Test Case User Guide

Optional preparation before image review

Prefetching downloads case images into local browser storage before you review them. It can reduce loading delays for large cases or a slow connection. You can start reporting and open cases before they are cached.

Sign in using your test invitation, open your assigned reporting test, and expand Image prefetching above the case list. The example below uses Test cases - Body - Batch A.

1. Select Add cases to work list to add the test cases to the PACScenter work list. This step does not download the images.

2. Select Open work list. The PACScenter review list opens in a new browser tab.

3. In PACScenter, find a case by its #Accession identifier. Click the button in its Cached column to download its images. Repeat for each case you want to prefetch.

4. Keep the PACScenter tab open so the images can download in the background while you report. Continue in the same browser and on the same device.

Prefetching example and download status

Example: prefetch case ACADA69633. In Figure 2, locate ACADA69633 in the #Accession column and click the red No button on the same row. Watch that case’s Cached status as the download progresses. A green Yes confirms that PACScenter reports the case as cached.

Check the Cached status. Adding cases to the work list alone does not mean that the images are ready.

• Red No means the case is not cached. • Orange In Progress means the download is underway, as shown for ACADA66722. • Green Yes means the case is cached, as illustrated by the separate sample cases in Figure 3.

Return to the reporting test and select the case you want to review. You can open it while prefetching continues; it does not have to show Yes before you start.

Browser storage. Prefetched images are stored locally in your browser. Storage limits or clearing browser data may remove them, so you may need to download them again. Use How it works in the Image prefetching panel to reopen these instructions.

Open the viewer

After selecting a case, use the PACScenter viewing area to review its image series. The images load automatically.

Use a second monitor

Using two monitors? Click Detach Viewer to open the image viewer separately and move it to your second monitor for a larger view.

Find the series menu and toolbar

Move the mouse to the left side of the viewer to display the series menu. Move it to the right side to display the toolbar. You can also access the toolbar by right-clicking an image. Figure 5 identifies the patient history bar, image area and toolbar.

Patient history bar. The purple box in Figure 5 marks the studies available for the selected case. Drag a study or series into the viewing area to open it.

View area. The blue box marks the area where images are displayed. PACScenter also supports multi-monitor viewing when configured.

Toolbar. The red box marks the tools used to change the image display, navigate series and create reconstructions.

Each study image is automatically assigned a unique colour for a better identification of the patient images. This colour appears as a horizontal highlighted bar at the top of each image.

Multiple exam dates

A patient may have multiple exams and studies from different dates. The screenshot below shows where study dates appear in PACScenter.

Select an image before using a tool

Before applying a tool, select an image panel. A yellow border identifies the selected panel.

The toolbar contains all the diagnostic tools that can be applied to the imaging study (Figure 6).

Move through image stacks

Two-button scrolling. Press and hold both the left and right mouse buttons while moving the mouse over the image. Move horizontally to advance through the series in larger steps; move vertically for finer movement. Release both buttons to stop. This works in standard image series and Free MPR.

Mouse-wheel scrolling. Use the mouse wheel for ordinary slice-by-slice navigation when only small adjustments are required.

The image operation tools are available in the second section of the toolbar.

Browse. Use Browse to move through an image stack or to play and pause dynamic images and cine loops. The viewing area is shown in Figure 5.

Drag the red slider to move through the study, or scroll the mouse wheel over the image for slice-by-slice navigation.

Sort the images

Use Number, Time or Position to choose how images are sorted. These options use the corresponding DICOM information.

Select a sort option from the toolbar or right-click menu. Use the ascending or descending option to change the order.

Change layouts and enlarge an image

PACScenter supports layouts of up to 5 × 5 views, with up to 25 images per screen. The default layout depends on the selected study.

Drag from the top-left square in the layout selector to choose the number of views. Layouts may also be predefined for the imaging protocol.

Maximize and restore a panel

Maximize or restore a view. Use the Maximize tool to enlarge the selected panel.

You can also double-click a standard image panel to maximize it. Double-click again to restore the previous layout.

Zoom in and out

Zoom. Select Zoom, then hold the mouse button and move up to zoom in or down to zoom out. Use To fit to fit the image to the panel, or To original to restore its original size. Mammography views may also offer quadrant zoom options.

Adjust contrast and inspect details

Change brightness and contrast

Window level. Select Window Level, then click and drag over the image to adjust brightness and contrast.

Move a zoomed image

Pan. Select Pan, then hold the left mouse button and drag to move the image within its panel. This is useful when reviewing a zoomed image.

