Hologic QDR User Manual

QDR
Reference Manual
Caution: Federal (U.S.A.) law restricts this device to sale by or on the

order of a physician (or properly licensed practitioner).
Document No. MAN-00732 Revision 002

October 2007
The information contained in this Manual is confidential and proprietary to Hologic, Inc.
This information is provided only to authorized representatives of Hologic’s customers
solely for the purpose of facilitating the use of Hologic’s products. No information
contained herein may be disclosed to any unauthorized person for any purpose
whatsoever without the prior written consent of Hologic, Inc.
The information in this document is subject to change without notice.
©
Copyright 2000-2007 by Hologic, Inc. All rights reserved.
Discovery™, and Explorer™ are trademarks of Hologic, Inc.
QDR® and the Hologic logo are registered trademarks of Hologic, Inc.
HSA® is a registered trademark of The Johns Hopkins University Applied Physics
Laboratory.
Protected by at least some of the following U.S. Patents and foreign counterparts:
4,811,373; Re34,511; 5,040,199; 5,138,553; 5,165,410; 5,432,834; 5,483,960;
5,572,998; 5,657,369; 5,687,211; 5,715,820; 5,717,735; 5,748,705; 5,762,608;
5,771,272; 5,778,045; 5,835,555; 5,838,562; 5,838,765; 5,850,836; 5,891,033;
6,002,959; 6,009,147; 6,230,036; 6,233,473; 6,385,283.
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Windows® and Windows® XP are either registered trademarks or trademarks of
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All trademarks, registered trademarks, and product names used within this document are
the property of their respective owners.
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Table of Contents
Chapter 1 -
Introducing the QDR Series System ...................................................................................... 1-1
Introducing the QDR Series Models .................................................................................... 1-2
Introducing the System Hardware Components .................................................................. 1-3
Operator Console ........................................................................................................... 1-4
Computer Hardware and Peripherals ....................................................................... 1-4
4500 Power Module ....................................................................................................... 1-4
Delphi AC Power Isolation Module .............................................................................. 1-4
Examination Table ......................................................................................................... 1-4
Table Pad ................................................................................................................. 1-4
C-Arm ............................................................................................................................ 1-5
X-Ray Source and Detectors .................................................................................... 1-5
Laser ......................................................................................................................... 1-5
Control Panel for QDR Systems .................................................................................... 1-6
The Discovery and Explorer Control Panels ........................................................... 1-6
Discovery/Explorer Control Panel Switches and Indicators ............................... 1-6
The QDR 4500 and Delphi Control Panels ............................................................ 1-7
The QDR 4500 Control Panels ........................................................................... 1-7
The Delphi Control Panels .................................................................................. 1-7
QDR 4500/Delphi Control Panel Switches and Indicators ................................. 1-8
Introducing the APEX Software .......................................................................................... 1-9
Main Window Overview ............................................................................................... 1-9
Main Window Features .................................................................................................. 1-9
Introducing the Quality Control Spine Phantom ............................................................... 1-10
Introducing the Positioning Aids ....................................................................................... 1-11
Knee Positioner ............................................................................................................ 1-11
Foot Restraint (Hip Positioner) .................................................................................... 1-11
Head Positioner for A and SL Models ......................................................................... 1-12
Introducing the Product Support Materials ........................................................................ 1-12
Chapter 2 -
Understanding QDR Series Technology ................................................................................ 2-1
Introducing Key Elements ................................................................................................... 2-2
Presenting DXA Technology ......................................................................................... 2-2
Accuracy and Precision ................................................................................................. 2-3
Principles of Operation .................................................................................................. 2-3
Introducing the Scan Sites ................................................................................................... 2-4
Lumbar Spine ................................................................................................................. 2-4
Proximal Femur ............................................................................................................. 2-5
Forearm .......................................................................................................................... 2-6
QDR Reference Manual
Whole Body ................................................................................................................... 2-7

Understanding the Scan Results .......................................................................................... 2-8
Z-Score ........................................................................................................................... 2-8
T-Score ........................................................................................................................... 2-8
Reference Database ........................................................................................................ 2-8
Chapter 3 -
APEX Software ........................................................................................................................ 3-1
Understanding the Mouse .................................................................................................... 3-2
Holding the Mouse ......................................................................................................... 3-2
Mouse Tasks .................................................................................................................. 3-2
Using the Mouse with APEX Software ............................................................................... 3-3
Pointing with the Mouse ................................................................................................ 3-3
Clicking the Mouse ........................................................................................................ 3-3
Double-Clicking the Mouse ........................................................................................... 3-3
Dragging and Dropping ................................................................................................. 3-3
Understanding the User Interface ........................................................................................ 3-4
User Interface Windows ................................................................................................ 3-4
Main Window .......................................................................................................... 3-4
Tab Windows ........................................................................................................... 3-5
Dialog Windows ...................................................................................................... 3-6
Understanding Main Window Components ........................................................................ 3-7
Main Window Buttons ................................................................................................... 3-7
Using Menus ............................................................................................................ 3-8
Choosing Menu Items .............................................................................................. 3-8
Using Sub-Menus .................................................................................................... 3-9
Closing Menus ......................................................................................................... 3-9
Understanding Other Window Components .................................................................. 3-9
Entering Text ........................................................................................................... 3-9
Tabs ........................................................................................................................ 3-10
Drop-down Lists .................................................................................................... 3-10
Radio Buttons ........................................................................................................ 3-10
Command Buttons ................................................................................................. 3-10
Check Boxes .......................................................................................................... 3-11
Scroll Bars .............................................................................................................. 3-11
Sorting List Items ................................................................................................... 3-11
Identifying the Sort Order ...................................................................................... 3-11
Changing the Sort Order ........................................................................................ 3-12
Selecting Items From a List ......................................................................................... 3-12
Selecting One Item ................................................................................................. 3-12
Selecting Multiple Items ........................................................................................ 3-12
Selecting a Range of Items .................................................................................... 3-12
Introducing the System Software Reminders .................................................................... 3-13
iv Table of Contents
Flashing Buttons .......................................................................................................... 3-13

Daily QC ................................................................................................................ 3-13
System Backup ...................................................................................................... 3-13
Introducing the System Software Help .............................................................................. 3-14
Tool Tips ...................................................................................................................... 3-14
Online Context Sensitive Help .................................................................................... 3-14
Ticker Tape .................................................................................................................. 3-15
Chapter 4 -
Performing Daily System Operations .................................................................................... 4-1
Discovery Systems ............................................................................................................... 4-2
Discovery Circuit Breaker and Indicator ....................................................................... 4-2
Discovery-C, -Ci, -W and -Wi Control Panel ................................................................ 4-2
Discovery-A and -SL Control Panel .............................................................................. 4-4
Turning Discovery Power On and Off ........................................................................... 4-5
Beginning of the Workday ....................................................................................... 4-5
End of the Workday ................................................................................................. 4-6
Discovery Emergency Procedures ................................................................................. 4-7
Operator Action During a Power Failure ................................................................. 4-7
Shutting Down During a Power Failure ............................................................. 4-7
After Power is Restored ...................................................................................... 4-7
If Equipment Fails While in Operation .................................................................... 4-7
If AC Power has been Turned Off ........................................................................... 4-8
Explorer Systems ................................................................................................................. 4-9
Explorer Circuit Breaker and Indicator ......................................................................... 4-9
Explorer Control Panel .................................................................................................. 4-9
Turning Explorer Power On and Off ........................................................................... 4-10
Beginning of the Workday ..................................................................................... 4-10
End of the Workday ............................................................................................... 4-11
Explorer Emergency Procedures ................................................................................. 4-11
Operator Action During a Power Failure ............................................................... 4-12
Shutting Down During a Power Failure ........................................................... 4-12
After Power is Restored .................................................................................... 4-12
If Equipment Fails While in Operation .................................................................. 4-12
If AC Power has been Turned Off ......................................................................... 4-13
QDR 4500 Systems ............................................................................................................ 4-14
QDR 4500 Power Module ........................................................................................... 4-14
QDR 4500 Power Module Side Panel ................................................................... 4-14
QDR 4500 Power Module Rear Panel ................................................................... 4-15
QDR 4500 Control Panel ............................................................................................. 4-15
QDR 4500C and QDR 4500W Control Panel ....................................................... 4-16
QDR 4500A and QDR 4500SL Control Panel ...................................................... 4-17
Turning QDR 4500 Power On and Off ........................................................................ 4-18
Table of Contents v

QDR 4500 Emergency Procedures .............................................................................. 4-20
Shutting down during a power failure .............................................................. 4-20
After power is restored ..................................................................................... 4-21
If QDR 4500 Equipment Fails While in Operation ............................................... 4-21
If QDR 4500 AC Power has been Turned Off ....................................................... 4-21
Delphi Systems .................................................................................................................. 4-23
Delphi AC Power Isolation Module ............................................................................ 4-23
Delphi Control Panels .................................................................................................. 4-23
Delphi-C and -W Control Panel ........................................................................ 4-23
Delphi-A and -SL Control Panel ........................................................................... 4-25
Turning Delphi Power On and Off .............................................................................. 4-26
Delphi Emergency Procedures ..................................................................................... 4-28
Shutting Down During a Power Failure ........................................................... 4-29
After Power is Restored .................................................................................... 4-29
If Delphi Equipment Fails While in Operation ...................................................... 4-29
If Delphi AC Power has been Turned Off ............................................................. 4-30
Chapter 5 -
Quality Control ........................................................................................................................ 5-1
The Daily QC Procedure ...................................................................................................... 5-2
Start Daily QC ............................................................................................................... 5-2
Position the Spine Phantom ........................................................................................... 5-3
Automatic System Test .................................................................................................. 5-4
Auto QC Passed ............................................................................................................. 5-5
Review Analysis ...................................................................................................... 5-6
QC Plot .................................................................................................................... 5-7
About the QC Plot ............................................................................................... 5-7
Auto QC Failed .............................................................................................................. 5-9
Details ...................................................................................................................... 5-9
Review Analysis ...................................................................................................... 5-9
Plot ......................................................................................................................... 5-10
OK .......................................................................................................................... 5-10
About the QC Spine Phantom ............................................................................................ 5-10
QC Data Management ....................................................................................................... 5-11
Access Data Management ............................................................................................ 5-11
Set QC Plot Parameters ................................................................................................ 5-11
Select scans to be included in the QC Plot .................................................................. 5-13
Exclude Data Points from the QC Plot Screen ...................................................... 5-15
Create a New Phantom Record .................................................................................... 5-15
vi Table of Contents
Set up the QC Plot ....................................................................................................... 5-17

Plot Regression .................................................................................................................. 5-20
Archiving QC Phantom Scans ........................................................................................... 5-20
Chapter 6 -
Managing Patient Records ...................................................................................................... 6-1
Introducing Patient Records ................................................................................................. 6-2
Accessing the Records ................................................................................................... 6-2
Working with Patient Records ............................................................................................. 6-4
Overview of Patient Record ........................................................................................... 6-4
Biography Tab ......................................................................................................... 6-4
Insurance Tab ........................................................................................................... 6-6
................................................................................................................................. 6-6
Retrieving a Patient Record ........................................................................................... 6-7
Searching the Patient Drawer .................................................................................. 6-7
Creating/Editing a Patient Record ................................................................................. 6-9
New Patient ............................................................................................................ 6-10
Updating a Patient Record ..................................................................................... 6-12
Patient Biography ............................................................................................. 6-13
Patient Questionnaire ........................................................................................ 6-14
Introducing Scan Records .................................................................................................. 6-16
Scan Drawer ................................................................................................................. 6-16
Working with Scan Records .............................................................................................. 6-17
Scan Details ................................................................................................................. 6-17
Details Tab ............................................................................................................. 6-18
Identification Tab ................................................................................................... 6-19
Deleting Scan Files ...................................................................................................... 6-21
Archived Scans Tab ............................................................................................... 6-22
UnArchived Scans Tab .......................................................................................... 6-22
Retrieving the Scan Records ........................................................................................ 6-22
Performing an Analysis ......................................................................................... 6-23
Adding Scan Information from Other Manufacturer’s Systems ........................................ 6-24
Chapter 7 -
The Patient Examination ......................................................................................................... 7-1
The Patient Examination ...................................................................................................... 7-2
Preparing the Patient ...................................................................................................... 7-2
Patient Interview ...................................................................................................... 7-2
Patient Questions ................................................................................................ 7-2
Patient Preparation ................................................................................................... 7-3
Creating/Retrieving a Patient Biography ....................................................................... 7-4
Creating a Patient Biography ................................................................................... 7-4
Table of Contents vii

Retrieving a Patient Biography ................................................................................ 7-4

Using the Select A Patient Tab ........................................................................... 7-5
Confirming the Patient Information ......................................................................... 7-6
Filling out the Patient Questionnaire ....................................................................... 7-7
Using the Worklist Tab ....................................................................................... 7-8
Using Modality Worklist with a Study .................................................................. 7-13
Modality Worklist Operations ............................................................................... 7-16
Adding a Patient ................................................................................................ 7-17
Adding a Study ................................................................................................. 7-18
Matching an Existing Patient ............................................................................ 7-18
Selecting the Scan Type and Mode .............................................................................. 7-21
Positioning the Patient and C-arm ............................................................................... 7-21
Placing the Patient on the Table ............................................................................ 7-21
Positioning for the Specific Examination .............................................................. 7-22
Performing the Examination ........................................................................................ 7-22
Exiting the Examination .............................................................................................. 7-23
Adding Scan Comments ........................................................................................ 7-24
Performing the Analysis .............................................................................................. 7-24
Contrast and Brightness ......................................................................................... 7-25
Exiting the Analysis ..................................................................................................... 7-27
Using a Study ............................................................................................................... 7-28
Generating and Printing Reports .................................................................................. 7-32
Configuring the Report .......................................................................................... 7-32
Editing Physician’s Comments .............................................................................. 7-33
Chapter 8 -
Performing and Analyzing the AP Lumbar Spine Scan ...................................................... 8-1
The AP Lumbar Spine Examination .................................................................................... 8-2
Selecting the Scan Type and Mode ................................................................................ 8-2
Choosing the Scan Mode ......................................................................................... 8-3
Confirming Scan Parameters ................................................................................... 8-3
Positioning the Patient and C-arm ........................................................................... 8-4
Placing the Patient on the Table .............................................................................. 8-5
Positioning the Patient ............................................................................................. 8-5
Positioning the C-arm .............................................................................................. 8-6
Performing the Examination .......................................................................................... 8-7
Starting the AP Lumbar Spine Scan ........................................................................ 8-8
Repositioning the Scan ............................................................................................ 8-9
Choosing the Method of Analysis ......................................................................... 8-11
Methods of Analysis ......................................................................................... 8-12
Performing the Analysis ........................................................................................ 8-13
viii Table of Contents

One-Time™ Auto Analysis ................................................................................... 8-14

Manual Analysis .................................................................................................... 8-15
Performing the Manual Analysis ...................................................................... 8-16
Adjusting the Image Display ............................................................................ 8-16
Defining the Region of Interest (ROI) .............................................................. 8-16
The Global ROI Toolbox .................................................................................. 8-18
Viewing/Editing the Bone Map ........................................................................ 8-19
Marking Intervertebral Spaces .......................................................................... 8-21
Labeling The Vertebral Bodies ......................................................................... 8-23
Including or Excluding Vertebrae from Analysis ............................................. 8-23
Viewing Results ................................................................................................ 8-25
Alternate Scan Modes .................................................................................................. 8-27
Evaluating the Image ................................................................................................... 8-28
Scoliotic Spine Scans ......................................................................................................... 8-30
Adjusting the ROI Box ................................................................................................ 8-30
Marking Intervertebral Spaces of Scoliotic Spines ...................................................... 8-33
Pivoting an Intervertebral Line .............................................................................. 8-33
Chapter 9 -
Performing and Analyzing the Hip Scan ............................................................................... 9-1
The Hip Examination ........................................................................................................... 9-2
Selecting the Scan Type and Mode ................................................................................ 9-3
Choosing the Scan Mode ......................................................................................... 9-3
Left or Right Hip ................................................................................................. 9-3
Dual-Hip ............................................................................................................. 9-4
Confirming Scan Parameters ................................................................................... 9-5
Positioning the Patient and C-arm ................................................................................. 9-6
Placing the Patient on the Table .............................................................................. 9-7
Positioning the Patient ............................................................................................. 9-7
Positioning the C-arm .............................................................................................. 9-8
Positioning for the Left Hip or Right Hip Scan .................................................. 9-8
Positioning for the Dual-Hip Scan ...................................................................... 9-8
Performing the Examination .......................................................................................... 9-8
Starting the Hip Scan ............................................................................................... 9-9
Repositioning the Scan .......................................................................................... 9-10
Additional Steps for the Dual-Hip Scan ................................................................ 9-12
Methods of Analysis ......................................................................................... 9-15
Table of Contents ix
One-Time™ Auto Analysis ................................................................................... 9-16

