse button.

5. Right-click the mouse to call the context menu for the series icon and select one of the
items in the ECG Viewer section. The ECG will open in a new tab in the current window
(Fig. 11.1).

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 11.3. VIEW GRAPHS

Figure 11.1: ECG view window

11.3 View Graphs

If the graphs do not fit on the screen, then:

• pan them horizontally with the mouse, holding the left button;

• pan them vertically by rolling the mouse wheel.

If a series contains several pages, the View pages panel appears in the upper right-hand
part of the window (fig. 11.2).

Figure 11.2: View pages panel

To view the pages move the cursor over the scroll bar and rotate the mouse wheel or click
the buttons. The panel displays the current page number and the total number of
pages.

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CHAPTER 11. ECG VIEWER

11.4 Toolbar
The toolbar is at the top of the tab (Fig. 11.3).

Figure 11.3: Toolbar

11.4.1 Select Lead

To select the ECG leads to be displayed:

1. Click the Set visible leads button on the toolbar. The window shown in Fig. 11.4
will be displayed.

2. Check the leads to be displayed. By default, all the leads are displayed.

3. Click OK to apply the settings or CANCEL to cancel the actions.

Figure 11.4: Lead selection window

11.4.2 ECG Speed

Two speed values are available: 25 and 50 millimeters per second. The default speed is 50
millimeters per second. The required value is set using a switch (Fig. 11.5).

414
 11.4. TOOLBAR

Figure 11.5: Toolbar (speed setup)

11.4.3 Scale
Two scale values are available: 10 and 20 millimeters per millivolt. The default scale is 10
millimeters per millivolt. The required value is set using a switch (Fig. 11.6).

Figure 11.6: Toolbar (setting the scale)

11.4.4 Length Interval

To select a length interval:

1. Activate the Interval tool on the toolbar.

2. Move the mouse along the graph to find the point to start with (it does not matter if the
point is located on the left or on the right).

3. Click any mouse button to fix the point.

4. Move the mouse along the graph to locate the second point. The interval length value
will be displayed against the interval background.

5. Click any mouse button to fix the point.

To move the interval, locate the cursor on it and drag it holding down the left mouse button
or the button to which this tool is assigned.
Only one interval can be built at a time.
To delete the interval, deactivate the Interval tool.

11.4.5 Value Interval

To select a value interval:

1. Activate the Values Interval tool on the toolbar.

2. Move the mouse over the graph to locate the point to start with (it does not matter if the
point is located at the top or at the bottom).

3. Click any mouse button to fix the point.

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CHAPTER 11. ECG VIEWER

4. Move the mouse over the graph to locate the second point. The value matching the
interval will be displayed against the interval background.

5. Click any mouse button to fix the point.

The units of measure of a value interval for an ECG series are determined
automatically on the basis of the DICOM tags for the series. If the required
data are missing, the value of the selected interval is not displayed.
To move the interval, locate the cursor on it and drag it, holding down the left mouse button
or the button to which this tool is assigned.
Only one interval can be built at a time.
To delete the interval, deactivate the Values Interval tool.

11.4.6 Move to a Time Point on the Graph

To move to a particular time point on the graph, enter the values (minutes, seconds and mil-
liseconds) into the corresponding areas on the toolbar (Fig. 11.7) and click the GO TO button.
The graph will move to display its part starting from the specified time. You can drag the graph
with the mouse at any time.
If the entered time value exceeds the study duration, the graph will be out of vision. Enter
a new value or move the graph manually.
If some parameter has a zero value, it does not need to be entered. For instance, to move
to the time point 1 minute 110 milliseconds, enter the values as shown in Fig. 11.7.

Figure 11.7: Go to the time point 1 minute 0 seconds 110 milliseconds

11.4.7 Set Up Coordinate Plane

To display the scale on the coordinate plane, activate the Scale ECG tool on the toolbar
(by default it is inactive). To hide the scale line, click the button again.
The ECG scale is determined automatically on the basis of the DICOM tags
for the series. If the required data are missing, the scale line is not
displayed.

To change the color scheme, click the Choose color scheme button on the toolbar.
Two color scheme options are available: classic (set by default) and green (Fig. 11.8).

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 11.5. FREQUENCY FILTERS

Figure 11.8: Green color scheme

11.5 Frequency Filters

Functionality is available in the Pro edition

If an ECG is recorded with distorsions, use filters to correct the graphs.

When filters are used, graphs are changed. To establish a diagnosis, you
need to use original data.

These filters remove the components those frequency is higher than 35 Hz (the Low

pass filter 35 Hz button) or 75 Hz (the Low pass filter 75 Hz button). To apply the filter,
click the corresponding button. To cancel filtering, click the corresponding button again. Only
one filter can be applied at a time.
To remove power line interference from the ECG signal, use the Notch filter. The tool has
2 predefined values (50 Hz and 60 Hz). To select a filter value, click on the arrow on the right
side of the Notch filter button. The current value is marked with a flag. If you need to set
a different value, select the Custom... item in the button menu and set the value in the dialog
that opens. To use the filter with the current value, click on the Notch filter button. To
cancel filtering, click the button again.
To remove the walks of the baseline of the graph, use a High pass filter 1Hz. To apply the
filter, click the High pass filter 1Hz button. To cancel filtering, click the button again.

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11.6 Export series

Functionality is available in the Pro edition

When exporting, a series is saved in the filtered form. The series is stored in the local
storage in the same study. To open the export dialog, click on the arrow on the right side of
the Quick export ECG button.
If necessary, change the description of the series.
To upload the series to the default PACS server when exporting, check the Upload ECG
to the default server box in the export dialog.
To export the series with the default settings, click the Quick Export ECG button.

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Chapter 12

Image annotation

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The module described in this chapter is aimed for marking various objects on DICOM im-
ages manually with the help of contours and exporting them in JSON format. The results of
image annotation may be used for training neural networks created for recognition of image
components.
The following terms will be used in the description of the image annotation module:
Object — A selected part of an image.
Annotation — Marking objects.
Class (of objects) — Objects united by a quality specified by the user. A class is characterized
by a unique name and properties.
The image annotation module is available in the flat image viewer tab and provides for the
following functions:

• create / edit a list of object classes and unite classes in groups;

• select objects belonging to different classes with contours;

• export and import the tree of object classes and groups;

• save image annotation results and open them to continue work;

• export annotation results with DICOM data.

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12.1 Licensing the Image Annotation Module

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The image annotation module provides for dual-level access to the function. The users
with extended rights have an additional opportunity to create and edit classes and groups.
The other users may use the standard functions of the module, while the functions of creating,
editing and exporting the tree of object classes and groups is not available for them.
When a user launches the module and attempts to open the image annotation results, the
annotation panel with the standard functions of the module appears on the screen. If the user
does not have an active license for the image annotation module, a dialog box (see Fig. 12.1)
pops up suggesting that a free trial period should be activated.

Figure 12.1: The dialog box for the trial period activation

Additional functions of the image annotation module are available upon the user’s request.
No free trial period will be available in this case. If the license or the free trial period has
expired, the annotation panel will not be opened. A dialog box notifying the user that a license
must be purchased will pop up instead.

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 12.2. OPENING A SERIES IN THE IMAGE ANNOTATION MODE

12.2 Opening a Series in the Image Annotation Mode

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To open a series in the image annotation mode, proceed as follows:

1. Open the series in the flat image viewer tab.

2. Choose Image annotation on the main Image menu.

The image annotation panel will be opened on the right-hand side of the window (see
Fig. 12.2). This panel contains function buttons (in the red box) and the tree of groups and
classes (in the green box).

Figure 12.2: The flat image viewer tab in the image annotation mode

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The function buttons on the image annotation panel:

The Add class button is available when no elements or just one element has
been selected on the tree of groups and classes. If a group is selected, the new
class will be added to this group. If a class is selected, the new class will be
added to the group where the selected class belongs. If the selected class does
not belong to any group, the new class will be added to the superior level. The
button is only available for users who have extended rights.
The Remove group/class button deletes the selected groups and classes. The
button is only available for users with extended rights.
The Add group button creates a new empty group if there are no classes among
the selected list items. If one or more classes have been selected in the list, the
selected classes are combined into a new group.
The Import the tree of groups and classes button opens a dialog box for
selection of a JSON file in order to import a tree of groups and classes.
The Export the tree of groups and classes button opens a dialog box for
selection of a JSON file in order to save the results. When the user presses the
Save button, a new JSON file is created or the existing JSON file with the data on
the current tree of groups and classes is overwritten. The button is only available
for users with extended rights.
The Save results button allows for saving the current annotation results in order
to resume work with them after the program is relaunched. When the user
presses the button, a dialog box pops up for saving the data on all the objects
that have been marked for all the study series in the current tab. DICOM data are
not saved.
The Export results with DICOM button exports the image annotation results
together with the DICOM data. The data are exported into a separate folder or
archive.

12.3 Creating a Tree of Object Groups and Classes

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

A tree of groups and classes is a hierarchical list of items. The items of the superior level
are object groups and/or classes. The classes of objects that do not belong to any group are
shown at the top of the list.

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 12.3. CREATING A TREE OF OBJECT GROUPS AND CLASSES

12.3.1 Creating a New Class of Objects

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Attention! This function is only available for users with extended rights.

There are two ways to add a new object class:

• click the Add class button on the image annotation panel;

• through the context menu: right-click on the annotation panel and select the Add class...
option.

In the New class dialog box (Fig. 12.3)), print the name of the object class. By default, an
object class is assigned a name in Class <unique number> format.

Figure 12.3: The dialog box for adding a new object class

In order to avoid intersection of object contours, uncheck the Enable intersections of

objects box. The box is checked by default. Customize the color of the contours for this class
of object by pressing the color icon and selecting a suitable color in the respective dialog box.
Click OK to create a new object class or CANCEL to cancel.
If a group is selected when the user presses the Add class button, the new object class
will be added to the selected group. If a class is selected, the new object class will be added
to the group to which the selected class belongs. If the selected class does not belong to any
group, the new object class will be added to the superior level of the tree.

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12.3.2 Creating a Group of Object Classes

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Attention! This function is only available for users with extended rights.

There are two ways to add a new group:

• click the Add group button on the image annotation panel;
• through the context menu: right-click on the annotation panel and select the Add group...
option.
In the New group dialog box (Fig. 12.4), print the name of the group. By default, a group is
assigned a name in Group <unique number> format.

Figure 12.4: A dialog box for adding a new group

Click OK to create a new group or CANCEL to cancel.

If one or several classes are selected on the list when the user presses the Add group
button, these classes are automatically transferred to the new group. Otherwise, a new empty
group will be added.

12.3.3 Operations with Object Classes and Groups

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Attention! This function is only available for users with extended rights.

If the current tree of object classes and groups is changed, it may result in
incompatibility with the trees that were created earlier (see Section 12.3.4).

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 12.3. CREATING A TREE OF OBJECT GROUPS AND CLASSES

The following actions may be performed with groups and classes:

• moving. To change the structure of a tree of groups and classes, mouse over a group
or class and drag the selected group or class to another place on the tree while holding
the left mouse button;

• renaming. Double-click on the name of a group or class, type the new name and press
Enter on the keyboard;

• editing class parameters. Click the Settings button for the selected object class
and change the parameters in the Class settings dialog box. The interface of the Class
settings dialog box is identical with the interface of the dialog box for creating a new
class (see Fig. 12.3);

• deleting. Select a group or class. Click the right mouse button and select the Remove
group/class option from the context menu or click the Remove group/class button
on the image annotation panel.

When the user terminates work with the program, the current state of the tree of groups
and classes is saved in a JSON file if it contains at least one group and/or class. Otherwise,
the JSON file will be deleted. The file named ia_classes.json is placed in the <Path to the
storage>/ImageAnnotation directory where the <Path to the storage> is the path specified in
the Workspace section of the general settings window (see Section 16.1).
When the program is launched, the current tree of groups and classes is automatically
opened from the Specified JSON file. If such a file does not exist, an empty image annotation
panel will pop up when the program is launched.

12.3.4 Compatibility of Trees of Groups and Classes

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Each tree of groups and classes is assigned a unique identifier (uid) and a number of the
version which is changed when the structure of the tree is altered.
If the user, after importing/exporting the classes and groups tree, saving results or export-
ing results with DICOM data, performs one of the following actions with the tree of groups and
classes:

• adds a new class;

• changes the parent group for the class (by dragging);

• adds a new group;

• deletes a group;

• changes the name of a group,

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then the version of the tree of groups and classes will be changed (increased by 1). The
unique identifier (uid) of the tree will stay the same.
If the user, after importing/exporting the classes and groups tree, saving results or export-
ing results with DICOM data, performs one of the following actions with the tree of groups and
classes:

• deletes a class;

• changes the name of a class;

• changes the color of objects for a class;

• changes the intersection option for objects belonging to a certain class,

then a new uid will be generated for the tree of groups and classes, and the tree version
will be reset to 1.
Trees with the same uid are compatible and may be upgraded (see Section 12.4.2). Trees
with different uids are incompatible, but one tree may be replaced by another (see Sec-
tion 12.6.2).
The uid value and the tree version number are saved in a JSON file when the tree is ex-
ported, or when the annotation results are exported or saved.

12.4 Export and Import of the Tree of Groups and Classes

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The export and import option provides an opportunity to save and transfer a tree of groups
and classes as a JSON file from one computer to another. A tree of groups and classes created
by a user with extended rights may be shared by common users.

12.4.1 Export of the Tree of Groups and Classes

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

Attention! This function is only available for users with extended rights.

The function of exporting the current state of the tree of groups and classes provides
an opportunity to save the data on the tree of groups and classes specified on the image
annotation panel in a JSON file.
To export the current state of the tree of groups and classes, click the Export the tree of
groups and classes button on the image annotation panel. In the dialog box that pops

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up, choose a place where you want to save the file with the data and enter the name of the
file. Click Save to save the file or Cancel to cancel.
In case of an error, a respective dialog box will pop up.

12.4.2 Import of a Tree of Groups and Classes

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The function of importing a tree of groups and classes provides an opportunity to open a
tree of groups and classes from a JSON file on the image annotation panel.
To import a tree of groups and classes, click the Import the tree of groups and classes
button on the image annotation panel. In the dialog box that pops up, choose an exported
JSON file with data on groups and classes.
To upgrade a tree of groups and classes, import a superior version of the tree.
The imported JSON file with data on the tree of groups and classes from the
image annotation panel must be created by exporting the tree of groups and
classes (see Section 12.4.1).
Click Open to import the tree of groups and classes or Cancel to cancel.

12.5 Marking Objects with Contours

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

You can use contours to mark objects in DICOM images. Contours are drawn separately
for each image (slice, phase, or frame) with the ROI object (contour) tool in the Image viewer
tab in the image annotation mode.
To mark an object with a contour, proceed as follows:

1. Open a series in the Image viewer tab. Enable the image annotation mode (see Sec-
tion 12.2).

2. If there is no tree of groups and classes on the image annotation panel, it must be im-
ported or created.

3. In the line for the respective class on the image annotation panel, activate the ROI object
(contour) tool with the left, right, or middle mouse button. Use the same button
to work with the tool. For details on the use of tools, see Section 1.14.

4. Build a contour in one of the following ways:

• building contours manually. Build a contour around the chosen area while hold-
ing the mouse button with which the tool was activated. To finish the procedure,

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release the mouse button. To cancel the contour that has not been closed, press
Esc on the keyboard while holding the button;
• building contours with an isoline. Move the cursor around the selected area while
holding the Shift button on the keyboard. Under the cursor, you will see an isoline
characterized by even points density. You can only see an isoline on the surfaces
where a contour can be built. To build a contour with an isoline, click the left mouse
button or the mouse button with which the tool was activated.

The color of the contour is the same as the color selected for the class of objects.
Contours can only be built for the orthogonal projection that was received
from the modality.
Contours may intersect if the Enable intersections of objects box in the object class pa-
rameters is checked for at least one of them. This box is checked by default.
To disable intersection of contours, uncheck the Enable intersections of objects box in
the object class parameters. If intersection of contours is disabled, corrections will be made
after a contour is built or edited: the shared areas will be deleted.
When a contour is built or edited, intersection of the current contour with those that have
already been built may be prohibited. To prohibit intersection for the current contour, press
and hold the Ctrl key (or the Command key for macOS) on the keyboard when finishing the
building or editing procedure. The shared areas will be deleted.
If one of the contours is inscribed in the other, they are not considered intersecting.

12.5.1 Actions with Object Contours

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer provides for the following actions with object contours:

• editing. To edit a contour, place the cursor over it. When you hover over the contour line,
it is highlighted. Place the cursor over the area that needs editing and click the mouse
button. Draw a new contour while holding the button. To finish the editing procedure,
release the mouse button;

• deleting. Place the cursor over the contour line, press the Delete key on the keyboard
or click the right mouse button and choose the Remove object option from the right-click
menu;

• deleting all the Contours. To delete all the contours of the objects for the current series,
choose the Remove all objects option from the right-click menu. In the dialog box that
pops up, click YES to delete or NO to cancel.

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 12.5. MARKING OBJECTS WITH CONTOURS

12.5.2 Changing the Class of Object Contour

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

If the current tree of object classes and groups is changed, it may result in
incompatibility with the trees that were created earlier (see Section 12.3.4).
To change the class of the object contour, proceed as follows:

1. Place the cursor over the contour. When you hover over the contour line, it is highlighted.

2. Click the right mouse button and select the Classes option from the right-click menu
(Fig. 12.5). The group and the class of the selected object contour are ticked on the
dropdown list.

3. Change the class of the object contour by selecting a suitable option from the list.

Figure 12.5: Right-click menu for object contours

The characteristics of the selected class are applied to the contour.

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12.6 Saving and Opening Annotation Results

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer provides for an opportunity to save the annotation results in a JSON
file, as well as to open files with annotation results in order to resume work. When a file is
opened, the data contained in it are added to the data that already exist.

12.6.1 Saving Annotation Results

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To save the image annotation results, click the Save results button on the image
annotation panel. In the dialog box that pops up, choose the directory where the file with the
annotation results is to be saved and print the name of the file. Click Save to save the file or
Cancel to cancel.
The results are saved in a JSON file containing the following information:

• data on groups and classes;

• data on images (study ID, series ID, image ID);

• data on objects of the contours.

The saved file contains information on all the objects annotated for all the study series in
the current tab (for all series from the series panel of the current tab). The file is saved without
DICOM data.

12.6.2 Opening Annotation Results

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

To open the image annotation results that were saved earlier, select the Open image an-
notation results... option on the File menu. In the dialog box that pops up, select a saved
JSON file with annotation results.
The following conditions must be met in order to open the annotation results successfully:

• the uid of the tree of groups and classes in the JSON file must be the same as the uid
of the tree of groups and classes opened in the program;

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 12.7. EXPORT OF ANNOTATION RESULTS

• the version of the tree of groups and classes in the JSON file must be inferior to or the
same as the version of the tree of groups and classes opened in the program;
• in the local DICOM Viewer storage, there must be at least one series specified in the
JSON file.
If at least one of these conditions is not met, a dialog box notifying of the error will pop up
and the annotation results will not be opened.
If the version of the tree of groups and classes in the JSON file is superior to the version of
the tree opened in the program, a respective tree replacement notification will pop up when
the user attempts to open the annotation results.
If some of the series specified in the JSON file are missing from the local storage, a re-
spective notification will pop up when the user attempts to open the annotation results.

12.7 Export of Annotation Results

Functionality is available in a separate module which is activated in the Pro edition for an extra
fee

The DICOM Viewer provides an opportunity to export image annotation results with DI-
COM data. The data are exported in a separate folder or archive.
Exported data includes:
• a JSON file named ia_results.json that contains data about the tree of groups and classes
and about the marked outline objects;
• DICOM folder with dcm files of the series, on the images of which the objects were
marked and the DICOMDIR file.
To export annotation results:
1. Click the Export results with DICOM button on the image annotation panel.

2. In the Export image annotation results with DICOM dialog box (Fig. 12.6), enter the
name of the destination folder in the Folder name field.

