The Omnipacs viewer is a full featured, flexible, diagnostic tool that gives you a wide range of image viewing and manipulation capabilities. Because it is based on the Java programming platform it will run on any Java enabled Windows or Mac computer. Java is a free download, so there is no need for costly software or hardware in order to make the viewer run.
In addition, the OmniPACS viewer has been certified by the FDA for diagnostic image viewing. The transmission of data from the OmniPACS cloud to the viewer is encrypted meaning that it meets HIPPA’s patient confidentiality requirements.
Each and every OmniPACS account has the viewer built-in and includes all of the features discussed in the following pages. We’ve broken this guide into five sections: The Worklist; The Lightbox; Tools and Work Area; Alternate Display Modes and Advanced Features. The intent of this guide is to help you get the most out of the viewer and its features.
Before we begin there are a couple of minor pre-requisites:
Java version 1.4.2 or higher o Java is a freely available programming platform that powers the OmniPACS Viewer. o Macs with OS X have Java already installed. o For Windows users, you may already have it pre-installed. If not, you can go to www.java.com and download the latest version for free.
2GB of RAM recommended minimum o Most Windows and Mac PCs today have at least 2GB of RAM. o The more RAM the better because medical imaging studies can be quite large and take up a lot of system resources to view properly. This can be especially true of some CT and echocardiogram studies.
There are two types of viewing options: the Basic Viewer and the Diagnostic Viewer. For the purposes of this guide, we will explore the Diagnostic Viewer
Diagnostic Viewer o More complex, diagnostic web viewer
o Advanced tools and annotation features for analysis
Below is a typical OmniPACS Diagnostic web-viewer window.
When you click to view a new study from OmniPACS it will open the viewer in a new tab on your browser. If you have more than one monitor selected, it will open a second instance of the viewer in a browser pop-up window. The viewer is very easy to use and most users who have any experience with DICOM viewers are able to pick it up very quickly.
For the purposes of this guide, we’ve broken it down into four sections:
Tools & Work Area
The worklist gives you access to all available studies for a particular patient as well as the individual series within those studies. It is comprised of two side by side boxes; the study list and the series list.
The study shows all of the studies stored in OmniPACS for a particular patient. The viewer uses a patient’s ID number to identify if there is more than one study for a patient. If a single patient has multiple ID numbers, those studies with differing IDs will not show up.
The study list area is broken down into seven re-arrangeable columns:
Study Date o Can be arranged in ascending or descending order by clicking on the small green or red arrow to the left of the column name. o Can be searched by double clicking the column name and typing in a date or clicking on the down arrow to bring up a calendar.
Patient Name o Can be arranged in ascending or descending order by clicking on the small green or red arrow to the left of the column name.
Can be searched by double clicking the column name and typing in a name.
Birth Date o Can be arranged in ascending or descending order by clicking on the small green or red arrow to the left of the column name. o Can be searched by double clicking the column name and typing in a date or clicking on the down arrow to bring up a calendar.
Patient ID o Can be searched by double clicking the column name and typing in a patient ID.
Can be searched by double clicking the column name and typing in a description.
Referring Physician o Can be searched by double clicking the column name and typing in a physician name.
Modality o Can be searched by double clicking the column name and typing in a physician name.
On the left hand side of the study list are two small icons. The top icon is a blue circle when no search criteria has been entered. It turns red if you have entered in search criteria. If you hold the mouse over the red circle icon without clicking it will display what criteria has been searched for. By clicking on the circle when it is red it will reset the study list to the original list when you opened the viewer.
The yellow dual arrow icon refreshes the study list. If any new studies for that patient have arrived in RemotePACS since you opened the viewer, those studies will now display on the list.
To the left of the Study List is the Series List. Here, each series within a selected study is displayed. There are four re-arrangeable columns:
Not searchable or sortable.
(Series) Number o Can be arranged in ascending or descending order by clicking on the small green or red arrow to the left of the column name.
Can be searched by double clicking the column name and typing in a number.
Image Count o Can be arranged in ascending or descending order by clicking on the small green or red arrow to the left of the column name.
Can be searched by double clicking the column name and typing in a number.