Manual Analysis .................................................................................................... 9-17
Performing the Manual Analysis ...................................................................... 9-17
Adjusting the Image Display ............................................................................ 9-18
Defining the Region of Interest (ROI) .............................................................. 9-18
The Global ROI Toolbox .................................................................................. 9-20
Viewing/Editing the Bone Map ........................................................................ 9-21
Positioning the Neck Box ................................................................................. 9-24
Adjusting the Neck Box .................................................................................... 9-26
Viewing Results ................................................................................................ 9-27
For All Scans Except Dual-Hip ............................................................................. 9-29
For Dual-Hip Scans ............................................................................................... 9-29
Alternate Scan Modes .................................................................................................. 9-29
Evaluating the Image ................................................................................................... 9-30
Modifying Other Regions of the Hip ................................................................................. 9-33
About the Midline ........................................................................................................ 9-33
About Ward’s Triangle ................................................................................................ 9-35
About the Trochanter Region ...................................................................................... 9-37
Hip Structure Analysis® .................................................................................................... 9-38
HSA Toolbox ............................................................................................................... 9-39
Manually Adjusting the HSA Region Boxes .................................................... 9-39
Tips for Adjusting the HSA Region Boxes ...................................................... 9-40
Viewing Results ................................................................................................ 9-41
Chapter 10 -
Performing and Analyzing the Forearm Scan .................................................................... 10-1
The Forearm Examination ................................................................................................. 10-2
Prepare the Patient ....................................................................................................... 10-2
Creating/Retrieving a Patient Biography ..................................................................... 10-2
Measuring the Patient's Forearm .................................................................................. 10-2
Choosing the Scan Mode .................................................................................. 10-4
Confirming Scan Parameters ................................................................................. 10-4
Positioning the Patient and C-arm ............................................................................... 10-6
Placing the Forearm in the Scan Field ................................................................... 10-6
Positioning the C-arm ............................................................................................ 10-7
Starting the Forearm Scan ...................................................................................... 10-8
Exiting the Examination ............................................................................................ 10-11
Performing the Analysis ............................................................................................ 10-12
Choosing the Method of Analysis ....................................................................... 10-12
x Table of Contents
Methods of Analysis ....................................................................................... 10-13

Performing the Forearm Analysis ........................................................................ 10-14
Entering the Forearm Length .......................................................................... 10-15
Adjusting the Image Display .......................................................................... 10-15
Defining the Region of Interest (ROI) ............................................................ 10-16
The Global ROI Toolbox ................................................................................ 10-17
About the 1/3 Distal Region ........................................................................... 10-21
Viewing/Editing the Bone Map ...................................................................... 10-22
Adjusting the MID/UD Regions ..................................................................... 10-25
The MID/UD Toolbox .................................................................................... 10-26
Viewing Results .............................................................................................. 10-28
Exiting the Analysis ................................................................................................... 10-32
Generating and Printing Reports ................................................................................ 10-32
Evaluating the Image ................................................................................................. 10-32
Chapter 11 -
Performing and Analyzing the Whole Body Scan .............................................................. 11-1
The Whole Body Examination .......................................................................................... 11-2
Auto Whole Body ........................................................................................................ 11-2
Preparing the Patient .................................................................................................... 11-2
Choosing the Scan Mode ....................................................................................... 11-3
Positioning the Patient and C-Arm .............................................................................. 11-4
Placing the Patient on the Table ............................................................................ 11-5
Positioning the Patient ........................................................................................... 11-5
Starting the Whole Body Scan ............................................................................... 11-6
Choosing the Compare to Previous Analysis ........................................................ 11-9
Performing the Whole Body Analysis ................................................................... 11-9
Defining the Regions ...................................................................................... 11-10
Regions Toolbox ............................................................................................. 11-11
Viewing Results ................................................................................................... 11-15
Evaluating the Image ................................................................................................. 11-18
Chapter 12 -
Performing and Analyzing the AP/Lateral Spine Scan ...................................................... 12-1
The AP/Lateral Spine Examination ................................................................................... 12-2
Table of Contents xi

Placing the Patient on the Table .................................................................................. 12-2
Choosing the Scan Mode .................................................................................. 12-3
Positioning the Patient ................................................................................................. 12-4
Positioning the C-arm .................................................................................................. 12-5
Performing the AP Scan .............................................................................................. 12-7
Starting the AP Scan .............................................................................................. 12-8
Analyzing the AP Scan ................................................................................................ 12-9
Methods of Analysis ....................................................................................... 12-10
Performing the AP Analysis ...................................................................................... 12-11
One-Time™ Auto Analysis ................................................................................. 12-11
Manual Analysis .................................................................................................. 12-12
Performing the Manual Analysis .................................................................... 12-13
Defining the Region of Interest ...................................................................... 12-14
Marking Intervertebral Spaces ........................................................................ 12-18
Labeling The Vertebral Bodies ....................................................................... 12-20
Including or Excluding Vertebrae from Analysis ........................................... 12-20
Viewing Results .............................................................................................. 12-21
Verifying the Start Position ............................................................................ 12-22
Performing the Lateral Scan ...................................................................................... 12-25
Rotating the C-Arm for the Lateral Scan ............................................................. 12-25
Table Safety Feature ....................................................................................... 12-26
Confirming Scan Parameters ............................................................................... 12-26
Starting the Lateral Scan ...................................................................................... 12-26
Removing the Patient From the Table ................................................................. 12-28
Exiting the Examination ............................................................................................ 12-28
Analyzing the Lateral Scan ........................................................................................ 12-28
Choosing the Method of Analysis ....................................................................... 12-29
Performing the Lateral Analysis .......................................................................... 12-31
Defining the Region of Interest (ROI) ............................................................ 12-32
The Global ROI Toolbox ................................................................................ 12-33
Reanalysis Warning ........................................................................................ 12-33
Adjusting the Vertebral Boundaries ............................................................... 12-34
Adjusting Vertebral Bodies ............................................................................ 12-35
Confirming Lumbar Vertebrae Labels ............................................................ 12-36
Adjusting the Mid Regions ............................................................................. 12-38
xii Table of Contents

Viewing Results .............................................................................................. 12-39

Alternate Scan Modes ................................................................................................ 12-42
Chapter 13 -
Instant Vertebral Assessment and Quantitative Morphometry ........................................ 13-1
Introduction ........................................................................................................................ 13-2
Specification ................................................................................................................ 13-2
Patient Position and Scanning ...................................................................................... 13-2
Patient Positioning on A or SL System ................................................................. 13-2
Patient Positioning on C, Ci, W or Wi System ...................................................... 13-3
The IVA Examinations ...................................................................................................... 13-4
IVA Imaging Exam ...................................................................................................... 13-4
IVA with BMD Exam .................................................................................................. 13-4
IVA Imaging on an A or SL System .................................................................................. 13-4
Starting the Examination ............................................................................................. 13-5
The AP IVA Scan ........................................................................................................ 13-9
Confirming Scan Parameters for AP IVA Scan ................................................... 13-10
Positioning the Patient for the AP IVA Scan ....................................................... 13-10
Performing the AP IVA Scan .............................................................................. 13-11
Repositioning the Scan ................................................................................... 13-12
Using the IVA Image Viewer for AP IVA Scan ................................................. 13-14
Exiting the IVA Image Viewer ............................................................................ 13-14
If Only AP IVA Scan Selected ............................................................................ 13-14
If Both AP and Lateral IVA Scans Selected ................................................... 13-14
The Lateral IVA Scan ................................................................................................ 13-15
Confirming Scan Parameters for Lateral IVA Scan ............................................ 13-15
Performing the Lateral IVA Scan ........................................................................ 13-16
Using the IVA Image Viewer for Lateral IVA Scan ........................................... 13-19
Returning the C-arm to the AP Position .............................................................. 13-20
IVA Imaging on a C, Ci, W or Wi System ...................................................................... 13-21
Preparing the Patient .................................................................................................. 13-21
Creating/Retrieving a Patient Biography ................................................................... 13-21
Starting the Examination ........................................................................................... 13-21
Selecting the Scan Type and Mode ............................................................................ 13-22
The AP IVA Scan ...................................................................................................... 13-24
Positioning the Patient for the AP IVA Scan .................................................. 13-25
Table of Contents xiii


Using the IVA Image Viewer for AP IVA Scan .................................................. 13-29
Exiting the IVA Image Viewer ............................................................................ 13-29
Positioning the Patient for the Lateral IVA Scan ................................................ 13-31
Placing the Patient on the Table .......................................................................... 13-31
Positioning the Patient .................................................................................... 13-31
........................................................................................................................ 13-34
Using the IVA Image Viewer for Lateral IVA Scan ........................................... 13-36
IVA with BMD ................................................................................................................ 13-38
Preparing the Patient .................................................................................................. 13-38
Creating/Retrieving a Patient Biography ................................................................... 13-38
Starting the Examination ........................................................................................... 13-39
Selecting the Scan Type and Mode ............................................................................ 13-40
The AP IVA Scan ...................................................................................................... 13-43
Repositioning .................................................................................................. 13-46
Using the IVA Image Viewer for AP IVA Scan .................................................. 13-46
The AP BMD Scan .................................................................................................... 13-46
Confirming Scan Parameters for AP BMD Scan ................................................. 13-47
Performing the AP BMD Scan ............................................................................ 13-47
Analyzing the AP BMD Scan .............................................................................. 13-47
Exiting the AP BMD Analysis ............................................................................. 13-47
The Lateral BMD Scan .............................................................................................. 13-48
Confirming Scan Parameters for Lateral BMD Scan .......................................... 13-48
Performing the Lateral BMD Scan ...................................................................... 13-49
Exiting the Lateral BMD Scan ............................................................................. 13-50
Using the IVA Image Viewer for the Lateral IVA Scan ..................................... 13-53
Returning the C-arm to the AP Position .............................................................. 13-54
IVA Image Viewer ........................................................................................................... 13-55
The IVA Image Viewer ............................................................................................. 13-55
The Image ............................................................................................................ 13-55
The Patient Data ................................................................................................... 13-56
The Control Bar ................................................................................................... 13-56
Mouse Pointer Controls ....................................................................................... 13-58
DE Scan ..................................................................................................................... 13-59
Using Markers .................................................................................................................. 13-61
xiv Table of Contents

The Object of QM Markers ....................................................................................... 13-61

Using QM Markers .................................................................................................... 13-61
Flipping the Image ............................................................................................... 13-62
Adding QM Markers ............................................................................................ 13-63
Selecting Markers ................................................................................................ 13-64
Moving Markers .................................................................................................. 13-64
Editing Markers ................................................................................................... 13-64
Labeling Markers Sets ......................................................................................... 13-65
Deleting Marker Sets ........................................................................................... 13-66
QM Result Block ................................................................................................. 13-66
QM Results Block for Lateral IVA Scans ...................................................... 13-66
QM Results Block for AP IVA Scans ............................................................ 13-68
Generating and Printing Images and Reports .................................................................. 13-69
Printing IVA Images from the Reports Button .......................................................... 13-69
Sample Printouts ........................................................................................................ 13-72
Sample Image ...................................................................................................... 13-72
Sample Report ...................................................................................................... 13-73
Interpreting the IVA Image .............................................................................................. 13-74
Chapter 14 -
Compare and Follow-up ........................................................................................................ 14-1
Introducing Compare ......................................................................................................... 14-2
Steps ............................................................................................................................. 14-2
Restoring the Patient’s Baseline Scan ............................................................................... 14-3
Restoring a Baseline Scan ............................................................................................ 14-3
Evaluating the Patient’s Baseline Scan .............................................................................. 14-4
Evaluating Baseline Scan Patient Positioning ............................................................. 14-4
Reviewing Operator or Physician Comments ........................................................ 14-4
Baseline Positioning Acceptable ........................................................................... 14-5
Baseline Positioning Unacceptable ........................................................................ 14-5
Scanning Once to Duplicate Incorrect Baseline Positioning ............................ 14-5
Scanning Twice ................................................................................................. 14-5
Scanning Once with Correct Positioning .......................................................... 14-5
Evaluating Baseline Scan Analysis .............................................................................. 14-6
Performing the Follow-up Scan ......................................................................................... 14-7
Updating the Patient’s Biography Record ................................................................... 14-7
Performing the Follow-Up Scan .................................................................................. 14-7
Analyzing the Follow-up Scan .......................................................................................... 14-8
Generating a Rate of Change Report ............................................................................... 14-12
Rate of Change Report for Unlike Scan Modes ........................................................ 14-13
Rate of Change Report for Spine Scans with Different Regions ............................... 14-14
Table of Contents xv
Chapter 15 -
Reports .................................................................................................................................... 15-1
Introducing Reports ........................................................................................................... 15-2
Report Types ................................................................................................................ 15-2
Filing Report .......................................................................................................... 15-2
Interpreting Report ................................................................................................. 15-2
Referring Report .................................................................................................... 15-2
Rate of Change Report ........................................................................................... 15-3
Report Information Blocks .......................................................................................... 15-3
Header .................................................................................................................... 15-4
Patient Information ................................................................................................ 15-4
Scan Information .................................................................................................... 15-4
Image ..................................................................................................................... 15-5
DXA Results .......................................................................................................... 15-5
Reference Graph ............................................................................................... 15-5
Rate of Change Graph ....................................................................................... 15-5
Physician’s Comment ............................................................................................ 15-5
Printing Reports ................................................................................................................. 15-6
Printing a Report After Analysis ................................................................................. 15-6
Printing a Report Using the Report Button .................................................................. 15-6
Printing the Patient Questionnaire ......................................................................... 15-8
Editing the Physician Comment ............................................................................ 15-9
Print Dialog Box ........................................................................................................ 15-10
Previewing Reports .......................................................................................................... 15-11
Report Examples .............................................................................................................. 15-13
Filing Report .............................................................................................................. 15-13
Interpreting Report ..................................................................................................... 15-14
Referring Report ........................................................................................................ 15-15
Rate of Change Report ............................................................................................... 15-15
Patient Questionnaire ................................................................................................. 15-17
DICOM Reports ............................................................................................................... 15-18
Choosing the Report Type ......................................................................................... 15-19
Viewing a Scan’s Details ........................................................................................... 15-22
Entering the Accession Number and User Definable Entries .................................... 15-24
Previewing a DICOM Report .................................................................................... 15-25
Printing a DICOM Report .......................................................................................... 15-26
Saving a DICOM Report ........................................................................................... 15-27
Sending a DICOM Report ......................................................................................... 15-29
Sorting the Scan List .................................................................................................. 15-30
Selecting/Deselecting All Scans ................................................................................ 15-31
Viewing the Queue .................................................................................................... 15-32
Viewing a History of Sent Reports ............................................................................ 15-32
Refreshing DICOM Reports in the Queue ................................................................. 15-33
xvi Table of Contents

Deleting a DICOM Report from the Queue ............................................................... 15-34

Viewing a History of Sent Storage Commitment Reports ......................................... 15-36
Printing the HxReport ................................................................................................ 15-37
Closing DICOM ............................................................................................................... 15-38
Alternate Navigation ........................................................................................................ 15-39
Drag and Drop Records ............................................................................................. 15-39
Drag and Drop Patient Records ........................................................................... 15-39
Drag and Drop Scan Records ............................................................................... 15-40
Chapter 16 -
Archiving, Locating and Restoring Scans ........................................................................... 16-1
Overview ............................................................................................................................ 16-2
Handling Read/Write CDs ..................................................................................... 16-2
Formatting a Read/Write CD ................................................................................. 16-2
Removing a Read/Write CD .................................................................................. 16-3
Archiving Scans ........................................................................................................... 16-3
Locations ................................................................................................................ 16-4
Archive Labels ....................................................................................................... 16-5
Locating Scans ............................................................................................................. 16-5
Restoring Scans ............................................................................................................ 16-6
Copying Scans ............................................................................................................. 16-6
About Archiving and Restoring Scans ......................................................................... 16-6
How Scans are Transferred .................................................................................... 16-6
Transfer Progress Message .................................................................................... 16-7
Canceling a Transfer .............................................................................................. 16-7
Errors During Transfer ........................................................................................... 16-7
Notification of Successful Transfers ...................................................................... 16-7
How the System Handles Data Inconsistencies ..................................................... 16-7
How the System Handles Archive Data ................................................................ 16-7
Archiving Scans ................................................................................................................. 16-8
Archive Location ......................................................................................................... 16-8
Archive Process ........................................................................................................... 16-8
Locating Scans ................................................................................................................. 16-12
Restoring Scans ................................................................................................................ 16-16
Copying Scans ................................................................................................................. 16-19
Query/Retrieve Scans ...................................................................................................... 16-22
Query Parameters ....................................................................................................... 16-23
Study Level Filters ..................................................................................................... 16-24
Retrieve Queue .......................................................................................................... 16-25
Retrieve Queue Log ............................................................................................. 16-26
Managing Archive Locations ........................................................................................... 16-27
Troubleshooting Transfer Errors ..................................................................................... 16-28
Table of Contents xvii

Problems Accessing an Archive Location ................................................................. 16-28

Transferring Scans ..................................................................................................... 16-28
Archive Locations ...................................................................................................... 16-29
Advanced User Information ....................................................................................... 16-30
Chapter 17 -
System Backup and Recovery ............................................................................................... 17-1
Overview ............................................................................................................................ 17-2
Files Saved ................................................................................................................... 17-2
Media Formatting .................................................................................................. 17-3
Management of Media ................................................................................................. 17-3
Floppy Diskette ...................................................................................................... 17-3
SuperDisk™ ........................................................................................................... 17-3
Read/write CD ....................................................................................................... 17-3
Network Drive ....................................................................................................... 17-3
When to Run System Backup ...................................................................................... 17-3
Naming the Backup File .............................................................................................. 17-4
Running the System Backup .............................................................................................. 17-5
Errors and Exceptions ........................................................................................................ 17-6
Backup file with the same name .................................................................................. 17-6
Drive is not accessible ................................................................................................. 17-7
Drive does not have enough space ............................................................................... 17-7
Drive is not accessible ................................................................................................. 17-8
System Recovery ............................................................................................................... 17-8
Chapter 18 -
Configuring the System ......................................................................................................... 18-1
Introduction to System Configuration ............................................................................... 18-2
System Tab ........................................................................................................................ 18-3
Date Format ................................................................................................................. 18-3
Patient Biography ........................................................................................................ 18-3
Autopositioning for Hip Scans .................................................................................... 18-3
Report Dose Area Product ........................................................................................... 18-3
Language ...................................................................................................................... 18-4
Customer ...................................................................................................................... 18-4
Default Ethnicity .......................................................................................................... 18-4
Model, S/N, System ID ................................................................................................ 18-4
Data Directory .............................................................................................................. 18-4
Software ....................................................................................................................... 18-4
Last System Backup Date ............................................................................................ 18-4
Last Service Date ......................................................................................................... 18-4
Analyze Tab ....................................................................................................................... 18-5
Default ......................................................................................................................... 18-5
xviii Table of Contents

General Options ........................................................................................................... 18-6