Figure 12.6: A dialog box for export of image annotation results with
DICOM

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3. Specify the path to the destination folder in the Create in field or click on the folder
button to select a folder in the folder selection dialog box. If the path specified does not
exist, an error notification will pop up when the OK button is clicked.

4. To compress the exported data, check the Compress files box. The name of the Folder
name field will be changed to File name. The data will be exported to a ZIP file, the
name of which will be specified in the File name field. By default, the Compress files
box is not checked.

Click OK to export the annotation results or CANCEL to cancel.

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Chapter 13

Network

To avoid personal data disclosure, secure channels should be used for data
transfer via the network.

13.1 Services
13.1.1 DICOM Service (PACS Server functionality)
The DICOM Viewer can take on the role of a PACS server. The data in the Local Storage will
be available for clients. To do this, enable and set up the DICOM Service and add clients to
the PACS Servers list (section 13.2).
Select the Services... item from the Network menu. In the drop-down menu, choose the
DICOM Listener... option. The dialog box shown in Fig. 13.1 will pop up.

Figure 13.1: Service DICOM Listener

To set up the DICOM Listener Service:

1. Check the Enable box.

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2. In the AE Title field, enter a user-defined title for the computer that the is installed on
to identify it on the server. The length of AE Title value shall not exceed 16 characters.
Cyrillic letters and «\» symbols in AE titles are not allowed.
3. In the Port field, specify any free port of the computer the DICOM Viewer is installed on.
If you are not sure which value to specify, use the default value. This information can be
obtained from your system administrator.
4. To restore the service default settings, click DEFAULTS.
5. To save the current settings for all the users of this PC, check the Shared settings (for
all users) box. It can only be done if the DICOM Viewer was launched by a user with
administrator privileges. The users who do not have administrator privileges cannot
check or uncheck this box. In such a case an error message will pop up.
6. Click OK to apply the settings or CANCEL to cancel. If the port is busy, the message
Dicom Listener cannot be run. Error message: The address is protected will pop up.
In this case, select another port and repeat the previous action.

13.1.2 HIS/HTTP Service

This service is used to manage the DICOM Viewer using the http protocol. Select the Ser-
vices... item from the Network menu. In the drop-down menu, choose the HIS/HTTP Ser-
vice... option.The dialog box shown in Fig. 13.2 will pop up.

Figure 13.2: HIS/HTTP Service dialog box

To set up the HIS/HTTP Service:

1. Check the Enable box.
2. In the Port field under the Enable checkbox, specify any free port of the computer the
DICOM Viewer is installed on. If you are not sure which value to specify, use the default
value. The default port number is 8080. This information can be obtained from your
system administrator.
3. To restore the default settings, click DEFAULTS. By default, the Enable box is unchecked,
and port 8080 is used.
4. Click OK to apply the settings or CANCEL to cancel. If the port is busy, the message will
pop up. In this case, select another port and repeat the previous action.

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 13.1. SERVICES

13.1.3 Web Access

Functionality is available in the Pro edition

Select the Services... item from the Network menu. In the drop-down menu, choose the
Web Service... option.The dialog box shown in Fig. 13.3 will pop up.

Figure 13.3: Web service dialog box

To set up the Web access:

1. Check the Enable box.

2. In the Port field under the Enable web Access checkbox, specify any free port of the
computer the DICOM Viewer is installed on. If you are not sure which value to specify,
use the default value. The default port number is 8090. For access from other com-
puters, add the web access port to your firewall exceptions. If necessary, contact your
system administrator.

3. In the User name field, enter the user name.

4. In the Password field, enter the user password.

5. In the Session timeout (sec.) field, enter a timeout after which the session is terminated
if the connection is lost. When the connection is restored, you need to enter your user-
name and password again.

6. To restore the default settings, click DEFAULTS. By default, the Enable box is unchecked,
and port 8090 is used.

7. Click OK to apply the settings or CANCEL to cancel.

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At the bottom of the dialog, there is a link that must be entered into the browser for web
access to the DICOM Viewer http://youraddress:<port>, where instead of youraddress you
need to type in the ip address or the computer name on which the DICOM Viewer is installed.

13.1.4 Secure DICOM Listener Service

The secure DICOM listener service provides for secure data transfer over the net using the
TLS protocol.
The secure DICOM listener service and the open DICOM listener service may be used
simultaneously by different ports.
Select the Services... item from the Network menu. In the drop-down menu, choose the
Secure DICOM Listner... option. The dialog box shown in Fig. 13.4 will pop up.

Figure 13.4: Secure DICOM Listner dialog box

To set up the Secure DICOM Listner Service:

1. To enable the secure DICOM listener service, check the Enable box.

2. In the AE Title field, print an arbitrary name of the computer with the DICOM Viewer
installed for identification on the server. The length of AE Title value shall not exceed 16
characters. Cyrillic letters and «\» symbols in AE titles are not allowed.

3. In the Port field, specify any unoccupied port of the computer with the DICOM Viewer
installed. The port number must be different from the values stated for other services

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 13.1. SERVICES

(such as Web Service, HIS/HTTP Service, DICOM Listener Service). The default port
number is 3100.

4. In the Trusted peer certificates, a list of trusted (root) certificates for the DICOM service
is created. By default, the list is empty.
A trusted certificate (root certificate) is a public key certificate which is used to sign the
peer certificate. It is used to confirm the identity of the peer (the unit on the other end
of the line).
To create a list of trusted certificates, click the CHOOSE button. In the Trusted peer
certificates dialog box (Figure 13.5), the list of trusted certificates is provided.

Figure 13.5: Trusted peer certificates dialog box

To add a certificate, click ADD. In the dialog box that pops up, choose the certificate file.
Certificate files must have (pem), (crt), or (cer) extension.
In Figure 13.5, you see that the file «root_Example.crt» is added to the trusted certificates
list. It is the server root certificate.
If the certificate you are trying to add has already been added to the list, an error mes-
sage will pop up.

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To delete a certificate from the list, highlight the respective line and click REMOVE. To
delete all the trusted certificates, click REMOVE ALL.
Click OK to apply the settings or CANCEL to cancel.
The trusted certificates added to the list are saved in the OS registry or in the config-
uration file as binary data. After the settings are saved, there is no need to keep the
certificate files on the disk.
To enable verification of the certificates of the clients connected, check the Verify peer
certificate box. In this case, when a secure connection to the DICOM service is es-
tablished, authentication of the client is performed. For successful authentication, the
client’s certificate has to be signed by one of the trusted DICOM Service certificates. If
the Verify peer certificate box is not checked, the secure DICOM Service accepts any
client connections.

5. In the Certificate box, the paths to the public key certificate files and DICOM listener
service private key files are to be provided. By default, these paths are not provided.
A public key certificate is an electronic document containing the public key, the infor-
mation about the key owner and its intended use. The certificate is signed by the cer-
tification authority having issued the key and proves that the public key belongs to its
owner.
The public key is available to anyone. It is used to encrypt data when the client estab-
lishes a connection with the server.
The private key is kept at the server. It is used to decrypt data received from the client.
To provide the paths to the public key certificate file and the private key file, click CHOOSE.
To provide the paths to the public key certificate file and the private key file, click BROWSE
in the Certificate and private key dialog box (see Figure 13.6). In the box that pops up,
choose the files you need. The public key certificate file must have (pem), (crt), or (cer)
extension. The private key file must have (key) extension.

Figure 13.6: Certificate and private key dialog box

In our example shown in Figure 13.6, we have added the paths to the client’s private key
file «INOBITEC.key» and the public key certificate file «INOBITEC.crt».

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In the lower part of the Certificate and private key dialog box, you see the verification
status of the public key certificate and the private key. Here are the possible variants of
the verification status:

• No certificate — the path to the public key certificate file has not been provided.
• No private key — the path to the private key file has not been provided.
• Incorrect certificate — the path provided is invalid / the file for which the path has
been provided does not exist / the file for which the path has been provided is
damaged or does not contain a valid public key certificate.
• Incorrect private key — the path provided is invalid / the file for which the path
has been provided does not exist / the file for which the path has been provided is
damaged.
• Data in the following format: <Certificate name>, <Company name>, <Country
abbreviation> — the public key certificate and the private key provided is valid.

Attention! You cannot check the compatibility of the public key certificate
file with the private key in the Certificate and private key dialog box.

The OK button will be activated after you provide the valid paths to the public key cer-
tificate file and the private key file. Click OK to apply the settings or CANCEL to cancel.

6. To save the current settings for all the users of this PC, check the Shared settings (for
all users) box. It can only be done if the DICOM Viewer was launched by a user with
administrator privileges. The users who do not have administrator privileges cannot
check or uncheck this box. In such a case an error message will pop up.

7. To restore the default settings, click DEFAULTS.

8. Click OK to apply the settings or CANCEL to cancel.

13.2 Set Up PACS Server Connection

In this window, you can set up the connections with the applications which can exchange data
with the DICOM Viewer, using the DICOM protocol. In this case, the DICOM Viewer can take
on the role of a PACS server and the other applications will be clients, and vice versa. Since
most of the applications with which a connection can be established can take on the role of a
PACS server, the connections with them are set up in this window, regardless of whether they
will be servers or clients in relation to the DICOM Viewer.
To open the window to connect to PACS servers, select the Network menu and the Server
list item or press Ctrl+S (or command+S for macOS). The dialog box shown in Fig. 13.7 will pop
up.

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Figure 13.7: PACS server connection dialog box

The DICOM Viewer allows you to download several series from the PACS server at the
same time, making several parallel connections to the PACS Server. However, not all PACS
Servers support a large number of simultaneous connections, and this leads to errors when
downloading data. Setting the maximum number of connections is described in 16.7.5. This
setting applies to all PACS Servers.

13.2.1 Add PACS Server

To add a new PACS server:

1. Click the button.

2. Enter the server name in the Server nickname field.

3. Enter a comment in the Server description field. This field may be left blank.

4. Select DICOM from the Server type dropdown menu.

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5. Select the target mode from the Server mode dropdown menu.

6. Select the server character set from the Character set dropdown menu.

7. In the Client name (SCU) field, enter the value specified in Section 13.1.1 in the AE Title
field.

8. In the Service name (SCP) field, enter the name of the server that the PACS server is
installed on.

9. In the Server host name or IP field, enter the server name or IP address.

10. In the Server port field, enter the server port to accept connections by the DICOM pro-
tocol.

11. To establish a secure connection, check the Use secure mode (TLS) box. For details
see Section 13.2.3.

12. To save the information without closing the window, click OK.

13. To save the information and close the window, click SAVE.

14. To close the window without saving the changes, click CANCEL.

The required information can be obtained from your system administrator. Other PACS
servers are added in a similar way.
If you have several servers on your list, you can assign a server that will be active by
default when starting the DICOM Viewer. To do this, check the Default server box in the
server connection settings.
If another default server is already assigned, its box will be unchecked when you assign a
new server.
If this server is also a client in relation to the DICOM Viewer, it is necessary to allow it to
exchange data. To do this, check the box Allow C-FIND and C-MOVE. Configure the client ap-
plication in accordance with the User Manual of this application. The connection configuration
of two «Inobitec DICOM Viewer» applications is described in section 13.2.5.
To make the server available to all the users, you need to check the Shared server (multi-
user support) box for this server. To do that, you need to run the DICOM Vieweras an ad-
ministrator. Otherwise the box will be inactive. The users that do not have the administrator
privileges cannot change the public server settings or delete it.
To delete a server from the list, click the button.

Attention! After you click this button, the deletion cannot be undone.

13.2.2 Downloading Data from the PACS Server via WADO service
The DICOM Viewer provides an opportunity to download studies and separate series from
the PACS server via WADO web service. Studies at the PACS server are found with command
C-FIND.

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To enable access to the PACS server via WADO service, in the PACS server connection
dialog box (Fig. 13.7) choose WADO-RS from the Server mode drop-down list. When choosing
the WADO-RS mode, you will see the WADO settings dialog box (Fig. 13.8).

Figure 13.8: WADO settings dialog box

Set up the connection:

• in the Service root path field, provide the path to the PACS server internal service pro-
cessing WADO-RS queries. The field is empty by default;
• the Secured connection (HTTPS) box is used to enable/disable the https protocol for
communication with the PACS server when downloading data via WADO service. The
box is unchecked by default. If the box is checked, the https protocol is used to com-
municate with the PACS server; if it is unchecked, the http protocol is used;
• in the Port field, provide the value of the http or the https port (depending on the Secured
connection (HTTPS) box status) within the range from 1 to 65535. The default value is
80. If an invalid value is entered, the OK button will be blocked;
• in the Login and Password fields, provide the data to connect to the PACS server. The
fields are empty by default.
Click OK to apply the changes or CANCEL to cancel.
To change the current WADO service connection parameters, click the SETTINGS button
next to the Server mode drop-down list in the Server list dialog box (see Fig. 13.7).
WADO service settings may be exported and imported (see Section 16.9). The data to con-
nect to the PACS server (login and password) are not saved when the settings are exported.

13.2.3 Secure PACS Server connection via the TLS protocol

If you launch the DICOM Viewer 2.4 or an inferior version of the program on
your PC, all the TLS parameters will be reset.

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By default, the AE Title of the secure connection via the TLS protocol is the same as the
AE Title of the non-secure connection. Hence, it is recommended to change the name in the
settings window. The secure TLS connection service and the non-secure connection may be
used simultaneously by different ports.
To enable the secure connection mode, check the Use secure mode (TLS) box in the
server parameters dialog box (see Figure 13.7). By doing this, you will activate the TLS SET-
TINGS button for secure mode setup.
The TLS SETTINGS dialog box is shown in Figure 13.9.

Figure 13.9: TLS Settings dialog box

To add a trusted peer certificate, click CHOOSE. In the dialog box that pops up, choose the
trusted (root) PACS Server certificate file. The trusted (root) PACS Server certificate file must
have (pem), (crt), or (cer) extension.
In our example, the root certificate file «root_Example.crt» is being added.
To enable verification of the trusted (root) certificate at the time of establishing a connection
with the PACS Server, check the Verify peer certificate box. In this case, when a connection
is being established, the client’s authentication is performed. For successful authentication,
the PACS Server certificate has to be signed by a trusted certificate.
The program automatically checks the presence of a valid certificate in the file. If the file
is damaged or does not contain a certificate, a message will pop up.
If you have chosen the file containing the valid certificate, you will see the following infor-
mation in the Trusted peer certificate box: <Certificate name>,<Company name>, <Country
abbreviation>.
If the peer certificate verification mode has been enabled on the PACS Server, the client’s
authentication must be performed to establish a connection. Check the Authentication of the
client box and click CHOOSE.
In the Certificate and private key dialog box (Figure 13.10), the paths to the public key
certificate file and the private key file are provided.

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Figure 13.10: Certificate and private key dialog box

To provide the paths to the public key certificate file and the private key file, click BROWSE.
In the box that pops up, choose the files you need. The public key certificate file must have
(pem), (crt), or (cer) extension. The private key file must have (key) extension.
In our example shown in Figure 13.10, we have added the paths to the client’s private key
file «INOBITEC.key» and the public key certificate file «INOBITEC.crt».
In the lower part of the Certificate and private key dialog box, you see the verification
status of the public key certificate and the private key. Here are the possible variants of the
verification status:

• No certificate — the path to the public key certificate file has not been provided.

• No private key — the path to the private key file has not been provided.

• Incorrect certificate — the path provided is invalid / the file for which the path has been
provided does not exist / the file for which the path has been provided is damaged or
does not contain a valid public key certificate.

• Incorrect private key — the path provided is invalid / the file for which the path has been
provided does not exist / the file for which the path has been provided is damaged.

• Data in the following format: <Certificate name>, <Company name>,

<Country abbreviation> — the public key certificate and the private key provided is
valid.

Attention! You cannot check the compatibility of the public key certificate
file with the private key in the Certificate and private key dialog box.
The OK button will be activated after you provide the valid paths to the public key certificate
file and the private key file. Click OK to apply the settings or CANCEL to cancel.

13.2.4 Check PACS Server Availability

To check if the server is available, click the button in the PACS server connection window.
If the server is available, the system will return the following message: Server network status:
Online.

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Otherwise the following message will be returned: Server network status: Offline.The
error details will be displayed below.
Server is unavailable.
Connection request failed.
Failed to establish association
0006:0317 Peer aborted Association (or never connected)
0006:031c TCP Initialization Error: No error
If a message similar to the one shown below appears, it, most likely, means that the Server
host name or IP or Server port fields are filled in incorrectly, or the target PACS server is not
running.

13.2.5 Configuring the connection of two applications Inobitec DICOM Viewer

For example, the DICOM Viewer #1 takes on the role of a PACS-server and DICOM Viewer #2
takes on the role of a client.
A device with the DICOM Viewer #1 has the following parameters:

• AE Title: VIEWER-SERVER;

• Host IP address: 192.168.1.101;

• Port: 3001.

A device with the DICOM Viewer #2 has the following parameters:

• AE Title: VIEWER-CLIENT;

• Host IP address: 192.168.1.102;

• Port: 3002.

To configure the server:

1. Enable and set up the DICOM service (section 13.1.1), set AE Title as VIEWER-SERVER,
set Port as 3001.

2. Add a client in the Set Up PACS Server Connection window (section 13.2.1). Set the
following parameters for the fields:

• for field Server type — DICOM;

• for field Server mode — C-MOVE;
• for field Client name (SCU) — VIEWER-SERVER;
• for field Service name (SCP) — VIEWER-CLIENT;
• for field Server host name or IP — 192.168.1.102;
• for field Server port — 3002;
• check the box Allow C-FIND and C-MOVE.

Now, DICOM Viewer #1 is ready to accept incoming connections from the client with the
AE Title = VIEWER-CLIENT, IP = 192.168.1.102 and port=3002.

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To set up a client:
Add the server in the Set Up PACS Server Connection window(section 13.2.1). Set the
following parameters for the fields:

• for field Server type — DICOM;

• for field Server mode — C-MOVE;

• for field Client name (SCU) — VIEWER-CLIENT;

• for field Service name (SCP) — VIEWER-SERVER;

• for field Server host name or IP — 192.168.1.101;

• for field Server port — 3001;

Now DICOM Viewer #2 is ready to connect to the server with AE Title = VIEWER-SERVER,
IP = 192.168.0.101 and port=3001.
If you enable and set up the DICOM-service and check the box Allow C-FIND and C-MOVE
for the VIEWER-SERVER server in the DICOM Viewer #2 settings, then DICOM Viewer #2 will
be able to take on the role of a server and DICOM Viewer #1 will be able to take on the role of
a client. Thus, the DICOM Viewer can take on the role of a client and a server simultaneously.

13.3 Network Operation Status

Network operations refer to information transfer and reception between the DICOM Viewer
and the PACS servers.
To view the network operation status, select the Network menu and the Network status
item.
The window contains three tabs: Downloading, Uploading and History. The Download-
ing and Uploading tabs display the queues of studies loaded from the PACS server or sent to
the PACS server respectively.
If some data is being transferred at the moment, the study queue will be displayed in the
corresponding tab (Fig. 13.11). The studies positioned at the top of the list are the first to be
processed.

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Figure 13.11: Queue of studies sent to the PACS server

When using the Downloading and Uploading tabs, the same actions are used.
The following actions with a study can be performed (select a study first):

• change the position in the queue, using the and buttons respectively;

• cancel the study processing, using the button. In this case, only the information
that is already loaded will remain on the server.

To clear the queue, click the button. In this case, the studies, including the one
currently processed, are deleted from the list, and their processing is interrupted. If a study is
already being processed (In progress status), you cannot change its position in the queue.
The top of the History tab displays the list of studies loaded, sent or canceled. At the
bottom of the tab, there is a list of studies whose transfer failed.

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CHAPTER 14. THE LOCAL STORAGE

Chapter 14

The Local Storage

The storage is a folder on the computer disk where the DICOM data is stored.
The data kept in the local storage may be lost through the hard drive
damage, improper users’ activities, or third-party software impact. To avoid
data loss, back up the data.

