WORKSTATIONS
What is the proper way to delete patient images from the workstation if space needs to be freed on the local hard drive?
To free up space on a Catella workstation that is used for diagnosis, go to the Local Archive (Menu, Worklist, Local Archive) and delete the patients from there.
Don 't diagnose pending patients as a method of freeing up space. The space isn't freed up until the images are moved to the completed patient list and then into the Local Archive where they are deleted based on age. This technique incorrectly diagnoses patients and sends that information to other Catella systems (as well as to report generators).
Deleting patients from the pending list is also not recommended.
Also remember, the number of medical images produced by modern x-ray equipment is increasing at an exponential rate. But, the cost of storage is dropping even faster. If your workstation is more than two years old, you may want to consider upgrading your hard drive capacity.
Where is the command to “synch” window/level, pan and zoom within a study and across multiple screens held?
These are held in the configuration files for the Catella workstation software.
Our doctor wants to temporarily review images at home. Can this be done?
If you set the doctor up as a “referring physician,” you can install Catella WebVue at his home as a reviewing platform. In this way, images can be automatically routed to your doctor once they are received from the modality.
CAUTION: WebVue is not to be used for diagnosis. A Catella Diagnostic Workstation should be used as it provides the proper resolution and window/level features
Blank images or names appear for a patient. What is the cause?
The blank images and names are probably coming from the fact that an older Catella workstation does not have enough storage for the incoming images. Installing a larger hard drive to deal with your increased workload can easily solve this. Please note that a warning message appears on your “worklist” that indicates when you have a shortage of storage capacity.
If you need to delete patients from the Catella workstation to create room, do not diagnose the patient (OK Next). Instead, delete them from the Local Archive.
Please explain the “place holder” images.
Some outgoing line speeds are particularly slow and the physician will wait for extended periods of time to get images. DICOM has no method of telling the receiver how many images it is sending. To address these issues, we create and sent small placeholders over slow lines to indicate that there will be an image coming later. In other words, you may see some patients with some images marked “not available”. These indicate that you need to wait for the full set of images to arrive before diagnosing the patient.
Since the bandwidth of the incoming line is limited, it takes time for images to arrive. It appears that while an image from clinic 1 is coming in, the images from clinic 2 are waiting. Is there any way to give priority to one sender over another?
Catella maintains a separate communications channel for each remote sending site. So images being sent from 2 clinics will be arriving in parallel. If a single CR would take 3 minutes, two sites each sending a CR should just about double that time to 6 minutes. It might then appear that an image comes in from site 1, then a few minutes later an image comes in from site 2, even though they are being received in parallel.
Can we synchronize Window/Level so that when monitor 1 is changed all other monitors with the same Study & Series will change also?
Yes. To do this, edit the doctor's preferences file.
Before changing this file, it is always a good idea to copy the existing file (either in the existing location by selecting Copy and Paste from the Edit commands in the Windows Explorer or to a floppy diskette), in case there is a problem. To edit the file, go into the Windows Explorer and click on the file C:\Program Files\AMS\Catella\DataElements\Doctors.Ini. The Doctors.ini file has an entry for each doctor consisting of 15 lines of text, starting with LAST and ending with DICTATION VOLUME. Modify the line marked SYNC from No to Yes for each doctor that you want synchronized. Save the file (FILE, SAVE).
The dictation for one patient appears to be included under another patient. Is this possible?
No. But here is an example for a situation that was reported to us:
It was reported that dictation for patient A was mistakenly included in patient B. There appeared not to be dictation for patient B, and files for patient A could not be found on the workstation.
The Catella Workstation Event Log indicated that patient A was brought up first. There was significant (about 4 ½ minutes) dictation. However, the patient's dictation was never sent to transcription (the NEXT PATIENT command was not issued). Instead, after completing the dictation, someone moved to images of patient B and started deleting patients from the workstation's worklist. This deletion included patient A.
Since patient A's dictation had not been sent, it remained (for safety considerations) on the Catella Workstation. By retrieving one Patient A image from the archive, patient A's dictation was re-activated. Now by issuing the NEXT PATIENT command, the dictation was sent to transcription.
