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VistA Imaging Display Tips and Timesavers for Providers
Editor: Disregard any numbers after
Section 1: Main Imaging Display Window
This is session 228, VistA Imaging Display, Tips and Time Savers for Providers. My name is Brian Laufer.
And I'm a Primary Care Provider at the Alaska VA Health Care System in Anchorage, Alaska. With me
today is Cliff Sorensen, who is with the OI National Training and Education Office, VistA Imaging project
team.The first half of this session will be an overview of customizing user preferences, filters, viewing
images from remote sites, how to do image comparisons, how to display multiple MUSE studies or EKG
studies, and a few other time-saving tips. The second half of this session will involve two examples of
patient treatment scenarios using VistA Imaging display.Cliff, why don't you go ahead and get started.
Thanks, Dr. Laufer.This is part one, the main imaging display window. Here I'm going to talk about the
toolbar or shortcut buttons, and the settings in the main imaging display window.To get started, click
the CPRS icon on the desktop and select a patient.
Click the Tools menu.
Click VistA Imaging Display.
And minimize CPRS, as seen here.
Starting from the right-hand side of the main VistA Imaging window and working towards the left, the
first shortcut or toolbar button is the Remote Image Views Configuration button. Click this button to
display a list of sites where the veteran has been seen and the connection status of each site and the
number of images at each site.
If a site is disconnected, it will display in red lettering with a line drawn through its name on the remote
image tool bar in the main display window as seen here. DoD -- or Department of Defense -- and HDR -or Health Data Repository -- may display as sites in the Remote Image Views Configuration list. Since
this demonstration is not connected to a VA Medical Center database, those sites are not displayed.
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Currently, VistA Imaging does not have an interface with these facilities, which are located in Austin,
Texas. And they will be displayed as being in a disconnected status.
There are three ways to connect to a disconnected site. Click the site name displayed in red lettering.
Click the Connect All button. Or from the Remote Image Views Configuration list, highlight the site
name from the list and click the Connect button as seen here.
You can also disconnect from a site by selecting it from the list and clicking the Disconnect button as
demonstrated.
To Disconnect from all remote sites, click the Disconnect All button.Users may occasionally find that
they are not able to automatically connect to a remote site on their initial attempt. This problem can
usually be solved by manually connecting to a remote site. This should only occur the first time a user
auto-connects to a specific remote site.Next, in the main display window, is the Select Patient button.
Because we selected our patient via CPRS, this button is grayed out. If the VistA Imaging display client is
launched as a stand-alone application, this button will be active and clicking it will activate the Patient
Name box in the main display window.In the Remote Image Views Configuration window, click the Close
button
On the main VistA Imaging display window toolbar, click the User Preference button; which is the third
from the right.
There are three tabs containing choices to customize each user's personal preference settings. Click the
Patient Selected tab and you will notice that there are five choices to select from.I would suggest that
the Show Image Listing window be the only box which should be checked. And I will explain why I
suggest this in just few moments.So click off the Show Abstract window check mark.
Next, click the Abstract and Group Windows tab.
Display Remote Abstracts is the only option on this tab. I suggest that this box remain unchecked,
unless you have created a private filter for a specific subset of images, and you need to view the abstract
images from remote sites as well as the local images. Placing a check mark in this box will significantly
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slow down the process of loading images, especially from remote sites. Next, click the Remote Image
View tab.
If the Remote Image Views Auto-Connect Enabled choice is checked, the software will attempt to
connect to any remote site where the veteran has been seen.Click that box as seen here.
This may have an adverse impact on the Local Area or the Wide Area Network response time, depending
on the number of connection attempts being made by the software. If this option is disabled, sites will
not automatically be connected; however, they will appear in the Remote Image Views Configuration
site list. This option is enabled by default. A sub-option -- Only Auto-Connect to Sites in Local VISN -- is
selectable if the Remote Image Views Auto-Connect Enabled box is checked. Enabling this option will
configure the software to connect to sites within the local VISN only. If the patient has visited a site
outside the local VISN, the site is not automatically connected. This option is disabled by default. The
next choice is the Hide 'Patient Active' Sites With 0 Images on Toolbar. Selecting this option will display
only those sites where the patient has at least one imaging study on the Remote Image View toolbar. If
this option is disabled, then all sites where the patient has visited will appear on the Remote Image View
toolbar, even if there were no imaging studies performed on the patient at that specific site. This option
is disabled by default.The last choice is Hide Disconnected Sites For Selected Patient on Toolbar.
Selecting this option will display only the currently connected sites where the patient has visited on the
Remote Image View toolbar. If there was an error in the processing of connecting to a remote site, or if
a site is disconnected, then that site would not appear on the Remote Image View toolbar. If this option
is disabled, then all sites where the patient has visited will appear on the Remote Image View toolbar in
the main imaging window and the disconnected sites will be displayed in red lettering with a line
through the site name. This option is also disabled by default.If you make any changes to these
selections, remember to click the Save button, as seen here.