14.1 View Storage Status

To view the storage status, select the Storage menu and the Storage status... item. The
window shown in Fig. 14.1 will pop up.

Figure 14.1: Storage info

The following information is displayed in the window: the number of studies in the storage;
the total number of images in all studies; the size of data stored in the storage (gigabytes and
bytes).

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14.2 Verify Storage

To check the storage, select the Storage menu and the Verify storage... item. The checking
process shows whether all images the related to the studies are located in the storage. The
checking progress (percentage of work performed) is displayed on the screen.
If all the files are found in the storage, the All files in storage are valid message will be
displayed.
If any of the files are not found in the storage, the message like Found 10 missed files in
the local storage. Please, try again to download studies. will be returned. In this case, you
need to reload all the studies to the storage to display all the images properly. To clear the
storage, perform the actions described in the next section.

14.3 Clear Storage

To clear the storage, select the Storage menu and the Clear storage... item. In this case, the
All local studies will be deleted. Do you really want to clean up the local storage? message
will be displayed. Click YES to clear the storage or NO to cancel. After the storage is cleared,
click OK in the clearing progress window.

14.4 Automatic Local Storage cleaning

Automatic cleaning is performed at the following intervals:

• every time;

• once a day;

• once a week;

• once a month.

To activate/deactivate automatic cleaning, check/uncheck the Automatic local storage

cleaning box and select the cleaning interval (see section 16.7.6).

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CHAPTER 15. DISK CREATOR

Chapter 15

Disk Creator

15.1 General information

The disk creator allows you to write information to CDs, DVDs and Memory Cards. To open
the disk creator, click the DICOM CD/DVD Creator button on the toolbar. To select the
tab location (in the current window, in a separate window or in the full screen mode), click
on the arrow on the right side of the button. To open the creator window in a new tab in the
current window, click on the button.
The disk creator window is shown in Fig. 15.1.

Figure 15.1: Disk creator

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 15.1. GENERAL INFORMATION

To work with the creator, the Work Folder should be set up, i.e. the folder to store the
disk image to be written. By default, the Work Folder is located in the temporary folder of the
operating system. To change it, click on the Select the work folder where DICOM CD/DVD
image will be created button and select the directory in the dialog that opens. If, when
opening the creator, the Work Folder already contains data, then the dialog with the question
Do you want to clear work folder before inserting new data? is displayed. Click YES to clear
or NO to leave the data.
If the disk image is damaged, it may become impossible to work with it. If errors occur
when adding or removing data, manually clean the Work Folder.
After being written, the data in the Work Folder can be saved for later use or it can be
automatically deleted. Automatic cleaning of the Work Folder can be enabled before burning
the image (see Section 15.3).
The top part of the creator contains the control buttons:

Select a work folder where DICOM CD/DVD image will be created is used to
change the Work Folder.
Remove series from the DICOM CD/DVD image: to delete the selected series, click
on the button. To delete the selected study, click on the arrow on the right side of
the button and select the Remove studies command.

Clear DICOM CD/DVD image deletes all studies from the image.

The Include Inobitec DICOM Disc Viewer to the DICOM CD/DVD image button
described in Section 15.2.3.
Burn created DICOM CD/DVD image to the optical disk writes information from the
creator to the disk.
Write created DICOM CD/DVD image to the flash card or folder writes information
from the creator to the memory card (flash card) or folder.

The Size parameter displays the size of the disk image. The same information is duplicated
by the green bar on the graph (Fig. 15.2).

Figure 15.2: Disk Image size

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15.2 Add Data to Disk Creator

15.2.1 Automatically Add Data to a Disk Image
Since version 1.14.0, it is possible to automatically add data to a disk image.
To set up automatic adding of studies select the main menu Options->Settings...->
Modules->DICOM CD/DVD Creator and click the Settings button. In the window that opens
check the Add selected studies at opening DICOM CD/DVD Creator box. By default the box
is checked. Click OK to apply the settings or CANCEL to cancel.
To add studies to the disk image automatically:

1. Load studies to the DICOM Viewer.

2. Select the required study (several studies, holding down the Shift or Ctrl key (or the
Command key for macOS). For more information, see Section 1.9).

3. Click the DICOM CD/DVD Creator button on the toolbar. If the creator is closed,
it opens, and the selected studies are added to the image.

If the Work Folder is not set. Choose Work Folder and try again error occurs, then set
the Work Folder for the creator (see Section 15.1), or it will be automatically created in the
temporary folder of the operating system the next time you start the Disk Creator.

15.2.2 Manually Add Data to a Disk Image

To add studies or series to the disk image manually:

1. Load studies to the DICOM Viewer.

2. Select the required study (or several studies, holding down the Shift or Ctrl key (or the
Command key for macOS). For more information on how to select several studies, see
Section 1.9).

3. To add an entire study to the disk image, click the Add selected studies to DICOM
CD/DVD image button on the Studies Import/Export Panels.

4. To add a series, select it on the series panel and click on the left part of the Add selected
series to DICOM CD/DVD image button on the Series Import/Export Panels. The
information will be added to the creator. To select several series, hold down the Shift or
Ctrl key (or the Command key for macOS). For more information, see Section 1.9).

If the Work Folder is not set. Choose Work Folder and try again error occurs then set the
Work Folder for the creator (see Section 15.1) or it will be automatically created in the temporary
folder of the operating system the next time you start the Disk Creator.

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 15.3. BURN IMAGE

15.2.3 Adding the Inobitec DICOM Disc Viewer to the Disk Image
To be able to view the images recorded on the disk without having to install special software,
add the Inobitec DICOM Disc Viewer to the disk image. It requires no installation and runs
directly from the disk on Windows and macOS.
To add the Inobitec DICOM Disc Viewer to the disk image, click the Include Inobitec
DICOM Disc Viewer to the DICOM CD/DVD image button. When cleaning the disk
image the Inobitec DICOM Disc Viewer is stored in the disk image.
To remove the Inobitec DICOM Disc Viewer from the disk image, click the button.
In the dialog box that opens, click YES to confirm the deletion or click NO to cancel.

15.3 Burn image

If you need to write a DICOMDIR file to a disk (memory card), enable the corresponding option
in the Dick Creator settings dialog (see Section 16.7.7).
Data burning may fail for some models of CD/DVD-ROMs. To increase the reliability of
recording enable image buffering (see Section 16.7.7). In this case, the buffer file for writing is
created entirely in the temporary folder of the current user just before writing to disk. Buffer
files are created before each recording and are deleted from the hard disk only when the
DICOM Viewer is closed. Hence, the amount of free space on the hard disk should be taken
into account when writing to the disk multiple times within one session of the program.

15.3.1 Write to Disk

Attention! In Linux and macOS you can write data to a memory card or burn
a disk image created in the Work Folder to a disk, using the operating
system tools.
More detailed information in the Section 15.3.3.
To write information to a disk:

1. Click the Burn created DICOM CD/DVD image to the optical disk button on the
Disk Creator toolbar. The window shown in Fig. 15.3 will pop up.

2. If necessary, select the recorder device from the dropdown menu.

3. Edit the disk name if necessary.

4. If necessary, check/uncheck the Set minimal write speed box.

5. If necessary, check/uncheck the Automatically clean up the DICOM CD/DVD image

after burning disk box.

6. Click OK to write or CANCEL to cancel.

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Figure 15.3: Writing parameters

If the Automatically clean up the DICOM CD/DVD image after burning disk box is checked,
the information stored in the Work Folder of the creator will be deleted. Otherwise you will be
able to record it again.

15.3.2 Write to Memory Card or Folder

To write information to a memory card (flash card) or folder:
1. Click the Write created DICOM CD/DVD image to the flash card or folder button
on the Disk Creator toolbar. Dialog box is swown in Figure 15.4.

Figure 15.4: Write to the flash card or folder dialog box

2. Select a memory card or folder on your hard disk. To do this, enter the path in the Path
to write field or click the button and select the path in the dialog that opens.

3. If necessary, check/uncheck the box Automatically clean up the DICOM CD/DVD im-
age after writing data.
4. Click OK to write or CANCEL to cancel.

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 15.4. VIEW STUDIES WRITTEN ON DISK

15.3.3 Burn an image to CD / DVD in Linux and macOS operating systems

To write information to a disk:

1. The Work Folder should be created, i.e. the folder to store the disk image to be written.

2. Save the information to the created directory, in accordance with the Section 15.3.2.

3. Burn a disk image created in the Work Folder to a CD/DVD using the operating system
tools or special applications.

15.4 View studies written on disk

Insert a disk or memory card with DICOM data and the Inobitec DICOM Disc Viewer into the
computer. If autorun of disks and cards is enabled on the computer, the Inobitec DICOM Disc
Viewer will start automatically. Otherwise, on Windows run the Start_Win file, on macOS run
the DICOMViewer file. Both files are located in the root directory of the disk or card.
The written studies are automatically displayed on the Study Panel.

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CHAPTER 16. DICOM VIEWER SETTINGS

Chapter 16

DICOM Viewer Settings

To change the settings, select the Options menu and the Settings... item. The window shown
in Fig. 16.1 will pop up.

Figure 16.1: DICOM Viewer setup window. General settings

The setup menu will be displayed on the left side of the window.
The DEFAULTS button allows you to restore the settings for the current window which are
set upon the very first launch of the DICOM Viewer on the computer.

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 16.1. GENERAL

16.1 General
The following parameters are set up in this section:

• Working directory path. This is the local storage location. The path can be entered
manually or selected from the dialog box. To open the dialog box, click the button to the
right of the path input string.

• Log file path. The information about the DICOM Viewer operation is saved in the log.
The path can be entered manually or selected from the dialog box. To open the dialog
box, click the button to the right of the path input string. If the parameter is not specified,
the log file will be located in the directory where the DICOM Viewer is installed.

• Log file name.

• DICOM Viewer log specification. The following specification levels are available:

– Failure: registering information about errors that led to the DICOM Viewer failure;
– Error: registering information about all errors that may lead to the incorrect opera-
tion of the DICOM Viewer;
– Warning: registering all errors, whether or not they might lead to the incorrect
operation of the DICOM Viewer;
– Info: registering all errors as well as standard actions of the DICOM Viewer;
– Debug: registering all errors and standard DICOM Viewer actions with detailed
information.

After changing the logging level, you do not need to restart the program.

• Use a shared folder to store service information (the Use shared settings (multi-user
support) box) and path to a shared folder.

• Customize the cache memory limits. You may provide for a soft and a hard limit.

– In the Soft field, specify the maximum volume of cache to be used by the program
before it makes an attempt to clear the memory by deleting the data that are not
used. The default value is determined automatically on the basis of the amount of
RAM on the device with the DICOM Viewer installed.
– In the Hard field, specify the maximum volume of cache that can be allocated for
cached data. The default value is equal to the amount of RAM on the device with
the DICOM Viewer installed.

The cache memory limit is specified in Gibibytes (GiB), accurate to a thousandth, from
0.125 to 999999999999.999. Its value must not exceed the memory size. If you attempt
to set a limit exceeding the memory size, a warning message will pop up. The value
provided in the Hard field must be greater than the value in the Soft field. If the limit
values fail to meet these requirements, a warning message will pop up.
The fields for setting cache memory limits are provided with a restore recommended
value button . The restore recommended value button is displayed when the limit

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value provided is different from the recommended value. To restore the recommended
value of a cache memory limit, click the button in the respective field.
After the cache memory limits have been changed, the program must be relaunched. A
dialog box will pop up notifying the user of this necessity.

16.2 User interface

The following parameters are set up in this section:

• Interface language. Can be chosen from the drop-down list. The respective changes
will be applied after the program is restarted.

• Help language. Can be chosen from the drop-down list of the help system languages.
By default, the Auto option is selected, and the interface language is used as the help
language.
If the selected interface language is not used for the help system, English will be used as
the help language. If the user didn’t install the help system when installing the software,
the choice of the help language will not be available.
The selected help language will be applied after the program is restarted.

• Using native OS open/save file dialogs. For Windows XP, you can use dialogs only in
the DICOM Viewer style.

• Request for confirmation before closing the DICOM Viewer.

• Display Tooltips (the ToolTips box), Shortcuts and play Slideshows on the Tooltips. If the
ToolTips box is unchecked, the tooltips are not displayed at all.

• Showing the patient’s name on the tab stub. The patient’s name is taken from the Pa-
tientName(0010,0010) tag. The function is enabled by default.

16.3 Behavior
In this section, you can set up the parameters that can alter the behavior of the program:

• Allow to close the application running as different users. The option is disabled by
default. To activate the parameter, the DICOM Viewer has to be launched by a user
with administrator privileges. Users without administrator privileges cannot check or
uncheck this box. In such a case, a warning message will pop up.
It is recommended to activate the parameter if there are several user accounts in the
system. After the parameter is activated, the program launched by one user may be
closed during a different session by a different user.

The parameter cannot be set up on macOS.

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• Launch the viewer from the context menu. The parameter enables/disables loading
and opening DICOM studies in the program via the Explorer context menu. The initial
setting is provided by the user in the Extended parameters window when installing the
DICOM Viewer (see Fig. 7).

The parameter cannot be set up on Linux or macOS.

The parameter can be changed for the current user or for all the OS users. To change
the parameter for all the users, the DICOM Viewer has to be launched by a user with
administrator privileges. In this case, the parameter will be called Launch the viewer
from the context menu (for all users).
The parameter set for all the users can only be disabled after the program is launched
by a user with administrator privileges.
• Close to tray (the Show system tray icon box) and minimize to tray (the Minimize to tray
box).
• Launch the viewer automatically when the user logs in. The option is disabled by
default.
If several DICOM Viewer versions or editions were installed on the OS, then
when the option is enabled, only the current DICOM Viewer version and
edition will be launched automatically.
If you want the DICOM Viewer to be minimized to the system tray after the automatic
launch, the Show system tray icon and Hide at launch (the ”Show system tray icon”
option must be activated) options must be activated.
• Anonymous statistics collection (telemetry) function can be activated/deactivated. Teleme-
try function provides an opportunity to collect anonymous statistics in order to improve
the product.

16.4 DICOM
The following DICOM files processing parameters are set up in this section:
• Reading character set (character set of DICOM data);
• The Ignore parse errors option can be checked/unchecked;
• The Ignore file meta header length option can be checked/unchecked;
• The Allow reading broken files option can be checked/unchecked;
• The Perform color space conversion from YCbCr to RGB option can be
checked/unchecked. The option is disabled by default. The option is used when the
color model provided for in the PhotometricInterpretation (0028,0004) tag is invalid.
When the option is enabled, the color space is transformed from YCbCr to RGB. When
the setting is changed and saved, the program must be relaunched. A dialog box will pop
up notifying that the new setting will be applied the next time the program is launched.
When the program is restarted automatically, the option is not applied.

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16.5 Screen

This section is meant for customizing the DICOM Viewer windows display on the monitors
available for the OS.

16.5.1 Setting an Additional Monitor

The DICOM Viewer provides an opportunity to display information on several monitors, and
the user does not have to move the windows manually.
To use an additional monitor, proceed as follows:

1. Select the Options menu and the Settings... item.

2. Open the Screen section. The window similar to the one shown in Fig. 16.2 will pop up.

3. On the Special parameters of screen list, select the screen(s) to be used for the DICOM
Viewer. The screen status will be changed to Used.

4. Click OK or APPLY to apply the changes or CANCEL to cancel the actions. To restore
default settings, click the DEFAULTS button.

5. The DICOM Viewer needs to restart to apply the changes. The DICOM Viewer will re-
quest confirmation before restarting: The changes you are made requires restarting
the program to take effect. Do you want to restart the application?.

If you are still working with the opened studies, or if the information needs to be saved,
click NO to cancel the restart and set up the displays later. To restart the DICOM Viewer
click YES.

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Figure 16.2: Monitor settings

If only one screen is selected, the DICOM Viewer will be opened on this screen. If more
than one screens are checked, the DICOM Viewer windows are opened on the marked screens.
To close the DICOM Viewer just close any of the windows.

16.5.2 Customizing the Screen Parameters

The DICOM Viewer provides an opportunity to divide the screen into two parts and place two
windows side by side at launch.
To change special parameters of the screen, proceed as follows:

1. Select the Options menu and the Settings... item.

2. Open the Screen section. The window similar to the one shown in Fig. 16.2 will pop up.

3. Select the screen you want to split in the Special parameters of screen list. A Not used
screen cannot be selected.

4. Check the Split the screen for the selected screen (see Fig. 16.3).

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Figure 16.3: Special parameters of the screen

5. Select the left or the right window as the primary by choosing the respective option in
the Set as primary line. When the DICOM Viewer launched, the tab with the study list
appears automatically in the primary window. Only one window may be selected as the
primary. In other windows, the tab with the study list may be opened manually from the
main menu File->Study list.
6. In the Open the series by default line, check the boxes for the windows in which you
want to open series in the respective tabs (Image viewer, Volume reconstruction, MPR
reconstruction etc.) by double-clicking on the thumbnail or by pressing the respective
button on the toolbar. The order of opening series in the windows for which the Open
the series by default box has been checked is determined by the arrangement of the
windows (left-to-right or top-down).
7. Click OK or APPLY to apply the changes or CANCEL to cancel the actions. To restore
default settings, click the DEFAULTS button.
8. In the restart confirmation window, click YES to restart or NO to cancel restart and con-
tinue working.
When the user chooses the Show as detached window series arrangement (see Sec-
tion 1.4), the window is opened in the center of the screen. To fix a detached window, click

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the Fix window button in the window header. The window will be added as a tab to the
left window of the respective screen.
When the user chooses the Show fullscreen series arrangement (see Section 1.4), the
window is expanded to full screen. Open series windows may overlap. When the user exits
full screen mode, the series window is added as a tab to the respective program window.

16.5.3 High resolution monitor support

To automatically scale the interface for high-resolution monitors according to the scale of the
operating system, check the Enable High-DPI scaling box. The change will take effect the
next time you launch DICOM Viewer.

16.6 Skins

The following parameters are set up in this section:

• the DICOM Viewer layout (skin):

– light;

– dark (used by default).

• use the Viewer layout for the Help System.

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16.7 Modules
In this section you can specify the settings for particular modules (Fig. 16.4).

Figure 16.4: Modules

To browse the detailed information about each module, select the module and click the
Module info button. For some modules, special parameters are set. To do this, select the
module from the Installed modules list and click the SETTINGS button.

16.7.1 Set Up Image Viewer Module

Select the Image Viewer module from the Installed modules and click the SETTINGS button.
The Image viewer settings window contains four tabs with the following parameters:

1. General tab. The following parameters are set up:

• default tool (the one that activates when opening an image). Options:
– no tool;
– Adjust W/L;
– Ruler;
– Angle;

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– ROI rectangle tool;

– ROI ellipse tool;
– ROI polygon tool;
– Sync by point;
• default mode. Options:
– no mode selected;
– DSA mode;
• request for confirmation before deleting all annotations and measurements;
• enable/disable the warnings of non-bilinear interpolation;
• show TSE values in annotations;
• enable/disable default synchronization of series image scrolling;
• enable/disable slices scaling and position synchronization for various projections;
• enable/disable display of the series list for the current study on the context menu.
The function is enabled by default.

2. Image arrangement tab. The following parameters are set up:

• Confirm series closure on the arrangement changing option. The option is en-
abled by default. Switches off/on the display of the dialog box for series deletion
confirmation when the user selects a grid with fewer view windows than there are
open series in the study. The option is exported to the file saving the current DI-
COM Viewer settings (see Section 16.9.1);
• default series arrangement;
• splitter priority;
• default image arrangement;
• the number of images scrolled per click;
• Automatic fill with series option. The option is disabled by default. It enables/dis-
ables automatic study series arrangement in the given grid;
• image sorting method.

These parameters can be set for a specific modality. To add a modality, click the ADD
button and enter the name of the modality in the dialog that appears. To change the
settings for a previously added modality, select it in the Settings for modality drop-down
list. To delete the selected modality click the REMOVE button.