Important to remember:
1. ALWAYS use the NEXT PATIENT command to send the dictation to transcription.
2. Don't delete patients with “normal” diagnoses from the worklist. Use the OK-NEXT command to move them to the completed area and then to the Local Archive.
3. Try to get times and patient numbers or names when things go wrong. It makes it much easier to track what has happened.
4. In the case of “lost dictation,” try to push (or query) a single image for that patient. If there was pending dictation, it will be restored and then, using the NEXT PATIENT command, the dictation will be sent to transcription.
For one doctor the Worklist does not display, while for another it does. Any suggestions of what to check?
Check the power outlet, the UPS and any power strips used. In one case, it was discovered that the (3) outlets on the “Battery” side of the UPS unit were no longer functioning (possibly due to a short in the battery or the connectors). We plugged the computer and monitor into a working power strip and the system worked. The UPS needed to be replaced.
How can I tell if all images have arrived for a patient?
This is difficult because the DICOM standard does not include information about how many images are being sent. Here's how we try to help you with the Catella Workstation:
When a new image comes in for a patient that is currently being displayed, we display a message and then display the Worklist. To see the new images, the doctor reloads the current patient. (The doctor may want to move on to another patient first, to allow time for any additional images to arrive for the first patient.)
You should not try to bypass this procedure by clicking on "Advance Images" as this may generate errors. The worklist is put up as a safety measure to make sure that doctors are seeing all the images for a given patient. When the new patient images come in, the worklist pointers could change and may no longer point to the proper images. A “reload” updates all pointers.
The workstation appears to be slowing down. What should I check?
Sometimes there is no obvious cause when a computer slows down. This happens with all types of computers using all types of programs. Sometimes computers experience “run away” programs. This can happen on all Windows machines.
Here's a suggested response: log out of the program and restart it. If this does not clear up the problem, it might help to restart the computer.
Disk defragmentation is also helpful every six months or so. This groups the little bits of free space on your hard disk into big blocks that can be accessed more quickly. Since Catella workstations use high speed SCSI hard drives, this really isn't a big problem.
At your request, and assuming you have given us permission to connect to your system via our highly secure internet connection, we can also check your event log. Because we are constantly upgrading the capabilities of the Catella software, it may be that the workstation software has outgrown its hardware memory capacity. We have recently found that many older workstations cannot handle the “split screen” mode. While it is advisable to increase your system's hardware capability on a semi-annual basis, it is not a requirement. With older machines using split screen, for example, the workstation may react slowly when in “split screen” mode if there are a lot of images for the patient and a lot of images coming in for processing simultaneously. However, the workstation will regain its speed when the “split screen” feature is released.
Once I have started my dictation on a patient's image, do I have to complete it?
No. Dictation is held per patient until the patient's diagnosis is completed. That means that a doctor can start a patient's dictation, move to other patients and even log out. When the doctor returns to that patient, the “Remarks” box is immediately shown and the doctor can continue with the dictation without fear of loss of previous dictation.
“Lost Dictations” typically are reported when the doctor walks away from the workstation without finishing the patient. Either a technician or another doctor tries to use Catella, finds that they cannot get to the Worklist, Logout, or select the Skip function. They then reset the computer, and so the first physician reports a “lost” dictation.
The sound file will be stored in the D:\Orphaned Dictation area of the hard drive on the workstation. Normal Windows programs, such as Sound Recorder or Windows Media Player can be used to play these files
Sometime MR or CT locator images show and other times they do not. What could be happening?
We have never seen this where images from a given machine sometimes show locators and sometimes do not.
We have seen that some machines send locators and some do not. Older “legacy” machines that use DICOM converter boxes often do not send locator images. Older “DICOM compliant” machines also occasionally do not appear to send locator images. In several cases, we have found that the “pointers” for these images are in “private” DICOM fields. Today, much of this “hiding” is well documented in the PACS community. We can often help if we know the make, model and manufacture date of your equipment. In addition, Catella automatically selects an image that is orthogonal to the stacked images to be the locator. You can change that image if there are other orthogonal images.
We turn our workstations off over the weekend and on Monday morning the workstation is really slow. What could be the cause?