The MUSE EKG shortcut button has a red wave form. Select the shortcut button as seen here.
VistA Imaging will display MUSE study data, provided the systems have been interfaced. All cardiology
related study data is stored on the MUSE server and not in VistA Imaging. The study list displays all the
studies that a patient has on the MUSE server. There are separate columns for the test, date/time, site,
and confirmed.To sort by a particular column, click on the header name, such as Date/Time, as shown
here.
To view a study, highlight it from the list. For this example, click on study number one.
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Next, click on the study list button -- which looks like blue tablet with an arrow -- as seen here, to close
study window.
It is also possible to view multiple studies at the same time in order to compare them. To do that, click
the study list window button as seen here.
And select three studies to compare. For this example, click study number one. Hold down the Ctrl key
on the keyboard, and click study number two and study number three.
Close the study list window again
And all three studies will display in the window. Each of them has a vertical slider bar at the right, which
will allow the user to change position of the study in the window as demonstrated.
In order to make it easier to do comparisons between the study, click the blue arrow button on the tool
bar as shown here.
This resets all studies to the top left-hand corner. Next, click the Scroll Lock button, which looks like a
padlock, as shown here.
Now, all of the studies are locked together. For this example, select the vertical slider bar in the middle
window and move it up and down. All of the studies are synchronized together and they can be
compared line-by-line.
In the bottom left-hand corner of each study, in blue lettering, is the text overlay; which displays the
name and the date/time of the study and the three letter abbreviation of the location where the study
was performed.
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The user can choose to activate the pink grid, which displays in the background of each study, by clicking
the button on the toolbar as shown here.
There is also a shortcut button for the text overlay. It is suggested that the text overlay remain
activated, as shown here, in order to display the study information. The other toolbar buttons include a
zoom slider bar, and buttons to fit the study into the height or width of the window, a print button, and
a preferences button which contains choices to either print the EKG with solid lines or dotted lines.Close
the EKG window, as seen here.
The next button to the left is a shortcut which will open the Health Summary window, as seen here.
If there are health summaries loaded on your system, they will display here and can be selected from
the list.For now, close the Health Summary list as demonstrated.
The Open Abstracts window button is to the left of the Health Summary button. It opens the abstract
window, as shown here, if you accidentally closed it or if you chose not to launch it by changing your
user preferences.
Next is the Select/Create Image Filter button. I will discuss this option as part of the Image List window
later in this presentation. The last button at the far left of the toolbar is the Open Image List window
shortcut. It opens the Image List window if you accidentally closed it or if you chose not to launch it by
changing your user preferences.
Additional options -- although not shortcut buttons -- on the main display window are under the Reports
option, as seen here.
A Patient Profile, Health Summary, and Discharge Summary can all be accessed from VistA Imaging
Display window so that the user does not need to go back to CPRS just to see these particular
documents.Also on the main display window, to the right of the Patient Name box, is an indicator of the
number of the images which match the current filter. This information is also displayed in the Image List
window below the Filter tabs and at the top of the Abstract window.For now, close the Abstract window
as seen here.
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So, here's what we've covered. We've discussed the toolbar buttons in the main imaging display
window; such as the Remote Image View Configurations, the User Preference Settings, MUSE Studies,
Health Summaries, Abstract, and Image List shortcuts.
Section 2: Image List Window
This is part two, the Image List window features. Earlier I suggested that the Show Image Listing window
be the only box selected on the Patient Selected tab in the user preference settings. Using the Image
List window will provide you with most if not all of the information you will routinely use. In the center
of the Image List window are patient's images displayed in a spreadsheet type view. There are several
columns such as items, site, note title, procedure date, procedure, number of images, short description,
etc.I will talk about how to edit and manipulate the columns shortly, but for now let's start with the
toolbar buttons.If the toolbar is not visible, click Options.
And put a checkmark next to the Toolbar. Since we already have it, we need not do anything in this
case.
Select image number 1.
Click the first camera, which is the Open Image option.
Depending on the type of image selected, the full resolution viewer or the radiology viewer will display
the image.If there are multiple images in the study, the Group Abstract window will display and you will
select the image of interest as seen here by clicking the first image with the blue box.
For now, close the viewer.
And close the Group Abstract windows as shown here.
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The Preview Abstracts button is the next button to the right, which contains a camera with a blue square
in the upper left-hand corner. Activate the button as seen here.
And the image abstract, which you may be used to seeing in the Abstract window, will display in the left
side of the Image List window. If the Abstract Preview button has been deactivated, a gray square will
appear in place of the image abstract when it is activated again.This is a known issue with the software
and can be corrected by clicking on another study in the list, such as number 2 in this case.