3. Controllers tab. Sets up the actions associated with mouse actions. For details see
Section 16.7.10.

4. W/L settings tab. Sets up the default W/L values. If a value is not specified, the default
is 0.

5. W/L settings tab. The following parameters are set up:

• option Use recommended W/L for Series can be checked/unchecked;

• default W/L for DSA mode can be activated/deactivated;

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16.7.2 Set Up Study List Module

Select the StudyList module from Installed modules and click the Settings button. The fol-
lowing parameters are set up in the Study list config window:
• option Load local storage automatically can be checked/unchecked;

• option Ask to keep in storage autodownloaded series can be checked/unchecked;

• the period for which the data is loaded can be checked/unchecked;

• font options can be set up;

• option Allow to edit patient name and description can be checked/unchecked;

• option Warn about editing patient name and description can be checked/unchecked;

• option Download whole study by double click can be checked/unchecked;

• option Fixed thumbnail height can be checked/unchecked.

16.7.3 Set Up 3D Reconstruction Module

Select the 3D Reconstruction module from Installed modules and click the Settings button.
The window contains two tabs with the following parameters:
1. Render tab.

• Sets up the render device. Options:

– Auto;
– CPU (using the software facilities);
– OpenCL support;
– CUDA support.
– Metal support. Supported on macOS version 10.15 and greater.
The options available may vary depending on the configuration and equipment
settings.
Rendering devices based on CUDA are not supported by 32-bit operating
systems and macOS.

• Customize the cache memory limits for the selected imaging device.

By default, the imaging device is selected by the program automatically and is shown on
the drop-down list as the Auto option. The cache memory limits that can be changed are
displayed for this device. For each device on the drop-down list, the amount of memory
available for caching is displayed.
The fields for setting cache memory limits are provided with a restore recommended
value button . The restore recommended value button is displayed when the limit
value provided is different from the recommended value. To restore the recommended
value of a cache memory limit, click the button in the respective field.

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You cannot customize the cache memory limits for the CPU (software). The
cache memory limits for this device are calculated on the basis of the values
provided in the General tab (see Section 16.1).

2. Segmentation tab. The following parameters are set up:

• sets the default structure opacity;

• option Invert edit mask on MPR can be checked/unchecked;
• option Confirm on the structure removing activates the confirmation dialog box
when deleting a structure. The option is enabled by default;
• option Collapse new structure on creation determines whether the newly added
structure element on the segmentation panel list shall be collapsed or not. If the
option is enabled, the added structure is collapsed, if the option is disabled, it is
not. The function is enabled by default.
The Base volume option is always added in the expanded form, regardless
of the Collapse new structure on creation status.
A new structure element is added to the list on the segmentation panel when the
following actions are performed:
– a new structure is created;
– an existing structure or structure mask is copied;
– a surface is exported to a new structure;
– a series containing segmented structures is opened;
– data from an .spj or .autospj are loaded;
– data from DICOM RT are imported.

3. Project tab.

• Sets up the function of saving projects:

– Enables/disables the Save DICOM data of series option;
– Enables/disables the Enable autosaving option;
– Sets the autosave frequency on the Timeout dropdown list.
• Selects the mode in which the saved project is to be opened: 3D, MPR or Both.

4. Reconstruction tab.

• option Warn about varied slices distance can be checked/unchecked;

• option Warn about reducing quality because of reslicing can be checked/unchecked;
• sets up reconstruction by series with varying distances between slices. Options:
– Non uniform slice interpolation;
– Max uniform distance slice range.

5. UI tab. The following parameters are set up:

• Saving MPR view sizes. To change this parameter, checks/unchecks option Save
MPR view sizes. By default, it is unchecked;

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• MPR plane line thickness;

• MPR plane line colors;
• Disabling the display of the standard space orientation panel in the Volume re-
construction and 3D view windows of the MPR reconstruction tab. By default, it
is enabled. To disable the display of the panel, untick the Show a panel of stan-
dard projections in a 3D view box. The changed panel display settings are not
applied to the tabs and windows that had been opened before the changes were
introduced;
• selects in the list the action to be performed after CLUT is change if W/L is changed;
• Request for confirmation before deleting all measurements;
• Split brush cut and brash restore tools.

6. 3D controllers tab. Sets up the actions associated with mouse actions in the Volume
Reconstruction window. For details see Section 16.7.10.

7. MPR controllers tab. Sets up the actions associated with mouse actions in the MPR. For
details see Section 16.7.10.

16.7.4 Set Up Vessel Analysis Module

Select the Vessel analysis module from Modules and click the Settings button. The window
contains tab with the following parameters:

1. UI tab. The following parameters are set up:

• Enabling saving the window size in the Vessel analysis tab. By default, it is dis-
abled.
• Disabling the display of the standard space orientation panel in the 3D view win-
dow of the Vessel analysis and Coronary artery analysis tab.By default, it is en-
abled. To disable the display of the panel, untick the Show a panel of standard
projections in a 3D view box. The changed panel display settings are not applied
to the tabs and windows that had been opened before the changes were intro-
duced.
• Disabling the option Request a non-enhanced series to remove bones on window
opening. By default, it is enabled.

2. 3D controllers tab. Sets up the actions associated with mouse actions in the Volume
Reconstruction window. For details see Section 16.7.10.

3. MPR controllers tab. Sets up the actions associated with mouse actions in the MPR and
Vessel Analysis windows. For details see Section 16.7.10.

16.7.5 Set Up Network Support Module

Select the Network support module from Installed modules and click the SETTINGS button.
You can specify the maximum count of connections to a PACS Server.

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 16.7. MODULES

16.7.6 Set Up Local Storage Module

Select the Data storage module from Installed modules and click the SETTINGS button. The
window contains the following parameters:
1. the Automatic local storage cleaning option can be checked/unchecked;
2. cleaning interval can be set.

16.7.7 Set Up «DICOM CD/DVD Creator»

Select the DICOM CD/DVD creator module from the Installed modules and click the SET-
TINGS button. You can specify the following parameters:
• the «Add selected studies at opening DICOM CD/DVD creator» option can be
checked/unchecked;
• the «Add DICOMDIR file to created DICOM CD/DVD image before writing data» op-
tion can be checked/unchecked;
• the «Enable image buffering» option can be checked/unchecked.

16.7.8 Set Up Series fusion Module

Select the Series fusion module from the Installed modules and click the SETTINGS button.
The Controllers tab is used to customize the actions performed by the mouse.

16.7.9 Set Up PET Analysis Module

Select the PET Analysis module from Installed modules and click the SETTINGS button. You
can specify the following parameters:
The Common tab:
• Enable SUV mode automatically;
• MIP layer CLUT by default;
• window upper limit. The Max SUV value and Max window persent items are available;
• First layer modality by default for the PET+CT window;
• PET layer CLUT by default for the PET+CT window;
• CT layer opacity (%) by default for the PET+CT window;
• PET layer opacity (%) by default for the PET+CT window;
• option Ask before deleting all annotations and measurements can be checked/unchecked.
In the Controllers MIP tab you can associate tools with the mouse wheel and move opera-
tions for the MIP window, in the Controllers 2D tab you can do it for the CT and PET windows.
For details see Section 16.7.10.
The settings are applied the next time you open the PET Analysis window.
To restore default values, click the DEFAULTS button.

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16.7.10 Mouse Settings

In the Controllers tab of the Image viewer, 3D reconstruction, Vessel analysis and PET anal-
ysis modules’ customization window, the user may assign the operations performed by default
in the respective tabs to the mouse buttons, wheel and movements.
In the Mouse wheel operations section, you can set up the operations performed by de-
fault when the mouse wheel is rotated (with or without a modifier key).
To enable the selected operation, check the respective option in the Enabled column.
If required, choose a modifier key for the selected operation on the drop-down list in the
Modifier column.
In the Mouse keys operations section, you can set up the operations performed by default
when you press a certain mouse key (with or without a modifier key).
To assign the selected operation to a mouse key, select it on the drop-down menu in the
Pressed buttons column. If required, choose a modifier key for the selected operation on the
drop-down list in the Modifier column.
If the selected combination already exists, the identical lines are highlighted with red.
The operations assigned to the mouse keys and wheel are applied by default
only in the windows of the tab corresponding to the module being set up.
If you activate a tool on the DICOM Viewer toolbar with a mouse button, the operation
assigned to the button by default will be ignored. This operation will be performed by the
mouse button only after the tool is deactivated.

16.8 Set Up Hotkeys Module

In this section, you can specify hotkeys to perform different actions. To set up hotkeys:

1. Select the Options menu and the Settings... item.

2. Open the Hotkeys section. The window similar to the one shown in Fig. 16.5 will pop
up.

3. Select the target action in the table. If necessary, enter action name or hotkey in the
Filter field to filter the action list. The hotkeys specified for the selected action are dis-
played in the Key sequence column.

4. To modify or set hotkeys:

• change the value in the Key sequence field or

• click the RECORD button; next, press the key sequence you wish to assign on the
keyboard and to finish, click the Stop recording button.

The entered value will be immediately displayed in the Key sequence column of the
table.

5. To delete hotkeys, erase the value in the Key sequence field.

6. If the entered hotkeys are already used, a warning similar to the one shown in Fig. 16.6
will be displayed, and the value in the Key sequence column will be written in red. To
see which action corresponds to this hotkeys, click Show. Do not set the same hotkeys

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for the actions performed in one window. If the entered value cannot be set, a warning
similar to the one shown in Fig. 16.7 will be displayed.
7. To restore the original value of the hotkeys for the selected action, click the RESET
button.
8. To restore the original values of the hotkeys for all actions, click the RESET ALL button.
9. Click OK or APPLY to apply the changes or CANCEL to cancel the actions.
10. In the restart confirmation window, click YES to restart or NO to cancel the restart and
continue working.

Figure 16.5: Hotkeys

Figure 16.6: Warning about key sequence potential conflict

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Figure 16.7: Warning about invalid key sequence

The types of hotkeys are described in the following table:

Hotkey type Designation

Single key: any key of the alphanumeric keyboard Single key, e.g.: A or F5
or a functional key

Group of keys: two keys should be pressed Two single keys coupled by +, e.g.:
simultaneously. The first key is Ctrl key (or the Ctrl+S (or the Command+S key for
Command key for macOS), Alt key (or the Option macOS) or Shift+F5
key for macOS)or Shift, the second one is any key
of the alphanumeric keyboard or a functional key

A sequence of several keys of the alphanumeric Single keys or groups of keys,

keyboard or functional keys: keys should be separated by comma, e.g.: A,B,C
pressed one by one or Ctrl+F1,Ctrl+F2 (or the
Command+F1,Command+F2 key
for macOS)

16.9 Import and Export Settings

16.9.1 Export Settings
The export functionality allows you to save the current DICOM Viewer settings in a file. To
export settings:
1. Select the Options menu and the Export settings item. The save file dialog box will pop
up.
2. Select the location to save the settings file to and enter the file name.
3. Click Save to save the settings file or Cancel to cancel the actions.

16.9.2 Import Settings

The import functionality allows you to apply the settings specified earlier and saved in a file.
To import settings:
1. Select the Options menu and the Import settings item. The DICOM Viewer will request
confirmation for this action because all the current settings will be lost after the import.
Click Yes to continue or No to cancel the import.

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 16.9. IMPORT AND EXPORT SETTINGS

2. If you click Yes, the settings file selection dialog box will pop up. Select the needed file.

3. To import the settings, click Open. The DICOM Viewer will be restarted, and the settings
will be applied. To cancel the import, click Cancel.

16.9.3 Import CLUTs

The CLUTs import option provides an opportunity to use customized CLUTs (e.g. CLUTs cre-
ated by other users or CLUTs from previous DICOM Viewer versions).
CLUTs are saved in vt_config.xml file.
To import CLUTs, copy the vt_config.xml file to the Configs folder. The location of the
Configs folder depends on the operating system (see Section Service files).
For example, a user named Smith working on Windows will find the CLUTs for Inobitec
DICOM Viewer Pro 2.7.0 in the following folder:
C:\Users\Smith\AppData\Local \Inobitec \Inobitec DICOM Viewer Professional Edition 2.7.0\Con-
figs

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CHAPTER 17. DICOM TAG VIEWING

Chapter 17

DICOM Tag Viewing

17.1 DICOM Tags. General Information

A DICOM file presents data as a sequence of elements containing information about the image
(graph etc.), where the last element has the image (graph etc.) itself. Each element comprises
several parts, including:

• Tag — a unique element identifier comprised of a pair of values represented in the hex-
adecimal number system and determining the group number and the element number

• Data type — a line showing the data type abbreviation (two symbols)

• Data field length;

• Data — the information comprised in the element, including the image (graph etc.) itself

If the Data field contains information that cannot be represented in the form of a text (e.g.
an image or graph), then the respective column will read: Binary content. Hidden.
If the tag is standard, its name will be shown. If the tag is reserved by a certain modality
manufacturer or there is an error in its name, then the field will read: Unknown Tag & Data.
To learn about the data contained in this tag, you will need to study the documents for the
modality used in the study. The 7fe0,0010 (PixelData) tag contains an image, a graph or
some other visual data.
Examples of elements:

Element name Tag Type Length Data

0008,0020
StudyDate DA 8 20130107

1.3.12.2.1107.5.2.6.24186.
0020,000d
StudyInstanceUID UI 56 30000013011710501018700000060

0008,0060
Modality CS 2 MR

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Element name Tag Type Length Data

Unknown Tag & Data 0051,1009 LO 4 1.0
PixelData 7fe0,0010 OW 2 Binary content. Hidden.

17.2 DICOM Tag Viewer Window

There are four ways to view DICOM tags:
1. Select a series thumbnail on the series panel and click the Show image tags button
on the toolbar (see Section 1.4).
2. Right-click on a series thumbnail to call up the context menu and select the Show image
tags option.
3. Select the Show image tags option from the View tab of the main menu (see Section 1.1).
4. Open a study series in the Image viewer tab (see Section 2.31), right-click to call up the
context menu and select the Show image tags option.
ECG modality series (see Chapter 11) and series containing protocols (see
Chapter 18) are opened in the respective tabs. PDF documents are opened
in third-party software installed in the user’s OS. Series that do not conform
to the DICOM standard or series for which there are no special tabs to view
are opened in the DICOM tag viewer tab.
The DICOM Tag Viewer window is shown in Fig. 17.1.

Figure 17.1: DICOM Tag Viewer window

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17.2.1 Toolbar
The toolbar is placed in the upper part of the window (Fig. 17.2).

Figure 17.2: Toolbar

Tools:

The Copy button is used for copying the selected data to the clipboard.

The Detail button is used for showing the contents of the element in a separate
window.

The Expand all button shows the tag tree.

The Optimal view button shows only two levels of the tag tree.

The Collapse all button is used to collapse the tag tree.

The Zoom in button is used to enlarge the text size.

The Zoom out button is used to shrink the text size.

The Encoding drop-down menu allows for the selection of the character set used
for displaying data. By default, the character set provided for in the DICOM file is
used.

The Search button opens/closes the search bar at the bottom of the window.

The Switch to the previous image button shows the DICOM tags for the previous
image in the series.
The image indicator shows the current image number and the total number of
images in the series. The number is assigned to the image by the modality, and it
may be different from the sequence number of the image shown in the Image
Viewer window.
The Switch to the next image button shows the DICOM tags for the next image in
the series.

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 17.3. ANONYMIZE STUDIES AND SERIES

17.2.2 Tag Tree

The tag tree is placed under the toolbar. If several tags belong to the same group, the group
is unfolded and the tags are shown. Groups can be nested, one inside another. To unfold a
group, click + on its left; to collapse a group, click -. To unfold all the groups, click the Show
All button on the toolbar; to collapse all the groups, click Collapse All; to unfold only second
level groups, click the Best View button.
Tags cannot be edited. The data from the DICOM tag viewer tab can be copied to the
clipboard and then inserted in the report editor (see Chapter 18) or in any text editor. To copy
the value from the element field, select it with the left mouse button and click Copy on the
toolbar, or else choose Copy on the context menu.

17.2.3 Search
To open the search bar, click the Search button on the toolbar. The search bar will be displayed
at the bottom of the window. To close the search bar, click the cross on the right or the Search
button.
You can perform search by any data contained in the element. To perform search, enter
the text you need to find in the Search field. The elements with fully or partially matching
values will be highlighted in green; the first element found will be highlighted in orange. If no
matches are found, the text entered will turn red. The number of the element chosen and the
total quantity of the elements found is displayed on the right. To go to the next element found,
click the Next button; to go to the previous element, click the Previous button. To perform
case sensitive search, check the Match Case box. To highlight all the values found, check the
Highlight All box (it is checked by default).

17.3 Anonymize studies and series

Anonymization is possible only for the studies in the Local Storage or for those that are opened
from a folder or from a CD.
The DICOM Viewer 2.15 provides for an extended list of tags anonymized by default. If
the list of tags was edited by a user of DICOM Viewer 2.14 or inferior, the new tags will not
be added to the list of tags anonymized by default. The complete list of tags anonymized by
default will be restored after the user click the DEFAULTS button in the Anonymization dialog
box (Fig. 17.3) and performs the anonymization procedure. If required, you can edit the list of
tags anonymized by default (the procedure is described below).
The data stored in the following tags will be replaced with Anonymous value or deleted:

• (0010,0010) PatientName;

• (0010,0030) PatientBirthDate;

• (0010,0040) PatientSex;

• (0010,1010) PatientAge;

• (0008,0080) InstitutionName (institution or organization to which the identified individ-

ual is responsible or accountable);

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CHAPTER 17. DICOM TAG VIEWING

• (0008,0081) InstitutionAddress (mailing address of the institution or organization to

which the identified individual is responsible or accountable);

• (0008,0090) ReferringPhysicianName (name of the patient’s referring physician);

• (0008,1050) PerformingPhysicianName (name of the physician(s) administering the Se-

ries);

• (0008,1070) OperatorsName (name(s) of the operator(s) supporting the Series);

• (0008, 1010) StationName;

• (0018,1030) ProtocolName;

• (0008,1090) ManufacturerModelName.

The (0010,0020) PatientID (patient’s identificator) tag value will be replaced with a ran-
dom alphanumeric value.

To anonymize values stored in other tags, you must add these tags to the list (see below).

For the (0008,0018) SOPInstanceUID and (0020,000e) SeriesInstanceUID

tags, new values are generated by default when series are anonymized. If a
study is anonymized, the value of the tag (0020,000d) StudyInstanceUID is
additionally changed.
To anonymize studies:

1. Select one or more studies in the Local Storage, a local folder or a CD.

2. Select the Studies menu and Create anonymized copies of the selected studies... The
Anonymization dialog box (Fig. 17.3) pops up.

3. To add a tag to anonymize, type the group number to the Group field and type the
element number to the Element field and click the button (Fig. 17.3).

4. To delete a tag to anonymize, click the button.

5. By default, the data stored in tags is replaced by «Anonymous». To change the text value
of the tag, left-click on the respective field and enter the new value.

Warning! The format of the input data must comply with the DICOM
standard.

6. To disable tag anonymization without deleting the tag from the list, uncheck the box
against the chosen tag. By default, the boxes for all the tags added to the anonymization
list are checked.

7. To restore the default tag list, click the DEFAULTS button.

8. To Anonymize, click OK, to cancel click CANCEL.

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 17.3. ANONYMIZE STUDIES AND SERIES

Figure 17.3: Dialogue of anonymization

If other tags contain data that matches the data contained in anonymized tags, the warning
appears (Fig. 17.4).

Figure 17.4: Match data warning

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To view the tags containing the same data as the anonymized tags, click SHOW DETAILS....
To save the study without changing the tag data, click YES. To change the tag values, click
NO and add the selected tags to the anonymization list.
The tags with the data that matches the data contained in the anonymized tags are auto-
matically added to the Anonymization box (Figure 17.3). By default, the added tags are ticked.
To anonymize the tags, click OK; to cancel, click CANCEL.
The selected studies will be anonymized and saved to the Local Storage with the patient‘s
name Anonymous.
To anonymize the selected series:

1. Select study in the Local Storage, a local folder or a CD.

2. Select the series that you want to Anonymize. For details on how to work with series,
see Section 1.10.

3. Select the Studies menu and Create anonymized copy of series...

4. To add a tag to anonymize, type the group number to the Group field and type the
element number to the Element field and click the button (Fig. 17.3).