Contrast o Can be searched by double clicking the column name and typing desired contrast.
Please note that this field is populated by the acquiring modality only.
Series Description o Can be searched by double clicking the column name and typing in a description.
The lightbox area of the viewer shows individual images within a series and controls certain tools such as the localizer and hanging protocols, among other things. Each series will get its own individual lightbox.
Each individual image within a series is shown as an image thumbnail in scrollable columns. By default, the viewer puts only one column of images, but you can drag the column by the divider bar to show 2 or more columns of images. Each image is numbered and these numbers are generated by the original acquisition imaging modality.
You can open additional lightboxes by clicking on the “New Lightbox” button at the top right of the first lightbox. A new light box opens and is active immediately. This is accompanied by a second image viewer, which opens in the work area. If you select another study or series, the first image loaded is displayed in the new light box.
You can close all but the first lightbox by clicking on the “Close Lightbox” button on the top right of the lightbox you wish to close. This will close the lightbox as well as the viewer window in the work area.
Image Count Toolbar
Located just above the Image Thumbnails is the Image Count Toolbar. The number of images in the series will be displayed within brackets. For example,  indicates a series with four images in it.
There is also a menu in the Image Count Bar that can be displayed by rightclicking on the bar itself. This menu allows you to do two things. The first is the ability to re-download the images (Reload All Images) and the second is the ability to sort the thumbnail images based on several different criteria.
The viewer allows you to select your desired compression level. By clicking on this icon you will see options for downloading images at different compression ratios. Please note that higher compression ratios may degrade the quality of the images so we recommended not modifying this.
Studies that contain localizer information can display reference lines in a localizer image within the lightbox using this function. By clicking on the “Show Localizer” at the top of a particular lightbox, the localizer or scout image will appear in that lightbox.
On the far left hand side of the Lightbox, there are small white lines that indicate the download progress of the images within the series. Each downloaded image is represented by full white line, while a small white dot represents an image that has not yet downloaded.
The viewer contains pre-programmed hanging protocols that can be turned on and off by clicking on the “H” icon on the bottom left of the Lightbox. These hanging protocols are not customizable.
Additional Information about the Lightbox
By clicking on an image in the Lightbox you can select it to be viewed in the main Work Area.
The images in the Lightbox can be scrolled through using the scroll wheel on the mouse.
Each of the tools in RemotePACS viewer Toolbar gives you the ability to manipulate and enhance the images displayed in the Work Area (viewer). The Work Area is where the image(s) in a series are displayed. In this guide we’ll go over what’s tools and functions are available and how to use them on the images.
You can view the grayscale value or the pixel value for each pixel of the image. Click the Gray Values button on the toolbar. Then click, hold and move the mouse to any position in the image. The current grayscale value and the column and row coordinates of the mouse position (e.g. 1585 (231, 107) are displayed beside the mouse pointer. The first number is the grayscale value and the numbers in brackets are the pixel coordinates.
You can use this tool to manually adjust the brightness and the contrast of the image displayed in the Work Area. Click the Window/Level button the click and hold on the image. If you move the mouse up and down on the image while continuing to hold the left mouse button down you can adjust the brightness level of the image. By doing the same thing except moving the mouse left and right across the image, you can adjust the contrast levels in the image.
Window/Level in Rectangle
This tool calculates the optimum windowing based on a user drawn rectangle and applies it to the whole image. To use this tool select the “Level/Window in rectangle” button on the toolbar. Then select an image to use for auto windowing and click and hold the mouse button on the image. Drag a rectangle around the desired area and release the mouse.
The magnifier tool enlarges a small section of the image to 3x. Click the “Magnifier” button in the
toolbar. The mouse pointer then turns into a magnifying glass. Click, hold and drag the mouse over the section of the image you want to magnify. The section of the image you have selected with the mouse pointer is then displayed magnified in a separate zoom window.
The zoom tool will zoom in and out of an image in the Work Area. Click on the “Zoom” button in the toolbar then click, hold and move the mouse up or down on the image. Moving the mouse to the top zooms in and moving it to the bottom zooms out. Release the mouse once you have reached the required magnification.