And then clicking on the study of interest, number 1, as shown here.
The Open Report button, which looks like a tablet, will open an image report or progress note in the
new window as shown here.
Close the window by clicking the X in the corner.
Click the Preview Report button, which is a tablet with a blue square in the upper left-hand corner, to
display a preview of the report at the bottom of the Image List window as seen here.
The next button is the Fit Columns to Text, which will adjust the size of the columns as seen here.
Depending on the number of columns displayed, there may be a horizontal slider bar, which will allow
you to move and forth between the columns. Click on the horizontal slider bar and move it to the right
or left.
To the right of that is the Fit Columns in Window button, which will adjust the size of the columns to fit
into the window as seen here.
As mentioned earlier, you can edit and manipulate the columns by clicking the next button, select which
columns to display. Click the button, which will open up the box for the column selectors.
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Choose the columns you wish to display by placing a checkmark in the appropriate box and click the OK
button as seen here. For our demonstration, we will leave the settings as they are.
Each of the columns in the list can be sorted by clicking on a column header. For example, click
Procedure Date/Time as seen here.
In this case, the studies will be sorted in a date/time order. Other columns may be sorted alphabetically
or numerically, depending on their type of data. If a user makes any changes to these settings, they can
be saved to his or her profile and will be available the next time the VistA Imaging display is used.The
Stretch Window button allows you to expand or collapse the window. This feature can be toggled on or
off by clicking the button to return the window to its normal size. For this demonstration, we're going to
leave the window at full size.The Select/Create Image Filter button allows the user to create, edit, or
delete private image filters. Filters are displayed below the shortcut button toolbar as tabs. There are
two types of filters in VistA Imaging Display: public filters and private filters. Public filters are created for
all users and can only be edited or deleted by the VistA Imaging System Manager or other staff who hold
a special VistA security key. Public filters have a pound sign preceding their name, so that they are easily
distinguishable from private filters. In this example, the #All filters has been set as the default.Click the
#Advance Directives tab.
And the #All 2 year tab, as seen here, to view the images with different sets of sorting criteria.
To create a private filter, click the Select Image filter shortcut button as seen here.
The Image Filter Add/Edit window will display. And at the bottom left are the Public and Private Filter
tabs. The Public filter tab contains the filters exported with the software.Click the name of a filter in the
list -- as seen here, such as Rad All -- and the filter settings will be displayed on the right side of the
window.
To create a filter, click the Private tab as shown here.
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There is a private filter called Clinical All, which is exported with the software, as well as a public filter
called Clinical All. The Clinical All private filter can be edited or deleted by the user, as it is basically just
a place holder. In the center right side of the window is the Clinical tab and, if the user holds the
appropriate security key, the Administrative tab.For now, click on the Clinical tab.
To create a filter, first select a date range. All Dates is the default. And there are several choices of date
ranges exported with the software.
Click the dropdown arrow on the Date Range box.
And you will also notice that there is a Select Range choice. Click the Select Range to customize a date
range of interest.
Here is a hint for changing the date range. To quickly move from one month to another, click the name
of the month currently displayed, such as August in this example.
Select the month you want to change to, such as January.
To quickly change the year of interest, click the year displayed, such as 2006.
And use the down arrow to select the year 2003.
Section 2: Image List Window (Part 2)
In the To calendar, we are going to leave today as the default and click OK.
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Next, select the Image Origin. All is the default selection. However, any combination of choices is
available.On the Clinical tab, All Clinical Images is the default selection. There are also several VistA
packages to choose from such -- as Radiology, Medicine, Surgery, Lab, Progress Notes, and Clinical
Procedures. Any package or combination of packages can be selected by placing a checkmark in the
appropriate boxes.
There are also dropdown lists available to filter images by Type, as seen here; Specialty/SubSpecialty, by
clicking the down arrow; or in the Procedure/Event box, as seen here.
For this example, click the SubSpecialty/Specialty down arrow.
Click on Cardiology.
Click the Save As button.
A new window will open and a unique name for the private filter must be entered. In this example, type
in "Cardiology" as seen here.
And click Save.
Cardiology is now listed on the Private filter tab.Click OK, as seen here.
And the filter is placed on the toolbar at the far left. As Private filters are created, they are added to the
left side of the toolbar. Remember that since these are private filters, they do not have the pound sign
preceding their name and are available only to the user who created them.
To delete a filter, click the Select/Create Image Filter button with the blue checkerboard.
Highlight the name of the filter, in this case Cardiology.
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Right click the filter name.
And select Delete.
Click OK, as seen here.
Occasionally you may create a filter which displays 0 images or studies. There are two common reasons
for this. One is that a Procedure/Event was selected and the veteran has never had that particular study
performed. It is suggested that a subspecialty or specialty be selected in order to display a broader
range of images. Another reason for displaying 0 images is that the date range is set for too short of a
time frame. Edit the filter by expanding the date range and save the changes to the filter.There is no
limit to the number of filters or the types that the user can create for him or herself. It is suggested that
if a user makes changes to their user preferences, remote image view settings, or their private filter
settings, that they save these changes before exiting the client.For now, click Close on the Image Filter
window.