Display Region of Interest Coordinates ................................................................. 18-6
Enable Body Composition Analysis ...................................................................... 18-6
Image Display Options ................................................................................................ 18-6
Initially display unanalyzed Lateral Image as Single Energy ................................ 18-6
Initially display unanalyzed Hip image as Single Energy ..................................... 18-6
Display pseudo color image ................................................................................... 18-6
Image Pro ............................................................................................................... 18-6
Display Hip Axis Length ....................................................................................... 18-6
Lateral Options ............................................................................................................ 18-7
Display MID regions ............................................................................................. 18-7
Prevent vertical motion of ROI .............................................................................. 18-7
Analysis Option ........................................................................................................... 18-7
Disable Auto Low Density .................................................................................... 18-7
Disable Auto Analysis ........................................................................................... 18-7
Disable Auto Whole Body ..................................................................................... 18-7
Enable NHANES BCA .......................................................................................... 18-7
Image Style .................................................................................................................. 18-7
CAD BMD Tab ................................................................................................................. 18-8
Report Tab ....................................................................................................................... 18-10
Report - General Tab ................................................................................................. 18-10
Report - WHO Criteria Tab ....................................................................................... 18-12
Report - Least Significant Change Tab ...................................................................... 18-12
Configuring Reports .................................................................................................. 18-14
Configuring the Reports ....................................................................................... 18-14
Configure the Patient, Scan and Results Blocks ............................................. 18-14
Configure the Optional Reports ...................................................................... 18-16
Configure the Common Block ........................................................................ 18-19
Details of the Patient Block ................................................................................. 18-23
Details of the Scan Block ..................................................................................... 18-24
Details of the Results Block ................................................................................. 18-25
Details of the Reference Block for Configure Common Block Option ............... 18-26
Reference Block Hip Configuration ............................................................... 18-27
Reference Block Forearm Configuration ........................................................ 18-28
Reference Block Lateral Configuration .......................................................... 18-29
Configuring the Ancillary Report ........................................................................ 18-30
Archive Tab ..................................................................................................................... 18-31
Adding a New Location ............................................................................................. 18-31
Changing the Default Location .................................................................................. 18-32
Deleting a Location from the Archive List ................................................................ 18-32
Including Raw Data Files .......................................................................................... 18-33
Automatically Deleting Scans After Archiving ......................................................... 18-33
HL7 Tab ........................................................................................................................... 18-34
Entering HL7 Fields ................................................................................................... 18-34
Table of Contents xix

Changing HL7 Fields ................................................................................................. 18-36

Removing HL7 Fields ................................................................................................ 18-37
Scan Conversion .............................................................................................................. 18-39
History ............................................................................................................................. 18-41
Default Questionnaire Template ................................................................................ 18-41
Location of Completed Questionnaire ....................................................................... 18-42
Port ............................................................................................................................. 18-42
Print Patient Name and ID ......................................................................................... 18-43
DICOM Tab ..................................................................................................................... 18-44
Modality Worklist ...................................................................................................... 18-44
Configuring Modality Worklist ........................................................................... 18-45
Configure Worklist Provider .......................................................................... 18-49
Map Worklist Fields ....................................................................................... 18-51
DICOM Send Destinations ....................................................................................... 18-53
Add / Edit DICOM Send Destination Dialog ...................................................... 18-55
Configure DICOM Send ..................................................................................... 18-57
DICOM Storage Commitment Destinations ............................................................. 18-59
Add / Edit Storage Commitment Destination Dialog .......................................... 18-61
Configure Storage Commitment ......................................................................... 18-62
DICOM Query/Retrieve Destinations ....................................................................... 18-63
Add / Edit DICOM Query/Retrieve Destination Dialog ..................................... 18-65
Host ............................................................................................................................ 18-66
Privacy Tools ................................................................................................................... 18-67
Study Tab ......................................................................................................................... 18-68
Adding a Study .......................................................................................................... 18-68
Editing an Existing Study .......................................................................................... 18-72
Adding Items to an Existing Study ...................................................................... 18-72
Deleting Items from an Existing Study ................................................................ 18-74
Deleting a Study ......................................................................................................... 18-77
Renaming a Study ...................................................................................................... 18-78
Locating a Study from a Long List ............................................................................ 18-81
Chapter 19 -
Utilities .................................................................................................................................... 19-1
Starting a Utility ................................................................................................................ 19-2
System Configuration ........................................................................................................ 19-2
Usage ................................................................................................................................. 19-3
Usage Program Menu .................................................................................................. 19-4
Usage Summary Report ............................................................................................... 19-4
Technically Unacceptable Studies ......................................................................... 19-6
Usage Detail Report ............................................................................................... 19-6
Claims for Technically Unacceptable Studies ....................................................... 19-8
xx Table of Contents
Database Tools ................................................................................................................... 19-9

Patient Management .................................................................................................... 19-9
Starting Patient Management ................................................................................. 19-9
Managing Patients ................................................................................................ 19-10
Managing Patient Information ............................................................................. 19-12
Biography ........................................................................................................ 19-12
Insurance ......................................................................................................... 19-14
QC Phantom Details ............................................................................................ 19-15
Managing Patient Baseline Scans ........................................................................ 19-17
Removing a Patient From the System .................................................................. 19-18
Managing Scans ................................................................................................... 19-18
Moving Scans ................................................................................................. 19-21
Erasing Scans ................................................................................................. 19-23
Export/Import ............................................................................................................. 19-25
Types of Databases .............................................................................................. 19-26
Types of Data ....................................................................................................... 19-26
Types of Transfers ............................................................................................... 19-26
Export ......................................................................................................................... 19-27
Import ......................................................................................................................... 19-29
Reconcile ................................................................................................................... 19-31
Patient Callback ......................................................................................................... 19-33
Auto Baseline Utility ....................................................................................................... 19-36
Scan File Look ................................................................................................................. 19-36
Scan File Plot ................................................................................................................... 19-39
Emergency Motion .......................................................................................................... 19-40
AP Reposition .................................................................................................................. 19-40
Reference Curve .............................................................................................................. 19-42
Starting Reference Curve Editor ................................................................................ 19-43
Viewing Reference Curve Data ................................................................................. 19-44
Creating New Reference Curve Records ................................................................... 19-44
Copying a Reference Curve Record .......................................................................... 19-49
Editing Reference Curve Records .............................................................................. 19-51
Deleting Reference Curve Records ............................................................................ 19-52
Adding New Ethnic Groups ....................................................................................... 19-53
Restoring Reference Curve Database ........................................................................ 19-54
Rebuild Archive Index ..................................................................................................... 19-55
Install Options .................................................................................................................. 19-57
Chapter 20 -
Digital Imaging and Communications in Medicine (DICOM) .......................................... 20-1
DICOM Selections ............................................................................................................. 20-2
Configuring DICOM .......................................................................................................... 20-4
Table of Contents xxi

Using DICOM .................................................................................................................... 20-4

Troubleshooting ................................................................................................................. 20-5
Appendix A -
Options ..................................................................................................................................... A-1
Options List ......................................................................................................................... A-2
Forearm ......................................................................................................................... A-2
IVA ............................................................................................................................... A-3
IVA HD ......................................................................................................................... A-3
DICOM Store ................................................................................................................ A-3
DICOM Modality Worklist .......................................................................................... A-3
General Region of Interest ............................................................................................ A-3
Body Composition Analysis ......................................................................................... A-3
Decubitus Lateral .......................................................................................................... A-3
Small Animal ................................................................................................................ A-3
Prosthetic Hip ............................................................................................................... A-4
Enterprise Data Management ........................................................................................ A-4
Hip Axis Length ............................................................................................................ A-4
Infant Whole Body ........................................................................................................ A-4
Low Density Spine ........................................................................................................ A-4
International .................................................................................................................. A-4
DAP Meter .................................................................................................................... A-4
Hip Structure Analysis® (HSA) ................................................................................... A-4
Mobility ........................................................................................................................ A-4
Appendix B -
Operator Maintenance ............................................................................................................ B-1
Periodic Cleaning ................................................................................................................. B-2
Cleaning the QDR and Computer Components ............................................................. B-2
Cleaning the Table Pad .................................................................................................. B-2
Disinfecting the Table Pad ............................................................................................. B-2
Periodic Visual Inspection ................................................................................................... B-3
Checking for Adequate Clearance ................................................................................. B-3
Checking Cables and Outlets ......................................................................................... B-3
Inspecting the Table Pad ................................................................................................ B-3
Cleaning Accidental Spills ................................................................................................... B-4
Glossary
Index
xxii Table of Contents

Chapter 1
Introducing the QDR Series
System
This chapter introduces the operator to the QDR Series bone
densitometers. This series includes fifteen models of multiple detector,
fan-beam, Dual-energy X-ray Absorptiometry (DXA) bone
densitometers. Each model offers some unique scanning abilities that
meet the diagnostic needs of a particular clinical environment.
Content
Subject Page
Introducing the QDR Series Models 1-2
Introducing the System Hardware Components 1-3
Introducing the APEX Software 1-9
Introducing the Quality Control Spine Phantom 1-10
Introducing the Positioning Aids 1-11
Introducing the Product Support Materials 1-12
1-1
Introducing the QDR Series Models

Discovery-A
This model provides for the acquisition and analysis of scans of
the AP lumbar spine, supine lateral spine, hip, dual hip, forearm,
whole body, AP and lateral imaging (single and dual energy) and
visualization of abdominal aortic calcification.
Discovery-SL
AP and lateral imaging (single and dual energy) and visualization
of abdominal aortic calcification.
Discovery-W
the AP lumbar spine, hip, dual hip, forearm, whole body, AP and
lateral imaging (single and dual energy) and visualization of
abdominal aortic calcification.
Discovery-Wi
the AP lumbar spine, hip, dual hip, forearm and whole body.
Discovery-C
the AP lumbar spine, hip, dual hip, forearm, AP and lateral
imaging (single and dual energy) and visualization of abdominal
aortic calcification.
Discovery-Ci
the AP lumbar spine, hip, dual hip and forearm.
Explorer
the AP lumbar spine, hip and dual hip.
4500A
the AP lumbar spine, supine lateral spine, hip, dual hip, forearm
and whole body.
4500SL
the AP lumbar spine, supine lateral spine, hip, dual hip, and
forearm.
1-2 Introducing the QDR Series System

4500W
the AP lumbar spine, hip, dual hip, forearm, and whole body.
4500C
the AP lumbar spine, hip, dual hip, and forearm.
Delphi-A
whole body, AP and lateral imaging (single and dual energy) and
visualization of abdominal aortic calcification.
Delphi-SL
AP and lateral imaging (single and dual energy) and visualization
of abdominal aortic calcification.
Delphi-W
the AP lumbar spine, hip, dual hip, forearm, whole body, AP and
lateral imaging (single and dual energy) and visualization of
abdominal aortic calcification.
Delphi-C
the AP lumbar spine, hip, dual hip, forearm, AP and lateral
imaging (single and dual energy) and visualization of abdominal
aortic calcification.
Introducing the System Hardware Components

The QDR Series provides DXA technology in a modular design
that includes the Operator Console and Examination Table.
Figure 1-1 Printer
QDR System C-Arm
Components Monitor
Rear
Table Pad Safety
Note: Figure depicts Discovery-A. Stop
Keyboard
Computer
Front
Safety
Stop
Control Panel KP1068A-0101
Operator’s Console Examination Table
Introducing the QDR Series System 1-3

Operator Console
The Operator Console acts as the system controller and contains
the Computer Hardware and Peripherals.
Computer Hardware and Peripherals

The computer system consists of an IBM compatible PC, monitor,
keyboard and printer.
4500 Power Module

The Power Module is used on QDR 4500 systems only and is
located in the lower back section of the Operator Console. The
Power Module contains switches on the rear and side panels for
turning the computer system and instrument power on and off. It
also includes a key for enabling generation of X-rays.
Delphi AC Power Isolation Module

The AC Power Isolation Module is used on the Delphi System
only. It is a stand-alone unit that receives AC power from the
facility and isolates it using a transformer. This protects the
system from unwanted noise and spikes.
The only control on the AC Power Isolation Module is the circuit
breaker located on the front. It provides overload protection for
the system. The only indicator is a green lamp that shows when
the circuit breaker is on and power is applied to the module.
Examination Table
The Examination Table is the part of the system where the scans
are performed and the data is sent to the computer. The major
components are described below.
Table Pad
The Table pad provides a cushion for the patient during the exam
with indicators to help align the patient during the exam.

Figure 1-2
Table Pad (typical)
KP1068A-0102
Table 1-1. Item Description Function

Table Pad Guides
1 Scan Limit Indicates the maximum scan range of
border the unit. Patient positioning must be
Note: The Table Pad markings within this border.
vary with the different models.
2 Center Lines Used to center the patient on the table.
C-Arm
Note: Explorer C-arm also contains The C-arm and table drive motors provide the table and arm
its Control Panel. motion required to scan the X-ray beam along the patient’s body.
The C-arm contains the X-ray source, X-ray detectors and laser.
X-Ray Source and Detectors

The X-rays are generated underneath the table and projected
upward. At the top of the C-arm are detectors that convert the X-
rays into electronic data. This data is then sent to the computer
where it is converted to scan images.
Laser
The laser projects a red visual cross-hair indicator onto the patient
during the patient positioning procedure. The cross-hair indicator
shows the starting position of the X-ray beam.

Control Panel for QDR Systems

Note: Refer to Chapter 4 for a The control panel for the QDR Systems contain a set of switches
detailed explanation of the and indicators that control the movement of the table and C-Arm.
functions of the control panel.
This allows the operator to help the patient on and off the table,
and permits accurate positioning of the laser.
Also, an Emergency Stop button allows the operator to halt the
scan at any point that the operator feels that the patient’s safety is
in jeopardy.
The Discovery and Explorer Control Panels

The Discovery control panel is located on the right front of the
examination table. The C, Ci, W and Wi control panel is shown in
Figure 1-3 and the A and SL control panel is shown in Figure 1-4.
The Explorer control panel is located on the C-Arm and is shown
in Figure 1-5.
Figure 1-3
Discovery C/Ci/W/Wi
Control Panel
KP1068A-0402
Figure 1-4
Discovery A/SL
Control Panel
KP1068A-0403
Figure 1-5
Explorer
Control Panel
00158-001
Discovery/Explorer Control Panel Switches and Indicators

The Control Panel contains the following switches and indicators:
• C-Arm Controls: Arm (left) and Arm (right) switches
• Table Controls: Table (in) and Table (out) switches
• Laser switch - light blinks when laser is on

• Center Table switch (also centers the C-arm)

• Patient On/Off switch
• X-ray On indicator
• Emergency Stop button
• Power switch (all models except Explorer)
• Enable Lateral switch (Discovery-A and -SL models only)
• Table Lift switch (Discovery-A and -SL models only)
The QDR 4500 and Delphi Control Panels

Note: Refer to Chapter 4 for a The control panel allows the operator to control the movement of
detailed explanation of the the C-arm and table. This helps the patient to easily get on or off
functions of the control panel.
the table, and permits the operator to accurately position the
laser.
Also, an Emergency Stop button allows the operator to halt the
scan at any point that the operator feels that the patient’s safety is
in jeopardy.
The QDR 4500 Control Panels

The QDR 4500 Control Panels are located on the right front of the
examination table unit.
Figure 1-6
Table
QDR 4500 C and W Arm Laser
Center
Table
Patient
On/Off Stop
Control Panel
X-Ray
KP0886-0105
Figure 1-7 Table

Emergency
QDR 4500 A and SL Arm Laser
Enable
Lateral
Center
Table
Patient
On/Off Table Stop
Control Panel
X-Ray
KP0886-0106
The Delphi Control Panels

The Location of the control panel for the Delphi-C and -W is on
the front of the C-arm, the location of the control panel for the
Delphi-A and -SL is on the right front of the examination table.
The Delphi Control Panels contains a series of switches, buttons,
and indicator lights. The switches control the movements and the

indicator lights inform the operator these activities are in

progress.
Figure 1-8 Emergency
Delphi-C and -W Stop Button
Control Panel
KP0886-0107
Figure 1-9
Delphi-A and -SL Patient
On/Off
X-Ray EMERGENCY
Power
Control Panel Table Table Lift Stop
A A
R R Center
M M Table
Table
Enable R
Laser
Lateral
KP0886-0108
QDR 4500/Delphi Control Panel Switches and Indicators

The Control Panels contain the following switches and indicators:
This control panel includes:
• C-arm Left and Right switches
• Table In and Out switches
• Laser switch On/Off (light blinks when laser is on)
• Center Table switch (also centers the C-arm)
• Patient On/Off switch
• X-ray On indicator
• Emergency Stop button
• Laser On/Motion Enabled indicator (light blinks when
laser is on, Delphi-C and -W systems only)
• Instrument On/Off (Power) switch (Delphi systems only)
• Enable Lateral switch (4500A and SL, and Delphi-A and -
SL only)
• Emergency Table (Table Lift) switch (4500A and SL, and
Delphi-A and -SL only)

Introducing the APEX Software

Note: Refer to Chapter 3 for The QDR Series uses the Windows® XP operating system. The
detailed information about using
APEX software.
computer screens use a graphical user interface (GUI) that are
called windows. The primary interface consists of a main window
with buttons or menus that allow the operator to choose specific
tasks or actions.
Main Window Overview

Figure 1-10 1 2 3
The QDR Series
Main Window
Note: Figure depicts Discovery
Main Window, other models have
slightly different appearance but
the same functions.
KP1068A-0103
6 5 4 7
Main Window Features

The important features of the main window include:
1 - Menu Bar
The Menu Bar can be used with the mouse or keyboard to
perform or analyze a scan, create or edit patient records and
perform system maintenance functions.
2 - Main Work Area
The Main Work area acts as the holder for all the other windows
or dialog boxes the operator uses when acquiring or analyzing a
scan.

