Using the Viewing Protocol Setup form
To create a new Viewing Protocol through the Setup form, go to View > Viewing Protocols. This will display the Viewing Protocol Setup form.
If you wish to create a new default protocol which will be used by all users, click on the New button under the Default Protocols table.
The %-% symbol will be displayed under the Name column. Enter a name for the new protocol.
Enter a modality for the protocol from the Modality drop-down menu.
Enter a Body part for the modality. Leaving either one of the options (Modality or body part) as %, indicates that all possible values for that field will be matched by the protocol. You can choose a body part form the drop-down list or enter a new body part yourself.
Choosing a monitor layout
Once the layout form has been launched, choose the Number of monitors. You can choose a maximum of eight monitors for the viewing protocol.
Click Add at the bottom of the form. This will launch the Monitor Layout form.
Now you have to decide how many series of images you will like to view at once. How many images of each series will be visible at once is not relevant here, that will be decided later. You can choose to layout of the images on the monitor by choosing the Tile or Stack option and choosing the number of images in the Monitor Graphic above. As a result, each monitor can be tiled or stacked individually allowing you to mix and match as desired.
Tile Mode: one individual image of the series is displayed in one viewport. Scrolling through the images in a series will scroll to the next viewport, where the next image is displayed.
Stack Mode: all images within a series are displayed in one viewport. Scrolling through the images will scroll within the same viewport.
PowerServer is designed to prevent the skipping/dropping of image slices while scrolling through images in Stack/Cine mode.
A monitor can have a maximum of sixty four tiles. It is suggested that for default protocols of RF and XA modalities, Tile display should be chosen.
In the example above, a two monitor layout is displayed with the monitor on the left displaying the series in Tiles in a 2X3 layout. The monitor on the right will display the same study in a 1X2 Stack layout. A Tiled monitor will only display one viewport at a time. A user can have multiple viewports in a Stacked monitor.
For more information on layout options for viewports and within a viewport, please refer to the topics How Do I Set Up a Layout With Multiple Viewports? and How Do I Setup a Layout Within a Viewport?
If you like to display the current study that is being studied next to the other studies on the screen, check the Compare with prior studies option and choose the number of studies that should be displayed per monitor.
Select the Prior Selection Model that should be used to retrieve the priors and choose where Current Study Position should be. These changes will also become visible on the monitor graphic above.
The Prior selection Model can be customized in the Settings > Server Settings > Workflow > Relevant Prior Matching tab.
Choose an orientation for the patient in the Patient Explorer Layout. Setting the Patient Explorer Orientation to horizontal will place it at the bottom of the screen. Setting it to Vertical will place along the left side of the screen. The Patient Explorer Size determines the width of the explorer in pixels.
Image thumbnails automatically switch to series thumbnails when the number of images surpasses the max value of images thumbnails allowed. This is configurable by administrative users within System Configuration under the entry "Max Number of Series Images Allowed to have Image Thumbnails". The default value for the entry is 50.
Selecting display preferences
Click the Display Preferences tab.
In this section you need to determine the behavior of some user interaction properties.
Display Preferences
Checking the Mouse Wheel between Framesets checkbox enables the mouse wheel to scroll into the next or previous frameset or page, depending on the User option for Page Scrolling.
Note: Mouse Wheel between Framesets option disables the ability to hover over a frameset and scroll without clicking on the frameset first.
Regardless of the Mouse Wheel between Framesets setting in a viewing protocol, users when randomly hover over a different study, the system recognizes and selects the viewport and enables scrolling by Mouse Wheel on that specific study. This is useful when physicians hover the mouse on a different image series.
Checking the Mouse Wheel between Framesets checkbox indicates that as the user scrolls to the last image of the series, if they continue scrolling, the scrolling will continue into the next series. If this checkbox is unchecked, the user will have to explicitly select the new series to continue.
RamSoft PowerServer is designed to prevent the skipping/dropping of image slices while scrolling through images in Stack/Cine mode.
The Only Display Matched Series option will display only those series which match the Series matching Criteria defined in the View Series Settings Dialogue (The Dialogue and series matching criteria are described in detail in later steps). De-selecting the option will allow the Viewing Protocol to display unmatched series as well.
Note: This option is not applicable for MG studies as MG images are displayed irrespective of matching criteria.
The Auto Display CAD Results option will display CAD tags when a mammography study is opened (If is option is disabled, the user can view the CAD tags by selecting the CAD button 
from the study toolbar). This CADSR icon is visible in the toolbar only when the image is a CADSR object type.