5. To delete a tag to anonymize, click the button.

6. By default, the data stored in tags is replaced by «Anonymous». To change the text value
of the tag, left-click on the respective field and enter the new value.

Warning! The format of the input data must comply with the DICOM
standard.

7. To disable tag anonymization without deleting the tag from the list, uncheck the box
against the chosen tag. By default, the boxes for all the tags added to the anonymization
list are checked.

8. To restore the default tag list, click the DEFAULTS button.

9. To Anonymize, click OK, to cancel click CANCEL.

For the (0008,0018) SOPInstanceUID and (0020,000e) SeriesInstanceUID

tags, new values are generated by default when series are anonymized.
The selected series will be anonymized, saved to the Local Storage and marked anonymized.
Make sure that no personal data are retained in customized tags and that
standard tags only have anonymized data.

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Chapter 18

Report Editor

Functionality is available in the Pro edition

The DICOM Viewer report editor provides an opportunity to create, edit and save medical
documents, such as reports, opinions, statements etc. The documents created in Inobitec
DICOM Viewer may be opened for reading and editing in the Inobitec Web DICOM Viewer
and vice versa.
The DICOM Viewer report editor allows the user to format text, create and edit tables,
insert images from the clipboard.
The created user reports are saved as special SR series in the local storage and may be
exported as PDF files or DICOM DOC series.

18.1 Editor Window

Functionality is available in the Pro edition

The editor window is shown in Fig. 18.1. The windows and tools for editing text in the report
editor and template editor are the same.
The DICOM Viewer provides the user an opportunity to change the borders of the editor
window. For that purpose, mouse over a border so that the cursor takes the shape of or

. Then move the border while holding the left mouse button. The new window size will
be saved in the program and restored when you launch the editor again.

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Figure 18.1: Editor window

18.1.1 Toolbar

Functionality is available in the Pro edition

The toolbar is placed in the upper part of the editor window (Fig. 18.1).
In the upper left-hand corner of the toolbar, you can see a field where the user enters the
name of the document.
The name must not contain:

• such symbols as: :, >, <, ?, *, |, ", \, /, +, %, !, @;

• a space in the beginning of the name;

• a space or a dot at the end of the name.

If this rule is ignored, an error message will pop up when you try to save the template or
export a report in a PDF file.

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 18.1. EDITOR WINDOW

In the upper part of the editor window you will see the following buttons:

The Export button in the report editor window opens the menu for exporting the
report in a PDF file or a DICOM DOC series (see Section 18.2.4).
The same button in the template editor window opens the dialog box for exporting
the report template in a file (see Section 18.3.3).
The Save as button in the report editor window creates a new SR series with
report (see Section 18.2.3).
The same button in the template editor window creates a new template (see
Section 18.3.5).
The SAVE button in the report editor window saves the report in the current study
as a new series. When you click the same button again, the changes are saved in
the current series (see Section 18.2.3).
The SAVE button in the template editor window saves the changes in the current
template (see Section 18.3.5).

The Undo button cancels the last change in the report/template editor.

The Redo button repeats the last cancelled action in the report/template editor.

18.1.2 Text Editing Tools

Functionality is available in the Pro edition

The editor toolbar contains tools for editing text. Text editing tools in the report and tem-
plate editor have the same functions.

• drop-down list of font families. It is a complete list of the font families available in the
program;

• drop-down list of font sizes. It is a list of the most popular font sizes. It also provides an
opportunity to enter the required font size manually;

• buttons for changing the display style of symbols and text, such as:

– Bold ;

– Italic ;

– Underline ;

– Strikethrough .

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The style is changed for the highlighted text or for the text being typed.

• the Font color button is used for changing the font color. The changes are applied
to the highlighted symbol or part of the text;

• the Highlight color button is used for changing the background color. The changes
are applied to the highlighted symbol or part of the text;

• the Bulleted list button creates a bulleted list. The following types of bullets are
available:

– Bulleted list (filled circle) used by default;

– Bulleted list (empty circle);
– Bulleted list (filled square).

• the Ordered list button creates a numbered list. The following numbering styles
are available:

– Ordered list (numbers) used by default;

– Ordered list (lower roman);
– Ordered list (upper roman);
– Ordered list (lower case);
– Ordered list (upper case).

• drop-down list of preset font styles (font size and style). It provides for the following
options:

– Default (font size: 11, style: -);

– Heading 1 (font size: 22, style: bold);
– Heading 2 (font size: 17, style: bold);
– Heading 3 (font size: 13, style: bold);
– Heading 4 (font size: 11, style: bold);
– Heading 5 (font size: 9, style: bold);
– Heading 6 (font size: 8, style: bold).

• the Insert table button is used for adding tables to the document. When the user
presses the button, a dialog box for setting table parameters (Fig. 18.2) pops up.

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 18.1. EDITOR WINDOW

Figure 18.2: Dialog box for setting parameters of a table

If the cursor is placed in the beginning of a line, the table will be inserted in the same
line. If the cursor occupies a different position in the line, the table will be inserted in
the next line. By default, all the columns of a table have the same width. To change the
width of the column, move one of its borders to the right or to the left. The position of
the left border of the first column cannot be changed. The height of the table rows is
changed automatically depending on the content of the cells.
The commands for modifying table cells can be found on the context menu. The follow-
ing options are available:

– merging cells. Select the cells you want to merge. For that purpose, place the
cursor in the first cell and drag it through the cells to be merged while holding the
left mouse button. Click the right mouse button and select the Merge cells option
on the context menu;
– splitting cells. Place the cursor in a cell you want to split or select a range of cells.
Click the right mouse button and select the Split cells option on the context menu.
You can only use this command to split merged cells;
– inserting rows. Place the cursor in a cell next to which you want to add a row or
select several rows. Click the right mouse button and select either the Insert rows
above or the Insert rows below option on the context menu. If only one cell was
selected, one row will be added. If several rows were selected, the same number
of rows will be added to the table;
– inserting columns. Place the cursor in a cell next to which you want to add a column
or select several columns. Click the right mouse button and select either the Insert
columns to the left or the Insert columns to the rihgt option on the context menu.
If only one cell was selected, one column will be added. If several columns were
selected, the same number of columns will be added to the table;
– deleting rows. Place the cursor in a cell of the row you want to delete or select
several rows. Click the right mouse button and select the Removee rows option on
the context menu. If only one cell was selected, one row will be deleted. If several
rows were selected, all these rows will be deleted;
– deleting columns. Place the cursor in a cell of the column you want to delete
or select several columns. Click the right mouse button and select the Remove

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columns option on the context menu. If only one cell was selected, the column
with this cell will be deleted. If several columns were selected, all these columns
will be deleted;
– deleting a table. Place the cursor in a cell of the table. Click the right mouse button
and select the Remove table option on the context menu.

• the Align button is used for aligning text of the selected paragraph. The following op-
tions are available:

– Left align used by default;

– Centre align ;

– Right align ;

– Justify .

• the Line spacing button is used for setting the intervals between the lines of the

current paragraph, as well as the intervals between paragraphs. If you click the
button, a dialog box will pop up (see Fig. 18.3).

Figure 18.3: Dialog box for setting line spacing

The line spacing drop-down list provides for the following options:

– Single used by default;

– Proportional. This interval is calculated as the font height multiplied by the number
provided in the Value field. The range of values is from 1.0 to 10.0;
– Fixed. The exact line height value is provided in millimeters. The range of values
is from 0.5 to 120.0;

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 18.2. WORKING WITH REPORTS

– Minimum. The minimum line height value is provided in millimeters. The range of
values is from 0.5 to 120.0;

– Leading. An additional interval value is provided in millimeters. The range of values

is from 0.5 to 120.0.

In the Paragraph spacing (mm) section the user sets the intervals before and after the
current paragraph. The range of values is from 0.0 to 120.0.

18.2 Working with Reports

Functionality is available in the Pro edition

The DICOM Viewer allows the user to create empty reports (see Section 18.2.1) and reports
based on templates (see Section 18.2.2).

18.2.1 Creating an Empty Report

Functionality is available in the Pro edition

There are three ways to create a new report in the study list tab:

1. Select a study on the study panel. Select a study series on the series panel. Click the
arrow on the right-hand side of the Report button on the toolbar and select the
Empty report option on the drop-down menu (see Fig. 18.4).

2. Right-click on the series thumbnail and select Report->Empty report on the context
menu.

3. Select a series thumbnail on the series panel. On the main menu, select View->Report-
>Empty report.

To create a new report in the Image viewer tab, select a series on the series panel. Then
click the arrow on the right-hand side of the Report button on the toolbar and select the
Empty report option on the drop-down menu (see Fig. 18.4).

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CHAPTER 18. REPORT EDITOR

Figure 18.4: Drop-down menu of the Report button

An empty report named Report is created. The heading for the report editor window is
generated with the <Patient ID>,<Patient Name> values for the current study. You will find the
information on creating reports on the basis of templates in Section 18.2.2.

18.2.2 Creating a Report Based on a Template

Functionality is available in the Pro edition

To create a report on the basis of a template, select a series thumbnail and click the arrow
on the right-hand side of the Report button on the toolbar. On the drop-down menu that
pops up (Fig. 18.4), select the required template from the list. An editor window for reports
based on templates will be displayed on the screen. For details on templates (their creation,
editing, saving, and export) see Section 18.3.
To select a template that will be used by default when a report is created, click the arrow
on the right-hand side of the Report button on the toolbar. On the drop-down menu,
select Settings.

Figure 18.5: Dialog box for selecting the default template

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 18.2. WORKING WITH REPORTS

In the dialog box that pops up (Fig. 18.5), select the template to be used by default. Click
OK to save or CANCEL to cancel.
Clicking on the left-hand side of the Report button afterwards will create a report
based on the template that was selected by default.

18.2.3 Saving a Report

Functionality is available in the Pro edition

If there are any unsaved changes in the report text or name, the heading of the report
editor window will have an asterisk «*» symbol.
To save a report, click the SAVE button on the editor toolbar. The report will be saved
as a special SR series in the current study. The name and description of the series corresponds
to the name of the report. If you click the SAVE button again, the changes will be saved
in the current SR series. A thumbnail for a series with a report is shown in Fig. 18.6.

Figure 18.6: Thumbnail for a series with a report

To create a new SR series with a report click the Save as button on the editor toolbar.
In the dialog box that pops up, enter the name of the new report. By default, the name of the
current report or a transformed name of the current report (if the current name is inadmissible)
is shown in the dialog box. The work will be continued in the new SR-series report.
The name of the report is considered inadmissible if it is the same as the name of another
report or if it contains inadmissible symbols (see Section 18.1.1). When the report is saved, the
program automatically replaces inadmissible symbols in the file name with «_»; spaces in the
beginning and dots in the end of the name are deleted. If there is a name conflict, a number
in parentheses will be added to the name.

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CHAPTER 18. REPORT EDITOR

18.2.4 Exporting a Report

Functionality is available in the Pro edition

The DICOM Viewer provides an opportunity to export a report in a PDF file or a DICOM
DOC series.
To export a report in a PDF file, click the Export button on the editor toolbar and
select the Export to PDF file... option. In the dialog box that pops up, select the place where
you want to save the PDF file and enter the name of the file. The name of the report is used
as the file name by default. Click Save to save the PDF file or Cancel to cancel.
If the file name contains inadmissible symbols, an error message will pop up (see Sec-
tion 18.1.1).

To export a report in a DICOM DOC series, click the Export button on the editor
toolbar and select the Export to DICOM DOC series option. The name of the report is con-
sidered inadmissible if it is the same as the name of another report. If there is a name conflict,
a number in parentheses will be added to the name. A new DOC series is created as a result
of export. This series is saved in the current study.

18.2.5 Viewing and Editing a Report

Functionality is available in the Pro edition

There are several ways to open a created report for viewing or editing:

1. Double-click with the left mouse button on an SR series thumbnail on the series panel.

2. Select an SR series thumbnail and click the Report button on the toolbar.

3. Drag an SR series thumbnail to the study list window.

4. Drag an SR series thumbnail to the flat image viewer window.

You can edit the report name and contents. Save the edited report (for details see Sec-
tion 18.2.3).

18.3 Report Template

Functionality is available in the Pro edition

The DICOM Viewer provides an opportunity to create report templates to simplify work
with reports.

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 18.3. REPORT TEMPLATE

18.3.1 Creating an Empty Template

Functionality is available in the Pro edition

To create a new report template, on the main menu, select File->Report template->Create-
>Empty template. By default, an empty report template named Untitled is created. The Tem-
plate Editor window differs from the Report Editor window only by the fact that the icon
is displayed in the upper left corner, by which you can visually distinguish the Template Editor
from the Report Editor.

Figure 18.7: Editing the report template

In a template, you can provide for DICOM tags for substitution of values taken from series.
Code names of the tags provided by the user are to be separated by commas, no spaces,
and enclosed in triple parentheses. In Fig. 18.7, you can see tags for substitution of the patient
data and the date of the study.
When a report is created on the basis of a template, tags in triple parentheses are replaced
with the respective tag values from the selected series.

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CHAPTER 18. REPORT EDITOR

18.3.2 Loading a Report Template from a File

Functionality is available in the Pro edition

To load a report template from a file, on the main menu, select File->Report template-
>Create->Load from file... In the dialog box, select the template file and click Open.

18.3.3 Exporting a Report Template

Functionality is available in the Pro edition

The DICOM Viewer provides an opportunity to export a report template to a file.

To export a report template to a file, click the Export to file button on the editor
toolbar. In the dialog box that pops up, select the place to save the file and enter the file
name. By default, the name of the report template is used as the file name. Click Save to save
the report template in a file or Cancel to cancel.

18.3.4 Viewing and Editing a Report Template

Functionality is available in the Pro edition

Report templates can be edited only in the DICOM Viewer report editor. If
you use third-party software for this purpose, it may result in impossibility to
read the file.
To edit a report template, on the main menu, select File->Report template->Edit and choose
the name of the template. The selected report template will be opened in the template editor
window. Edit the name and the contents of the template. Save the edited report template.

18.3.5 Saving a Report Template

Functionality is available in the Pro edition

If there are any unsaved changes in the template text or name, the heading of the template
editor window will have an asterisk * symbol.
To save the report template, click the SAVE button on the editor toolbar. The name
of a report template is considered inadmissible if it is the same as the name of another tem-
plate or if it contains inadmissible symbols (see Section 18.1.1). When a template is saved, the
program automatically replaces inadmissible symbols in the file name with «_»; spaces in the

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 18.3. REPORT TEMPLATE

beginning and dots in the end of the name are deleted. If there is a name conflict, a number
in parentheses will be added to the name.
A report template is saved as a file in a separate ReportTemplates directory in the local
storage and set as the current in the template editor window.
If you click the SAVE button again, the changes will be saved in the current template.

To save a template with a new name, click the Save as button on the editor toolbar.
In the dialog box that pops up, print the name of the new report template. By default, the
name of the current report template or a transformed name of the current report template (if
the current name is inadmissible) is shown in the dialog box. Click OK to save or CANCEL to
cancel.
The new report template will be added to the Report button drop-down menu and to
the Edit and Remove items of the list of templates on the main menu File->Report template.

18.3.6 Deleting a Report Template

Functionality is available in the Pro edition

To delete a template, on the main menu, select File->Report template->Remove, and

choose a template from the list. In the dialog box that pops up, click REMOVE to delete
or CANCEL to cancel.
When a template is deleted, the respective file is deleted from the ReportTemplates folder
in the local storage. At the same time, the report template is deleted from all the menus.

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CHAPTER 19. PRINT IMAGES

Chapter 19

Print Images

The DICOM Viewer allows you to print images on paper or film using DICOM printers.
You must add images to the print list, then open the list in the preview window and print
the images.

19.1 Working with Print List

To print images, you should add them to the print list first. You can do this in the following
windows:

• View Flat Images window;

• Multiplanar Reconstruction window;

• Volume Reconstruction window;

• Planning of Pedicle Screw Installation window;

• Coronary Artery analysis window;

• PET Analysis window;

• Series Fusion window.

Depending on the way the image is captured, you can change the window level and width
in the print preview window (in this case, the labels on the screen are not captured) or cannot
change the window level and width (in this case the image is captured with all the labels and
annotations). For details, see the next Sections.
If the Add to print list button is inactive, click the left button on the header of the window
with the image to be printed or removed.
The print list is saved until the program is closed.

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 19.1. WORKING WITH PRINT LIST

19.1.1 Add/Delete Images in View Flat Images and Fusion windows

To add the current image to the print list, click on the Add to print list button. The button

will look as follows: . When browsing images, the button will look like this if the

current image is not on the print list, and like this if it is. If there are several image views
opened in the tab, note which view window is active (the title and frame of the active window
are highlighted in blue).
To remove the current image from the print list, click on the Add to print list button that
should look like this: . The image will be removed, and the button will change to .
Also, you can remove images in the Preview window (see Section 19.2).
In the View Flat Images and Fusion windows, there are two image capturing modes for
printing:
• View screenshot: the entire image, including the labels and annotations, is captured.
There is no capability to change the window width and level in the Preview window.

• Image capture: only the image of tissues is captured. There is a capability to change
the window width and level in the Preview window.

When you click on the Add to print list button, the previously selected capture mode

is used. To switch the capture mode, click the arrow on the right of the Add to Print List
button and select the target mode. The selected mode is marked with a flag and saved as the
default capture mode for the View Flat Images and Series Fusion windows.
If the image was captured in the Series Fusion window, then changing the window width
and level in the Preview Window is possible only for the first layer.
A filter applied to an image is taken into account when the image is added to the print list
(see Section 2.6).
An image to which a filter has been applied is not original, and the
measurement results may be inaccurate.

19.1.2 Add Images in Multiplanar Reconstruction and Volume Reconstruc-

tion windows
To add the current image to the print list, click on the Add to print list button.
In the Multiplanar Reconstruction and Volume Reconstruction windows, there are three
image capturing modes for printing:

• View screenshot: the entire image, including the labels and annotations, is captured.
There is no capability to change the window width and level in the Preview window.

• Image screenshot: only the image of tissues is captured. There is no capability to

change the window width and level in the Preview window.

• Entire image: only the image of tissues is captured. There is a capability to change
the window width and level in the Preview window (except the images captured in the
Volume Reconstruction window).

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When you click on the Add to print list button, the previously selected capture mode

is used. To switch the capture mode, click the arrow on the right of the Add to Print List
button and select the target mode. The selected mode is marked with a flag and saved as the
default capture mode for the Multiplanar Reconstruction, Volume Reconstruction windows.
If the fused image was captured in the Entire image Mode in the Multiplanar Reconstruc-
tion Window, then changing the window width and level in the Preview Window is possible
only for the first layer.
Deletion of the images captured in these modes is available in the Preview window (see
Section 19.2.3).
A filter applied to an image is taken into account when the image is added to the print list
(see Section 2.6).
An image to which a filter has been applied is not original, and the
measurement results may be inaccurate.

19.1.3 Add Series and Clear Print List

To add an entire series to the print list, click on the arrow on the right side of the Add to print
list button and select the Add entire series. Images will be added with default mode menu
item. This functionality is available only for the View Flat Images and Fusion windows.
When a complete series is added to the print list, the filters applied are ignored.
To clear the print list, click on the arrow on the right side of the Add to print list button and
select the Clear print list item.

19.1.4 Add Images from Different Studies

If the print list is not empty, and you are trying to add an image from another study, the DICOM
Viewer will return a warning You are trying to add image from different study.
To add the image, click YES. To clear the print list and add the current image, click REWRITE.
To cancel the addition and leave the current print list as it is, click NO.