3 - Filing Cabinet buttons

The Filing Cabinet buttons open the file cabinets that store patient
and scan records.
4 - System Function buttons
The System Function buttons start the major system maintenance
activities that the operator perform such as archiving (long-term
storage).
5 - System Message ticker tape
The System Message ticker tape provides a moving message
about activities that the operator may need to perform such as
reminding the operator to perform daily QC.
6 - Daily Function buttons
The Daily Function buttons begin five daily activities that the
operator may use to acquire and analyze a scan.
7 - Help
The APEX Online Help system provides step-by-step directions
for using the APEX software. The operator can access online help
by clicking on the Help button (either at the top or bottom of the
main window or on most dialog boxes), or by pressing the F1 key.
Introducing the Quality Control Spine Phantom

Note: Refer to Chapter 5 for Daily quality control procedures ensure that the QDR Series
more information about using system functions properly. When the operator performs daily
the QC Spine Phantom.
QC, the spine phantom is scanned. The system adds the results of
the scan to a database, and plots this on a graph. This records a
daily comparison to 10 separate measurements taken at the time
of the system’s installation, and provides the basis for the system
calibration.
Continuous, self-calibration is a feature of the QDR series. The

scanner has a calibration drum permanently installed inside the
unit that acts as an internal reference to automatically compensate
for variations in the emission from the X-ray source.1 A
calibration factor (CF) is listed on an individual scan report and is
used to identify if a scan was performed before or after a
calibration change or instrument failure.
1. pg. 63, Fogelman, I, Wahner, The Evaluation of Osteoporosis: Dual

Energy X-ray Absorptiometry in Clinical Practice, Martin Duntz, UK,
1994

Introducing the Positioning Aids

The QDR Series includes several aids to help the operator
position patients for specific exams. Positioning aids maintain the
correct patient position during the acquisition of a scan. They
include:
• Knee Positioner
• Foot Restraint (hip positioner)
• Head Positioner
Knee Positioner
Figure 1-11 Knee
The Knee Positioner
Positioner
KP1068A-0105
The large knee positioner is placed under the patient’s lower legs.
This allows positioning of the femurs so that they are as close to
90o to the spine as possible in order to flatten the back. The
operator can rotate the pillow to one of three sides to adjust for
the height of the patient and length of their legs.
Foot Restraint (Hip Positioner)

Figure 1-12
The Foot Restraint
R
Velcro
Strap
KP1068A-0106
The Foot Restraint (Hip positioner) maintains the correct position

of the femur and minimizes movement during the acquisition of a
hip scan. It is placed between the feet. The foot and leg of the side
being examined are rotated inwards, with the foot against the

fixture. A strap is placed around the foot, secured in the correct

position.
Head Positioner for A and SL Models

This Head Positioner is supplied on A and SL models and is
placed under the patient’s head for correct positioning during an
AP/Lateral Spine scan. It provides patient comfort to the elevated
arms. The arms must be moved away from the spine for both the
AP and lateral scans.
Figure 1-13
The Head Positioner
for A and SL Models
Head
Positioner
KP1068A-0108
Introducing the Product Support Materials

The QDR Series systems come with an array of support resources
such as manuals, online help and internet support. These include:
The QDR Reference Manual (this manual) provides system
technology.
APEX Online Help
The online help system provides step-by-step directions for using
the APEX software. Access online help by clicking on the Help
button (either at the top or bottom of the main window or on most
dialog boxes), or by pressing the F1 key.
QDR Series Technical Specifications Manual
The Technical Specifications Manual provides specifications and
regulatory information for QDR Systems.

Operator’s Manual
The Discovery and Explorer Operator’s Manuals provide user
instructions and are available in English, French, Italian, German,
Spanish, Brazilian Portuguese, and Polish.
Hologic Internet Site
The Hologic web site (http://www.hologic.com) provides a wide
variety of customer support information including service and
training offerings, FAQ, and contact information.
Information about cyber-security for QDR systems is available on
the Hologic web site at the following URL:
http://www.hologic.com/cc/netwrksec.htm


Chapter 2
Understanding QDR Series
Technology
This chapter provides explanations of the Quantitative Digital
Radiography application of DXA technology and the scan results
produced by the QDR Series systems.
Content
Subject Page
Introducing Key Elements 2-2
Introducing the Scan Sites 2-4
Lumbar Spine 2-4
Proximal Femur 2-5
Forearm 2-6
Whole Body 2-7
Understanding the Scan Results 2-8
2-1
Introducing Key Elements

To help provide the user with a fundamental understanding of the
operation of the QDR Series system, the key elements are
explained in the following sections:
• Presenting DXA technology (brief description)
• Introducing the scan sites (anatomical sites of the skeleton
areas that are scanned)
• Understanding the scan results (results produced by a scan
that can be interpreted by a physician)
Presenting DXA Technology

Dual Energy Absorptiometry (DXA or DEXA) is a method
utilized to measure bone density. Developed by Hologic in 1987,
these X-ray instruments emit alternating high, 140kVp, and low,
100kVp, X-rays. The first generation Hologic QDR instruments
used a single, or pencil X-ray beam, and a single detector. The
scanner worked by moving the detector and X-ray source in a
rectilinear pattern to acquire data of the lumbar spine and hip.
Continued development of the pencil beam single detector
configuration enabled a second generation of QDR instruments to
measure tissue composition, fat and lean, as well as bone. The
third generation QDR densitometers employ multiple detectors
and a dual energy X-ray fan-beam. The arm moves in a single
direction decreasing scan times from minutes to seconds with
improved image quality and equivalent precision. The beam
sweeps across a region of interest on the scan area in a fan-shaped
pattern, and is detected by a high-resolution multi-detector array
to form a high quality image.
B
C
KP0886-0201
2-2 Understanding QDR Series Technology

Accuracy and Precision

Accuracy is the ability to measure the bone mineral density
(BMD) of an object the same as by using an alternate method
such as ashing. Precision is the ability to reproduce the
measurement repeatedly. Independent tests scanning the same
patients on both pencil and fan beam instruments have
demonstrated no significant differences in accuracy. Studies have
reported a precision of 1% or better for spine, hip, and whole
body measurements when scanned on Hologic instruments.
Principles of Operation
The basic principle of DXA data acquisition is based on the
different bone and soft tissue attenuation characteristics at the two
pulsed X-ray levels. A calibration drum, comprised of known
amounts of bone and soft tissue equivalent materials is placed in
the beam. As the beam passes through the patient, more lower
energy X-rays than higher energy X-rays are absorbed by the
anatomical structures in the patient. The beam is then registered
by the detectors in the C-arm. The raw scan data, containing the
attenuation values of tissue, bone, and the calibration drum are
captured and transferred to a computer. An algorithm interprets
each pixel, creates an image and quantitative measurement of the
bone and body tissues.
Understanding QDR Series Technology 2-3

Introducing the Scan Sites

The scan areas that provide the most information about patterns
of bone loss include:
• Lumbar Spine
• Proximal Femur
• Forearm
• Whole Body
Lumbar Spine
The spine consists of a number of vertebrae categorized as
cervical (upper column), thoracic (mid column), lumbar (mid to
lower), and sacrum and coccyx (at the end). Significant bone loss
due to aging or osteoporosis is often observed in the vertebrae,
and particularly in the lumbar area.
KP0886-0202
The AP Lumbar Spine is the most widely used anatomical site for
the evaluation of osteoporosis. The vertebral bodies, L1 through
L4, contain approximately 40% cortical and 60% trabecular bone.
The high amount of trabecular bone and the relative ease of

reproducibility of positioning of the spine provide an important

source for baseline bone density data.
Proximal Femur
The femur is the skeletal site where the most serious
consequences of osteoporosis (fractures) often occur.
Femoral Neck
Trochanter
Ward’s
Triangle
Inter-trochanter
Total Hip
KP0886-0203
BMD results for proximal femur (Hip) scans, are reported for five
different anatomical areas: Total Hip, Femoral Neck, Trochanter,
Inter-Trochanter, and Ward’s Triangle.
• The Total Hip is the most reproducible measurement of
the hip and has become the preferred clinical
measurement of the hip bone mineral density.
• The Femoral Neck region contains a large proportion of
trabecular bone and provides an easily reproducible area
in the hip for DXA scanning. The analysis is completed
by placing a specific region at the anatomical landmark.
That landmark, called the “greater trochanter notch”
permits reproducibility for longitudinal scanning.
• The Trochanter is a triangular region whose boundaries
are the lateral edge of the femur and the inferior edge of
the neck box and the solid line where the edge of the
femur changes curvature below the trochanter.

• The Inter-Trochanteric region is below the Femoral

Neck to the bottom edge of the ROI.
• The Ward’s Triangle is located automatically by the
system and places a small box approximately 1cm x 1cm
at the area of minimum density in the femoral neck
region. For some patients, an area of minimum density
cannot be found. When this occurs, the Ward’s Triangle is
automatically centered at the intersection of the femoral
midline and the initial position of the bottom edge of the
femoral neck box.
Forearm
Bone loss may be notable in the forearm and for this reason it can
be used as a scan site. The forearm scan includes the region of the
radius and ulna and the wrist bones (carpals).
Carpal Bones
Ulna
Radius
KP0886-0204
The Ulna is the smaller of the two bones and is located laterally,
or on the “small finger side” of the forearm.
The Radius is larger than the Ulna and allows the rotation of the
forearm. This bone includes an important anatomical structure
described as the “Distal 1/3.” This is an active metabolic bone
site.
The Carpal bones are two rows of small bones also known as the
“Wrist” bones.

Whole Body
Note: Whole Body is available as Discovery-A, -W and Wi instruments allow regional and global
an option on Explorer. measurement of the Whole Body. An advanced application of
QDR technology can directly measure fat and skeletal mass and is
useful in research and clinical studies.
The anatomical
areas analyzed are:
• the head
• the left arm
• the right arm
• the left rib
• the right rib
• the T-spine
• the L-spine
• the pelvis
• the left leg
• the right leg
The subregion
analyzed includes
all of the above
except the head.
KP0886-0205

Understanding the Scan Results

The QDR DXA technology provides accurate and precise
measurement of small changes in bone mineral density (BMD)
measured in grams per centimeter squared (g/cm2). Presently
BMD measurements offer the physician the most reliable means
of recording the rate of bone loss or gain and estimating a
patient’s risk of fracture.
Z-Score
The Z-score is a measure of the difference between the patient’s
BMD and that of healthy people of the same sex, age and
ethnicity.
T-Score
The T-score is a measure of the difference between the patient’s
BMD and that of a young adult population of the same sex and
ethnicity.
Reference Database
The reference database represents the average results as a
function of age, sex, and ethnicity for a matched population.
Reference curves specify average BMD, and standard deviation
as a function of age. Each curve applies to a specific scan type,
analysis type, bone region, patient sex, and ethnic group.
Reference database reports use these reference curves for graphic
display, and for the calculation of Z and T scores. Each of these
curves compares a patient scan, or a series of patient’s scans, with
the reference database.

Chapter 3
APEX Software
The APEX software displays a user interface on the computer screen
that contains both words and pictures. This chapter provides
information on the use of this user interface and its features.
Content
Subject Page
Understanding the Mouse 3-2
Using the Mouse with APEX Software 3-3
Understanding the User Interface 3-4
Understanding Main Window Components 3-7
Introducing the System Software Reminders 3-13
Introducing the System Software Help 3-14
3-1
Understanding the Mouse

A graphical user interface (GUI) is designed so that you can move
easily from step to step with the help of a mouse. The mouse acts
like a keyboard.
The mouse allows you to move a bit faster around a computer
screen than using just the keyboard. You can use a mouse to move
the cursor (arrow) around on the computer screen, and “point” to
different objects.
The “mouse” is shaped so that it is easy for your hand to hold. As
a result, it looks like a mouse with a tail. The tail is the wire that
attaches the device to the computer. Although the look of this
device has changed for some computers over the last several
years, they are still generally referred to as a mouse.
Holding the Mouse

You hold a mouse by covering it with your hand. The mouse-tail
(wire) is positioned up at your fingers with your thumb resting on
the side. Your first finger rests lightly on the left mouse button
and your second finger rests lightly on the right mouse button.
The heel of your hand rests lightly on the back end of the mouse.
This helps you move the mouse more easily.
Mouse Tasks
You can use the mouse:
To... Move the mouse And...
and point...
Enter text Inside a field Press and release (click) the
in a field left mouse button once to
insert the cursor into a field
so that you can type text.
Perform an Anywhere on a Press and release the left
action button in a mouse button (click).
window
Move an To the object Press and hold the left mouse
object on button down.
the desktop Move the mouse, dragging
the icon to the spot that you
want it to remain.
Release the mouse button.
This is referred to as
dragging and dropping.
3-2 APEX Software

Using the Mouse with APEX Software

The mouse can have two or three buttons. You only need to use
the left mouse button with the APEX software.
Left Mouse
Button KP0886-0301
Pointing with the Mouse

As you move the mouse, an arrow moves on the screen. You must
point to an object before you can click on it.
Clicking the Mouse

Clicking the mouse means quickly pressing and releasing the left
mouse button. For example, when the instructions indicate to
click the OK button, it means positioning the arrow on the button,
and quickly pressing and releasing the left mouse button once.
Double-Clicking the Mouse

Double-clicking means clicking the left mouse button twice
quickly. Use the double-click function to open another window.
For example, double-clicking on a patient’s name displays the
Patient Record window instead of having to click on the name
once, and then click the OK button.
Dragging and Dropping

Dragging and dropping means pressing and holding the left
mouse button on an object or item, dragging that item to another
area of the screen, and releasing the mouse button.
APEX Software 3-3

Understanding the User Interface

The user interface refers to the screen displayed on your computer
monitor which is called a “window.” A window contains various
information which can be “opened and closed,” multiple
windows can be opened at the same time.
The User Interface windows contain words and picture such as
buttons and icons. These pictures represent sets of instructions to
the computer that are activated with the mouse.
User Interface Windows

The User Interface windows provide access to different scan
functions using buttons, menus, and a task bar. There are three
basic types of windows:
• Main window
• Tab windows
• Dialog windows
Main Window
Figure 3-1 Menu bar Main work area
The Main Window
Note: Figure depicts Discovery
Main Window, Explorer has
slightly different appearance but
the same functions.
KP1068A-0302
Function Buttons Ticker Tape
The main window includes function buttons, menu bar and a

ticker tape. It also has a main work area as shown in Figure 3-1.
3-4 APEX Software

Tab Windows
These windows are generally a series of windows with tabs that
are grouped together because they contain related information.
For example, the “Select a Scan” window is a series of three tabs
that allow you to select unanalyzed scans, analyzed scans, or all
scans.
Figure 3-2 Window Tabs Search Text Field
Tab Window
KP0886-0304
Sort List Function Button Scroll Bar
These windows can include:

• Window tabs
• Search Text fields
• Sort lists
• Function buttons
• Scroll Bar
APEX Software 3-5

Dialog Windows
Figure 3-3 Radio Button Drop Down Menu
Dialog Windows
Check Box
Text Field
Dialog windows allow you to perform certain actions such as

entering or editing information. For example, the Confirm
window allows you to enter patient’s height, weight, and the
operator’s initials.
These windows include a number of features such as:
• Radio buttons - allow you to choose one, and only one,
item from two or more items
• Drop down lists - allow you to select from a list of items
3-6 APEX Software

• Check boxes - allow you to choose the item (box checked)

or not (box unchecked)
• Text fields - allow you to enter text (from keyboard)
Understanding Main Window Components

Each window has unique features that allow you to acquire and
analyze a scan, and store the records for future use.
Main Window Buttons

The main window (see Figure 3-1) provides a series of buttons
that help you perform the primary tasks of the system.
Function Buttons
Button Description
This button initiates the daily QC procedure.
When flashing, indicates that daily QC needs to
be performed before you can begin scanning
KP1035A-0307 patients.
This button initiates the patient exam by

displaying a list of existing patients. You can also
add a new patient record, or edit an existing
KP1035A-0309 patient record.
This button allows you to locate archived scans

and restore them onto the computer. You can also
select a patient to get their biography and
KP1035A-0311 insurance details.
This button initiates Analyze of a specific scan to

generate BMD results.
KP1035A-0313
This button allows you to create, configure, or

print a report for a scan that has already been
analyzed.
KP1035A-0315
APEX Software 3-7

Filing Cabinet Buttons
Button Description
This button opens the Patient drawer and displays
a list of all patients on the system. You can also
add a new patient record, edit an existing patient
KP1035A-0317
record or input data from any DXA system for
patient follow up.
This button opens the Scan drawer and displays a
list of scans currently on the system. You can also
view scan details of a selected scan.
KP1035A-0319
System Management Buttons
Button Description
This button initiates saving scan data to selected
media so that it may be restored for later use.
KP1035A-0321
This button initiates back ups of the database in

case of computer failure.
KP1035A-0323
This button initiates exiting the software.
KP1035A-0325
Using Menus
The menus available in the software are listed in the menu bar at
the top of the window. In most cases, you can use the buttons to
perform the same tasks as some of the menu options.
Choosing Menu Items
You can choose a menu selection by:
1. Pointing to it with the mouse and clicking on it; or,
2. Pressing and holding the Alt key while typing the underlined
letter in the menu title. For example, from the main window
press Alt+F to open the Filing Cabinet menu, then press
Alt+P to open the Patient drawer.
3-8 APEX Software

Using Sub-Menus
Some menu selections display a sub-menu that appears alongside
the parent menu. Menu items that open a sub-menu display with a
right arrow (→) or left arrow (←) symbol. Select an item from a
sub-menu the same way that you select an item from a regular
menu. For example, press Alt + U to open the Utilities menu.
Scroll down to Database Tools, then scroll across to select an item
from the sub-menu.
Closing Menus
To close a menu, click anywhere outside of the menu.
Understanding Other Window Components

There are a number of other window components located on the
Tab and Dialog windows that allow you to perform actions that
include:
• Enter text
• Finding records stored in folders with tabs.
• Selecting an item from a list that drops down from a field.
• Selecting functions by turning on and off radio buttons.
• Performing tasks using command buttons.
• Moving up and down through a window using a scroll bar.
• Sorting a list.
• Selecting an item in a list.
Entering Text
KP0886-0327
Use the Tab key or your mouse to position the cursor into the text
field. Click once inside the text field to begin entering text.
APEX Software 3-9

