Using VistARad for MR VeHU Session 751H

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Using VistARad for MRVeHU Session 751H

• Kim Wilson, MD
• Southern Arizona VA Healthcare
• Tucson, Arizona

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Initial preparation

• Find and save names of cases in each modality
• At least 2 prior exams
• Similar related priors if appropriate
• Abdomen series prior CXR
• Shoulder MRI prior shoulder radiograph
• Longer exams are better
• Largest number of series in MRI and CT
• Both for the current exam and prior

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Initial preparation

• Try the default Hanging Protocols for each case,
  by simply double-clicking on the current study
• You can do this with other Radiologists to get a
  consensus
• Note things you would like to change
• Some of these changes can be made on the system
  HP
• Some changes will require creating a new HP

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Initial Preparation

• Identify common exams that have a standard
  technique
• MRI shoulder, MRI brain
• Can be a problem if you have different magnets,
  or different CT scanners
• Try to get the series names to be similar
• Save cases with priors
• The default HPs will not have linked images to
  your preference

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Initial Preparation

• Review and add templates
• System templates
• 1up 1up
• 1up 2up
• 2up 2up
• 4up 4up
• 9up 9up
• 1 wide
• Use the same naming system for new templates
• 2up 4up
• Note if it is on a monitor with outlying
  resolution (i.e. 5K when everyone else uses 3K)
  1up 1up 5K

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Templates

• Naming is very important
• Each time a user creates a HP, the template used
  will be saved by them and they will need to type
  the name in. It will say This name already
  exists, so when it is re-saved you want to be
  sure its the identical template.
• Be sure to note a different resolution for this
  reason because the outlying template will be
  filtered out on a different resolution monitor
  and cannot be used in a default HP

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Naming Hanging Protocols

• The list displays in alphabetical order, not by
  modality
• List can become long
• Begin each HP name with the modality
• MR shoulder
• CT chest
• This way they will group together
• The HPs also group by the users name They
  dont need to label it Wilsons chest CT

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Auto selection of an HP

• When you open an exam the HP used automatically
  will be selected in this order
• Personal CPT-specific HP
• System custom CPT-specific HP
• Personal modality-specific HP
• System custom modality-specific HP
• Default HP (usually modality-specific)

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Default MRI HP

• Stage 1 9up 9up
• Current on left monitor, prior on right
• Stage 2 9up 9up
• No priors all current exam
• Will open with this when no prior
• Will display all series of the first exam

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MRI knee

• Routine sequencing
• Easier to interpret when series are linked
• Usually has a prior radiograph
• Usually doesnt have a prior MRI

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MRI knee

• First, prepare settings in Manager for MRI

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MRI knee

• Patient I0005
• Highlight
• MRI knee
• Knee 3 views
• Select open with
• Choose template 4 up 4up

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MRI knee

• Drag the series individually to these viewports

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Adjust the images

• Link the two axial sequences
• Link the 2 Sagittal sequences
• Dont link coronal sequences (extra ones are for
  any additional sequences taken by the tech)
• Adjust apply to all for the knee x-ray (uncheck
  W/L)

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Test the layout and save

• Try looking at the images- make sure adjusting
  W/L on the axial and sagittal images does not
  affect the linked exam, but does propagate though
  the stack.
• W/L adjustment on the knee film should not affect
  the other knee images

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Save the Hanging Protocol
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Close the case

• Now, open the case by double clicking on the Knee
  MRI exam
• Should automatically open the prior knee
• Check the HP

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Tweaking the default MR

• Because it involves changing the layout of
  viewports, will require re-saving the HP as a new
  HP
• Select patient i0014
• Highlight the 2 MRI abdomen exams
• Select open with MR_2-Hd_SYS_INT

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Tweaking the default MR

• Go to stage 2
• Change the template to 4up 4up

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Tweaking the MR HP

• Drag the series to the viewports

Link the series
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Save the Hanging Protocol

• First, go back to Stage 1
• Save as
• MRI_2-Hd_adjusted

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• Save Stage
• Dont click on the pop up box
• Switch to Stage 2
• Then check Next stage

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Finishing up

• Click on case info
• Check Use this stage when no prior
• Save case info
• Save the viewports
• Save the HP
• Test

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Long MRI exam

• You can create a hanging protocol that displays
  12 up 12 up

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Additional MRI HP

• Opens a case with a comparison, with larger
  viewports (4 per monitor)
• More useful with greater than 2 monitors
• MRI exams usually have more than 4 series
• Preferable to be able to see all of the series
  simultaneously
• Can always bring up the entire exam in the
  browser
• Could be used for any MRI that has a prior done
  with the same protocol

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MRI generic with prior

• Select patient i0014
• Open the 2 MRI abdomen exams with the Template 4
  up 4 up
• Place the current series along the top row
• Place the prior exam along the bottom row
• Save as MRI generic with prior
• Save with the prior exact CPT code- so that it
  opens with a true matching prior

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MRI generic with prior

• Clear all of the viewports (Select template 4up
  4up again)
• Place the next 4 series of each case
• Save as Stage 2
• Select new template 9 up 9 up
• Place the current exam on the left monitor
• Place the prior on the right
• Save as the final stage