The Workstation is receiving all the queued up images not received over the weekend. We recommend that you log out all doctors, but keep the workstation on at all times to be ready to receive images when they are sent. In addition, computers are designed to be on all the time. Frequent start-up and shut down of the hardware can be more stressful to the equipment than just leaving it on. If the monitors are heating up the room, they may be turned off when not in use.
However, remember, even if the equipment is completely shut down, no images will be lost. The images are just stacked up in the Gateway, waiting for the doctor to log in.
Some images don't seem to have the “correct” window/level setting when received. What could be the cause?
The window/level settings being sent, while perhaps technically correct, may not be optimal. The technicians are letting the modality set the Window/Level rather than applying their expertise to improve on the machines' choices.
We have seen at some offices that this can happen if the technicians send the images first, then adjust the Window/Level. If that happens, Catella never gets the corrected images. Catella is showing the images the way they have been specified.
The physician should instruct the technicians to set the window/level to the proper settings to display the important features of the image, not all pixels. The technician should also be instructed to use the same Window/Level setting for all images in a series. The physician can then adjust the settings to get other exposures.
Why would some multiframe images show very dark, while others display much more as we would expect to see an image?
We have also noticed this on rare occasions. The problem appears to be the result of inconsistent technique at the time of acquisition.
To deal with this, you may want to set up some window/level presets. These are helpful if the technique cannot be as controlled by the technician. Presets are helpful, for example, in isolating soft tissue, bone, liver, and other specific regional viewing.
Here's a method for checking if you may want to use presets. To begin, set values of 650 for window and 325 for level for both MR and CT. See if that helps significantly over the default display. This is not an ideal method for everyday viewing since it requires a few button clicks (or voice commands) to get there, but it is much better than manual adjustment.
When inspecting each image, we found that this Window setting was just wide enough to present every pixel in the image with no saturation. Catella assumes that as a first display, the images should be presented with no saturation. The only way to preset all of these images at once with no saturation is to use the widest Window setting. This may indeed be the proper display if what the doctor is looking for is the brightest spots. Under this setting, the brightest spots show up well, but the general images are dark.
More likely, the doctor wants the images to be “well exposed”. As we have studied the makeup of images, we have found that very often there is indeed a very small percentage of pixels that spread over a large range. In these cases, that would require saturating the small percentage of bright pixels to create a better spread of the majority of pixels.
The doctor must decide what is the best way to initially display the images. Once he/she does that, there may be several ways to accommodate the choice:
· If the doctor wants to see all the pixels without saturation, there is no need to change the current setting of the modality, which sets the Window to be the full range of pixel values.
· If the doctor wants to see the images with compressed Windows (that represent the majority of pixels), the physician should instruct the technicians to set the Window before saving the images to that value. Then in the Window/Level menu, the optimize button will quickly display the image with no saturation (that is the function of the Optimize feature).
· The physician could also set Presets to common values. This would allow a quick change of displays.
· The doctor can use the Stack. The default Window/Level for the Stack mode is the value on each frame. So although one frame would be very dark, other frames, which have a good Window/Level setting, would look better.
What are the “image query” levels available on Catella?
Query is fashioned in accordance to the DICOM Patient Root Query method. Under that method, the first query gives the Patient ID or Name. Further query can get the Studies. The next level is Series and the final level is Image. At the Patient level, for example, DICOM has no facilities to return the modality. That is only returned after the Study level.
Why would I receive two sets of patient images from the same modality?
All images sent to the Image Router are routed according to its rules. That means that if an image (or exam) is sent a second time, it is routed as instructed. We assume that if it was sent a second time, there is probably a reason. Perhaps this is because the operator at the modality made a change or simply pressed the send button a second time. DICOM has no facility to “check” the images. However, the Catella workstation will only show you the most recent set of images (if the study and series numbers are the same).
The worklist mixes patients from different clinics/hospitals. Can we sort the worklist so that patients are presented in blocks, based on their location?
Yes – There is a box on the top of the worklist that allows you to change the sort from “oldest first” to “by institution” or “by patient name”.
Some of our images are only viewed on our 3D system, but the image set still goes to the Catella workstation. Can this be changed?
Absolutely. Contact your system administrator to have the routing rules changed.
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