Tabs
KP0886-0328
Some dialog boxes in the software have a series of tabs across the
top that let you view specific information. The tabs are similar to
folder tabs in a filing cabinet. Click once on the tab to open that
“folder.”
Drop-down Lists
The dialog box shows a drop-down list for the Spine Analysis.
Clicking on the down arrows displays the list of options from
which to choose. Highlight the desired field and click once.
Radio Buttons
KP0886-0330
Radio buttons allow you to pick one choice from a number of

options. Click in the small circle next to the option to select it. In
this example, a “filled” circle indicates that Choose Analysis
Method is the selected choice.
Command Buttons
KP0886-0331
Buttons activate an operation. In a dialog box, for example,

clicking on the Cancel button cancels the operation and closes the
dialog box. Some examples of buttons used in the software
include OK, SelectAll, DeselectAll, Cancel, Close, Next, Back.
3-10 APEX Software

Check Boxes
KP1035A-0331a
Check Boxes appear in various menus and are used to select one
or more items in a list.
Scroll Bars
Scroll bars appear on the right and bottom edges of some screens.
Use the scroll bars to view portions of the window that are not
entirely visible.
View hidden portions of the screen by clicking on the arrows at
either end of the scroll bar, or by dragging the slider box between
the arrows.
The horizontal scroll bar moves the contents within the window
left and right. The vertical scroll bar moves the contents of the
window up and down.
Sorting List Items

The software displays screens with listings such as patient data,
scan data, and so on. This section provides helpful hints on
changing the sort order of lists, as well as selecting items from a
list.
Identifying the Sort Order
KP0886-0332
APEX Software 3-11

An asterisk (*) in the heading identifies the sort order. For

example, an asterisk in the Patient heading indicates the sort order
is alphabetical by the patient’s last name.
Changing the Sort Order

You can change the sort order of listed items by clicking on the
heading above the item. For example, to sort the list by Patient
ID, click on Patient ID.
Selecting Items From a List

Selecting One Item
To select one item from a list, click on the item and the item
becomes highlighted. Then click OK to select that item.
Selecting Multiple Items

To select multiple items from a list, click on the first item, then
press and hold down the Ctrl key while clicking on subsequent
items. Selected items are highlighted. Release the Ctrl key and
click OK.
Selecting a Range of Items

To select a range of items, click on the first item in the range, then
press and hold the Shift key and click on the last item. Selected
items are highlighted. Release the Shift key and click OK.
3-12 APEX Software

Introducing the System Software Reminders

The software interface includes visual software aids and functions
to:
• Remind you to perform a certain task
• Show you the function of a button before you click on it
• Let you get help on a certain function or task
• View important system messages
Flashing Buttons
Flashing buttons indicate that you need to perform a task before
you can proceed with daily operations or that you are in danger of
losing unsaved information.
Daily QC
When the Daily QC button is flashing, it indicates
that you must perform QC before performing an
examination. Refer to Chapter 5, Quality Control,
KP1035A-0307 for detailed instructions for performing daily QC.
System Backup
When the System Backup button is flashing, it
indicates that you need to perform a system
backup. Backing up the system is a weekly
KP1035A-0323
procedure for ensuring that your data is protected
in the event of a system failure. You can still
perform your daily operations, but you should
perform the system backup (by clicking the
System Backup button), as soon as possible.
APEX Software 3-13

Introducing the System Software Help

APEX has many tools to help you run the software. Some of them
are:
• Tool Tips
• Online context sensitive help
• Ticker Tape messages
Tool Tips
Tool tips appear when you position the mouse pointer over a
button. A small rectangle appears with a description of the button.
You do not need to click the button to view the tool tip.
Online Context Sensitive Help

This feature gives you help on the active window, that is the
window or dialog box you are currently using.
To use Context Sensitive Help:
Step Action
1 If the blue Help button (see left) is visible, click it to get
KP0886-0333 help on the window that you are working on.
2 If the blue Help button is not visible, look for a Help button
KP0886-0334 on the currently open window.
3 Click Help if the button is there.
In either case, a screen similar to the one below appears.
The online help is standard Windows help and operates the
same.
KP0886-0335
You can learn more about Windows help by clicking Start

KP0886-0336
on the Windows Task bar and selecting Help.
3-14 APEX Software

Ticker Tape
KP0886-0337
The ticker tape appears at the bottom of the main window. It

displays helpful information, or instructions to remind you to
perform a specific task. For example, the ticker tape message
“Click on the System Backup button to start the...” displays,
along with a flashing System Backup button to remind you to
perform a system backup.
APEX Software 3-15

3-16 APEX Software

Chapter 4
Performing Daily System
Operations
This chapter provides information about the basic operating
procedures for the Discovery, Explorer, QDR 4500 and Delphi
systems including:
• Turning the System On and Off.
• Switches and indicators for daily system operation.
• Emergency procedures.
Content
Subject Page
Discovery Systems 4-2
Discovery Circuit Breaker and Indicator 4-2
Discovery-C, -Ci, -W and -Wi Control Panel 4-2
Discovery-A and -SL Control Panel 4-4
Turning Discovery Power On and Off 4-5
Discovery Emergency Procedures 4-7
Explorer Systems 4-9
Explorer Circuit Breaker and Indicator 4-9
Explorer Control Panel 4-9
Turning Explorer Power On and Off 4-10
Explorer Emergency Procedures 4-11
QDR 4500 Systems 4-14
QDR 4500 Power Module 4-14
QDR 4500 Control Panel 4-15
Turning QDR 4500 Power On and Off 4-18
QDR 4500 Emergency Procedures 4-20
Delphi Systems 4-23
Delphi AC Power Isolation Module 4-23
Delphi Control Panels 4-23
Turning Delphi Power On and Off 4-26
Delphi Emergency Procedures 4-28
4-1
Discovery Systems
Discovery Circuit Breaker and Indicator
The Discovery circuit breaker and indicator are located on the
back of the left pedestal (see Figure 4-1). Table 4-1 gives the
description and function of the circuit breaker and indicator.
Figure 4-1
Location of Discovery Circuit
Breaker and Indicator
KP1068_002-0401
Table 4-1 Description Function

Discovery Circuit Breaker
and Indicator Circuit Breaker Turns the power to the Discovery
system off (0) and on (1).
Indicator Glows green when the circuit breaker is
in the on (1) position.
Discovery-C, -Ci, -W and -Wi Control Panel

The Discovery-C, -Ci, -W and -Wi Control Panel (see figure
below) is located on the right front of the examination table. Table
4-2 gives the description and function of the switches and lamps.
Figure 4-2
Discover-C, -Ci, -W and -Wi
Control Panel
MAN-00175_002-0401
4-2 Performing Daily System Operations

Table 4-2 Switch/Lamp Function Lamp Indicators

Discovery-C, -Ci, -W and -Wi
Control Panel Switches and Patient On/Off The table moves to the
Lamps front-most position and
the C-arm moves to the
left-most position
Center Moves the table and C-
arm to the center
position
Arm (right) Moves the C-arm to the
right (towards the head
of the table)
Table (in) Moves the table toward
the back
Laser Turns the laser cross- When the laser is
hair indicator ON or ON the Laser On/
OFF Motion Enabled
green indicator
blinks
Arm (left) Moves the C-arm to the
left (towards the foot of
the table)
Table (out) Moves the table toward
the front
EMERGENCY Pressing this button
Stop Button stops scanning
immediately. Pressing
the button down and
turning it to the right
resumes normal
operation.
X-Ray When X-rays are
(amber indica- being produced this
tor) indicator is ON
Power Turns the power to the When the indicator
instrument on or off is green, power is
ON in the
instrument
Performing Daily System Operations 4-3

Discovery-A and -SL Control Panel

The Discovery-A and -SL Control Panel (see Figure 4-3) is
located on the right front of the examination table. Table 4-3 gives
the description and function of the switches and lamps.
Figure 4-3
Discovery-A and -SL
Control Panel
MAN-00175_002-0403

Discovery-A and -SL Control
Panel Switches and Lamps Patient On/Off The table moves to the
front-most position and
left-most position
Enable Lateral Enables the C-arm and Light Blinking ON
table to move for the = You need to
acquisition of the AP/ perform a task as
Lateral Spine scan. The instructed.
system instructs you
how and when to use
this switch.
Center Moves the table and C-
arm to the center
position
of the table)
the back
OFF Motion Enabled
green indicator
blinks
X-Ray (amber When X-rays are
indicator) being produced this
indicator is ON


the table)
the front
EMERGENCY Moves the table up Light ON = Enabled
Table Lift when pressed. when you press the
Emergency Stop
switch.
EMERGENCY Pressing this button
Stop Button stops scanning
the button down and
resumes normal
operation.
Power Turns the power to the When the indicator
instrument on or off is green, power is
ON in the
instrument
Turning Discovery Power On and Off

Do not use the circuit breaker on the back of the left pedestal (see
Figure 4-1) to turn the power on or off. If the green indicator light
above the circuit breaker goes out while the system is running or
if the indicator is not on at the beginning of the day, refer to the
“Discovery Emergency Procedures” on page 4-7.
Beginning of the Workday

Perform the following steps at the start of each workday to turn
the Discovery System on.
Step Action
1 Verify that the green indicator on the back of the left
pedestal is on (Figure 4-1).
This light indicates that the system is receiving AC power.
2 On the Control Panel (see “Discovery-C, -Ci, -W and -Wi
Control Panel” on page 4-2 or “Discovery-A and -SL
Control Panel” on page 4-4). press the Power button.
The Power green indicator illuminates.

Step Action
Note: Because the computer and 3 On the Operator Console, turn the computer on.
peripherals may vary, refer to The monitor (in power save mode) and printer(s) should
documentation that came with the
already be on during a normal day’s power-up.
Discovery System for controls
and indicators on the computer, The computer boots itself and starts Windows XP. It then
monitor and printers. starts the APEX software automatically. If there are any
problems, warning messages will tell you what to do.
End of the Workday

Perform the following steps at the end of each workday to turn the
Discovery System off.
Step Action
1 Make sure only the Main Window appears on the monitor.
This is to ensure that you are not in the middle of any
function and all activity has stopped.
2 Click Exit.
The Exit button is in the lower right-hand corner of the
screen.
KP1035A-0325
3 In the Exit QDR System dialog box that appears, select
“Exit QDR with shutdown?” and click OK.
KP1068A-0404
This shuts down the APEX software, and the Windows XP

operating system
4 On the computer, press the power on/off switch to power
off the computer.
5 Turn off the Discovery System by pressing the Power
switch on the control panel (see “Discovery-C, -Ci, -W
and -Wi Control Panel” on page 4-2 or “Discovery-A and
-SL Control Panel” on page 4-4).
The green indicator in the Power button goes out.
Important: Do not turn off the Do not turn off the printer(s).
circuit breaker on the back of the
left pedestal (see Figure 4-1). The Do not turn off the monitor. It goes into power save mode
green indicator should remain on. when the computer shuts down.

Discovery Emergency Procedures

While operating the Discovery there are three emergency
situations that may require your action:
• A facility power failure occurs
• Equipment fails while in operation
• System is turned off
Operator Action During a Power Failure

If the facility power fails, it is a good idea to turn off all the
equipment. When the power returns, frequently it is not stable and
can spike up and down for a few moments. You should wait a few
minutes after power returns to turn on the equipment.
Shutting Down During a Power Failure

Step Action
1 If the system was in operation when the power failure
occurred, assist the patient from the table
The Patient On/Off switch will be inoperative at this time.
2 Turn off the computer.
Note: Refer to documentation 3 Turn off the circuit breaker (see Figure 4-1).
that came with the system for Since this is a power failure condition, the green Indicator
controls and indicators on the
should already be off.
computer, monitor and printer.
After Power is Restored

Step Action
1 After waiting a few minutes for the facility power to
stabilize,
Turn on the circuit breaker.
The green indicator light above the circuit breaker goes
on.
2 Turn the computer on.
3 Perform the procedure in “Beginning of the Workday” on
page 4-5).
If Equipment Fails While in Operation

If the operator determines that the equipment has malfunctioned
(e.g., X-Ray is on and C-arm is not moving) perform the
following procedure.

Emergency Stop Procedure:

Step Action
1 On the Control Panel, press the red Emergency Stop
Button.
The table and the C-arm immediately stop moving, and the
X-rays and laser turn off.
2 Assist the patient off the table.
Note: The power should not be 3 Turn off the circuit breaker (see Figure 4-1).
restored without consulting
Hologic. 4 Disconnect the power cord from the AC outlet (if
possible).
5 Call Hologic customer service.
If AC Power has been Turned Off

If for any reason the circuit breaker has been turned off (not
because of an equipment failure), or the plug has been pulled
from the wall, use the following procedure to apply power to the
system:
Applying power to the system:
Step Action
1 If necessary, place the power cord into the AC outlet.
Note: If the system does not turn 2 Place the circuit breaker in the 1 (on) position (see
on, make sure that the power cord Figure 4-1).
is plugged into the wall. If it is,
The green Indicator above the circuit breaker illuminates.
call Hologic customer service.
3 Perform the procedure in “Beginning of the Workday” on
page 4-5

Explorer Systems
Explorer Circuit Breaker and Indicator
The circuit breaker and indicator, on Explorer, are located on the
Power Module (see Figure 4-4). Table 4-4 gives the description
and function of the circuit breaker and indicator.
Figure 4-4
Location of Explorer Circuit
Breaker and Indicator
00132-001

Explorer Circuit Breaker
and Indicator Circuit Breaker Turns the power to the Explorer system
off (0) and on (1).
Indicator Glows green when the circuit breaker is
in the on (1) position.
Explorer Control Panel

The Explorer Control Panel (see Figure 4-5) is located on the C-
Arm. Table 4-5 gives the description and function of the switches
and lamps.
Figure 4-5
MAN-00175_002-0401

Switches and Lamps Patient On/Off The table moves to the
front-most position
Center Moves the table to the
center position


of the table)
the back
OFF Motion Enabled
green indicator
blinks
the table)
the front
EMERGENCY Press this button to
Stop Button immediately stop
scanning. Press the
button down and turn it
to the right to resume
normal operation.
X-Ray When X-rays are
tor) indicator is ON
Turning Explorer Power On and Off

Do not use the circuit breaker on the Power Module (see
Figure 4-4) to turn the power on or off. If the green indicator light
above the circuit breaker goes out while the system is running or
if the indicator is not on at the beginning of the day, refer to the
“Explorer Emergency Procedures” on page 4-11.

the Explorer on.
Step Action
1 Verify that the green indicator on the Power Module is on
(Figure 4-4).

Step Action
Explorer System for controls and
indicators on the computer, The computer boots itself and starts Windows XP. It then
End of the Workday

Explorer off.
Step Action
1 Make sure only the Main Window appears on the monitor.
2 Click Exit.
screen.
KP1035A-0325

“Exit QDR with shutdown?” and click OK.
KP1068A-0404
This shuts down the APEX software, and the Windows XP

operating system
4 On the computer, press the power on/off switch to power
off the computer.
Important: Do not turn off the Do not turn off the printer(s).
circuit breaker on the Power
Module. The green indicator Do not turn off the monitor. It goes into power save mode
should remain on. when the computer shuts down.
Explorer Emergency Procedures

While operating the system there are three emergency situations
that may require your action:




Step Action
1 If the system was in operation when the power failure
The Patient On/Off switch will be inoperative at this time.
2 Turn off the computer.
Note: Refer to documentation 3 Turn off the circuit breaker (see Figure 4-4).
that came with the system for Since this is a power failure condition, the green Indicator
controls and indicators on the
should already be off.

Step Action
stabilize,
Turn on the circuit breaker (see Figure 4-4).
The green indicator light above the circuit breaker goes
on.
3 Perform the procedure “Beginning of the Workday” on
page 4-10.
If Equipment Fails While in Operation

(e.g., X-Ray is on and C-arm is not moving) perform the
following procedure.


Step Action
Button (see Figure 4-5).
Note: The power should not be 3 Turn off the circuit breaker.
restored without consulting
Hologic. 4 Disconnect the power cord from the AC outlet (if
possible).
If AC Power has been Turned Off

If for any reason the circuit breaker has been turned off (not
because of an equipment failure), or the plug has been pulled
from the wall, use the following procedure to apply power to the
system:
Step Action
1 If necessary, place the power cord into the AC outlet.
Note: If the system does not turn 2 Place the circuit breaker in the 1 (on) position (see
on, make sure that it has power Figure 4-4).
(that is, the cord is plugged into
The green Indicator above the circuit breaker illuminates.
the wall). If it is, call Hologic
customer service. 3 Perform the procedure “Beginning of the Workday” on
page 4-10.

QDR 4500 Systems

QDR 4500 Power Module
The Power Module supplies electrical power to the QDR 4500
system and is located below the workstation table. The Power
Module right side and back panel include on/off switches, circuit
breakers, X-ray key and lamp indicators.
QDR 4500 Power Module Side Panel

The Power Module side panel contains the computer on/off
switch, the instrument power switch, the X-ray enable key, and
most of the circuit breakers (See Figure 4-6 and Table 4-6). These
circuit breakers protect different parts of the system. Under
normal operating conditions, these circuit breakers should remain
on. Under normal circumstances you will not have to take any
action with the circuit breakers.
Figure 4-6
Key Switch
Side Panel Indicator
Instrument X-Ray Enable ON

Computer Power
Power
OFF
CB1
10A
Computer
CB2
4A
24/28VDC Supply
CB3
1A
n15VDC Supply
3A CB4
24VDC
CB5
10A
28VDC
X-Ray Supply Pedestals X-Ray Emission Ind.