In the Image List window, click the center button in the top right to reduce this down to a smaller size.
On the main VistA Imaging display window, click the word Options, as seen here.
And verify that there is a check mark next to Save Settings On Exit, which in our case is there. If it is not,
place a check mark next to this setting.
Here's what we've covered. We discussed the shortcut buttons in the Image List window, the difference
between Public and Private filters, and how to create or delete a Private filter.
Section 4: Remote Image View
This is part three -- Remote Image View functionality. The Remote Image View enhancements to VistA
Imaging Display introduced the ability to view patient images that have been acquired and are stored at
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any VA medical facility without the requirement of logging on to the remote system. A Remote Image
icon will be displayed in place of the image abstract, depending on the selection made under the user
preference settings. For now, we need to activate our remote site by clicking on the word Washington,
DC in the main display window.
A connection will be made to the remote site and those patient images will be loaded to the system.
Two other things that will help us at this point is to click on the #All filter.
And in the interest of demonstrating all of the images, I would suggest turning off the Report Preview,
which is the tablet with the blue square, so that now we see all of the images in full view.
To make it even easier, you may wish to maximize the image list window, as shown here.
A Remote Image icon will be displayed in place of the image abstract, depending on the selection made
under the user preferences. Remote images will also be identified in the Image List window under the
Site column. Interactions with the images are unchanged from prior versions of the software. However,
users may prefer to use the Image List window while browsing both local and remote images because of
the ability to filter and sort studies to rapidly find images of interest. Network connectivity plays a large
role in the performance of Remote Image Views. Remote Images will only load as quickly as the
network will allow.Another feature is the option to automatically cache images and studies for
temporary storage on the user's local machine. This allows the user to select images or studies one at a
time to be retrieved and brought to the workstation in the background, allowing the user to continue
viewing images while caching is occurring. The images will then display very quickly when the user
selects them for viewing.
To cache images, right click on study number two in the Image List window as seen here.
Select the Cache Images option.
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The images will be brought to the user's local machine and will be available for viewing as soon as they
have arrived. As the images are being cached, a traffic light icon will display in the Image List window.
Yellow indicates the images are being retrieved. Green indicates that the caching has completed. These
temporarily cached images are deleted from the user's local machine when the VistA Imaging display
client is closed.So, here's what we've covered. We've seen the remote site code in the Image List
window, the Remote Image Abstract icon, and how to cache remote images to the local workstation.
Section 5: Full Resolution Viewer
This is part four -- the Full Resolution Viewer. There are two viewers associated with VistA Imaging
Display. One is the Full Resolution Viewer. And the other is the Radiology Viewer. The Full Resolution
Viewer allows you to open an unlimited number of images at the same time. This can be used for
comparing images, such as sequential patient photographs or scanned documents. Only scanned
documents and photographs can be displayed with the Full Resolution Viewer. Radiology images and
non-radiology DICOM images -- such as ophthalmology, dental, ultrasound, and nuclear medicine
images -- will be displayed in the Radiology Viewer. DICOM is just another way of sending images to the
VistA Imaging archive. All you need to know is that the images will automatically open in the correct
viewer when you click on them. You cannot, however, compare X-rays and scanned documents in the
same viewer.From the Image List window, select an image -- as we have done in this case -- and open it
by clicking on the image abstract, as seen here.
Open additional images from the Group Abstract window if applicable. In this case, click both the
images.
You may have to move the Full Resolution View window to the right or left to see your Group Abstract
window by moving your mouse to the blue title bar and dragging it to the left.
Now you see the Group Abstract window behind. And click image number two in the list.
At this point, click the X in the Group Abstract window to close that window.
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In the background, click on the Image List window once again.
In our case, we are going to highlight study number 5 in the list by single clicking...
...and clicking in the abstract on the left side of the window.
Again, open the first image by single clicking it.
And open the second image in the Group Abstract window by clicking it.
In the Full Resolution View window, maximize the window by clicking the middle box.
The default layout for the Full Resolution View window is two over two. However, this can be
customized by clicking the Layout option, as seen here, and making a selection from the available
choices.
The active image in the Full Resolution Viewer has a blue border around it. To maximize the active
image, either double click the image, as seen here...
...or double click it once again to return it to its normal size.
You can also highlight the image.
And go to the toolbar and click the Maximize Image button, which is the fourth icon from the right. And
click on it once.
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To return the other images to the Tile All layout, click the four white squares to the right of the
Maximize Image just once, and the images will be tiled into view again.