The image can be moved so that hidden areas can be viewed or brought into the viewer's center of focus. To do this, click on the “Pan” button. The mouse pointer turns into two double-headed arrows that form a cross. Click and hold and move the mouse in any direction. Once the image is in the required position, release the mouse button.
Please Note: If the image is smaller than the currently visible viewing area, you cannot move the image out of the image viewer.
You can also hide parts of an image using the shutter function, which works like shades on a fluorescent screen. To hide parts of an image, first click the “Shutter” button on the toolbar. Move the mouse pointer to the edge of the image viewer. When the mouse pointer turns into a horizontal double-headed arrow click and hold and drag the image black border inwards until the part of the image you want to hide is hidden.
To remove the shutter, drag the shutter back to the far edges of the image viewer again using the mouse.
The select ROI tool allows to you to select, manipulate and delete objects, measurements and annotations that have been drawn on an image. To use this tool click on the “Select ROI” button from the toolbar then left click the line or X that is part of an object on the image. That will select the image. You can hit the “Delete” key to remove it, or click and drag the object to another part of the image, or select the “X” and make the object larger or smaller.
Also, you can click on the “Select ROI” button from the tool and left click on the edge of an object on an image. If you then right click on the edge of the same object you will be given a dropdown menu that will have options to remove that object, remove all objects on the image or to change the color of the object.
To measure the length of a line on an image click on the “Distance” button in the toolbar. Now click the starting point of your distance measurement on the image. Move the mouse to the end point. As you are drawing, the line moves with the mouse pointer. Click again to mark the end point on the image. The length of the line is displayed to the right of the line.
Please Note: This function works with images that contain accurate pixel size data. Ultrasound images frequently do not contain pixel size data so the length of the line will be measured in pixels.
Rectangle and Circle
The measurement of rectangles and circles is performed in the same way as measurement of distances. For rectangles, the length (l) and width (b) are measured, and for circles the radius (r). For both objects the measurement also calculates the surface area (A) as well as the mean (M) and the standard deviation (S) of the grayscale values in the image, which can be used to determine the density. The values are displayed next to the object you have drawn.
To draw a circle or a rectangle, click Rectangle on the toolbar. Left click on the image to specify one corner of the rectangle. Move the mouse pointer to where you like to place the opposite corner of the rectangle. As you are drawing, the sides of the rectangle are visible. Click again to stop drawing. The rectangle is now completed.
To draw a circle, click the image to specify the center of the circle then move the mouse pointer to where you want to place the outer rim of the circle. As you are drawing, the circle is visible. Click again to stop drawing the circle.
Angle (3 point)
A three-point angle describes a normal angle defined by two lines that terminate at a point. The enclosed angle between 0° and 180° is calculated. To measure a 3-point angle, click the Angle button on the toolbar then left click to define the starting point of one line. Move the mouse to the vertex of the angle. Left click again to specify the position of the vertex. Now move the mouse to the end of the second side and left click again to stop drawing.
A four-point angle describes an angle defined by two intersecting lines, where the point of intersection may also lie outside the area visible on screen. The smaller of the two angles between 0° and 90° enclosed by the lines is calculated. To measure a four-point angle, click the “4-Point Angle” button on the toolbar then left click on the image to define the starting point of one line. Move the mouse to the vertex of the angle. Left click again to specify the end of the first line. Repeat this to draw the second line. The angle will be between the two lines, if they were extrapolated, is displayed next to the first line drawn.
You can draw polygons with any number of edges using the “Polyline” tool. For polygons the mean value (M) and the standard deviation (S) of the grayscale values in the image and the distance from the first to the last point along the edge of the polygon are calculated.
To draw a polygon, click the “Polyline” button on the toolbar then left click the starting point for the polygon in the image. Move the mouse to the polygon's next corner and left click again at that point. Repeat this until you have drawn the complete polygon, except for the last point. As you are drawing, the distance from the first to the last point along the edge of the polygon is displayed next to the first point. Move the mouse to the last point of the polygon and double-click at that point as this automatically closes the polygon.
To draw a freehand line, click the “Freehand” button on the toolbar, then left click on the image in the viewer to define the starting point of the line. Keep the left mouse button pressed and draw the line. Once you have reached the end of the desired line, release the mouse.