CB6 CB7 CB8 CB9 15VAC max 3A
6A 3A 3A 3A
KP0886-0401

The functions of the switches and indicators are:

Components Computer Power Switch Turns the computer, monitor, and
printer ON and OFF.
Instrument Power Turns the QDR 4500 instrument ON
Switch and OFF.
X-ray Enable Key Enables or disables X-ray generation.
X-ray Enable Lamp When lit, indicates that X-rays can be
generated.
Circuit breakers Only used by the operator if there are
problems with the power supply to
different areas of the system.
X-ray Emissions Ind. You can use this outlet to enable an
indicator light (an X-ray warning light)
such as a red light bulb.
QDR 4500 Power Module Rear Panel

Note: Refer to page 4-20 for more The main power switch (CB1) is located on the rear panel of the
information about operator power module. It is generally used only after a power failure, to
actions during a power failure.
turn the system OFF and then ON.
Figure 4-7
Power Module Rear
Panel
CB1
Main
Power
Main
Power Power 115VAC max 10A
Indicator Cord To Power Strip
KP0886-0402
QDR 4500 Control Panel

Note: The QDR 4500C and The Control Panel, located on the right of the examination table
QDR 4500W Control Panels do unit, allows you to direct the movement of the C-arm and table, and
not include an Enable Lateral
turn on the laser. This means you can move the C-arm to correctly
or Emergency Table switch.
position the laser. You can also position the C-arm and table so that
the patients can easily get on or off the table.

QDR 4500C and QDR 4500W Control Panel

Figure 4-8
Table
QDR 4500C and W Center Patient
Arm Laser Table On/Off Stop
Control Panel
X-Ray
KP0886-0105
This Control Panel has a series of buttons to move the table, C-

arm, and turn the laser cross-hair indicator on or off. Indicator
lights verify that components are on or enabled (see Figure 4-8
and Table 4-7). An Emergency Stop button allows the operator to
halt the scan at any point that the operator feels that the patient’s
safety is in jeopardy.
QDR 4500C and W Control
Panel Switches and Lamps Arm ← → Moves the C-arm left or Light ON = C-arm is
right. moving either left or
right.
Table ↑↓ Moves the table in or Light ON = Table is
out moving in or out.
Laser Turns the laser cross- Light Blinking ON
hair indicator on or off = The laser is on. It
will automatically
turn off after several
seconds.
Center Table Moves the table and C- Light Blinking ON
arm to the center =Table and C-arm
position moving to the center
position.
Patient On/On Moves the table and C- Light Blinking ON
arm to the patient on/off = Table and C-arm
position moving to the
patient on/off
position.
X-ray on Lamp Light ON = X-rays
being produced.

Emergency Stop Pressing button stops

button scanning immediately.
Pressing the button
down and turning it to
the right resumes
normal operation.
QDR 4500A and QDR 4500SL Control Panel

This Control Panel has a series of buttons to move the table, C-
arm, and turn the laser cross-hair indicator on or off (see Figure 4-
9 and Table 4-8). This control panel also includes an Enable
Lateral button to move the C-arm and table into position for the
acquisition of the AP/Lateral Spine scan. Indicator lights verify
that components are on or enabled. There are two emergency stop
buttons. One button shuts down the system whenever the operator
feels the patient’s safety is in jeopardy. The other stops table
movement.
Figure 4-9
Table
QDR 4500A and SL Enable Center Patient Emergency
Arm Laser Lateral Table On/Off Table Stop
Control Panel
X-Ray
KP0886-0404

QDR 4500A and SL Control
Panel Switches and Lamps Arm ← → Moves the C-arm left or Light ON = C-arm is
right.
Table ↑↓ Moves the table in or Light ON = Table is
out. moving in or out.
hair indicator on or off. = The laser is on. It
will automatically
seconds.


how and when to use
this switch.
position. moving to the center
position.
Patient On/Off Moves the table and C- Light Blinking ON
position. moving to the
patient on/off
position.
Emergency Moves the table up Light ON = Enabled
Table when pressed. when you press the
Emergency Stop
switch.
being produced.
Pressing the button
the right resumes
normal operation.
Turning QDR 4500 Power On and Off

Note: The Instrument (Figure 4- These procedures are performed at the beginning and end of each
6) and Main Power Switch work day.
(Figure 4-7) should always
remain on.

Each of the steps that you complete at the beginning of the
workday, or whenever you need to restart the system, are critical
to the correct functioning of the system. For example, turning the
computer system on without enabling X-ray generation causes the
system to power up as a workstation, which makes it incapable of
scanning.

Turning the QDR 4500 System On:

the system on and enable X-ray generation:
Step Action
1 On the rear panel, verify that the Power indicator is lit (see
Figure 4-7).
This light indicates that the system is in standby mode.
2 On the right side panel, verify that the Instrument Power
switch is in the ON position (see Figure 4-6).
3 On the right side panel, turn the Computer Power Switch
to the ON position.
This switch turns on the computer, monitor, table, and
printer.
4 On the right side panel, turn the X-ray Enable key
clockwise to enable X-ray production (see Figure 4-6).
The X-ray Enable indicator light, when lit, indicates the
system can produce X-rays.
End of the Workday

At the end of workday, verifying that the instrument and main
power switches remain in the ON position is important. When
you turn off the computer and disable the X-ray key, the
instrument power goes into a standby mode. Standby mode means
that power is maintained to the X-ray detector. This eliminates
warming up the detector when the system is turned on which can
take a considerable amount of time.
Turning the QDR 4500 System Off:
Perform the following steps, in the order shown, at the end of
each workday to turn the system off:
Step Action
1 On the main window, click the Exit button.
The system displays the following message:
KP0886-0405
4-19
Step Action
2 Select “Exit QDR with shutdown” and click OK.
The system displays a message indicating that it is OK to
shut the computer down.
3 On the right side panel of the Power Module, turn the X-
ray Enable key counterclockwise (vertical) to disable
production of X-rays (see Figure 4-6).
The X-ray enable indicator light goes off when you turn
the key in the disabled (upright) position.
Note: Do not turn the Instrument 4 On the right side panel, turn the Computer Power switch
Power Switch off. to the OFF position (see Figure 4-6).
This shuts off the computer, table, monitor, and printer.
Note: Leaving the Instrument 5 On the rear panel, verify that the Power indicator light is
Power Switch on eliminates lit (see Figure 4-7).
warming up the detector when the
This light indicates that the system is in standby mode and
system is turned back on.
power is maintained to the X-ray detector.
QDR 4500 Emergency Procedures

During operation of the QDR System there are three emergency
situations that may require operator action:

In the event that your facility experiences a power failure, it is
important to unplug the QDR system from the wall outlet even
when you have used the switch to turn it OFF. This protects it
from damage due to power surges when power is restored.
Shutting down during a power failure

Step Action
1 On the side panel, turn the X-ray Enable key
counterclockwise to the OFF position (see Figure 4-6).
2 On the side panel, turn the Computer Power switch to the
OFF position.
3 Unplug the QDR system from the wall outlet.
4-20
After power is restored

Step Action
1 When power is restored, plug the QDR system into the
wall outlet.
2 On the side panel, turn the Computer Power switch to the
ON position.
3 On the side panel, turn the X-ray Enable key clockwise to
enable X-ray production (see Figure 4-6).
The X-ray Enable indicator, when lit, indicates the key is
in the proper position to generate X-rays.
4 Allow the system to warm up for the same amount of time
that the power was off or for one hour, whichever is
shorter.
Note: Refer to Chapter 5 for 5 Perform the daily QC procedure to verify that the system
detailed instructions for is functioning properly.
performing daily QC.
If QDR 4500 Equipment Fails While in Operation

(e.g., X-Ray is on and C-arm is not moving, equipment sparks or
smokes, etc.) perform the following procedure.
Step Action
Button.
The table and the C-arm immediately stops moving, and
the X-rays and laser turn off.
Note: The power should not be 3 Go to the back of the Power Module (Figure 4-7) and turn
restored without consulting off the Main Circuit Breaker.
Hologic.
4 Remove power to the Power Module (if possible).
If QDR 4500 AC Power has been Turned Off

If for any reason the circuit breaker on the Power Module
(Figure 4-7) has been turned off (not because of an equipment
failure), or the plug has been pulled from the wall, use the follow-
ing procedure to apply power to the system:
4-21

Step Action
Note: If the Power Module Power 1 On the Power Module, place the Main Circuit Breaker
Indicator does not turn on, make circuit breaker in the 1 (on) position.
sure that it has power (that is, the
The Power Module Power Indicator illuminates.
cord is plugged into the wall). If it
is, call Hologic customer service. 2 Perform the procedure titled “Turning QDR 4500 Power
On and Off” on page 4-18.
4-22
Delphi Systems
Delphi AC Power Isolation Module
The AC Power Isolation Module contains a power transformer,
circuit breaker and power indicator (see Figure 4-10). Table 4-9
gives the description and function of the switches and indicators.
Figure 4-10
AC Power Isolation Module
KP0886-0406
Circuit Breaker Indicator
.
AC Power Isolation Module
Circuit Breaker Turns the power to the Delphi System
off (0) and on (1).
Indicator Glows green when the circuit Breaker

is in the on (1) position.
Delphi Control Panels

Delphi-C and -W Control Panel
The Delphi-C and -W Control Panel (see Figure 4-11) is located
on the front of the C-arm. It contains the controls and indicators
that allow the operator to move the table and the C-arm to
properly position the patient for a scan. Table 4-10 describes the
switches, indicator lights and Emergency Stop Button on the
control panel.
4-23
Figure 4-11 Emergency

Delphi-C and -W Stop Button
Control Panel
KP0886-0107

Control Panel Switches and
Indicators Table In Moves the C-arm left or
right.
Table Out Moves the table toward

the front.
Arm Right Moves the C-arm to the

of the table).
Arm left Moves the C-arm to the

the table).

OFF. Motion Enabled
green indicator
blinks.
Patient On/Off The table moves to the

front-most position and
left-most position.
Center Table Moves the table and C-

arm to the center
position.
X-Ray On When X-rays are

tor) indicator is ON.
4-24
Laser On/ When this indicator

Motion Enabled is blinking, the laser
(green indicator) is on;
when this indicator
is not blinking, the
table and C-arm can
be moved.
Instrument On/ Turns the power to the When the indicator

Off instrument on or off. is green, power is
ON in the
instrument.
Emergency Stop Pressing this button

Button stops scanning
the button down and
resumes normal
operation.
Delphi-A and -SL Control Panel

The Delphi-A and -SL Control Panel (see Figure 4-12) is located
on the right front of the examination table. It contains the controls
and indicators that allow the operator to move the table and the C-
arm to properly position the patient for a scan. Table 4-11
describes the switches, indicator lights and Emergency Stop
Button on the control panel.
Figure 4-12
Delphi-A and -SL Patient X-Ray EMERGENCY
On/Off
Control Panel Table Table Lift Stop Power
A A
R R Center
M M Table
Table
Enable R
Laser
Lateral
KP0886-0108

Delphi-A and -SL Control
Panel Switches and Lamps Arm Moves the C-arm left or Light ON = C-arm is
right.
4-25
Table Moves the table in or Light ON = Table is

out. moving in or out.
hair indicator on or off. = The laser is on. It
will automatically
seconds.
how and when to use
this switch.
position. moving to the center
position.
Patient On/Off Moves the table and C- Light Blinking ON
position. moving to the
patient on/off
position.
Emergency Moves the table up Light ON = Enabled
Table Lift when pressed. when you press the
Emergency Stop
switch.
are being produced.
Pressing the button
the right resumes
normal operation.
Power Switch Turns equipment power
on and off.
Turning Delphi Power On and Off

The procedure to turn power on and off the Delphi System is
described below.
4-26
Do not use the circuit breaker on the AC Power Isolation Module

(Figure 4-10) to turn power on or off. If the indicator light on the
AC Power Isolation Module goes out while the Delphi System is
running or if the light is not on at the beginning of the day, refer to
the Emergency Power Procedure below.

the Delphi System on.
Step Action
Note: If the AC Power Isolation 1 Verify that the indicator on the AC Power Isolation
Module light is not on, refer to Module is on (Figure 4-10).
Emergency Power Procedures
below.
2 On the Control Panel, press the Instrument On/Off
(Power) button.
The Instrument On/Off (Power) green indicator
illuminates.
Delphi System for controls and
indicators on the computer, The computer boots itself and starts Windows. It then
End of the Workday

Delphi System off.
Step Action
1 Make sure only the Delphi main window appears on the
monitor.
2 Click Exit.
screen.
KP1035A-0325
4-27
Step Action
“Exit QDR with shutdown?” and click OK. (See below.)
KP0886-0405
This shuts down the APEX software, and the Windows
operating system
4 If the computer did not automatically shut itself down,
press the power on/off switch on the computer.
5 On the control panel press the button to turn power off:
• Instrument On/Off button on the -C and -W
control panel (see Figure 4-11)
• Power button on the -A and SL control panel (see
Figure 4-12)
Important: Do not turn off the The green indicator in the Instrument On/Off (Power)
circuit breaker on the AC Power switch goes out when power to the instrument is off.
Isolation Module. The green
indicator should remain on. Do not turn off the printer(s).
Do not turn off the monitor. It goes into power save mode
when the computer shuts down.
Delphi Emergency Procedures

During operation of the Delphi System there are three emergency
situations that may require operator action:

4-28

Step Action
1 If the Delphi was in operation when the power failure
Remember that the Patient On/Off switch is inoperative at
this time.
Note: Refer to documentation 2 Turn the circuit breakers on the AC Power Isolation
that came with the Delphi System Module (see Figure 4-10) off.
for controls and indicators on the
The green indicator to the right of it goes off.

Step Action
stabilize,
Turn the circuit breaker on the AC Power Isolation
Module (Figure 4-10) on.
The green indicator light to the right of it goes on.
3 Perform the procedure “Beginning of the Workday” on
page 4-27.
If Delphi Equipment Fails While in Operation

(e.g., X-Ray is on and C-arm is not moving, equipment sparks or
smokes, etc.) perform the following procedure.
Step Action
1 On the Operator Control Panel, press the red Emergency
Stop Button.
Note: The power should not be 3 Go to the AC Power Isolation Module (Figure 4-10) and
restored without consulting turn off the circuit breaker.
Hologic.
4 Remove the power the AC Power Isolation Module (if
possible).
4-29
If Delphi AC Power has been Turned Off

If for any reason the circuit breaker on the AC Power Isolation
Module (Figure 4-10) has been turned off (not because of an
equipment failure), or the plug has been pulled from the wall, use
the following procedure to apply power to the Delphi System:
Step Action
Note: If the AC Power Isolation 1 On the AC Power Isolation Module, place the circuit
Module Indicator does not turn breaker in the 1 (on) position (see Figure 4-10).
on, make sure that it has power
The AC Power Isolation Module Indicator illuminates.
(that is, the cord is plugged into
the wall). If it is, call Hologic 2 Perform the procedure “Beginning of the Workday” on
customer service. page 4-27.
4-30
Chapter 5
Quality Control
The QDR system uses the daily Quality Control (QC) procedure to
ensure that the system and software are performing properly prior to
scanning patients. Since Bone Mineral Density (BMD) changes slowly
in humans, it is essential that measured BMD changes are attributable
to biological change rather than densitometer drift.
The QC procedure must be performed once per day prior to using the
system to scan patients. This chapter provides information and
instructions for performing the QC procedure.
This chapter does not include the QC procedures for Step Phantom
Calibration for Body Composition. Refer to Appendix A for
information on this Option.
Content
Subject Page
The Daily QC Procedure 5-2
Start Daily QC 5-2
Position the Spine Phantom 5-3
Automatic System Test 5-4
Auto QC Passed 5-5
Auto QC Failed 5-9
About the QC Spine Phantom 5-10
QC Data Management 5-11
Plot Regression 5-20
Archiving QC Phantom Scans 5-20
5-1
The Daily QC Procedure

Important: This procedure must Daily QC is used to verify that the QDR system meets system
be performed each day prior to specifications.
scanning patients.
The Daily QC procedure includes all activities that begin when
you start QC, and ends when the QC plot has been evaluated and
determined to be acceptable. The Daily QC procedure takes
approximately 2 minutes and consists of the following steps:
• Start QC
• Position the Spine Phantom
• Automatic System Test
• Automatic Scan and Analysis of the Spine Phantom
• Add the QC Scan to the Plot
• Evaluate the QC Plot
• Exit QC
Start Daily QC
To start the daily QC procedure click on the Daily QC button in
the main window.
The system displays the “Daily QC Setup” window, prompting
you to place the specified phantom on the table.
KP1035A-0307
Note: Alternatively, you can select

Daily QC from the QC pull-down
menu in the main window to start
the daily QC procedure.
KP0886-0502
5-2 Quality Control

Position the Spine Phantom

To position the spine phantom on the table refer to Figure 5-1 and
Figure 5-2 and follow the procedure below.
Figure 5-1
Spine Phantom Registration
Mark A
Figure 5-2
Spine Phantom and Laser
Cross Hair Position
B
Quality Control 5-3

To position the spine phantom on the table:

Step Action
1 Place the spine phantom on the table with the registration
mark (see "A" in Figure 5-1) to the left, foot end.
Note: Use the horizontal line of 2 Position the phantom parallel to the back of the table.
the laser to confirm that the
phantom is straight on the table
3 Align the laser cross hair (see "B" in Figure 5-2) with the
registration mark.
4 Once the spine phantom is properly positioned, click the
Continue button.
The systems starts performing an automatic system test.
Automatic System Test

The QDR system automatically performs a system test to verify
proper operation of its X-ray subsystem prior to scanning the
spine phantom. The following screen is displayed during system
test:
KP0886-0504
5-4 Quality Control

If the automatic system test succeeds, a message appears on the

screen indicating that the system test passed.
KP0886-0505
If the automatic system test fails, the system displays a message

stating that the test failed, and information on how to correct the
error.
KP0886-0506
To correct a failed system test:

Step Action
1 Read the message in the Error window.
Note: The error message varies 2 Perform the steps as instructed in the Error window to
depending on why the system test correct the error and repeat the QC procedure.
failed.
Auto QC Passed
Upon successful completion of the system test, the system runs
Auto QC. When Auto QC has been completed, a window appears
giving either a passed or failed message.
When Auto QC passes, the message is “Daily QC has passed”
(see Figure 5-3).
Quality Control 5-5