Magnify a local area

Magnifier. Select Magnifier, then hold the left mouse button over an image to magnify a local area. Move the mouse while holding the button to inspect another area. Figure 15 shows the control.

Change orientation and reset the display

Rotate an image

Rotate. Use the 90° right, 90° left or free rotation options to change image orientation.

Flip an image

Flip. Use the horizontal or vertical flip options to reverse the image display as needed. Check the orientation labels after making changes.

Reset the display

Reset. Select Reset and click the image to restore its original display. Annotations are retained.

Locate the same anatomical point

Pointer. Hold the left mouse button and move the pointer over an image to identify the corresponding location in other planes. Select an anatomical point to move compatible linked series to the corresponding position. Moving the pointer updates the related views. See Figure 19.

Understand MPR and localizers

Multiplanar reconstruction (MPR) supports orthogonal and free-plane reconstructions, synchronization between compatible series, and localizer mini-maps. The available options are shown in Figure 20.

Where the study supports MPR, reference lines show the relationship between planes. Red lines indicate the slice range, and the green line marks the selected slice position in the related view.

Localizer mini-maps show the position of a series relative to images in another orientation. Switch between localizers where several are available. Drag the reference lines to change the displayed location.

Synchronize compatible series

Synchronize with a selected series

Sync with selected series. Select the reference image panel so that it has a yellow border. Navigate in another series to show the corresponding MPR reference lines in the selected panel.

Synchronize series with the same orientation

Sync with same orientation. Enable this option to link compatible series that share an orientation. For example, scrolling in one sagittal series moves other sagittal series to the corresponding position.

Synchronize with previous studies

Sync with previous studies. This requires compatible studies for the same case, such as two CT examinations. Open the previous study in another view, select the series to compare, then enable synchronization to navigate corresponding positions together.

Create multiplanar reconstructions

Orthogonal MPR

Orthogonal MPR. Select a suitable source series with a yellow border, then use Orthogonal MPR to reconstruct axial, sagittal or coronal views. Generated series are not sent to the PACS archive by default. Where available, the upload control sends a generated series to the PACS server.

Free MPR

Free MPR. Use Free MPR to reconstruct images in freely chosen planes. The default layout contains axial, coronal and sagittal views. Coloured lines identify the corresponding planes in the other views. Drag a plane line to rotate the plane or adjust its angle.

Cross-reference lines and cursor. Use the POINTER to locate an anatomical point in one plane and identify the corresponding position in the other planes. Reference lines indicate the relationship between views: the selected slice is shown in green and the related slice range in red.

Synchronization between series. Open the MPR menu and select Enable sync with same orientation to link navigation across compatible series that share an orientation.

Individual Free MPR panels. Double-click the axial, coronal or sagittal panel to enlarge it. Double-click again to restore the three-panel view.

Adjust slab thickness and save hangings

Combine slices with the slab tool

Slab tool. Combine multiple consecutive slices into a thicker reconstructed image to make certain structures easier to see.

Free MPR slab controls. Adjust slab thickness within Free MPR to create thicker reconstructions. Where configured, use 2 mm or 3 mm presets to reduce the grainy appearance of thin-slice images. Check the displayed thickness before interpretation.

Save and reuse an image arrangement

Hangings. Persist hanging saves the displayed image arrangement, including window level adjustments. You can save more than one hanging for a study and switch between them using the toolbar, context menu or configured shortcuts. Saved hangings can also be removed.

Change other viewer settings

Choose a browsing mode

Browse. Series-level browsing moves through the stack using the mouse wheel. Mouse-based series browsing uses the left mouse button while dragging up or down. Image-level browsing displays series images in individual views.

Show labels rulers and advanced controls

Visualization. Use these options to show or hide image labels and rulers. Show advanced controls lets you enter precise window width and window centre values.

Use fullscreen and auto hide menus

General. Use Enable/Disable Full Screen to switch between fullscreen and normal viewing. Enable auto-hide menus controls whether menus hide automatically. The default is configured under Accounts > Settings.

Keyboard shortcuts

Use these keyboard assignments as a reference for the original PACScenter configuration. Shortcuts may vary by deployment. Right-click an image to check the tools and assignments available in your viewer.

Mouse menu and troubleshooting

Open tools from the mouse menu

Right-click any displayed image for quick access to the diagnostic tools and available assignments.

MPR buttons are greyed out

Wait until the grey progress bar in the image view fills or the loading indicator under the series icon disappears. If MPR remains disabled after loading, the selected series may not support MPR.

Navigation or synchronization is unexpected

Confirm the correct series is selected and the intended synchronization mode is enabled. If a problem persists, record the case identifier, browser version and steps needed to reproduce it.