The Patient Annotations drop-down menu will display the patient annotations (Patient ID, Accession Number etc) in the viewport. Unspecified option is chosen when the user does not care about displaying the annotations. If the user wants to display the annotations for the study, he will choose the Show option. If the user does not wish to see the display option, he can choose the Hide option.
The Image Annotations menu will display the Image annotations (e.g. SUV value) in the viewport. Unspecified option is chosen when the user does not care about displaying the annotations. If the user wants to display the annotations for the study, he will choose the Show option. If the user does not wish to see the display option, he can choose the Hide option.
The Select menu will display an image in the viewport based on selected Image view option . Frame option is chosen when the user wants to view all the images in a frame. If the user wants to view all the images in a Frameset, the Frameset option is selected. If the user wants to view all the images in a Study, the Study option can be selected. By default, the Frame option is selected.
Selecting the Link option will enable Plane linking by default. Plane Linking allows linking series within the same study of an active viewport. For more information on Linking, please refer to the topic on Linking Images Across Series.
Default Series Settings
Next you will need to define the default settings for the new matching series and unmatched series
Checking Display scout thumbnail, will display a scout thumbnail for each series in the bottom right corner of each viewport.
The Scout Lines field determines whether scout lines are displayed on the images by default. If the No Scout Line option is turned on, the scout lines will have to be manually turned on by the user, if they wish to view them.
The Zoom Level options determine the magnification of the images displayed on the screen. Fit Window will re-size the image so it is fully visible within the viewport that it is being displayed in. Fit Width will re-size the image/HC so that the width is maximized inside the viewport. True Size will display images in anatomic size, unless these are x-rays, in which case they will be presented in film size. Choosing the True Size option will activate the True size zoom factor option which can be used to determine the size by which the image will zoom in comparison to the original image. The default is 1.0. The Pixel Size option will render every single pixel when displaying the images. Setting the Zoom Level to Unspecified will not apply a zoom level to the images, and will use the zoom setting in the current presentation state instead. The Auto Size (MG) option will automatically calculate the best-fitting zoom level for all images in the study and apply it. This option is only available for a mammography study with modality MG. Please see the topic How Do I Use the Auto Size Feature for MG Images? for more details about this option.
The Display Modality PRs across multiple stacks option is used to display studies which have multiple presentation states. This option divides the presentation states and displays them in separate stacks for viewing. For example, if a CT series contains two presentation states, this option will allow the viewing protocol to create three stacks, first one with just the CT image, second stack with the presentation state and the third stack with the second presentation state. Note that this feature works only with a manufacturer created presentation state and is useful for viewing multi-echo studies.
Once you have configured all these options as desired, click Next.
Creating series matching rules
Click the Series tab.
There are two sections of the Series Order screen. The Series Set table on the right consists of a set of series rules. Each Series Set entry contains multiple Series Matching Rules. All these rules will automatically be part of the Series Set. An advantage of having Series Sets is that it allows a protocol to support multiple scanner types. When the protocol has been chosen, each set of these series rules is examined in order to determine the one that is the closest match for the current study. This is done by comparing each series matching algorithm against each rule set to find the best match. The set which is the closest match is used to display the study. Any series that did not match a rule are displayed at the end (the rules applied to the unmatched series are defined in the Display Preferences screen).
To create a new Series Matching criteria click the New button under the Series Set table to create a new series set named Default. User an change the name of the series set by clicking the name in the table (e.g. Series Set Two). The user can define a Series Set name of up to 255 characters in length.
Click on blank rule in the Series Matching Criteria table and define the parameters for the rules. Click the Save button to save the rule. If you will like to edit the rule you just created, click the View Series Settings Button.
Click the New button below the Series matching Criteria table and add another rule.
Although any user can view the Series Set and the Series matching Criteria, only a user with Admin privileges can change their order or edit them.
Series Settings
Checking Display scout thumbnail, will display a scout thumbnail for each series in the bottom right corner of each viewport.
Selecting Use series matching rule only once will match the series rules only once with the series. If the rule matches a series, that rule will be applied to that series and will not be matched any further. For example, if a set of rules have been defined for a series, the first rule will be matched against the series. If the first rule matches the series, the rule will not be matched any further and the system will continue to match the remaining rules against the series.
The Match remaining Series option will apply series settings such as Windows Presets, Presentation State Sharing, etc. to series that do not match any other rules.