Figure 5-3
QC Results Window for Auto QC
Passed
KP0886-0507
The QC Results window for a passed Auto QC contains 3

buttons: Review Analysis, Plot, and OK.
Note: If QC passes, performing If Auto QC passed, click on OK to start the daily operation of the
Review Analysis and/or Plot is System.
not required.
The Review Analysis button and the Plot button are described
below (for informational purposes).
Review Analysis
To review the analysis of the Auto QC scan, click on the Review
Analysis button from the QC Results window for a passed Auto
QC. The Analysis window appears (see Figure 5-4).
Figure 5-4
Auto QC Analysis Window
KP1035-0507a
Verify that the phantom has been properly positioned and that the
scan was properly analyzed. If these items appear to be
satisfactory, click Close to continue.
If not, click Close and repeat the procedure, making sure to
properly position the phantom.
From the QC Results window (see Figure 5-3) click OK to start
the daily operation of the System.
5-6 Quality Control

QC Plot
To review the QC plot, click on the Plot button from the QC
Results window for a passed Auto QC. The QC Plot window
appears (see Figure 5-5).
Figure 5-5
QC Plot Window
KP1035-0507b
When the QC Plot window is displayed, the BMD values are

shown along the y axis (left side) of the QC plot. The example
above shows the mean value at calibration time (green horizontal
center line) as 0.987.
The BMD tab is displayed by default. To show BMC or Area
values, select the appropriate tab by clicking on it.
The QC Plot Window contains four buttons
Button Function
<< Back Returns to the Auto QC passed window
(see Figure 5-3).
Plot Regression Refer to Plot Regression on page 5-20
Print Prints the QC Plot
Close Returns to the system main window
About the QC Plot

A QC plot is a graph of the results of a series of scans of the same
QC Spine Phantom over time. The graph shows a number of
statistical indexes designed to help you to determine if there have
been significant changes in the measurements generated from the
scans.
Scan Dates
Scan dates are displayed along the horizontal axis. The example
above shows the scan dates from August, 2000 to October, 2002.
Quality Control 5-7

Data Points
The small green circles are called data points. One data point
displays for each analyzed QC scan that is included in the QC
plot. The most recent data point is shown as a filled in green
circle. Any data point that falls off the graph (above or below) is
displayed as a red cross at the top (for data point above the scale)
or bottom (for data point below the scale) of the graph.
Mean Value at Calibration
The green horizontal line indicates the mean value at calibration.
This value is set by Hologic and is located at the mean value of
the measured parameter (in this case BMD) when your system
was calibrated. It is used as a guideline to compare the results of
your Daily QC scans to your QDR system when it was last
calibrated.
QC Limit Values
Note: An obvious drift, or points The red dashed lines represent the upper and lower QC limits for
outside the limit lines, should be your system. The limits are set by Hologic and are located at ±
reported to Hologic.
(plus or minus) 1.5% of the mean value at calibration
Setup
The setup area shows the type of QC scan performed, phantom
type (Spine, Block or Hip) and ID, and system serial number.
Reference Values
The Reference Values area shows the values that were
determined during the most recent database setup. It includes the
limits, the mean BMD, and the standard deviation (SD) for the
mean.
Plot Statistic
The Plot Statistics area shows the following:
• Number of Points
Number of scans contained in the QC plot.
• Mean
The mean is the average of all QC scans plotted.
• S.D.
The S.D. is the Standard Deviation from the mean for the
QC scans in the plot. The standard deviation indicates the
spread of plotted values from the mean.
• CV
The CV is the coefficient of variation for the values in the
5-8 Quality Control

graph. The smaller the CV percentage, the better the

precision of the results.
Auto QC Failed
If Auto QC fails, the message is “Daily QC failed” and a series of
steps is provided as shown in the example in Figure 5-6.
Figure 5-6
QC Results Window for Auto QC
Failure
KP1035-0508
If Auto QC fails, the QC Results Window contains four buttons:

Details, Review Analysis, Plot and OK.
Details
Clicking Details provides additional information about the QC
failure as shown in the example in Figure 5-7.
Figure 5-7
QC Results Details Window
Note: If the phantom is

positioned correctly and QC
fails a second time, contact
Hologic Customer Service.
KP1035-0508a
Review Analysis
Clicking the Review Analysis button displays an analysis
window similar to the one shown in the example in Figure 5-4.
From this window you will be able to verify that the phantom has
been properly positioned and that the scan was properly analyzed.
Click Close to return to the QC Results Window.
Quality Control 5-9

Plot
Clicking Plot from the QC Results window for a failed Auto QC
displays the Analysis window of the QC Plot (similar to the one
in Figure 5-5).
OK
Clicking OK, from the QC Results window for a failed Auto QC,
returns to the system main window so Daily QC can be re-run.
About the QC Spine Phantom

Your QDR system includes a DXA spine phantom that is used
during the Daily QC procedure. It is used to test the system’s
calibration and precision. The phantom is designed to produce
scan data that resembles patient data. Other phantom types are
available from Hologic.
Each QC Spine Phantom is assigned a name in the patient name
field. The information about the QC Spine Phantom is stored in
the patient database. If a patient name for the QC Spine Phantom
does not exist, the daily QC procedure will create a record.
The format of the patient name for the QC Spine Phantom is as
follows:
Phantom Number
<Type> Phantom # < Phantom ID>
Type: Spine, Block, or Hip KP0886-0512
5-10 Quality Control

QC Data Management
Occasionally there may be a need to manage the QC data
contained in your QDR system’s database. This section provides
information and instructions for managing the quality control
data. It includes the following:
• Access Data Management
• Set QC plot parameters
• Select scans to be included in the QC plot
• Create a new phantom record
• Set up the QC plot
Access Data Management

Follow the procedure below to gain access to the QC data
management functions.
To access QC data management functions:
Step Action
1 In the main window, click on QC in the menu bar.
The system displays the QC sub-menu.
2 Click on the QC Data Management sub-menu item to
display the QC Data Management sub-menu.
The system displays the QC Data Management functions
installed in your system, see below.
KP0886-0513
Set QC Plot Parameters

The “Quality Control Plot Parameters” window, shown below,
allows you set the parameters needed for the QC Plot graph.
Quality Control 5-11

KP0886-0514
The following table describes the fields in the Quality Control

Plot Parameters window.
Field Description
QC Plot Setup Indicates which QC Spine Phantom to
include in the QC plot. Choose from a list
of valid QC Spine Phantoms used with your
system.
Note: The North American format Start Date The date of the first scan you want to
is mm/dd/yyyy; the International include in the QC plot.
format is dd.mm.yyyy (for
example: 07/04/2002 is July 4,
2002; 04.07.2002 is 4 July 2002).
Leaving the date fields blank
results in all QC scans being
included in the QC plot.
End Date The date of the last, or most recent scan you
want to include in the QC plot.
Plot button Generates a QC plot based on the
parameters you specified.
Cancel Button Cancels the operation and returns you to the
main window.
To set plot parameters:
Step Action

Step Action
display the QC Data Management sub-menu. Click on
Plot.
The system displays the “Quality Control Plot Parameters”
window.
3 To change which QC Spine Phantom is used to plot the QC
graph, click on the down arrow in the QC Plot Setup field
and select the QC Spine Phantom.
Note: If you include a large span 4 To change the Start and/or End dates, enter the starting and
between dates, or leave the date ending dates using the following format:
fields blank, the graph may be
difficult to read, as it will include a mm/dd/yyyy (North America) or dd.mm.yyyy
large number of data points. (International).
If you leave both dates blank, all QC scans stored on your
system will display on the plot. If you leave the End date
blank, all scans from the start date on will display.
5 Click the Plot button to display the QC plot with the new
parameters. Click the Cancel button to cancel the operation
and not save any changes to the Plot Parameters.
Select scans to be included in the QC Plot

The “Select Quality Control Scans” window, shown below,
allows you select the scans to be available for plotting in the QC
Plot graph.
KP0886-0515

The following table describes the fields in the “Select Quality

Control Scans” window.
Field Description
Included Scans Lists scans that will be used to calculate the
baseline data for the QC plot.
Excluded Scans Lists scans that will not be included in the
calculations to determine the baseline.
Include Scans Use this button to move selected scans from
button the Excluded list area to the Included list
area.
Exclude Scans Use this button to move selected scans from
button the Included list area to the Excluded list
area.
All QC scans performed on your QDR system will be
automatically listed under scans to be included for plotting of the
QC Plot graph. You should only exclude scans that you know to
be invalid from this list.
To include or exclude scans:
Step Action
Select Scans.
The system displays the “Select Quality Control Scans”
window.
Note: To select multiple scans, 3 To include scans, select each scan from the “Excluded”
hold the Ctrl key while clicking on section of the window and click the Include Scans button.
each scan. To select a range of
scans, click on the first scan in the
range, and hold the Shift key while
clicking on the last scan in the
range.
4 To exclude scans, select each scan you want to exclude

from the “Included” section of the window and click the
Exclude Scans button.
5 Make sure there are at least twenty scans listed in the
Included area.

Step Action
6 Click the OK button when done to generate the baseline
data for QC plot. Click the Cancel button to cancel the
operation.
Exclude Data Points from the QC Plot Screen

In addition to the method described above, QC scans can also be
excluded directly from the Quality Control Plot screen. Only
scans that you know to be invalid should be excluded.
To exclude scans from the QC Plot screen:
Step Action
1 From the QC Plot screen, click on the data point to be
excluded,
or,
click and drag a box around the data points to be excluded.
The system displays the Scan Information screen.
KP0886-0516
Note: Only scans that you know to 2 Highlight the scan, or scans, to be excluded by clicking on
be invalid should be excluded. them.
Note: Excluded scans are not
deleted from the database.
3 Click OK to exclude the scans.
Create a New Phantom Record

This section provides information and instructions for creating a
new phantom record in the patient database. Every phantom used

in the QC procedures should have only one record describing it in

the patient database.
The “Add Quality Control Phantom” window, shown below,
allows you add new phantoms to the patient database.
The following table lists and describes the fields in the “Add
Quality Control Phantom” window.
KP0886-0517
Field Description
Phantom Type Indicates the type of phantom. The drop
down list includes standard types: Spine
Phantom, Hip Phantom, and Block
Phantom as well as non-standard phantom
types: Other1 Phantom, Other2 Phantom,
and Other3 Phantom. The phantom type
you select appears in the Phantom Name
area at the top of the window.
Phantom Number Indicates the number or name of the
phantom. A valid string can include
numbers and letters. The number (name)
you enter appears in the Phantom Name
area at the top of the window.
Comment Stores any comments you enter about the
phantom in the patient database.
To add a new QC Spine Phantom:
Step Action

Step Action
display the QC Data Management sub-menu. Choose New
Phantom.
The system displays the “Add Quality Control Phantom”
window.
3 Click the down arrow in the Phantom Type field and select
the type of phantom you want to add.
4 Enter the name of the phantom in the Phantom Number
field.
If the name you enter already exists in the patient database,
the system displays an error message. Respond to the error
message and enter a unique name in the Phantom Number
field.
5 Enter any relevant comments in the Comment field.
6 Click the OK button to add the new phantom to the patient
database, or click the Cancel button to return to the main
window without adding a new phantom.
Set up the QC Plot

This section provides information and instructions for specifying
the phantom, scan type, and serial number that will be used in
plotting. This information generates the baseline data used in the
QC plot.
Setting up a QC plot involves two steps:
1. Specifying data in the “Quality Control Plot Setup” window
2. Including or excluding scans in the “Select Quality Control
Scans” window
Use the “Quality Control Plot Setup” window, shown below, to
begin setting up the QC plot.
KP0886-0518

The following table lists and describes the fields in “Quality

Control Plot Setup” window.
Field Description
QDR Serial Number Indicates the system’s serial number.
Phantom Name Lists phantoms used in analyzed QC
scans performed on the system
specified by the serial number.
Changing the system’s serial number
changes the list of phantoms.
Scan Type Lists scan types that have been used in
analyzed QC scans of the phantom
specified in the Phantom Name field.
Changing the phantom name changes
the scan types for the plot setup.
When you finish selecting information in the “Quality Control
Plot Setup” window, click the Next button to display the “Select
Quality Control Scans” window, shown below.
KP0886-0519
This window allows you select QC scans to be included in the QC

Plot. The scans listed are based upon the criteria you selected in
the previous window. Only scans matching the criteria you
entered displays. For example, the window above only shows
scans matching the following criteria:
QDR Serial Number = 3009
Phantom Name = SPINE PHANTOM #6124
Scan Type = a Lumbar Spine

The following table lists and describes the buttons in “Select

Quality Control Scans” window.
Field Description
Select All button Selects all scans contained in the list of
QC scans for the system and phantom
you selected.
Deselect All button Deselects all selected QC scans.
Finish button Instructs the system to calculate QC
data associated with the selected scans
for display in QC Plot.
Cancel button Cancels the operation and returns you
to the main window.
To setup a new QC plot:
Step Action
Setup Plot.
The system displays the “Quality Control Plot Setup”
window.
3 Verify the system’s serial number in the QDR Serial
Number text entry area.
4 Click the down arrow in the Phantom Name field, and
select the phantom you want to use to generate baseline
data.
5 Click the down arrow in the Scan Type field, and select the
scan type you want to use to generate baseline data.
6 Click the Next button to continue.
The “Select Quality Control Scans” window is displayed.
Note: A minimum of twenty scans 7 Select the scans to be used for the QC plot.
are recommended for sufficient • Use the Select All button to select all QC scans.
statistical information to set up a
new plot. • Use the Deselect All button to deselect all selected
Note: To select multiple scans, scans
hold the Ctrl key while clicking on 8 Click the Finish button when done so that the system can
each scan. To select a range of calculate data for display in QC Plot. Click the Cancel
scans, click on the first scan in the
range, and hold the Shift key while
button to cancel the operation.
clicking on the last scan in the
range.

Plot Regression
The QDR system provides a way to perform linear regression and
display it on the QC plot.
To display linear regression on the Quality Control Plot, click the
Plot Regression button. Slope is shown in the lower portion of
the graph.
The example below shows a BMD linear regression plot.
Figure 5-8
Regression Plot Example
KP0886-0521
The linear regression option calculates a least squares fit that

represents the change in the plotted QC parameter with time. The
slope of the line is calculated and displayed.
Regression can also be performed on BMC and Area plots by
selecting that tab and clicking the Plot Regression button.
Archiving QC Phantom Scans

The QC Phantom Scan provides information on how the QDR
system is functioning. Having access to these scans allows
Hologic to verify the operation of your system. All QC Phantom
scans should be archived when you archive the patient scans (see
“Archive Process” on page 16-8 of Chapter 16).

Chapter 6
Managing Patient Records
This chapter provides information about accessing the patient and scan
records in the QDR system.
Content
Subject Page
Introducing Patient Records 6-2
Working with Patient Records 6-4
Introducing Scan Records 6-16
Working with Scan Records 6-17
Adding Scan Information from Other 6-24
Manufacturer’s Systems
6-1
Introducing Patient Records

The QDR system stores patient and scan information in a database
that is also referred to as the filing cabinet. The three types of
records stored include:
• Patient Records
Each patient has a record of biographical and insurance
information. Recall this record from the Patient Drawer
each time a patient returns for a scan.
• Scan Records
A scan is data gathered from a patient, or phantom, during
each exam. The scan data, along with additional
information about the scan characteristics and the patient,
is stored in the Scan Drawer of the filing cabinet. These
can include both analyzed scans and unanalyzed scans.
Note: Refer to Chapter 14 for • Analysis Reports
more information about Reports.
When a scan is analyzed, a report can be generated, saved
(hardcopy), and retrieved later.
Accessing the Records

The main window provides access to records in the filing cabinet
several different ways. The method selected depends upon where
you are during an exam, or what types of tasks are being
performed. For example, when starting to acquire a scan, select
the Perform Exam button.
Or, if the scan has been performed but the analysis is not
complete, select the scan from the Scan Drawer by clicking on the
Scans button.
You can find and retrieve an archived scan (not stored on the
computer) by clicking the Locate Scans button. You can select a
patient record by clicking the Patients button.
The following table lists the methods of finding records in the file
cabinet.
6-2 Managing Patient Records

Note: Refer to Chapter 3 for The following table lists the methods of finding records in the file
additional information about using cabinet.
the buttons or menu on the main
window. When... And needed Then retrieve from...
is...
Performing a A patient Patient Drawer by:
new scan record • Clicking the Patients
button in the main window,
selecting the desired
patient, and dragging them
to the Perform Exam
button; or,
• Clicking the Perform
Exam button in the main
window; or,
• Choosing Exam, then
Perform Exam from the
menu bar at the top of the
main window.
Analyzing a The scan Scan Drawer by:
previously results • Clicking the Scans button
performed in the main window and
scan dragging the desired scan to
the Analyze Scan button at
the bottom of the main
window; or,
• Clicking the Analyze Scan
button in the main window;
or,
• Choosing Exam, then
Analyze Scan from the
menu bar at the top of the
main window.
Looking for a An archived Main window by:
scan that is scan • Clicking the Locate Scans
not stored on button
the computer
Managing Patient Records 6-3

Working with Patient Records

One important aspect of acquiring and analyzing scans includes
ensuring that you have a current patient record. This record
remains in the Patient Drawer so that it readily accessible each
time a scan is performed or analyzed, or if it needs to be updated.
Overview of Patient Record

The patient record is divided into two sections, the biography tab,
and the insurance tab.
Biography Tab
Field Description
Last Name Patient’s last name and suffix, if applicable (e.g.
III)
First Name Patient’s first name
MI Patient’s middle initial (no punctuation is
necessary)

Field Description
Sex Click the drop-down list to choose F (Female) or
M (Male)
Ethnicity Click the drop-down list to choose Asian,
Hispanic, White or Black.
DOB Date of Birth. Click the arrows to select the
month, day and year.
Patient ID Medical record number/X-ray #/SS #
Identifier 2 Department number
Referring Click the drop-down list to choose name of the
Physician physician that referred the patient or type a new
name. Entering a new name stores that name on
the system.
Click Delete followed by YES to remove the
name from the patient’s record and from list of
physician names stored on the system.
Menopause Patient’s age at the onset of menopause
Age
Height/Weight Today’s height and weight. Body Mass Index is
automatically calculated as height and/or weight
is entered or changed.
Body Mass Automatically calculated from Height/Weight
Index entries.
Patient Information that is specific to the patient such as
Comment “Premenopausal study”

Insurance Tab
KP0886-0602
Field Description
Name Name of the patient (filled in by the system)
Patient ID Patient ID (filled in by the system)
Plan Patient’s insurance plan
Group Patient’s insurance group
Insurance Patient’s insurance company
Address 1 Patient’s street address
Address 2 Additional address information, such as
apartment number or PO Box
City Patient’s city
State Patient’s two letter state code
Postal Code Patient’s zip code

Retrieving a Patient Record

The QDR system allows the operator to retrieve a record several
different ways from the patient drawer. The method often depends
on the task being performed. The primary method involves using
the Patients button located on the main window.
KP1035A-0317
To go to the Patient Drawer:

Step Action
Note: Refer to the table on page 1 Click the Patients button in the main window.
6-3 in this chapter for suggestions The system displays the Patient Drawer window with a list
about alternative methods for
of existing patient records.
accessing the Patient Drawer.
Searching the Patient Drawer

Note: It is important to avoid Once you have accessed the patient drawer, you can search the
creating duplicate patient records. Patient Drawer for a record by one of the following methods:
Therefore, you should search for
the correct patient record before • Using the scroll bar
creating a new record.
• Using a search criteria such as patient’s last name, ID, or
date of birth.