19.2 Edit print list in Preview window

19.2.1 Preview
The Preview windows are intended to control the printing and final editing of the print list. The
Preview window is used to view printing on paper and save images to a pdf file, the DICOM
Preview is used for printing on film. To open the target window, select the File menu and the
Preview item or the DICOM Preview item. The settings made in one window do not affect the
settings in the other one except deleting images. The print list is common for both windows,
hence, the images deleted in one of the windows are deleted from the print list, and they
disappear in the other window.
The DICOM Preview tab is shown in Fig. 19.1.

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 19.2. EDIT PRINT LIST IN PREVIEW WINDOW

Figure 19.1: DICOM preview window

The toolbar is located at the top (Fig. 19.2), and the bottom part shows what the printed
images will look like (preview page).

Figure 19.2: Toolbar

The toolbar contains the following elements:

The Update button refreshes the preview page after the print list
has been changed
The Fit width button adjusts the preview page size to the screen
width

The Fit page button adjusts the preview page size to the tab size

The Page scale field. The scale is entered from the keyboard
manually or selected from the dropdown menu. To open the
dropdown menu, click on the arrow on the right side of the
panel
The Zoom in button zooms in the page. The current scale is
displayed in the Page scale field

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The Zoom out button zooms out the page. The current scale is
displayed in the Page scale field

The Portrait button sets the portrait layout for the page

The Landscape button sets the landscape layout for the page

The First page button is used to jump to the first page if the
images do not fit into a single page
The Previous page button is used to jump to the previous page if
the images do not fit into a single page
Page input field. It shows the current page and the total number
of pages. To go to the page you need, print its number and press
the Enter key on the keyboard
The Next page button is used to jump to the next page if the
images do not fit into a single page
The Last page button is used to jump to the Last page if the
images do not fit into a single page
Page template drop-down list. It allows to select a predefined
page template (see Section 19.2.2)
The Edit page template button opens the Page Template
Settings dialog (see Section 19.2.2)
The Resolution (DPI) drop-down list (only for the Preview
window). The list allows to set print resolution (clarity)
The Printer dropdown menu (only for the DICOM Preview
window). It specifies the DICOM printer

The Zoom tool allows to zoom selected images

The Pan tool allows to shift selected images inside cells

The Reset transformation tool allows to reset all the

transformations made using the Zoom and Pan tools
The Adjust W/L tool allows to change the window width and
level
The Arrow tool allows to make graphic labels such as arrows.
For details on how to do it see Section 2.33
The Pencil tool allows to build freeform contours. For details on
how to do, it see Section 2.33

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The Text tool allows to make text labels. For details on how to
do, it see Section 2.33
The Ellipse tool allows to make graphic labels such as an ellipse.
For details, on how to do it see Section 2.33
The Rectangle tool allows to make graphic labels such as an
rectangle. For details, on how to do it see Section 2.33
The Polygon tool allows to make graphic labels such as a
polygon. For details, on how to do it see Section 2.33
The Remove all annotations tool removes all annotations from
the image. For details, on how to do it see Section 2.19.12
The Show labels tool allows to show the information about an
image. For details, on how to do it see Section 19.2.4
The Show reference image tool allows to display a reference
image. For details, on how to do it see Section 19.2.5
The Remove selected images button allows to remove selected
images from the print list (see Section 19.2.3)
The Page setup (only for the Preview window) opens the print
settings dialog

The Print button opens the print dialog

The Clear print list command removes all the images from the
print list. To use it, click the arrow on the right side of the Print
button and select the Clear print list item
The Export to PDF tool (only for the Preview window) saves
images to a pdf file

19.2.2 Set Up Page Templates

The Page templates tool allows you to arrange images in arbitrary order. After the program
has been installed, the following templates will be available:
• one image on the screen;
• two images, one on top of the other;
• 2x2 grid;
• 3x2 grid.

To open the page template editing dialog, click the Edit page template button. The
dialog box for the print preview window is shown in Fig. 19.3. For the DICOM preview tab, in

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the dialog box, instead of the Spacing parameter you will see a drop-down menu for choosing
the film size.

Figure 19.3: Page template settings dialog

Select the desired template from the drop-down list. To add a new template, click the
CREATE TEMPLATE button, to delete a template, click the DELETE button.

Attention! Deleting a template cannot be undone.

To change a template name, enter a new name in the Template Name field.
For the Preview tab set the space between images in the Spacing (mm) field.
For the DICOM preview tab, choose the film size from the “Film size” drop-down menu.
The default value is Chosen film size for printer. If this value is chosen, the size of the film will
be as set for your printer. The DICOM printer settings are described in Section 19.3.2. If you
choose a different value for the printing template, the size provided for by the printer settings
will be ignored.
On the left-hand side of the window you see the arrangement of images on the page. To
divide any cell into any number of lines and columns, left-click on that cell to select it and
enter the required number of lines and columns in the left and the right fields indicated by the
arrows in Fig. 19.3. Then click SPLIT.
If the column and/or row count is greater than 1, you can merge an arbitrary number of
cells. The merged cells must form a rectangle. For example, set the Row count to 3 and the

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Column count to 4. Next, select cells 7, 8, 11, 12. To do it, move the cursor from cell 7 to cell 12,
holding the left mouse button. Next, click MERGE. The four selected cells will be merged.
To split any cell into an arbitrary number of rows and columns, select this cell, enter values
in the rows and columns fields and click the SPLIT button. The cells made by splitting can
only be merged with each other.
The cells created in such a way can only be merged with other cells from the same group.
To add the header and/or the footer, proceed as follows:

1. Check the Header box to add the header and the Footer box to add the footer. The
header and the footer will be shown in the scheme representing the cell arrangement.

2. Specify the header/footer height in points.

3. Choose an image for the header/footer. To do that, click the BROWSE button and choose
a file with jpg, jpeg, jpe or png extension in the dialog box that pops up.

4. To use this header/footer for all the templates without a header/footer (including the new
templates by default), click the Set this header as default or Set this footer as

default button in the dialog box. Then click YES to apply or NO to cancel.

To save the changes, click OK or APPLY, to cancel, click CANCEL.

19.2.3 Cells
If the page template contains several cells, then to apply the Zoom, Pan, Adjust W/L tools
to several images on one page or to delete an image (images), you need to select the corre-
sponding cells. To select, click the left mouse button on the cell. To remove a selection, click
on the image again. To select multiple cells:

• To select multiple cells that are contiguous (next to each other): click on the first cell and
click on the last one, holding the Shift key on the keyboard.

• To select multiple cells that are anywhere on the page: click the left mouse button on
each one, holding the Ctrl key (or the Command key for macOS) on the keyboard.

• To remove a selection, click on the any selected cell again.

Warning! If any of the graphic label tools or one of the «Zoom», «Pan»,
«Adjust W/L» tools is active, selection and removing of the selection are not
available.
To remove the images in the selected cells click the Remove selected images button.
To swap images in cells, drag an image to the target cell, holding the left mouse button.
The images will be swapped.

19.2.4 Print Labels

If an image is captured without labels, you can add them in the Preview Window. To do it, click
the Show labels button. The tags that should be displayed are marked with flags. To

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display or hide a label, click the arrow on the right side on the Show labels button and
select the target item.
To set the font size, select the Show annotation text size... item in the button menu.
To select the DICOM tags that should be displayed in the left-hand bottom corner, select
the Set visible tags... item in the button menu and in the dialog that appears mark the target
tags with flags.
If one or more cells are selected, the settings will be applied only to these cells.

19.2.5 Reference image

The DICOM Viewer provides an opportunity to add reference images to the print list. You can
ascribe the same reference image to all the images on the list, or a different image to each of
the images on the list. To ascribe several reference images to each study added to the print
list, you can create a separate list of reference images.
To add a reference image:

1. Choose an image from the same study that has been added to the print list. Click the
arrow on the right side of the Add to print list button and select the Add as
reference image item. This image will by default be ascribed to all the images from the
same study included in the print list.

2. If you need to add a new reference image to the list or replace it with a different one,
repeat the previous step. You will see a notification that a reference image has already
been added. To add another reference image to the list, click the YES button; to replace
the previous reference image, click the REWRITE buton, to cancel, click the NO button.

3. Open the Preview or DICOM Preview window. If the Show reference image tool is
inactive, activate it with the left mouse button. A reduced reference image is displayed
in the corner of each image. If there is more than one image on the list of reference
images, the first image added to the list will be displayed.

4. To adjust the display of the reference image, click the arrow on the right side of the
Show reference image button and select the Reference image settings... item.
You can set up the following properties:

• image alignment;
• dimention ration;
• project line width (mm).

5. To replace the reference image attributed to a separate image, highlight it and click the
arrow on the right side of the Show Reference Image button, then click the Select
Reference Image... button. Choose the image you need in the dialog box and click
CHOOSE. If no image has been selected, the reference image will be changed for all
the images on the print list. If there are images from different studies on the print list, the
reference image can be changed only for the images selected. The Select Reference
Image... function is also available in the right-click menu.

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6. To delete a reference image from the list, click the arrow on the right side of the Show
Reference Image button, then click Select Reference Image... item. Choose the
image you need in the dialog box and click the DELETE button.

7. To hide/show a reference image, click the Show Reference Image button. If there
are some images selected, the action will be performed only for them.

If there are images from different studies on the print list, reference images will be ascribed
to them separately.

19.3 Print Images on Film

19.3.1 Set Up DICOM Printers
To set up the DICOM printing parameters, select the Network menu and the DICOM printer
setup... item. The window shown in Fig. 19.4 will be displayed.

Figure 19.4: DICOM printing settings window

To add a DICOM printer to the list:

1. Click the Add printer button on the toolbar. The printer setup dialog box (Fig. 19.5)
will be displayed.

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2. Enter a user-defined printer name into the Name field.

3. In the SCU AE Title field, enter the name of the client allowed to access the printer (this
parameter is defined in the printer settings).

4. In the SCP AE Title field, enter the printer name (this parameter is defined in the printer
settings).

5. Enter the printer network address in the Host field.

6. Enter the printer port in the Port field.

7. Check the Default box if the printer should be used by default.

8. Click OK to apply the changes or CANCEL to cancel them. To save the information
without closing the window, click APPLY.

Figure 19.5: DICOM printer setup dialog box

All the added printers will appear on the printer list. The default printer can be assigned
directly from the list by checking the box next to the printer.
To delete a printer from the list, select it and click the Remove printer button. Click
YES in the confirmation dialog to delete the printer or NO to cancel the deletion.
To edit the printer settings, select the printer and click the Edit printer button.

To check whether a printer is available, select it and click the Info printer button. If
the printer is available, the printer list will display the Online status for the printer. If not, the
Offline status will be displayed. If the status has not been checked, its value will be Unknown.

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19.3.2 Set Up DICOM Printing Parameters

To set up the DICOM printing parameters, select the Network menu and the DICOM Printer
setup... item. The window shown in Fig. 19.4 will pop up.
The settings must be in strict compliance with the specification for the
DICOM printer.
Set the required parameters on the printing setup panel:

1. Set the film source (Unit or Processor).

2. Set the film cutting.

3. Set the magnification type. If you need to print the images with the original resolution,
select None. If you need to fit the images to the film size, select one of the magnification
types (Bilinear, Cubic or Replicated). In this case, the printer will change the image
resolution according to the selected algorithm to maximize the image size on the page
and retain its proportions.

4. Select the resolution to print the images (Standard or High). Set the print quality in DPI
(dots per inch) for the options Standard and High.

5. Choose the film size from the Film size drop-down menu.

6. Choose the media type from the Medium drop-down menu.

7. Since version 1.11, you can not deactivate the Print as one image option.

8. If necessary, enable the printing of labels.

9. For color printing check the Color print box.

You can also specify the film size in the tab for setting the page templates. If the Chosen
film size for printer parameter has been chosen, the size of the film will be as set for your
printer. Otherwise, the size of the page template will be used (see Section 19.2.2).

19.3.3 Setting Up the Default DICOM Print Parameters

Certain makes of DICOM printers may not support some print parameters described in the
DICOM standard. If a parameter passed to the printer is not supported, an attempt to print
may fail. To prevent such errors, the DICOM Viewer provides for an opportunity not to specify
certain parameters and not to pass them to the DICOM printer.
To set up the default DICOM printing parameters, select the Network menu and the DICOM
Printer setup... item.
In the DICOM Print dialog box (Fig. 19.6), the user may choose Default values for the
following parameters:

• Film Destination;

• Trim;

• Magnification type;

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• Medium.

A Default value means that the value has not been specified and is to be determined by
the DICOM printer.
The values for the Film size and Resolution (dpi) parameters must be chosen from the
drop-down lists.

Figure 19.6: DICOM printing settings by default

19.3.4 Print

You can print images on a DICOM printer from the DICOM preview window (see Section 19.2).
To open it select the File menu and the DICOM Preview item. To print images on a DICOM
printer, click the DICOM print button on the toolbar. The window shown in Fig. 19.7 will
be displayed.

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Figure 19.7: DICOM print

The parameters in the window correspond to the default parameters specified during the
printing setup. Change these parameters if necessary and click the PRINT button to initiate
the printing or CANCEL to cancel.
If the printer is not available the message like Pinter «PrinterName» is not available will
be displayed.

19.4 Print Images on Paper

For this purpose, a printer for printing on paper should be connected to your computer and
set up. The DICOM Viewer does not have the functionality to set up such a printer.
Printing on paper is possible from the preview window (see Section 19.2). To open it, select
the File menu and the Preview item. The Preview tab will be displayed.
The preview window is similar to the DICOM printer preview window, except the Print
setup button on the toolbar opening the printing system settings. Printing is carried out
by the OS facilities. If necessary, consult the printer manual and the OS help reference.
To enable/disable printing annotations, click the Show labels button on the toolbar.
To set the displayed annotation parameters, press the arrow on the right-hand side of the
Show labels button (for details see Section 2.27).

19.5 Printing Pages Export

The DICOM Viewer provides an opportunity to export pages for printing to the default DICOM
server or to the local storage. The default DICOM server settings have been described in
Section 13.2. The image is exported in compliance with the current print settings.

Attention! The red frame shows the images to be exported .

Export to the local storage is performed regardless of whether or not the images have been
successfully uploaded to the DICOM server. Each time the same set of pages is exported, a
new series is created in the local storage.
To export the current page, click the Export page to default server button. To export
all the pages containing images for printing, click the arrow on the right side of the Export page
to default server button and choose the Export all pages item.

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Chapter 20

Integration

20.1 Launch from the Command Line

Attention! On macOS, command line parameters are not supported.

If the DICOM Viewer has already been launched on the computer, the command line
parameters will be sent to the program that has been launched. The program will not be
launched again (see Launch multiple instances of the program).
Launching the program from the command line allows you to set specific parameters for
the current session of the program, change the settings and get help information about the
command line options. To launch the DICOM Viewer use the following syntax on the com-
mand line:
[<path_to_the_program>]< executable_program> [ --help] | [--study-folder <path> [--open-
series-images | --open-series-mpr | --open-series-volume | --open-series-endoscopy [--series-
uid <uid> | --series-index <index>]]] | [--pacs-aetitle <aetitle> [--patient-id <patientID>] [--study-
uid <studyUID>] [--series-index <seriesIndex> | --series-uid <seriesUID>] [--open-series-images]
] | [--aet <aet>] | [--import-settings <path> [--use-imported-listener-aetitle | --aet <aet>] [--update-
scu-aetitle]] | [--export-settings <path>]

--help: display the help information about the command line options, exit the program.

--study-folder <path>: display the study (studies) contained in the specified folder. The
following startup parameters apply:

--patient-id <patientID>: show the study with the specified patientID. Parameter
has higher priority than --study-uid
--open-series-images: display the first series in the flat image view window
--open-series-mpr: display the first series in the multiplanar reconstruction window
--open-series-volume: display the first series in the volume reconstruction window
--open-series-endoscopyPRO : display the first series in the virtual endoscopy win-
dow
Any of these parameters can be used with the following parameters:

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--study-uid "<studyUID 1> \…\<studyUID N>": open the first series from each
of the selected studies on the list with the respective studyUID
--series-uid "<seriesUID 1> \…\<seriesUID N>": open series from the list with
the respective seriesUID
--series-index "<seriesIndex 1> \…\<seriesIndex N>": open series from the list
with the respective seriesIndex. The seriesIndex parameter numeration starts
with zero and depends on the current type of sorting series in the study

--pacs-aetitle <aetitle>: attempt to open study list from PACSServer which AE Title matches
the specified AE Title. For connection, the parameters provided in the connection set-
tings for the particular server are used (see Section 13.2). The following options can be
used with this option in different combinations:

--patient-id <patientID>: show the study with the specified patientID. Parameter
has higher priority than --study-uid
--study-uid "<studyUID 1> \…\<studyUID N>": on the list of studies, search for the
studies with the respective studyUID
--series-uid "<seriesUID 1> \…\<seriesUID N>": for the selected studies, choose
the series with the respective seriesUID
--series-index "<seriesIndex 1> \…\<seriesIndex N>": for the selected studies, choose
the series with the respective seriesIndex. The seriesIndex parameter numeration
starts with zero and depends on the current type of sorting series in the study
--open-series-images: display the selected series in the flat image view window. If
a series is not selected, the first one of the first study is used

The list of parameters’ values is provided in one line with «\» separator. The list of study-uid
and series-uid parameters is composed as follows: the first parameter value from the study-
uid list is matched by the first parameter value from the series-uid list, the second parameter
value from the study-uid list is matched by the second parameter value from the series-uid
list, etc. If one of the lists contains fewer values than the other one, empty values are added.
Empty values can only be provided in the beginning and in the middle of the list.
Attention! The list of parameter values must not be ended with the «\»
separator.
The same correlation exists between study-uid and series-index parameters. The values
from the series-uid list have a higher priority than the values from the series-index list. If
the value of the series-uid parameter is not empty, the respective value of the series-index
parameter is ignored. Below, you can see an example of transmission of study-uid, series-uid
and series-index parameters’ lists to a console command:
C:\Users\user\DICOMViewerPro2.16.0\viewer.exe --study-folder D:\dicom_data --study-uid
"\<studyUID 2> \<studyUID 3> \<studyUID 4>"--series-uid "<seriesUID 1> \\<seriesUID 3>"--series-
index "<seriesIndex 1> \<seriesIndex 2>"

On Linux, you must use «\\» instead of «\».

In this case, the above example will have the form of:

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C:\Users\user\DICOMViewerPro2.16.0\viewer.exe --study-folder D:\dicom_data --study-uid

"\\<studyUID 2>\\<studyUID 3>\\<studyUID 4>"--series-uid "<seriesUID 1>\\\\<seriesUID 3>"--
series-index "<seriesIndex 1>\\<seriesIndex 2>"

In this example, four pairs of series-uid and/or series-index parameters’ values identifying
series are transmitted. They are matched by study-uid parameters’ values. Let’s consider
each pair of values from the example.
study_uid = "", series_uid = <seriesUID 1>
study_uid = <studyUID 2>, series_index = <seriesIndex 2>
study_uid = <studyUID 3>, series_uid = <seriesUID 3>
study_uid = <studyUID 4>, series_index = 0
If the series-uid and/or series-index index parameter value is empty (the fourth pair of
values in the example), the first study series is chosen (series_index = 0). ). If a series from
the study is selected by the value of the series-index parameter, the current type of sorting
series in the study is taken into account.
If an empty study-uid value is transmitted, then:

• with commands for opening series from the catalogue:

– the value is ignored if the respective series-uid value is not empty. Search for
studies on the list is performed by the series-uid;
– if the respective study-uid is not provided, the series-uid for the first study found
on the list is used;

• with commands for opening series from the PACS server:

– the study-uid for the first study found on the list is always used.

Attention! If some AE Titles of several PACSServers match, then data will be

searched on the first PACSServer on the list. PACSServers are sorted by the
«Server nickname» field.
For details on how to set up connection to PACSServer, see Section 13.2.
The length of AE Title value shall not exceed 16 characters. Cyrillic letters and «\» symbols
in AE titles are not allowed.
The following options are used to change the settings. After executing any of these com-
mands, the program exits. In case of a successful execution, the word Done appears on the
command line.