Each image can be manipulated individually by right clicking on the image, as seen here, or by using the
shortcut buttons on the toolbar under the word Image. There are also additional manipulations under
View.
The images can be manipulated simultaneously by clicking the Apply Actions to All Images button which
is at the far left-hand side of the toolbar. Click it once.
And then manipulate the images using any of the tools, such as the zoom slider bar, by moving your
mouse onto the Zoom slider bar, holding down the left mouse button, and dragging to the right or left.
Selecting the icon with the red circular arrows, as seen here, resets the images to their original setting.
Remember to disable the Apply to All button by clicking it after you have finished manipulating the
images.
To close a selected image, highlight the image, as seen here.
And click the Close Selected Images button on the toolbar, which is a box with one X in the corner.
To view the report associated with an image, highlight the image of interest.
And click the Report icon, as seen here on the toolbar.
Clicking it once will bring the image report into a new window. For now, we can close the image report
window.
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Images may be copied to the clipboard or printed by utilizing the appropriate button on the toolbar, as
seen here. We will look at the Copy to Clipboard button, which is the first button on the left side of the
second toolbar, by clicking it once.
You would then be prompted for an Electronic Signature Code. And you would have to make your
selection for the reason for copying, which are all patient privacy and HIPAA regulations that we are not
going to go into at this point.So you can click the Cancel button.
Additional information about each image is available by right clicking the image...
...and selecting the Image Information option from the dropdown.
This will display when the image was captured, by whom, and includes a statement indicating whether
the image was captured before or after its associated note title.
If you do not see all this information, move your mouse to the lower right-hand corner and expand the
window so that you can see all of the information. Click and drag the lower right-hand corner and drag
to resize this window.This may be important to providers in determining if the image was captured to a
new note or procedure, or if it was captured as an addendum. Additional information regarding the full
resolution viewer is available by clicking Help.For now, let's close the Image Information window by
clicking the Close button.
And close the Full Resolution View window by clicking the X in the upper right-hand corner.
If the Group Abstract window is still displaying, click the X to close that window so that the Image List
window remains in view. So here's what we've covered. We discussed the Full Resolution Viewer, and
how to manipulate the images and their layout, how to view a report, copy or print an image, and how
to view additional image information.
Section 6: Radiology Viewer
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This is part five -- The Radiology Viewer. To quickly view only radiology images, click the #Rad All filter
tab, as demonstrated here.
Select a study from the Image List window by clicking on it. In this case, Case #229; which is item
number 3 in this list.
Then click the chest X-ray abstract at the left-hand side of the window with a single left mouse click.
And a Group Abstract window will open showing all the images in the study.Click the image of interest -in this case the PA Chest X-ray, which has the blue border around it -- with the left mouse button, which
will open the Radiology Viewer as demonstrated.
When there is more than one image in the study, the image number control in the upper right corner of
the Radiology Viewer will allow paging back and forth through the images in the group. In the Radiology
Viewer window, click the first single right arrow to the right, which will allow you to see the next image
in the window.
You can page backwards to see the first image by clicking the single left arrow once to return to the
previous image.
You can also do comparison images in the Radiology Viewer. And in this case, we're going to leave the
PA Chest X-ray as we see it. We're going to click the X in the corner of the group abstract window to the
far right.
In the background, click the Image List window.
And in this case, we want to compare this chest X-ray with Case #240 -- which was dated 1/23 of '03 and
is number 15 in the item list. Single click this study.
Single click on the chest X-ray abstract to the left.
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And in this case, on the image with the blue border, do a right mouse button click.
And then left click on the option that says Open Image in 2nd Radiology Window.
For now, let's maximize the Radiology Viewer by clicking the center box at the top right.
The active image has a yellow border at the bottom. In this case, the right image is the active image.
And by clicking on the left image in the window, it becomes the selected image.
You can manipulate the window and level values, or the brightness and contrast, in either of the images
simultaneously or together. And in this case, we're going to manipulate the left sided image by moving
our mouse into the image itself, holding down the right mouse button, and then dragging up and down
and right to left to adjust the brightness and contrast of this image.
When you release the right mouse button, the image will retain the settings which you have just
manipulated. To return the image to its original settings, click Image option on the main window.
And click the ResetImage option as seen here.
There is a magnifying glass tool, which is available by clicking the Magnify option on the toolbar...
...moving the mouse into the image and holding down the left mouse button and dragging around the
image as seen here. Releasing the left mouse button will deactivate the tool.
The Report button will display the short description and the radiology report associated with the image.
Click the Report option on the toolbar, as demonstrated, and the Image Report window will display.
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Click the X in the Image Report window to close this.
Image manipulation operations can be applied to either the selected images or to all images. If the
Apply to All button is depressed, as seen here on the toolbar, the image manipulation operations will be
applied to all images.
In this case, click the single right arrow in the image paging at the top to move to image number two to
display the lateral chest X-rays.