You can add text and numerical annotations to an image. To write an annotation, click “Text Annotation” button on the toolbar then left click the point in the image where you want to place your annotation. The position is marked by an x and a text input box with the title "Please enter text". Click the text box and enter the annotation text.
Two types of arrows are available: single-headed arrows and double-headed arrows. To draw an arrow, click the “Arrows” button on the toolbar and from the submenu click the single or doubleheaded arrow. Now left click on the image to define the starting point of your arrow and move the
mouse to the end point. Left click on the image to define the end of your arrow.
If you have two lightboxes open it is also possible to synchronize two or more series by scrolling through manually. To utilize this tool click on the “Synchronize Images” button located on the toolbar. By right clicking directly on the icon a submenu will appear that has two options: Synchronize with mouse wheel and Synchronize with cursor keys (default). If Synchronize with mouse wheel is selected, you can use the scroll wheel on the mouse to scroll through a series and other linked series will scroll in sync. The Synchronize with cursor keys option functions similarly, but uses the ← and → keys instead of the scroll wheel.
Cine Loop Scroll
Using the cine browsing function, you can quickly browse through the entire series of images in the light box.
To activate the cine loop scroll function, ”Cine Loop Scroll” button from the toolbar then left click and hold the mouse and move it vertically across the image. The image viewer then browses through the images in the sequence one at a time. To stop browsing, release the mouse.
If there are several series with different clipping planes in a study, these clipping planes can be displayed in other quadrants, or hidden again. To use this function, load the series in separate lightboxes then click “Display Localizer” on the toolbar. The spatial position of the current image in the active lightbox is displayed as a clipping plane in the other images displayed in the image viewer.
The “Show Overlays” button loads a dropdown menu that allows you to turn on and off specific or all image overlays. These overlays include:
Text – DICOM Information located mostly in the corners
ROIs – This includes measurements and text annotations
ROIs Text – Only text annotations
Ruler – The ruler displayed on the right hand side of the image
Orientation – Any orientation contained in the image (ie. Anterior, posterior, etc)
DICOM – Any DICOM Data
You can select the default zoom factors for enlarging images by clicking on the “Zoom Factor” icon and selecting the desired option from the dropdown menu.
There are three available display modes in the RemotePACS viewer. The default display mode is stack, where images in the same series are “stacked” on top of one another and you can use either the scroll wheel or the left and right keys to scroll through them. The other two options are Cine (images are displayed in a continuous film sequence) and MPR/MIP. The “Display Mode” button gives you a dropdown menu to select any one of the three available modes.
You can control the number of images within a series that can be displayed. Images will always be displayed in a grid and several grid arrangements are available with a single click:
Window/Level Preset, Invert and Reset
The RemotePACS viewer offers a large number of window/level presets. You can access this list by clicking on the “Window/Level” button located on the toolbar and from the dropdown menu click on the desired preset.
In addition, you can reset the window/level settings to original and invert the image to a negative view from this same dropdown menu.
When the image is zoomed the image display may become grainy. You can use the interpolation function to smooth the image. If you are zoomed in on an image simply click the “Interpolate” button from the toolbar. This will smooth out the image.
Fit Image to Window
You can set the image zoom factor to fill the image viewing window. This function is useful for a complete view of a large image where the original resolution of the image is larger than the work area. This function is turned on by default when opening an image. If you have adjusted the zoom factor and wish to set the image back to fit the window size click on the “Fit Image to Window” button from the toolbar.
Follow Actions on All Images
To apply all future actions to the whole series, so that all of the images in the light box are updated with your changes at the same time, click the “Follow Actions on All Images” button on the toolbar.
At the right of the image there are two sliders and a grayscale palette. The grayscale palette shows the entire viewable grayscale range in 5% Grayscale palette steps. You can use the grayscale palette to check that the windowed grayscale is displayed correctly on your monitor. The entire range should be visible on your monitor. To the right of the grayscale palette are the two sliders for adjusting Grayscale window the grayscale window. The left slider changes the level setting. The vertical position of the slider represents the centre of the grayscale range displayed, as can be seen in the grayscale palette. When you move the slider, the grayscale window is shifted. The right slider adjusts the width of the grayscale window. To enlarge it, move the slider upwards, to reduce it, move the slider downwards. The current Level/Window settings are shown in the bottom right hand corner of the image if overlays are on.