--aet <aetitle>: parameter AE Title for DICOM Listener is set to <aetitle>

--import-settings <file>: imports settings from <file>

--use-imported-listener-aetitle: parameter AE Title for DICOM Listener is set to

value from <file>
if the option --aet <aetitle> is used at the same time then AE Title for DICOM
Listener is set to <aetitle>
--update-scu-aetitle: Client name (SCU) for PACS Servers of the DICOM Listener
will remain the current

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if the option --aet <aetitle> is used at the same time then Client name (SCU)
for PACS Servers is set to <aetitle>

--export-settings <file>: exports settings to <file>.

20.2 Launching the DICOM Viewer with a URL Command

The DICOM Viewer may be launched by clicking the link on the web browser page.
If the DICOM Viewer has already been launched on the computer, the URL parameters
will be sent to the program that has been launched. The program will not be launched again
(see Launch multiple instances of the program).

20.2.1 Enabling the DICOM Viewer Launch with a URL Command

on Windows
To enable the DICOM Viewer launch with a URL Command on Windows, the DICOM Viewer
must be registered in the URI system as inobitec.
The DICOM Viewer is automatically registered in the URI system when the software is
installed. To enable the support of the DICOM Viewer launch with a URL Command, check
the Register the schema «inobitec» to launch a viewer with parameters from browser box in
the Extended parameters window (Fig. 7). By default, the box is not checked. If this option has
been activated, administrator privileges will be required in the process of software installation.
When the DICOM Viewer is deleted, it remains registered in the URI system.

20.2.2 Enabling the DICOM Viewer Launch with a URL Command

on Linux
In order to enable the DICOM Viewer launch from a browser on Linux, when the Applmage
file is run for the first time, it must be integrated with the system. A support program, such as
AppImageLauncher may be required for the OS to make an integration request.
When the application is integrated, the scheme is registered for the current user (the desk-
top file from Applmage is installed in ∼/.local/share/applications).
The Firefox browser installed with Snap or Flatpack deployment utilities will
not follow any third-party URI schemes due to the security policy.

20.2.3 Enabling the DICOM Viewer Launch with a URL Command

on macOS
The support of the DICOM Viewer launch from a browser on macOS is enabled automatically
when the DMG file with the application is opened.
To reset the scheme provided, use the following command:
/System/Library/Frameworks/CoreServices.framework/Frameworks/LaunchServices.framework/
Support/lsregister -u <Path to the installed app file>

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20.2.4 Launching the DICOM Viewer with the help of a URL Command
To test the DICOM Viewer launch, enter the inobitec:// command in the address bar of the
browser.
The DICOM Viewer window will be opened after confirmation of the request.

The following parameters (in the key=<value> or key format) are available for URL requests:
study-folder=<path> — the path to the directory with the study files. If there are several
studies, then the following options are applied to the first study in the list:
open-series-images — display the first series in the flat image view window
open-series-mpr — display the first series in the multiplanar reconstruction window
open-series-volume — display the first series in the volume reconstruction window
open-series-endoscopy — display the first series in the virtual endoscopy window
study-uid=<study_uid 1>\…\<study_uid N> — the list of unique identifiers (UID) of the
studies containing a series to be opened in the image viewer tab
series-uid=<series_uid 1>\…\<series_uid N> — the list of unique identifiers (UID) of the
series to be opened
series-index=<series_index 1>\…\<series_index N> — the list of series indexes to be
opened. Numbering of the series-index parameter starts from zero and depends on the
current type of series sorting in the study
patient-id=<patient_id> — the identifier of the patient, for whom the study list is to be
opened
pacs-aetitle=<pacs_aetitle> — provide the AE Title for the PACS server. For connection,
the parameters provided in the connection settings for the particular server are used
(see Section 13.2). Only the following command can be used with this option:
open-series-images — open the first series in the flat image view window
Transmission in URL requests of a list containing study uid (study-uid), series uid (series-
uid), and series indices (series-index) to be loaded is performed in the same way as the trans-
mission of parameters’ lists in the command line (see Section 20.1).
The following format of the URL command is used for launching the DICOM Viewer
inobitec://?param_1=”value_1”&...&param_m=&...&param_n=”value_n”
In this format, the param_m parameter has no value. Quote symbols must be replaced by
the respective code designations. It is also recommended to replace any symbols different
from letters and numbers by code designations in the names of parameters and values.

Below you can see some examples of console commands and respective URL commands.

Example 1.
viewer.exe --study-folder “D:/DicomData/001” --series-index “0” --open-series-mpr console
command corresponds to
inobitec://?study%2Dfolder=%22D%3A%2FDicomData%2F001%22&series%2Dindex=
%220%22&open%2Dseries%2Dmpr= URL command.

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In the multiplanar reconstruction window, the command opens a series with 0 index of the
first study contained in the D:/DicomData/001.

Example 2.
viewer.exe --pacs-aetitle “PACS_Inobitec” --patient-id “9Htqj5c” --open-series-images con-
sole command corresponds to
inobitec://?pacs%2Daetitle=%22PACS%5FInobitec%22&patient%2Did=
%229Htqj5c%22&series%2Dindex=10&open%2Dseries%2Dimages= URL command.
In the flat image viewer window, the command opens the first series of the first study with
9Htqj5c patient id, which is placed on the PACS Server with AE Title PACS_Inobitec.

If there is a mistake in the URL request, the DICOM Viewer window is opened, and an error
notification is added to the log file. If there is a mistake in one of the request parameters, the
other parameters are processed all the same.

20.3 HTTP RPC service

The Inobitec DICOM Viewer provides an HTTP RPC Service that allows you to execute com-
mands. Now two commands are supported:
• DownloadAndOpenStudy;
• DisplayStudy.

20.3.1 Command «DownloadAndOpenStudy»

• DownloadAndOpenStudy — command allows you to download the study from the PACS
Server to the Local Storage and then open it. When this command is received, the
DICOM Viewer searches the required study in the Local Storage. If the study is in the
Local Storage, then the DICOM Viewer opens its first series in flat images view mode.
If the required study is not found in the Local Storage, the DICOM Viewer will send a
download request to the PACS Server and after the start of the downloading files will
open study in the flat images view mode.

The samples of configuration files and HTTP RPC service test pages are available in the
HTTP_RPC_test_pages archive at:
https://inobitec.com/downloads/dicomviewer/.
To execute the DownloadAndOpenStudy command using the C-GET or C-MOVE meth-
ods:
1. In the DICOM Viewer switch on the DICOM and HIS/HTTP services by selecting the
Services option on the Network menu (for details, see Sections 13.1.1 and 13.1.2).
2. Send HTTP RPC request to open study by sendind POST request containing xml file
in the special format (e.g. downloadAndOpenStudy.xml in the HTTP_RPC_test_pages
folder).
Specify the following parameters in the downloadAndOpenStudy.xml file:
• PatientID (optional) — ID of the patient whose study should be opened;

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CHAPTER 20. INTEGRATION

• StudyInstanceUID=<StudyInstanceUID 1>\…\<StudyInstanceUID N> — list of UID of the

studies to be opened. The parameter is mandatory if parameter AccessionNumber is
not present;

• AccessionNumber=<AccessionNumber 1>\…\<AccessionNumber N> — the list of study

Accession Numbers to be opened. The parameter is mandatory if parameter StudyIn-
stanceUID is not present;

• AET — AE Title of the PACS Server;

• IP — network address of the PACS Server;

• port — DICOM port of the PACS Server;

• CommandType (optional) — method to download images from the PACS Server to the
DICOM Viewer. The values C-GET (by default), C-MOVE and WADO-RS can be used. If
you use the C-MOVE method then the PACS Server must be configured appropriately.

If the DICOM Listener... (see Section 13.1.1) is disabled, data from the PACS Server can only
be downloaded via C-GET. In this case, the SCU «CLIENT» value is transferred to the PACS
Server by default.
The samples of HTTP RPC service configuration files are given in Section 20.3.3.
To execute the DownloadAndOpenStudy command via WADO Web service, proceed as
follows:

1. In the DICOM Viewer, switch on the HIS/HTTP service by selecting the Services option
on the Network menu (for details, see Section 13.1.2).

2. Send HTTP RPC request to open study by sendind POST request containing xml file
in the special format (e.g. downloadAndOpenStudy.xml in the HTTP_RPC_test_pages
folder).

The following additional parameters are provided in the downloadAndOpenStudy.xml file:

• WadoServiceRootPath — path to the PACS Server internal service processing WADO-

RS requests;

• IsWadoSecured — enabling/disabling the https protocol for data exchange with the
PACS Server when data are downloaded via WADO service. If the parameter value is
true, then the https protocol is used for data exchange with the PACS Server; if the value
is false, then the http protocol is used;

• WadoPort — http- or https- port value (depending on the IsWadoSecured parameter

value);

• WadoAuthLogin — username for connection with the PACS Server;

• WadoAuthPassword — password for connection with the PACS Server.

To execute the DownloadAndOpenStudy command via the WADO Web Service, the Com-
mandType parameter must have the WADO-RS value.
The samples of HTTP RPC service configuration files are given in Section 20.3.3.

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 20.3. HTTP RPC SERVICE

The list of UID studies to be loaded is transferred within the StudyInstanceUID parameter
value of the HTTP RPC request. The list of study registration numbers is transferred within
the AccessionNumber parameter value of the HTTP RPC request. In both cases, the lists of
parameters are transferred in the same way as they are transferred in the command line (see
Section 20.1).
The values of the StudyInstanceUID and AccessionNumber, parameters provided in the
xml file must belong to the same study. If the StudyInstanceUID and AccessionNumber pa-
rameters do not belong to the same study, you will not be able to download the study.
The list of StudyInstanceUID and AccessionNumber parameters is composed as follows:
the first StudyInstanceUID parameter value is matched by the first AccessionNumber param-
eter value, the second StudyInstanceUID parameter value is matched by the second Acces-
sionNumber parameter value, etc.
You may search for and download a study using only the value of the AccessionNumber
parameter. To do that, delete the values of thePatientID and StudyInstanceUID parameters
from the downloadAndOpenStudy.xml file leaving only the AccessionNumber and the PACS
Server parameters (AET, IP, and port).
If the AET, IP, and port values have not been provided, the study will be downloaded from
the DICOM Server (PACS) set by default. If only one or two parameters out of three (AET, IP,
and port) have been provided, the command is considered invalid.
Also you can use the test page (testpage.html in the HTTP_RPC_test_pages folder):

1. In the DICOM Viewer, switch on the DICOM and HIS/HTTP services by selecting the
Services option on the Network menu (for details, see Sections 13.1.1 and 13.1.2).

2. Open the testpage.html file.

3. Fill in the following fields:

• AET — AE Title of the PACS Server;

• IP — network address of the PACS Server;
• Port — DICOM port of the PACS Server;
• StudyUID — UID of the study to be opened;
• Destination IP — network address of the DICOM Viewer;
• Destination port — HTTP port of the DICOM Viewer.

4. Click the «Send command» button.

20.3.2 Command «DisplayStudy»

• DisplayStudy — command allows you to open study from the Local Storage. When
this command is received, the DICOM Viewer searches the required study in the Local
Storage. If the study is in the Local Storage, then the DICOM Viewer opens its first series
in the flat images view mode. At the moment to obtain this command the study should
already be stored in the Local Storage.

The samples of configuration files and HTTP RPC service test pages are available in the
HTTP_RPC_test_pages archive at:

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CHAPTER 20. INTEGRATION

https://inobitec.com/downloads/dicomviewer/.

To execute DisplayStudy command:

1. In the DICOM Viewer, switch on the DICOM and HIS/HTTP services by selecting the
Services option on the Network menu (for details, see Sections 13.1.1 and 13.1.2).

2. Send HTTP RPC request to open study by sendind POST request containing xml file in
the special format (e.g. displayStudy.xml in the HTTP_RPC_test_pages folder).

Specify the following parameters in the displayStudy.xml file:

• PatientID (optional) — ID of the patient whose study should be opened;

• StudyInstanceUID=<StudyInstanceUID 1>\…\<StudyInstanceUID N> — list of UID of the

studies to be opened.

Also you can use the display.bat test script from the HTTP_RPC_test_pages folder:

1. In the DICOM Viewer, switch on the DICOM and HIS/HTTP services by selecting the
Services option on the Network menu (for details, see Sections 13.1.1 and 13.1.2).

2. Specify the following parameters in displayStudy.xml file:

• PatientID (optional) — ID of the patient whose study should be opened;

• StudyInstanceUID=<StudyInstanceUID 1>\…\<StudyInstanceUID N> — list of UID
of the studies to be opened.

3. Execute the script in the comman line with the following parameters:
display.bat [ip] [port]
where:

• ip — network address of the DICOM Viewer;

• port — HTTP port of the DICOM Viewer.

The samples of HTTP RPC service configuration files are given in Section 20.3.3.
The list of UID studies to be loaded is transferred within the StudyInstanceUID parameter
value of the HTTP RPC request. The list of parameters is transferred in the same way as it is
transferred in the command line (see Section 20.1).

20.3.3 Configuration Files of HTTP RPC service

The templates for configuration files of HTTP RPC remote procedure call service are provided
below.
«downloadAndOpenStudy.xml» for the C-MOVE method

<?xml version="1.0" encoding="utf-8"?>

<methodCall>
<methodName>DownloadAndOpenStudy</methodName>
<params>
<param>

516
 20.3. HTTP RPC SERVICE

<value>
<struct>
<member>
<name>PatientID</name>
<value>
<string>
8211038be1bebb57fb131414a04818f4f5c8f25f4a02cccec2b0cc20
\...\8211038be1bebb57fb131414a04818f4f5c8f25f4a02cccec2b0cc21
</string>
</value>
</member>
<member>
<name>StudyInstanceUID</name>
<value>
<string>
1.2.276.0.7230010.3.1.2.1658924591.30288.1727881038.636
\...\1.2.276.0.7230010.3.1.2.1658924591.30288.1727881038.637
</string>
</value>
</member>
<member>
<name>AET</name>
<value>
<string>PACS_Inobitec</string>
</value>
</member>
<member>
<name>IP</name>
<value>
<string>192.168.0.235</string>
</value>
</member>
<member>
<name>port</name>
<value>
<string>3000</string>
</value>
</member>
<member>
<name>CommandType</name>
<value>
<string>C-MOVE</string>
</value>
</member>
</struct>
</value>
</param>
</params>

517
CHAPTER 20. INTEGRATION

</methodCall>

«downloadAndOpenStudy.xml» downloading data from the PACS server via WADO ser-
vice

<?xml version="1.0" encoding="utf-8"?>

<methodCall>
<methodName>DownloadAndOpenStudy</methodName>
<params>
<param>
<value>
<struct>
<member>
<name>PatientID</name>
<value>
<string>
8211038be1bebb57fb131414a04818f4f5c8f25f4a02cccec2b0cc20
\...\8211038be1bebb57fb131414a04818f4f5c8f25f4a02cccec2b0cc21
</string>
</value>
</member>
<member>
<name>StudyInstanceUID</name>
<value>
<string>
1.2.276.0.7230010.3.1.2.1658924591.30288.1727881038.636
\...\1.2.276.0.7230010.3.1.2.1658924591.30288.1727881038.637
</string>
</value>
</member>
<member>
<name>AET</name>
<value>
<string>PACS_Inobitec</string>
</value>
</member>
<member>
<name>IP</name>
<value>
<string>192.168.0.235</string>
</value>
</member>
<member>
<name>port</name>
<value>
<string>3000</string>
</value>
</member>

518
 20.3. HTTP RPC SERVICE

<member>
<name>WadoServiceRootPath</name>
<value>
<string>path/to/service</string>
</value>
</member>
<member>
<name>IsWadoSecured</name>
<value>
<string>false</string>
</value>
</member>
<member>
<name>WadoPort</name>
<value>
<string>8010</string>
</value>
</member>
<member>
<name>WadoAuthLogin</name>
<value>
<string></string>
</value>
</member>
<member>
<name>WadoAuthPassword</name>
<value>
<string></string>
</value>
</member>
<member>
<name>CommandType</name>
<value>
<string>WADO-RS</string>
</value>
</member>
</struct>
</value>
</param>
</params>
</methodCall>

«displayStudy.xml»

<?xml version="1.0" encoding="utf-8"?>

<methodCall>
<methodName>DisplayStudy</methodName>
<params>

519
CHAPTER 20. INTEGRATION

<param>
<value>
<struct>
<member>
<name>PatientID</name>
<value>
<string>
8211038be1bebb57fb131414a04818f4f5c8f25f4a02cccec2b0cc20
\...\8211038be1bebb57fb131414a04818f4f5c8f25f4a02cccec2b0cc21
</string>
</value>
</member>
<member>
<name>StudyInstanceUID</name>
<value>
<string>
1.2.276.0.7230010.3.1.2.1658924591.30288.1727881038.636
\...\1.2.276.0.7230010.3.1.2.1658924591.30288.1727881038.637
</string>
</value>
</member>
</struct>
</value>
</param>
</params>
</methodCall>

520
Chapter 21

Licensing

21.1 Trial period

The demo mode allows users to try out the DICOM Viewer using it without any functionality
limitations for 14 days. The only requirement is connecting your computer to the Internet. After
the 14 day trial period, the DICOM Viewer will go inactive. To continue working wuith it, you
must purchase a license. The trial period for each edition is set separately.
A license key enables you to activate the DICOM Viewer versions released within a year
of the key purchase. The versions released after the one-year period are not activated, but
the trial period is available for them. To extend the activation period of the new versions for
another year, purchase a subscription to updates.
Starting from version 1.11.0, specialized modules can additionally be connected to the Pro
edition. Such modules are licensed and paid for separately. The main functionality remains
available in the Pro edition.

21.2 The First Launch and Licensing

21.2.1 Registration on the License Server Using Internet

When you first start the DICOM Viewer after installing, it will attempt to register itself on the
license server. During its registration, the DICOM Viewer does not transmit any personal data.
If you have a license key, select License... from the Help section of the main menu. In the
dialog box that opens (Fig. 21.1), enter the license key and click OK to confirm or CANCEL to
cancel the input. If the license key is not valid, the activation fails.

521
CHAPTER 21. LICENSING

Figure 21.1: License key input dialog box

To close the DICOM Viewer, select Exit from the File section of the main menu.
The Lite and Pro editions are registered separately.
If the license key does not support the activation of Additional Modules, and you need to
replace it with a new one, click on the ENTER NEW KEY button and enter the new key.

21.3 Purchase of a License

14 days after the activation date of the trial version, a dialog box similar to the one shown in
Fig. 21.1 will be displayed upon starting the DICOM Viewer. Further work without the license
key input will be impossible.
To purchase a license, follow the https://inobitec.com/buy/ link.
Send a request for further information to the [email protected] address.

522
Chapter 22

Help System and User Assistance

22.1 Help System

The Help System is available from the DICOM Viewer interface. To use the Help System, you
need to check the box Help->Assistant for the required languages during the installation of
the program.
The Help System language is the same as the one previously set in the DICOM Viewer. If
the help files for selected language are missing, or the Help System is not installed, a dialog
with a relevant message appears at the Help System startup. In this case, reinstall the DICOM
Viewer and check the box Help->Assistant for the required languages during the installation
of the program.
The Help System interface language coincides with the language set in the operating sys-
tem.

22.1.1 Launch the Help System

The Help System is context-sensitive, it allows to open the sections describing the interface
elements, the features that are currently in use. There are three ways to launch the Help
System:

1. From the main menu. Open the Help menu and select the Contents... item. The Help
System will open on the page containing information about the active tab.

2. From a tooltip. Place your cursor on a button to display a tooltip. If this button corre-
sponds to a page of the help system, then there will be a Help link in the tooltip. Click
this link to open the Help System page. The tooltips are described in section 22.2.

3. Using the hotkey. Place your cursor on the required interface object (button, panel,
dialog window, etc) and press the hotkey to open the Help System. If this object corre-
sponds to the interface page, the Help System will be opened on this page.

If the Help System is already running, then it opens the required page.
If the selected interface object does not correspond to any page, the Help System will be
opened on the last viewed page.