The lateral chest X-rays seen here are not in the proper orientation, meaning that the patient appears to
be facing towards the left. And the proper orientation would be with the patient facing towards the
right.Click the rotate option as seen here.
And select FlipHorizontal.
To change the view from two images back to one image, click the ViewSettings option at the top.
And select 1x1 Stack.
Click the Apply to All button so that it is no longer activated.
And close the Radiology View window with the X in the corner.
If the Group Abstract window is still being displayed, click the X in that window as well.
Section 7: Radiology Viewer (Part 2)
Next we're going to talk about viewing CAT scans. From the Image List window and using the #Rad All
filter, select the CT Thorax, which is item number 6 in the Image List.
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Single click the abstract at the left side of the window.
And instead of viewing the scout image, which is image number 1 in the Group Abstract window, single
left click on image number 2.
To show you how to do simultaneous comparison of images with different tissue density presets, in this
case, right click on the second number two image.
And left click the Open Image in 2nd Radiology View Window again.
Maximize the Radiology Viewer by clicking the box in the upper right-hand corner.
Activate the left-hand image by single clicking it.
Go up to the CTPreset option.
And in this case, select Lung as your tissue density setting.
Click on the right-hand image to activate it.
Again, click the CT Preset option.
And select Mediastinum in this case.
Now we have both images tied side-by-side with different tissue densities. Click the Apply to All button
on the toolbar.
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And now we can step through the study with both sets of presets. By clicking the single arrow to the
right will move us one image down the stack.
And if you click the double arrow to the right, it will move you to the next tenth image in the stack.
Continuing to click the double right arrow will move you another ten images.
Or by clicking the double arrow to the left will move you back ten images higher into the study.
Click the Apply to All button to deactivate the feature.
And to return to viewing the study one image at a time, click the View Settings option.
And select the 1x1 Stack as demonstrated.
There are also options to view images in either a 3x2 or 4x3 layout. Click the View Settings options as
seen here.
And select the 3x2 Layout.
Again, use the single or double arrow paging buttons to move through the images, as shown here, by
clicking the single arrow to the right as many times as necessary to view the study.
For now, we can close the Radiology Viewer by clicking the X in the upper right-hand corner.
And by clicking the X in the Group Abstract window, which is still displayed.
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So here's what we've covered. We've seen how to open a Radiology Image and use the paging arrows to
display additional images, how to window and level an image, how to use the magnifying glass tool, how
view comparison images side-by-side in the Radiology Viewer, and how to manipulate images
simultaneously. We viewed CAT scans and used the CTPresets and we changed the layout view for the
images. Next, Dr. Laufer is going to present you with two patient treatment scenarios using VistA
Imaging.
Section 8: User Preferences and Scenario 1
First we need to set some user preferences for our scenarios. Open CPRS from your desktop by double
clicking the icon.
And selecting patient I1211, as seen here.
Click OK.
Click the Tools option.
And select VistA Imaging Display.
After Imaging opens and synchronizes with the patient, minimize the CPRS window.
And close the abstract window at the left by clicking the X in the corner.
From the main Imaging display window, click the Options.
View Preferences.
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On the patient selected tab, remove the check mark from the Show Abstract window box.
Click the Abstract and Group Windows tab.
And ensure that that box remains unchecked.
Click the Remote Image View tab.
And all of the boxes should be unchecked.Click Save at the bottom.
From the main Imaging Display window, once again click the Options menu
If there is not a check mark next to the Save Settings On Exit, please place one there.
We are now ready to start with scenario number one. In scenario number one, you are a provider at the
Salt Lake City Outpatient Primary Care Clinic. And you are following-up on an 88-year-old male patient
who you know well. Unknown to you, prior to today's visit, the veteran vacationed in the Washington,
DC area, was hospitalized for chest pain. Initially, he was rushed to a local community hospital. And
after a short hospitalization, he was transferred to the Washington VA Medical Center. He has now
returned to Salt Lake City and is here to see you and follow-up on the recommendations of the
cardiologist at the Washington VA. He does not have any records, and assumes that you have access to
all the records from both the community hospital and the Washington VA.So the first task in scenario
one is to pull up the last three EKGs, view them all on the same page, and review them line-by-line,
simultaneously.During the live session at VeHU this year, we allowed the providers the opportunity to
figure out the scenario solutions on their own. For this presentation, we are going to walk you through,
step-by-step, all of the answers to the questions in the scenarios. So for the EKG instance, we're going
to click on the EKG icon button on the main Imaging Display window, as seen here.
A VistA Imaging EKG Display window will open. Maximize the window and notice that the study list is
available.
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To view three EKGs at the same time and review them simultaneously, select the studies by highlighting
them, holding down the Ctrl key on the keyboard, and selecting additional studies. In this case, we are
going to select studies one, two, and three.