Last Action on All Images
If the “Follow Actions on All Images” button was turned off, you can apply the previous action done on the current image to all of the other images in the series by clicking on the “Last Action on All Images” button.
This button will reset all of the window/level settings on an image to the settings used when the image was originally opened.
ALTERNATE DISPLAY MODES
The RemotePACS offers three different display modes. The default mode is “Stack” and that is covered by the majority of the tools listed above. The two additional display modes are “Cine” and “MPR”. We’ll cover both of these in more detail in this section.
You can browse through all of the images displayed in the lightbox or display a multi-frame series by switching to cine mode. To switch to cine mode click the “Display Mode” button on the toolbar and select “Cine”. This will change the button from “Stack” to “Cine” as well
enable the cine tools and disable any tools not available in cine mode.
In Cine Mode a control bar appears below the images.
Click the forward and reverse arrow buttons to play through the images.
Click the First Image and Last Image buttons to go to the beginning or the end of the loop.
Click the Pause button to stop playing.
You can adjust the frame speed by dragging the marker and moving it left or right. The current frame speed is indicated to the right.
This option lets you interactively view image records in several layers as well as create
MPRs (multiplanar reconstructions) and MIPs (maximum intensity projections). To switch to
MPR display mode, click on the “Display Mode” button on the toolbar and select “MPR”.
This will change the button from “Stack” or “Cine” to “MPR” as well as enable the MPR and MIP tools and options. When the slicer is started, the image viewer is divided into four quadrants. The last active series is shown in the upper left quadrant and the two orthogonally aligned MPRs in the two lower quadrants.
You can change the orientation of the planes as you wish. The planar cross can be rotated and the planes can be moved individually.
To turn the planar cross, first click the “Navigator” button to display the planes. Move the mouse to one end of the planar line. You’ll see that the cursor changes into a double-headed arrow. While holding down the mouse button, move the mouse until the cross has reached the required position then release the mouse.
Turning the planar cross changes the position of the slice planes in the lower two quadrants. To move a plane, move the cursor to the central part of a planar line. Once again, it changes into a double-headed arrow. Move the plane of the selected quadrant by clicking and dragging it. Alternatively, you can use the mouse wheel to scroll through the image slices in any quadrant.
To move both planes simultaneously, move the mouse directly to the intersection of the cross. The cursor turns into a cross. By clicking and dragging, move the planes in the other two quadrants simultaneously.
Reset Planes To reset the planes to their original position, click the “Reset Geometry” button in the toolbar.
In the upper right quadrant you can make following settings for database storage of reconstructed images:
Manual configuration of the layer thickness of MPRs or MIPs,
Selecting between MPR and MIP construction
Selection of the sectional orientation
Series description editing
Reconstructing image slices using “Image” or “Series” and loading them into the next light box.
Please Note: That most of the changes made using the Advanced Features will only be saved if the user hits the “Close” button when finished. Closing the browser window or browser tab without clicking “Close” will cause any changes to be discarded.
If you have accessed one of the other Advanced Features and wish to return to viewing images, you can click on the “Images” button to return the image viewer to the Work Area.
Here you can save one or more images from a series to a directory on your local
PC. First, switch to the Data workspace by pressing “Data” on the Work Area menu
bar. A window with two tabs, Database and Export, opens. Next select the Export tab. The tab with input boxes for exporting data appears in the Work Area. Now click the “...” button, to select a target directory where you want to save the images. A file search window will open. In the file search window, click on the target directory where you want to save the images and confirm by clicking “Open”. Now enter a filename in the relevant input box in the Export window.
Now you need to select an export format from the list box and choose your settings for the individual options. The following export formats are available:
TIFF (Tagged Image File Format) - For this format you can choose between the following ways of image compression: o None o ZIP o Packbits
JPEG - Here the image quality can be adjusted.
