I’m including some follow-up from Wednesday’s PACS meeting that includes some helpful hints. If I’m not completely clear on what I mean below, I apologize, I will know more in January when I rotate through Thornton Hospital.
Below are problems I thought were either significant enough to report a status on or that there ARE solutions to help you out in your work right now. Please recognize that many many other problems were discussed, there just aren’t good immediate solutions to them but your voices have been heard.
PROBLEM: Help! (as pertains to PACS, not life in general)
SOLUTION: As a general help, there IS a user manual loaded on every workstation that I am told is actually very helpful, you should be able to access it by hitting F1. You can also access this on the internet from anywhere at: http://emhpacs.com/documents/client/en/client_index.html
PROBLEM: Various types of system crashes.
SOLUTION: Continue to report system crashes, there is no one solution to this problem and I have seen good evidence that Agfa and UCSD IT are working to resolve many of the particular issues involved with these crashes do occur.
PROBLEM: The wrong type of studies are showing up in my worklist
SOLUTION: For any problems with the actual type of studies in your worklist including either missing studies or extraneous studies, please email me directly at firstname.lastname@example.org. I am currently the one responsible for making the radiology service worklists into lists that actually work.
ON CALL/STAT STUDIES/IBOX
PROBLEM: When a patient has multiple incoming studies of a certain modality (for instance CT head/cspine/chest/abd on a trauma patient), the study constantly refreshes making it impossible to either view images or i-box.
SOLUTION: The proposed workaround is that people should highlight a stack of studies from the worklist and then select “add to cycle list”, NOT select “cycle,” we believe this will cause the studies not to be refreshed as additional images are obtained of other studies.
Additionally, there is a “right arrow tab” (difficult to describe more specifically) in each worklist that specifies whether the worklist will be automatically refreshed. This has by default been turned off as of Wednesday on all accounts and should help as well with the above problem. The downside is that if a study is only partially finished, you need to REMOVE the study from your cycle list and then add to cycle again (just like on the old system so people should be used to that).
PROBLEM: Various problems with the ibox.
SOLUTION: One workaround that’s been instituted is to LOCK the ibox of all approved studies. Yes, I recognize there are times when it would be helpful to ibox an old study to leave oneself a quick note. However, on call residents have had problems mistakenly putting the ibox in an old study rather than in the new study the ibox was meant for.
For several residents, the ibox was asking to “save or discard” a partial ibox read when the resident wanted to look at an old comparison study. This doesn’t occur all the time or on all workstations, a setting change was made on Wednesday that is supposed to fix this, let me know if it persists.
An additional hint: The study that is highlighted at the top of your screen AND in the list of a patient’s studies on your 3rd screen is the one the ibox is open for if you’re confused.
PROBLEM: How do I get rid of a patient who is on my cycle list
SOLUTION: If you right click on any patient name at bottom of your center monitor, you can “close” or “close all” patients. If you choose “close” you take that patient OUT of your cycle list. Sort of the opposite of when you “add to cycle list”.
PROBLEM: Why can I only see 2 patient tabs on the bottom of my center monitor?
SOLUTION: The tabs aren’t there to show you the names of the say 10 patients on your list. That’s what the popup window is for. In most instances you should only have 1 name visible there, the current patient from your cycle list. A second patient’s name arises when you pop up an additional study NOT in your cycle list because say a clinician interrupts and wants you to look at a study, you can look at it, then close it and return to your cycle list.
PROBLEM: How do I save my cycle list or list of studies?
SOLUTION: Everyone should know how to create and use a “scheduled worklist”. This is a temporary worklist which preserves your list of studies for a few days so you can do your day to day work. If you are on a service with more than 1 resident/attending I highly advise pulling studies into your personal “scheduled worklist” and cycling off of that rather than trying to read off the main worklist.
PROBLEM: Paperwork should be the last series in the study
SOLUTION: If paperwork is labeled series 99 it will show up last so this can be done, Agfa is working on getting that message out to techs who send us studies.
PROBLEM: Saving things.
SOLUTION: Users have different preferences on this one. Some people like it when the Save screen pops up at the end of every study. If you like this, then you want to have the “prompt to save study” checked in your User Profile in the customize tool. One alternative that I personally prefer is to enable the “Configurable study save” tool. You may notice there are TWO save icons in the toolbar at the top of the screen. One is the configurable study save tool. In your user profile, there is a tab called “configurable study save” that allows you to check which settings you want to save on a study. For instance, I’ve saved Geometry Window Level and Markup. On the other hand, for instance, I have NOT saved pan/magnification since that could mean someone else looking at the study later doesn’t recognize it’s a zoomed up image. Once you check some things here, I believe there is already a keyboard shortcut built in so that every time you hit “S” it saves the things you’ve configured, meaning you can hit “S” every time you markup a study and never lose a measurement. If there is no shortcut, ask your nearest tech-savvy resident to create one for you.