Close the Study List window by clicking blue icon in the upper right-hand corner.
If you have not manipulated the images, you can click the padlock at the top, next the Study List
window.
And then manipulate any of the vertical scroll bars on the tracing windows and they will track
simultaneously, as seen here.You can close the EKG window. And we will go on to item number two.
Next, we want you to find a copy of the stress test done at the community hospital in Washington, DC.
In order to do that, we first need to make a connection to Washington, DC on the main display window
by clicking the red lettering for the Washington VA Medical Center.
Once the connection is made, Washington is listed in green lettering.In order to more quickly find the
images from the Washington VA Medical Center, in the Image List window, click the Site column header.
And now you'll notice that all of the Washington images are listed alphabetically at the top.In order to
view the images more easily, you may wish to maximize the Image List window.
And on the toolbar, you may want to fit the columns to the text, which is the fifth button from the left.
And click it once.
As you'll notice, of the Washington studies, there's nothing there which says stress test. As happens
frequently, you will receive documents from an outside source. And when they are scanned in by the
scanning staff, an inaccurate description may have been applied to the indexing fields. In this case, it
was named Non-VA scanned EKG instead of a stress test. Highlight number one in the list and double
click it.
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What you will now see is that this is indeed a 27-page stress test and not just a plain EKG. Just wanted
to point out that, at times, you may not actually be looking for what it was you thought you were out to
find. And so you have to use your imagination in some points to find the images.
For now, go ahead and click the X in the Full Resolution View window. The next test of scenario number
one is to find the procedure note and view the images from the catheterization done at the Washington
VA. To do this, we're going to minimize VistA Imaging for a moment, and return to our CPRS chart by
clicking it in the toolbar at the bottom of the window.
Section 9: User Preferences and Scenario 1 (Part 2)
Click on the Reports tab, as seen here
When the Reports tab opens, click the + sign next to the Clinical Reports option, as demonstrated.
In the list, click the + sign next to the Progress Note option.
And single click on Progress Note at the top.
Next, come to the remote data available icon, which is in blue lettering at the top right-hand side of the
window, and single click it.
Put a check mark in the Washington, DC site box.
And click the Remote Data Available button again.
In the background, the Washington, DC studies and progress notes will be retrieved. And in order to
easily see them, click on the Facility header column as shown here.
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Which puts it in alphabetical order. And if you click it again, it should be in reverse alphabetical order.
Here you'll see the cardiology note title with the two-tone blue imaging indicator icon so you know that
this was the procedure note for that cardiac catheterization. If you single click the cardiology note in
that list, you will see the report.And if you double click this note.
And return to VistA Imaging Display, which is in the toolbar at the bottom of the window.
Maximize the Image List window, which is hidden in the toolbar at the far left-hand side.
Single click on item number 2, which is the cardiology consult procedure.
Single click on the abstract to the left.
And even though the abstract says that this image is on the remote server, if you single click the blue
box which is showing right now, the image should appear for you.
It will open into the Radiology Viewer. And you'll notice that in the bottom right-hand portion of the
window is the DICOM Multiframe Cine Viewer.If you click on the button which says Cine at the top left
of that window.
The images will show the motion of the study. Right now we have the Play Once mode selected, so it
will only go through the images one time.
For now, we can close all of these windows by clicking the X in the corner of the Cine Viewer, the
Radiology Viewer, and the Group Abstract window.
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Lastly, we want to find the last chest film that was done at the remote site and pull it up to view. The
simplest way to do so would be to change our focus from the tabs from the #All to the #Rad All,
meaning all radiology images, with a single click.
And there you will notice that in the Procedure Date/Time column, they are listed in date/time
order.And the first item on that list is a Chest 2 Views PA and Lateral. Double click number 1 in the list.
In the Group Abstract window, it's showing us that those images are on the remote server. Single click
on the first blue box in the Group Abstract window, which will open the PA Chest X-ray.
Back in the Group Abstract window, right click on image number two.
And then left click on Open in 2nd Radiology Window.
You now have the PA and Lateral Chest X-rays side-by-side from the Washington VA.Close the Radiology
Viewer by clicking the X in the corner.
And close the Group Abstract window as well.
This is the end of scenario one. We will go with scenario two in just a moment.
Section 10: Scenario 2
This is scenario number two. An 88-year-old patient is being seen in Pulmonary Clinic for consultation
for a new chest nodule. The patient tells you that he has had multiple chest films in the past at other
VAs, but he is not sure where or when. Item number one in this scenario is to look in VistA Imaging and
choose a preset filter to view only radiology studies from all sites on the index list. To perform this, click
the #Rad All filter tab, which will put into view all the radiology images that this patient has had,
regardless of the site.
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Next, we want to make a filter to view only radiographic studies for the past three years on the index
list.To accomplish that, we're going to start with the Create/Select Image Filter, which is the blue and
white checkerboard shortcut button on the Image List window, and single click it.