JPEG 2000 - For this format a compression factor can be defined.
DICOM - If Selecting DICOM as export format, you can choose afterwards to generate a DICOM conform directory within your selected target directory by pressing the “DICOMDIR creation” button.
Furthermore for the formats TIFF, JPEG and JPEG 2000 the following settings are possible:
Burn overlays - Overlays will be exported together with the image.
Zoom - The image will be exported with the selected zoom factor (factor 1 = original size).
Scale fonts - Overlays will be scaled up according to the zoom factor selected above.
Now you need to select the required image from the light box by clicking on it, or select multiple images by holding the “Ctrl” key and clicking on the required images. Then start the image export by clicking the “Export selected images” button. The current export status is displayed in the status bar at the bottom of the tab. Once the export has been completed successfully the images are saved in the selected target directory.
Setup – Image Overlay and ROI Colors and Fonts
You can adjust the color of overlays and the fonts used in the viewer. Begin by clicking on the
“Setup” button located on the Work Area menu bar. This will open up the setup options in the
Work Area. Now within the “Images” tab, select the “Standard” sub-tab. Here you can adjust the
DICOM Overlay font and color
ROI (text annotation) font and color
ROI color for any objects, marks or measurements made on an image.
Some additional options are listed but are unavailable.
The RemotePACS viewer comes with the DICOM image overlays pre-configured for several modality types. However, if you need to add, modify or remove some information in the DICOM
overlay you can do this by clicking on “Setup” on the Work Area menu bar. This will open up the
setup options in the Work Area. Now select the “Images” tab and then select the “Overlays” sub-tab. There are several options available:
Modify Existing DICOM Overlay Elements - Double-click the directory icon for a modality at the left of the tab. This will open the directory tree for that modality and a list of elements that can be used as overlays for images from this modality will be opened. The DICOM code (elements/groups) is shown in brackets. Now double-click an element on the list. Input boxes and list boxes are now displayed on the right of the overlay window. You can configure the following settings in the various input boxes:
An element/group in the list (the modality code is shown in the input box)
The position of the element in the image (the row where the element will be positioned) o The prefix that will appear in front of the element as an overlay o The suffix that will appear after the element
Creating DICOM Overlay Elements - To add a new element or a group of elements to the list click an element in the list, click the “New” button. A new row is added to the list. With this line selected right-click the input box for that group/element. A drop down menu containing a list will appear, with the single elements combined into groups. Now move the mouse over the individual groups. Another drop down menu containing a list of the associated elements will be displayed for each one, with the DICOM codes shown in brackets. Select the element you want by clicking on it, then confirm by clicking “Save”. The element you selected is then displayed on the left of the configuration tab as a new element. You can edit the new element by entering its details on the right of the tab. The overlays will now always be displayed on the images using these settings when you load a series.
Removing DICOM Overlays - To remove an element from the list click on the element and then click “Remove”. Confirm the change by clicking the “Save” button. You can restore elements you have removed by clicking “Restore”.
Creating DICOM Overlays for New Modalities - You can also add new modalities, as long as they are physically stored in RemotePACS. To create a new modality, click the entry “New” on the left of the tab at the bottom of the directory tree. This creates a new directory at the modality level. Now add a name and a description for the new directory for the modality in the input boxes on the right of the tab. Confirm the details you have entered by clicking the “Save” button.
Setup – Adding Additional Monitors
The RemotePACS viewer allows each user to setup for multiple monitors. You can adjust the number of monitors that the viewer will take advantage of by clicking on the “Setup” button in the Work Area menu bar then clicking on “Desktop”. In the Work Area you will see “Screens” with an
adjustable number to the right of it. You can increase the number by clicking the up arrow to the right. Similarly you can lower the number by clicking the down arrow.
Link The “Link” button in the Work Area menu bar gives you the ability to share a particular study with someone for a limited time. It will not require the end user to create an account with
RemotePACS. Once the link has expired anyone you shared the link with will no longer be able to access it.
The “Close” button located in the Work Area menu bar will close the currently opened viewer session. It will also save any changes made to settings during this session, including, but not limited to, DICOM Overlay modifications, number of screens, and ROI color and font changes.