PROBLEM: Voxar issues, most notably I can’t save Voxar (new MPR) images.
SOLUTION: That is a known issue that Agfa’s working on right now, they were able to get it to work in a few instances. Most of the other Voxar issues that were brought up seemed to have solutions (i.e. cross-hairs) which I unfortunately don’t have the knowledge to explain here.
PROBLEM: ROI tool hard to use
SOLUTION: I empathize. Try to get used to the new tool. For one thing, use your mouse scroll wheel, it allows you to shrink the circle as needed (only to about 1 cm in size though on CT, that’s a known bug because its supposed to shrink down to 1 pixel, Agfa knows). After you shrink or enlarge to the size you want it, then grab the corners and change the shape around like with the old system.
PROBLEM: How to “project” images on your 3rd monitor either when you need color for say ultrasound on a black and white station or for conferences especially in MRI (MRI AND BODY FELLOWS LISTEN UP!)
SOLUTION: A few of the MRI fellows were taught how to use “extended monitor display” which is a tool that is loaded already in everyone’s floating toolbars. Our AGFA rep built a keyboard shortcut under the letter “D” for display that is already in everyone’s logins. You should be able to float your mouse over a study series, hit “D” and the series will pop up on your third monitor. Projection mode as a tool is now outdated now that this tool which existed in a flawed manner previously works correctly.
SOLUTION: Call PACS for help, everyone is supposed to have their keywords.
PROBLEM: Talktech is slow.
SOLUTION: Yes I know. One issue-please recognize that there is a delay in Talktech logging out after you logoff PACS. A lot of Talktech crashes are due to trying to do something to quickly after you’ve logged out of PACS, give it a good 10 seconds to unload itself.
PROBLEM: I miss talktech addendum. Addending reports in Talk is now cumbersome.
SOLUTION: You should be able to just click on the dictation (microphone) button and your Talktech prelim should come up, you may not actually have to “sync into dictation.” Advanced users – if you want try creating a keyboard shortcut to “dictate now” it should work sort of like how the addendum used to.
Agfa is going to contact Mike Crook to obtain the Talk Addendum script, apparently there is nothing to stop us from using it again, although given what’s above, it may not be needed. On the old system a lot of people used “A” as a keyboard shortcut for talk addendum. Once talk addendum becomes available again, go ahead and change that from “display annotation” if you like, that wasn’t a keyboard shortcut that we specified so you have permission to change it.
PACS UPGRADE NOTICE
This upgrade will provide improved functionality for the PACS system. One of the most significant changes is that the Web 1000 application will no longer be necessary. All users will have the same system functionality regardless of where they view images. Please see below for important information on the upgrade.
Phase 1 – During this phase we will upgrade the core PACS servers and install the new application on all existing dedicated PACS workstations.
Dates: December 7-9
Start Time: 9:00 p.m. December 7th
Completion 4:00 p.m. December 9th
During the upgrade weekend all PACS functionality will be supported by our backup system. Studies older than 4 weeks will be unavialble for viewing in the IMPAX system, however, older studies may be viewed on Web 1000.
Logging onto the system: In an effort to improve ease of access to our system and to minimize the number of passwords we must keep track of, we will be converting all user accounts to Active Directory (AD) authentication. The login and passwords are the same as used for accessing other UCSD applications such as the Clinical Web Portal, Groupwise e-mail, Sharepoint, or Outlook e-mail. Please call our PACS hotline at extesion 10244 if you have any difficutly accessing the system.
Phase 2 – Upon completion of the phase one, we will begin rolling the application out to all hosital computers. In addition, we will provide installation instructions for users who may need to view studies while off-site. This process will take several weeks to complete.
Web 1000: As part of this upgrade we will phase out the Web 1000 application over a 3 month period and it will be removed from service on March 1st, 2008. Login and passwords for the Web 1000 system will not change from those currently used.
Training: Clinician and radiologist training is being coordinated by Dr. Meg Richman (email@example.com). An online tutorial is also available at http://rad-pub.ucsd.edu/tutorial/
PACS Support Hotline: 619-471-0244 If no answer, please leave a detailed voice mail and and support team will be paged.
PACS Support Pager (7/24): 619-290-3936