We're going to click the Clinical tab in the center of the window.
And we're going to start in the lower left-hand corner by clicking the Private filter tab.
Next, at the top right, in the Date Range box, click the down arrow.
And click on the <Select Range> choice.
In the From calendar, click the word August.
Change this to January by single clicking it.
Click the year 2006.
And use the dropdown arrow to the right to select 2003.
We are going to leave the To calendar date as today's date and click OK at the bottom.
We now have a date range from January 1, 2003 through August 24 of 2006. In the Image Origin box, All
is the default, which we will leave set as-is.Next, since we only want to see Radiology Images, and
Radiology is one of the available VistA packages, place a check mark in the Radiology selection box.
Lastly, at the bottom, click Save As.
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And in the Private Filter name box, call this "Radiology 3 Years".
And click Save.
You will notice that the Radiology 3 Years is now placed on your Private filter tab. And click the OK
button on the Image Filter window...
...which will now place a new Private Filter tab in the Image List window, showing only those radiology
images from January 1, 2003 through August 24, 2006.Next, we are going to cache three chest X-rays
from our remote site to our local workstation. To do that, we're going to click back to the #Rad All filter.
And in order to make the images easier to find, click the Site header column, as seen here, so that all the
Washington studies are together at the bottom of the list.
Highlight the first Washington study, as seen here, and do a right click.
And then choose Cache Images, of the choices in the dropdown, and do a left click.
Next, highlight the subsequent study, which is item number 15 in the in the Image List window. Right
click again.
Select Cache Images.
And do the same for item number 16 in the list, by right clicking...
...selecting the Cache Images.
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...and then clicking on another study in the list to remove it from item 16.
What you will notice in the item column is that we now have three stop light icons. All three are green,
meaning that those images have been cached to the local workstation and they will remain there for
viewing until VistA Imaging Display is closed. It's important to remember that these images will remain
on the workstation even if you change patients. Until you close the VistA Imaging Display client, they
will remain on the workstation in a temporary holding file. Next, we're going to do some comparisons of
side-by-side images of chest films done at Washington with one done at Salt Lake City. So to begin with,
we're going to select the Salt Lake City chest X-ray -- which was dated 4/19/04 and is Case #229, or in
this list, it is item number 3 -- and single click that item.
Click the abstract to the left, opening up the Group Abstract window.
From the Group Abstract window, single click on the PA chest X-ray, which has the blue border, which
will open the Radiology Viewer.
Next, close the Group Abstract window to the right by clicking the X in the upper right-hand corner.
And in the background, click the Image List window -- which is behind the Radiology Viewer -- with a
single left mouse.
Next we want to find a comparison chest X-ray for this patient which was done at Washington, DC. And
it was dated January 23, 2003 and is case #240, which is item number 15 in the list. Single click item
number 15.
Single click the abstract to the left.
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And when this Group Abstract window opens, right click the PA Chest X-ray with the blue border.
And left click Open in 2nd Radiology Window
In the Radiology Viewer, you now have comparison chest X-rays -- one from Salt Lake City, one from
Washington -- as you will notice in the yellow bar, which is at the bottom of the selected
image.Maximize the Radiology Viewer by clicking the center button.
And our next challenge is to compare the lateral chest X-rays side-by-side, and to do it with only two
mouse clicks. To accomplish this, first click the Apply to All button on the toolbar.
And next click the paging button to the right, the single arrow, which is image number two of two, which
now brings the lateral chest X-rays into view.
Next, we want you to put these lateral chest X-rays into the opposite orientation or the proper view
with only two mouse clicks. And to do so, click the Rotate button on the top menu.
And select FlipHorizontal.
Section 11: Scenario 2 (Part 2)
You now have the lateral chest X-rays in the proper orientation. Lastly, we want you to open the report
for each of the two studies and do so without changing the focus of the window.To do so, click the Apply
to All button to deactivate this tool.
In the active image, which in this case is on the right-hand side because of the yellow border, click the
Report option on the toolbar, which will then bring that report window into view.
And it may be helpful to drag that Report window from the center over to the left side of the window by
moving your mouse onto the blue title bar, clicking with your left mouse, and dragging to the left. This
way, you have the report over the opposite chest X-ray so that you know that the chest X-ray in view
and the report match.
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Click the X in the Report window.
Highlight the left image.
And click the Report button once again.
You may wish to drag this window over to the right image so that you can compare the report with the
actual chest X-ray by left clicking on the title bar and dragging the Report window to the right.
Close the Report window by clicking the X in the upper right-hand corner.
And close the Radiology Viewer the same way.
If the Group Abstract window remains open, you may close it as well.
Congratulations. You have completed your scenarios and are now a VistA Imaging expert.
Additional information resources are available at the Web sites listed here.
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