Display modality presentation states across multiple stacks option is used to display studies which might have multiple presentation states. This option separates the presentation states and shows them in separate stacks for the viewer. For example, if a CT series contains two presentation states, the option will allow the protocol to create three stacks, first one with just the CT image, second stack with the the first presentation state and a third stack with the second presentation state.
The Exclude previously matched series will apply the rule to only those series that have not been already matched by any previous rules. Thus, if a series set has several rules defined, the protocol will go through them one by one and if the series does not match any defined rules, it will apply the above rule to the series.
The Scout Lines field determines whether scout lines are displayed on the images by default. If the No Scout Line option is turned on, the scout lines will have to be manually turned on by the user, if they wish to view them.
The Zoom Level options determine the magnification of the images displayed on the screen. Fit Window will re-size the image so it is fully visible within the viewport that it is being displayed in. Fit Width will re-size the image/HC so that the width is maximized inside the viewport. True Size will display images in anatomic size, unless these are x-rays, in which case they will be presented in film size. Choosing the True Size option will activate the True size zoom factor option which can be used to determine the size by which the image will zoom in comparison to the original image. The default is 1.0. The Pixel Size option will render every single pixel when displaying the images. Setting the Zoom Level to Unspecified will not apply a zoom level to the images, and will use the zoom setting in the current presentation state instead. The Auto Size (MG) option will automatically calculate the best-fitting zoom level for all images in the study and apply it. This option is only available for a mammography study with modality MG. Please see the topic How Do I Use the Auto Size Feature for MG Images? for more details about this option.
The Slice Order option defines the order in which the slices will be displayed in the viewing protocol. The - To + option while load in the order of last to first slice while the + TO - option will load them from first to last. The Default option will load them in the order they appear in the image.
Choosing a value from either the Window Preset or Filter dropdown menu, will automatically apply that preset or filter to the series as it is displayed on the screen.
Note that when you apply the viewing protocol with the "Invert" image preset, the Invert preset is always applied on the image and will override any existing invert state of the presentation state applied on the image.
Series Display
Finally, the Series Display section with the View drop-down menu is used to create rules for a Fusion (2D), MPR or Slab MPR series. The rules can be saved as a part of the viewing protocol like any other rule. The 2D option is the default option and used when the study being shown is not MPR series. This will be the default view in most cases. The MPR option will be used when displaying any normal MPR series. The Slab MPR option will be used to create an MPR viewport along with a Slab view. If the user chooses this option, the various rendering parameter options become available to the user. The options are MIP (Maximum Intensity Projection), MinIP (Minimum Intensity Projection), AveIP (Average Intensity Projection) and VR (Volume rendering) and will be applied to the viewing protocol according to the view desired by the user. The Slab Thickness option allows the user to adjust the thickness of the slabs used in the MPR.
Fusion can be done within a viewport if the series are PET and CT series. In this case the Fusion option becomes available in the View drop-down menu. Fusion series viewport will be created as a result of PET-CT fusion. Choosing the Fusion option will activate the Series Order to Fuse With drop-down menu. The menu has the various PET series with their order number and the user must choose one of them to be fused with the CT series.
If the Series Matching Criteria has just been created, it might take a few moments for the Series Order to Fuse With drop-down menu to update.
Click Finish to close the dialog and to return to the Series Order dialog.
Creating printing rules
Click the Print tab. Here you can create defaults for the layout of study images on sheet of film. One layout can be created, for each size of film.
To add a new layout, click the New button. This will add a new row to the list.
Select the Film Size as well as the number of Rows and Columns that should be printed.
Choose whether the printing should be done in Portrait or Landscape mode. If one image per sheet of film is being printed, the orientation option will be unavailable. In such a case, the system automatically determines the best orientation selection when printing.
The last option to set is the Print Size. This determines the zoom level used when printing the images. If the zoom level should correspond to what is shown on screen, choose the As Shown on Screen option. If the images should always be printed in True Size, that option should be selected. Click the check mark to save the entry. Once you have created all the desired print layouts, click the Save button and the new protocol has been created.
The following outlines how viewing protocols will operate with reference to studies and priors, Multi-monitor setups and comparison mode:
| Scenario | Action |
|---|---|
| Study has no Priors and both Protocols with Comparison mode and without Comparison mode exist | Choose the viewing protocol with no comparison mode. |
| Study has no Priors and only Protocols with Comparison mode exist | Use the protocol with comparison mode |
| Study has Priors and both Protocols with Comparison mode and without Comparison mode exist | Use the protocol with comparison mode. |
| Study has Priors and only Protocols without Comparison mode exists | Use protocols with no comparison mode |