523
CHAPTER 22. HELP SYSTEM AND USER ASSISTANCE

22.1.2 Help System Settings

The default Help System skin coincides with the DICOM Viewer skin. To disable the use of
the DICOM Viewer skin, uncheck the Use the selected style for Help System box (see Sec-
tion 16.6).

22.2 Tooltips
Tooltips appear while hovering the cursor over a button or another interface element. It con-
tains information about this item.
The tooltip for a button contains the following information:

• button name;

• hotkey (if specified);

• a link to a page in the Help System (if specified);

• a slideshow with a brief demonstration of the instrument capabilities or a view mode (if
specified).

A slideshow appears 3 seconds after the appearance of the tooltip and is played back
cyclically. After that, to close a tooltip, click a mouse button or rotate the mouse wheel. If
there is a slideshow for this button, a countdown appears in the form of points in the lower
right part of the tooltip. To display a slideshow, check the box Slideshow Tips during the
installation of the DICOM Viewer.
The DICOM Viewer allows you to disable the display of hotkey, slideshow or completely
disable the tooltips (see Section 16.1).

524
“Hotkeys”

Most part of the hotkeys can be changed (Chapter 16.8).

Note that we only use Latin characters for default key combinations. To use
a default key combination, switch to the Latin keyboard layout.

Accepted Abbreviations
LMB — left mouse button;

RMB — right mouse button;

MMB — middle mouse button;

MW — mouse wheel;

Left — left arrow;

Right — right arrow;

Forward — forward arrow;

Back — back arrow.

Key Combinations Used in All Windows

For Windows and

For macOS Effect
Linux
Ctrl + S Command + S DICOM server list management window
Network message queue management
Ctrl + N Command + N
window
Ctrl + E Command + E Call the image export setup dialog
Ctrl + Q Command + Q Quit the program
Ctrl + Z Command + Z Undo

525
“HOTKEYS”

For Windows and

For macOS Effect
Linux
Ctrl + Y Command + Y Redo

F1 — open the help System;

F11 — switch to the full screen mode and exit from it;

Esc — exit from the full screen mode.

Key Combinations Used in Image View Window

For Windows and

For macOS Effect
Linux
fn + option +
Alt + Delete Delete markers and measurements
Backspace
MW rotation Scrolling Switch from slice to slice
Shift + LMB Shift + LMB Browse images (forward)
Ctrl + LMB Command + LMB Browse images (back)
move the cursor move the cursor
up/down holding up/down holding Slide images forward/back
LMB LMB
move the cursor move the cursor
Edit W/L
holding RMB holding RMB
Ctrl + MW rotation Command+Scrolling Zoom
Shift + MMB Drag the image
RMB RMB Call the context menu
Ctrl + E Command + E Call the image export setup dialog

[ — Switch to the previous image;

] — Switch to the next image;

H — mirror image horizontally;

V — mirror image vertically;

526
 K — activate the tool Marker;

N — activate the tool Line marker;

I — activate the tool Rotate;

Z — activate the tool Image scaling;

M — activate the tool Image shift;

W — activate the tool Adjust W/L;

A — activate the tool Arrow tool;

T — activate the tool Text tool;

O — activate the tool Polygon tool;

E — activate the tool Ellipse tool;

R — activate the tool Ruler;

C — activate the tool Angle;

B — activate the tool Kobb angle;

P — activate the tool Point value;

L — activate the tool ROI rectangle;

Q — activate the tool ROI ellipse;

G — activate the tool ROI polygon;

Y — activate the tool DSA;

Shift+A — switch the projection to axial;

Shift+C — switch the projection to coronal;

Shift+S — switch the projection to sagittal;

F5 — export the image with the latest settings.

Key Combinations Used in 3D Reconstruction Window

For Windows and

For macOS Effect
Linux
MW rotation, Ctrl +
Scrolling Zoom
MMB

527
“HOTKEYS”

For Windows and

For macOS Effect
Linux
Shift + MMB Drag the model
Alt + MMB Alt + MMB Center the model
MMB Option + LMB Rotate the model
Key combinations for Clipping Box tool
Command +
Ctrl + holding the holding the
mouse button with mouse button
Zoom the Clipping Box symmetrically
which the tool was with which the
activated tool was
activated
Shift + holding
Shift + holding the
the mouse
mouse button with
button with Pan the Clipping Box
which the tool was
which the tool
activated
was activated
Option +
Alt + holding the holding the
mouse button with mouse button
Rotate the Clipping Box
which the tool was with which the
activated tool was
activated

I — activate the tool Model rotation;

Z — activate the tool Model scaling;
M — activate the tool Model shift;
C — activate the tool Polygon cut;
T — activate the tool Remove table;
W — activate the tool Adjust W/L;
B — activate the tool Clipping box;
J — activate the tool Ruler;
K — activate the tool Marker;
N — activate the tool Line marker;
P — activate the tool Select model point;
F5 — export the image with the latest settings.

528
Key Combinations Used in DICOM Tag View Window

For Windows and

For macOS Effect
Linux
Ctrl + F Command + F Open the search panel
Esc Esc Close the search panel
Ctrl + C Command + C Copy the selected cell

Key Combinations Used in Curvilinear Reconstruction Mode

For Windows and Linux For macOS Effect

Command + LMB on a Jump to the surface the point is
Ctrl + LMB on a curve
curve located on
Shift + drag the mouse Shift + drag the mouse
Drag the curve
holding LMB holding LMB
RMB on a curve RMB on a curve Context menu

Key Combinations Used in Multiplanar Reconstruction Window

For Windows and

For macOS Effect
Linux
Ctrl + MW rotation Command + Scrolling Zoom
Shift + MMB Drag the image
MW rotation Scrolling Switch from slice to slice

Left, Right, Forward, Back — move planes;

F5 — export the image with the latest settings;

529
“HOTKEYS”

Z — activate the tool Model scaling;

M — activate the tool Model shift;

K — activate the tool Marker;

N — activate the tool Line marker;

J — activate the tool Ruler;

O — activate the tool Polygonal ruler;

C — activate the tool Angle;

B — activate the tool Kobb angle;

P — activate the tool Point value;

L — activate the tool ROI rectangle;

Q — activate the tool ROI ellipse;

G — activate the tool ROI polygon.

Key Combinations Used in Virtual Endoscopy Window

For Windows and Linux For macOS Effect

LMB in the navigation LMB in the navigation
Set the camera position
menu menu
MMB Rotate the camera
Shift + MMB Drag the camera
MW rotation Scrolling Zoom
RMB RMB Context menu

Left, Right — rotate the object relative to the camera axis;

Forward, Back — move the object along the camera axis;

R — activate the tool Ruler;

K — activate the tool Marker;

N — activate the tool Line marker.

530
 INDEX

Index

3D Reconstruction . . . . . . . . . . . . see Volume custom . . . . . . . . . . . . . . . . . . . . . . . . . . 100

Reconstruction grid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
stacked . . . . . . . . . . . . . . . . . . . . . . . . . 100
A of series
AIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287 auto . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Anonymize . . . . . . . . . . . . . . . . . . . . . . . . . . . 477 custom . . . . . . . . . . . . . . . . . . . . . . . 98, 99
Arrangement grid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
of Images . . . . . . . . . . . . . . . . . . . . . . . . . 464 stacked . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Axial section . . . . . . . . . . . . . . . . . . . . . 211, 260 DSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
DTI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
B
Brightness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 E
C ECG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Camera Orientation . . . . . . . . . . . . . . . . . . 409 ECG Viewer . . . . . . . . . . . . . . . . . . . . . . . 63, 412
Cardiac function analysis . . . . . . . . . . . . . 376 Edit
Clipping Box . . . . . . . . . . . . . . . . . . . . . . . . . . 221 Patient Name . . . . . . . . . . . . . . . . . . . . . . 75
Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Study Description . . . . . . . . . . . . . . . . . . 75
CLUTs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Erosion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Command Line Keys . . . . . . . . . . . . . . . . . . . 30 Export surface . . . . . . . . . . . . . . . . . . . . . . . . 319
Command Line Options . . . . . . . . . . . . . . 508 F
Contrast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Fill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Coronal section . . . . . . . . . . . . . . . . . . . . . . 260 Frequency Filters . . . . . . . . . . . . . . . . . . . . . . 417
Curved MPR . . . . . . . . . . . . . . . . . . . . . . . . . . 268 Frontal section . . . . . . . . . . . . . . . . . . . . . . . . 211
Cut invisible volume . . . . . . . . . . . . . . . . . . . 219 Full Screen Mode . . . . . . . . . 56, 60, 60, 526
D Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62, 238
DICOM Printer . . . . . . . . . . . . . . . . . . . . . . . . 503
G
DICOM Service . . . . . . . . . . . . . . . . . . . . . . . 433
glb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
DICOM Tags . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Grow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
DICOM tags . . . . . . . . . . . . . . . . . . . . . . . . . . 474
Grow bones . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Diffusion Tensor Imaging . . . . . . . . . . . . . 293
Digital Subtraction Angiography . . . . . . . 195 H
Dilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Help System . . . . . . . . . . . . . . . . . . . . . . . . . 523
Disk Creator . . . . . . . . . . . . . . . . . . 64, 79, 450 Hotkeys . . . . . . . . . . . . . . . . . . . . . . . . . 470, 525
Adding viewer to image . . . . . . . . . . . 453
Write to Disc in Linux and macOS . 455 I
Write to Disk . . . . . . . . . . . . . . . . . . . . . . 453 Image annotation . . . . . . . . . . . . . . . . . . . . . 419
Write to Memoky card . . . . . . . . . . . . . 454 Image Filters . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Display mode Image registration . . . . . . . . . . . . . . . . . . . . 249
of images Image stitching . . . . . . . . . . . . . . . . . . . . . . . . 164

531
INDEX

Import surface . . . . . . . . . . . . . . . . . . . . . . . . 321 Network . . . . . . . . . . . . . . . . . . . . . . . . . 433, 446

Importing a Structure from DICOM RT . 325
Installing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 O
obj . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319, 374
J Opening . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
jpg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Opening DICOM studies by dragging
and dropping . . . . . . . . . . . . . . . . . . 65
L Opening DICOM studies from the context
Label . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 menu . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Launching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Opening Segmentation Projects . . . . . . 348
Launching the Program . . . . . . . . . . . . . . . . 47 Opening Zipped DICOM Studies . . . . . . . 65
Launching the Web Viewer . . . . . . . . . . . . . 52 Orientation Cube . . . . . . . . . . . . . . . . . . . . . 198
Leads . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414
License . . . . . . . . . . . . . . . . . . . . . . . . . . 521, 522 P
Local Storage . . . 62, 67, 79, 448, 457, 466 PACS Server . . . . . . . . . . . . . . . . . . . . . . 73, 439
pdf . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
M Perfusion Scoring . . . . . . . . . . . . . . . . . . . . . 126
Maximum Intensity Projection . . . . . . . . . 286 PET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Merge layers . . . . . . . . . . . . . . . . . . . . . . . . . . 241 PET analysis . . . . . . . . . . . . . . . . . . . . . . . . . 389
automatically . . . . . . . . . . . . . . . . . . . . . 244 ply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319, 374
by point . . . . . . . . . . . . . . . . . . . . . . . . . . 245 png . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
manually . . . . . . . . . . . . . . . . . . . . . . . . . 245 Print Images . . . . . . . . . . . . . . . . . . . . . . . . . . 494
Minimum Intensity Projection . . . . . . . . . 286 by default . . . . . . . . . . . . . . . . . . . . . . . . 505
MinIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507
MIP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286 on Films . . . . . . . . . . . . . . . . . . . . . . . . . . 506
MPR . . . . . . . see Multiplanar Reconstruction on Paper . . . . . . . . . . . . . . . . . . . . . . . . . 507
Multi-monitor Window Design . . . . . . . . . 460 Page template . . . . . . . . . . . . . . . . . . . . 499
Multi-segment Growing . . . . . . . . . . 219, 336 Print images
Multiplanar Reconstruction . 239, 241, 259, Reference Image . . . . . . . . . . . . . . . . . 502
408, 529 Product Registration . . . . . . . . . . . . . . . . . . 521
3D Cursor Mode . . . . . . . . . . . . . . . . . . 265 Projection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Build Surface . . . . . . . . . . . . . . . . . . . . . 268
Curvilinear Reconstruction . . . . . . . . 268 R
Cutting Plane Mode . . . . . . . . . . . . . . . 265 Region Growing . . . . . . . . . . . . . . . . . . . . . . 330
Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 Remove holes . . . . . . . . . . . . . . . . . . . . . . . . 219
Line Markers . . . . . . . . . . . . . . . . . . . . . 284 Remove noise . . . . . . . . . . . . . . . . . . . . . . . . 219
Markers . . . . . . . . . . . . . . . . . . . . . . . . . . 283 Rendering transfer function . . . . . . . . . . . . 174
Mirror Image Horizontally and Report editor . . . . . . . . . . . . . . . . . . . . . . . . . 481
Vertically . . . . . . . . . . . . . . . . . . . . . 288 ROI
Orthogonal Planes . . . . . . . . . . . . . . . . 264 ellipse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Polygonal Line Markers . . . . . . . . . . . 284 polygon . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Reslice . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Rotate Image . . . . . . . . . . . . . . . . . . . . . 287 S
Rotate Planes . . . . . . . . . . . . . . . . . . . . . 265 Sagittal section . . . . . . . . . . . . . . . . . . . 211, 260
Slice Thickness . . . . . . . . . . . . . . . . . . . 286 Saving Segmentation Projects . . . . . . . . 348
Multiplanar reconstruction . . . . . . . . . . . . . 62 Scout lines . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64, 70
N Segmentation . . . . . . . . . . . . . . . . . . . . . . . . 300
NETWORK . . . . . . . . . . . . . . . . . . . 513, 515, 516 Intersection of structures . . . . . . . . . . 341

532
 INDEX

Mask . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307 Graphic Label Tool . . . . . . . . . . . . . . . . 201

Subtraction structures . . . . . . . . . . . . 340 Mirror Image Horizontally and
Unification of structures . . . . . . . . . . . 339 Vertically . . . . . . . . . . . . . . . . . . . . . 207
Setting View flat images
CLUTs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 Angle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Render settings . . . . . . . . . . . . . . . . . . . 230 cardiothoracic ratio measurements 122
Scout lines . . . . . . . . . . . . . . . . . . . . . . . . 188 Cobb angle meter . . . . . . . . . . . . . . . . . 118
Visualization . . . . . . . . . . . . . . . . . . . . . . . 171 Delete Measurements . . . . . . . . . . . . . 124
Workspace . . . . . . . . . . . . . . . . . . . . . . . . 189 distance measurement on US
Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456 studies . . . . . . . . . . . . . . . . . . . . . . . . 125
Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472 Drawing Parameters . . . . . . . . . . . . . . . 123
Import . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472 Intensity at a Point . . . . . . . . . . . . . . . . . 120
Import CLUTs . . . . . . . . . . . . . . . . . . . . . 473 Intensity Average . . . . . . . . . . . . . . . . . . 121
Modules . . . . . . . . . . . . . . . . . . . . . . . . . . 464 magnifier . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Monitor . . . . . . . . . . . . . . . . . . . . . . . . . . . 460 measurement of blood flow velocity
Shrink . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 on US studies . . . . . . . . . . . . . . . . . 125
Skins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463 measuring angles between intersecting
Sort studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 rulers . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Splited Screen . . . . . . . . . . . . . . . . . . . . . . . . . 86 Move Measurements . . . . . . . . . . . . . . 124
Stitching Mode . . . . . . . . . . . . . . . . . . . . . . . 255 Move Measurements Results . . . . . . 124
stl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319, 374 pan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Storage . . . . . . . . . 62, 67, 79, 448, 457, 466 play . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Structure Export . . . . . . . . . . . . . . . . . 323, 324 Polygonal Ruler . . . . . . . . . . . . . . . . . . . . 117
Structure Export to DICOM RT . . . . . . . . 324 rotate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Study List Export . . . . . . . . . . . . . . . . . . . . . . . 77 Ruler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Surface . . . . . . . . . . . . . . . . . . . . . . . . . . . 314, 317 Standard Deviation in an Area . . . . . . 121
SUV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 time lapse measurement on US
Switch between Series . . . . . . . . . . . . . . . . . 93 studies . . . . . . . . . . . . . . . . . . . . . . . . 125
Synchronize Images . . . . . . . . . . . . . . . . . . 205 video recording . . . . . . . . . . . . . . . . . . . 105
System Requirements . . . . . . . . . . . . . . . . . . 30 zoom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
View Several
T Images at a Time . . . . . . . . . . . . . . . . . . 100
Tab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Series at a Time . . . . . . . . . . . . . . . . . . . . 96
Tab display mode . . . . . . . . . . . . . . 56, 60, 63 Studies at a Time . . . . . . . . . . . . . . . . . . 94
Technical Support . . . . . . . . . . . . . . . . . . . . . . 17 Virtual Endoscopy . . . . . . . . . . 239, 403, 530
Tooltips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524 Camera Fly . . . . . . . . . . . . . . . . . . . . . . . 406
U Customize MPR Navigation Panel . 405
Uncompress series . . . . . . . . . . . . . . . . . . . . 80 Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
Uninstalling . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Measurements and Markers . . . . . . . 408
Move Camera
V Automatically . . . . . . . . . . . . . . . . . . . 406
Vessel analysis . . . . . . . . . . . . . . . . . . . . . . . 360 Manually . . . . . . . . . . . . . . . . . . . . . . . 406
Vessel Tree Segmentation . . . . . . . . . . . . 332 Surface Reconstruction . . . . . . . . . . . 409
Vessles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Virtual endoscopy . . . . . . . . . . . . . . . . . . . . . 62
View Flat Images . . . . . . . . . . . . . . . . . 82, 526 Visualization
ADC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 CPU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 466
Calibration Sizes . . . . . . . . . . . . . . . . . . 207 CUDA . . . . . . . . . . . . . . . . . . . . . . . 210, 466
Export . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Metal . . . . . . . . . . . . . . . . . . . . 210, 314, 466

533
INDEX

OpenCL . . . . . . . . . . . . . . . . . . . . . 210, 466

Volume Reconstruction . . . . . 210, 239, 527
3D Angle . . . . . . . . . . . . . . . . . . . . . . . . . 227
Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Delete All Areas except Selected
Area . . . . . . . . . . . . . . . . . . . . . . . . . . 216
Delete Area . . . . . . . . . . . . . . . . . . . . . . . 216
Delete Table . . . . . . . . . . . . . . . . . . . . . . 220
Export Rotation to Series . . . . . . . . . . 229
Inverse Polygon Cut . . . . . . . . . . . . . . . 216
Markers . . . . . . . . . . . . . . . . . . . . . . . . . . 228
play . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Polygon Cut . . . . . . . . . . . . . . . . . . . . . . . 216
Polygonal Ruler . . . . . . . . . . . . . . . . . . . 223
Remove Bone Tissue . . . . . . . . . . . . . 234
Rotation . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Ruler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
Scaling . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Shift . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Sphere Cut . . . . . . . . . . . . . . . . . . . . . . . . 217
Sphere Restore . . . . . . . . . . . . . . . . . . . 217
Surface ruler . . . . . . . . . . . . . . . . . . . . . . 224
Volume reconstruction . . . . . . . . . . . . . . . . . 62
Volume stitching . . . . . . . . . . . . . . . . . . . . . 256

W
Window Level . . . . . . . . . . . . . . . . . . . . . . . . . 108
Window Width . . . . . . . . . . . . . . . . . . . . . . . . 108

534
 GLOSSARY

Glossary

editing mask — a template that restricts the structure mask. The editing mask is defined by
the CLUTs. 309

multiphase series — series contained more then one phase. 193, 252

phase — image group with different location. If the study contains images of the same body
part taken at intervals (for example, contrast studies), then images with different loca-
tions are grouped into phases and sorted according to the time taken to create the
image. 193, 252

structure — part of the volume defined by the mask or surface. 300

structure mask — voxel volume obtained as a result of segmentation. 308

voxel — element of a 3D image containing the value of a raster element in 3D space. 235

535
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We wish you success in your work!

536