Search Field Scroll Bar
KP0886-0604
Patient Data
To search the Patient Drawer using the scroll bar:

Step Action
Note: An asterisk (*) in the 1 To move down through the list of patients, click on the
heading identifies the sort order. lower portion of the vertical scroll bar or on the down
arrow on the right of the patient window.
List of patients moves up.
2 To move up through the list of patients, click on the upper
portion of the vertical scroll bar or on the up arrow on the
right of the patient window.
List of patients moves down.
3 Select the patient’s name by clicking on it.

Patient Name
KP0886-0605
Scroll Bar
To search the Patient Drawer using the search text field:
Step Action
Note: An asterisk (*) in the 1 To search by last name, click the correct heading;
heading identifies the sort order. Asterisk displays near heading title (i.e., Patient Name,
Patient ID, Birth Date, or whatever search criteria you
elect to use) and search criteria displays next to text field.
2 Point to the text field with the mouse, and click with the
left mouse button.
3 Type the search criteria.
Patient list moves, displaying those names that match the
search criteria.
4 Select the patient’s record by clicking on it.
5 To search by another criteria, began at step #1, clicking on
the heading (for example, Birth Date).
Asterisk displays near heading title.
6 Complete steps 2 through 4 for each of the search criteria,
as needed.
Creating/Editing a Patient Record

From the Patient Drawer you can create a patient record for a new
patient or edit the patient record for an existing patient.

New Patient
Before entering a new patient record, search the database for an
existing record to avoid duplicate entries. If a record does not
exist, create a new record, adding biographical and insurance
information.
Click on New Patient to create new

biography and insurance data.
KP0886-0606
To create a new patient record:

Step Action
Note: Refer to page 6-3 in this 1 Click the Patients button in the main window.
chapter for more information The system displays the Patient Drawer window with a list
about retrieving an existing
of existing patient records.
record.
2 Click the New Patient button to add a new patient record.
The system displays the Patient window with Biography
and Insurance tabs at the top.
Note: Refer to pages 6-4 and 6-6 3 Click the Biography tab, enter the patient’s biography
for field descriptions of the information then click OK.
Biography and Insurance tabs.
The Patient Drawer window appears.
4 Click the Insurance tab, enter the patient’s insurance
information, and click OK.

Figure 6-1
Patient Screen, Biography Biography Tab
Insurance Tab
To enter patient biographical information (see Figure 6-1):

Step Action
1 Place the cursor in a field by pointing with the mouse to
the text box.
2 Click in the text box.
Blinking cursor displays in the field.
3 Type the appropriate information.
Use the keyboard Tab key or the mouse to move to the
next field.
4 Click on the Insurance tab.
Insurance dialog window displays.

Figure 6-2
Patient Screen, Insurance
KP0886-0608
To enter Insurance information (see Figure 6-2):

Step Action
1 Place the cursor in a field by pointing with the mouse to
the text box.
2 Click in the text box.
Blinking cursor displays in the field.
3 Type the appropriate information.
4 Move to the next field.
5 Click OK when finished.
Patient’s name displays in Select a Patient window.
Updating a Patient Record

You can change the information on a patient’s record any time,
simply by retrieving the record, and entering the new information.
You can also fill out the patient Questionnaire.

Figure 6-3 Edit Patient button

Patient Drawer, Edit Patient
KP0886-0609
Patient Biography
To edit a patient record:
Step Action
1 Click the Patients button in the main window.
The system displays the window with a list of patients
sorted alphabetically by last name.
Note: Refer to page 6-7 for 2 Search for and select the patient’s name.
instructions on searching the
Patient Drawer.

Step Action
3 With the patient’s name highlighted, click the Edit
Patient button (see Figure 6-3).
The system displays the Patient window with Biography
and Insurance tabs.
Note: Refer to pages 6-4 and 6-6 4 To edit biography information, click the Biography tab
for field descriptions of the and change information, as needed.
5 To edit insurance information, click the Insurance tab and
change information, as needed.
6 Click OK when done to return to the Patient Drawer
window.
Patient Questionnaire
The Questionnaire button appears if the Mobility option is
installed.
The Patient Questionnaire (see Figure 6-4) is a method of
electronically entering and saving bone density related patient
information.

Figure 6-4 Header

Patient Questionnaire Window Today’s Date
Patient
information
Questionnaire
Update Header button
The Header comes from the Header Block placed on Reports (see
“To configure the Header Block” on page 18-21).
Patient Information comes from the Patient Biography screen (see
“New Patient” on page 6-10). If the Patient Biography has been
changed (see “Updating a Patient Record” on page 6-12) then the
patient information (as well as the Header) can be updated by
clicking on the Update Header button.
To fill out a New or edit an Existing Patient Questionnaire
Step Action
1 On the Patient screen, Biography tab, click the
Questionnaire button.
The Questionnaire window appears (see Figure 6-4).
2 The following operations can be performed from the

Questionnaire:
• Clear button. Updates the Header, Patient
information, and changes the date to today while
clearing answers to all questions.
• Update Header. Updates the Header, Patient
information and changes the date to today.
• Print button. Prints the current questionnaire.
• Cancel button. Exits the Questionnaire without
saving data and returns to the previous window.
3 Click OK to save the Questionnaire and return the to
previous screen.

Introducing Scan Records

Scan data is gathered from a patient, or phantom, during each
exam. The QDR system stores the scan data, along with
additional information about the scan characteristics and the
patient. These can include both analyzed scans and unanalyzed
scans.
Scan Drawer
The Scan Drawer window allows you to display scans currently
stored in the QDR database. This includes analyzed, unanalyzed,
or a list of both (all scans).
The Scan Drawer window also allows you to delete scans from
the database and retrieve scan details about the selected scan and
the associated patient.
KP1035A-0319
From the Scan Drawer, you can also:

• initiate an exam
• analyze the scan
• initiate a report

Working with Scan Records

Click Scans in the main window to display the Scan Drawer
window.
The system displays the following information in the headings of
the Scan Drawer window. An asterisk (*) next to the heading
specifies the sort order of the list. For example, an asterisk in the
Scan Date heading displays the list of scans in order by date.
Field Description
Patient Name The patient’s name, or phantom, for which the scan
was performed and analyzed.
Patient ID The patient’s ID number.
Scan Date The date on which the scan was performed.
Scan Type The type of scan performed.
Scan ID The scan identification number.
Analysis Date The date the scan was analyzed.
Scan Details
When a scan is highlighted, you can click the Scan Details button
to view details and identification information about the scan.
Scan Details button

(only active when a
scan is highlighted)
KP0886-0611
When Scan Details is selected, the Scan Property window

displays with two tabs, Details and Identification.

Details Tab
The Details tab allows you to edit the Accession Number, Height,
Weight, Operator, Scan Comment, and three additional user
defined fields (shown as HL7 Field 1, HL7 Field 2, and HL7
Field 3) in the dialog box below.
The user defined field labels shown are examples of user
definable label names. The labels and entry fields may not appear
on the dialog box. See “HL7 Tab” on page 18-34 for details on
enabling/disabling the displaying of these fields and defining
their label names.
Field Description
Patient Name The patient’s name, or phantom, for which
the scan was performed and analyzed.
Accession Number Number of your choice.
Study Instance UID A DICOM attribute which uniquely
identifies a study. Worklist option must be
installed on your system and you must be
logged in as Administrator for this label and
field to appear.
HL7 Field 1 Sixteen characters of your choice.
Height Height at the time of the scan.
Weight Weight at the time of the scan.
Operator Initials of person who performed the scan.
Scan Comment Information added to scan by operator.

Identification Tab
The Identification tab lists information specific to the scan. You
cannot edit any of the fields in the Identification tab.
Field Description
Patient Name Name of patient as entered on the patient
record.
Patient ID The patient’s ID number.
Scan ID ID number assigned by the system.
Scan Date Day, Month, Year, and time the scan was
performed.
Scan Mode Identifies speed at which scan was performed.
Scan Type Scan Type
Serial Number Number assigned by the software to this scan
after it is completed
Machine Type QDR model number the scan was performed
on
6-19
Field Description
Analysis Date Day, Month, Year and time the scan was
analyzed
Archive 1 Date The date the scan was initially archived. If the
scan has not been archived, this field displays
as blank
Archive 2 Date The date the scan was next archived. If the
scan has not been archived to a secondary
location, this field displays as blank.
KP0886-0613
6-20
Deleting Scan Files

Scan files can be deleted from the Scan Drawer by clicking the
Delete Files button.
KP0886-0614
Delete Files button
Clicking the Delete Files button closes the Scan Drawer and
opens the Delete Scans window.
KP0886-0615
The Delete Scans window displays with two tabs, Archived Scans
and UnArchived Scans. Click on the Archived Scans tab to see all
the archived scans in the database.
6-21
Archived Scans Tab

To delete an archived scan, highlight the desired scan and click on
the Delete Scan Files button. The scan will be deleted. Multiple
scans may be selected by using the Shift or Ctrl keys.
To select all of the scans in the database click the Select All
button. To deselect all highlighted scans click the Deselect All
button.
UnArchived Scans Tab

Caution: Unarchived scans To delete unarchived scan(s), click on the UnArchived Scans tab
cannot be recovered after they are to see all the unarchived scans in the database. Highlight the
deleted.
desired scan and click on the Delete Scan Files button.
Multiple scans may be selected by selecting them while pressing
the Shift or Ctrl keys.
Retrieving the Scan Records

Storing scan information makes it possible to recall previous
scans when comparing studies. It also allows the operator to
analyze the day’s scans in one sitting, rather than after each
individual exam. Generally, the following tasks are performed
with a scan record:
• Retrieve a scan to view the analysis results
• Retrieve a scan to perform an analysis
• Retrieve a scan to compare scan results during analysis
The scan must be selected and dragged onto one of the following
buttons:
• Perform Exam
• Analyze Scan
• Report
To go to the Scan Drawer:
Step Action
Note: Refer to the table on page 6- 1 Click the Scans button in the main window.
3 of this chapter for suggestions The system displays the Scan Drawer window with a series
about alternative methods.
of tabs listing analyzed, unanalyzed, or all scans stored on
the system.
6-22
Unanalyzed Scans tab

Analyzed Scans tab
All Scans tab
KP0886-0616
To view a scan:
To View... Click...
analyzed scans the Analyzed Scans tab to view a list of all
analyzed scans currently stored in the
database.
unanalyzed scans the Unanalyzed Scans tab to view a list of
all unanalyzed scans currently stored in the
database.
all scans the All Scans tab to view a list of both
analyzed and unanalyzed scans currently
stored in the database.
Performing an Analysis
If the operator is unable to analyze a scan immediately after it has
been performed, it is stored on the computer as an unanalyzed
scan. The analysis can be performed later.
To complete an analysis:
Step Action
Note: Refer to page 6-22 for a 1 Click the Unanalyzed tab.
review of retrieving scans.
2 Select the scan from the list.
3 Drag the scan to the Analyze Scan button on the main
window.
The Analyze Setup window displays so that you can select
an analysis method.
6-23
Adding Scan Information from Other

Manufacturer’s Systems
The QDR system has the capability of adding data from other
manufacturer’s systems into its database for use on various
reports (such as Rate of Change). To do this, the data from the
other manufacturer’s scans must first be converted (see “Scan
Conversion” on page 18-39). Information for other
manufacturer’s scans can be added to the database for an AP
Lumbar Spine or Left, or Right, Hip scan.
In order to enter this information two things are required:
1. A hardcopy of a patient scan report of the AP Lumbar Spine
or Left, or Right, Hip from the other manufacturer, and
2. The patient must have a Patient Record (see “Creating/Edit-
ing a Patient Record” on page 6-9).
Entering data from other manufacturer’s scans:
Step Action
1 Click Patients to bring up the Patient Drawer window.
2 Highlight the patient’s name and click the Patient Scan tab
to bring up a list of scans for that patient.
KP0886-0617_1
Note: If the patient’s name does

not appear on the Patient window
a Patient Record must be created
(see “Creating/Editing a Patient
Record” on page 6-9).
KP0886-0617_2
6-24
Step Action
3 Click Scan Entry to bring up the Manual Scan Entry
window.
KP0886-0617_3
KP0886-0617_4
Note: If the other manufacturer is 4 Click the drop down menu next to BMD Results from and
not on the drop down list contact select the other manufacturer.
your MIS or RIS department to
have them create this information
in the QDR database.
KP0886-0617_5
Note: Only information from an 5 Click the drop down menu next to Scan Site and select the
AP Lumbar Spine or Left, or Right, type of scan from the other manufacturer’s hardcopy scan
Hip can be entered into the
report.
database.
KP0886-0617_6
6-25
Step Action
6 In the Scan Date field, enter the Month, Day and Year of
the other manufacturer’s scan report.
KP0886-0617_7
7 If entering data for:

• spine scan see “Entering data from other
manufacturer’s scans for spine” below.
• hip scan see “Entering data from other
manufacturer’s scans for hip:” on page 6-27.
Entering data from other manufacturer’s scans for spine:
Step Action
1 In the BMD field enter the total BMD on the scan report
into the Total field.
KP0886-0617_8
2 Ensure that the Regions of the scan report reflect the

regions in Regions included in Total.
If one or more of the regions are missing on the scan report,
click the region (L1, L2, L3, and/or L4) to remove the
check mark () from the box, excluding that region.
3 Click Region Details to bring up the Region Details Entry
window.
KP0886-0617_9
KP0886-0617_10
6-26
Step Action
4 Enter the data from the scan report for the BMC and Area
for the appropriate regions (L1, L2, L3 and L4).
5 Click OK to close the Region Details Entry window.
6 Click OK to close the Manual Scan Entry window
Entering data from other manufacturer’s scans for hip:
Step Action
1 In the BMD field enter the Total, Neck and Trochanter
data from the scan report.
KP0886-0617_11
2 Click OK to close the Manual Scan Entry window

With the information from the other manufacturer’s scan report
added to the QDR database, this scan will be reported under the
patient’s name on the Patient Drawer and the scan can be selected
for various reports (such as Rate of Change).
6-27
6-28
Chapter 7
The Patient Examination
The QDR system is used to perform an X-ray scan of the AP Lumbar
Spine, Hip, Forearm, AP/Lateral Spine, or Whole Body (depending
upon which model you have). Optional examinations are explained in
Appendix A.
To complete a patient examination the operator must perform a series
of different procedures. Some of these procedures are unique to the
anatomy being examined and are reported in subsequent chapters;
some of these procedures are the same for all types of examinations and
are described in this chapter.
Content
Subject Page
The Patient Examination 7-2
Preparing the Patient 7-2
Creating/Retrieving a Patient Biography 7-4
Selecting the Scan Type and Mode 7-21
Positioning the Patient and C-arm 7-21
Performing the Examination 7-22
Exiting the Examination 7-23
Performing the Analysis 7-24
Exiting the Analysis 7-27
Using a Study 7-28
Generating and Printing Reports 7-32
7-1
The Patient Examination

The goal of performing an examination is to acquire a quality
scan that produces accurate results when analyzed. The reports
generated from the analysis of the scan are used by a physician as
part of an ongoing treatment plan for osteoporosis and other
related conditions.
The following is a list of procedures used to perform a patient
examination:
1. Preparing the patient
2. Creating/Retrieving a patient biography
3. Selecting the scan type and mode
4. Positioning the patient and C-arm
5. Performing the Examination
6. Exiting the Examination
7. Performing the Analysis
8. Exiting the Analysis
9. Generating and printing a report
Preparing the Patient

To prepare the patient the operator must
• interview the patient
• prepare the patient for the examination
Patient Interview
The answers to the following questions may help to setup the
scanning procedure, could impact the interpretation of the test
results, or even postpone the exam.
Patient Questions
The following is a list of suggested questions to ask the patient.
Some questions may not apply to all examinations, but questions
such as possible pregnancy should be asked before any
examination.
• Is there any chance of pregnancy?
If the patient is female, and within childbearing age, you
must ask if she is pregnant. If the patient is pregnant, or
may be pregnant, postpone the scan until pregnancy is
ruled out.
7-2 The Patient Examination

• Has the patient had any procedure using the following

substances within the last 7 days:
– Iodine
– Barium
– Nuclear medicine isotope study
The isotope activity may affect the results of the bone
densitometer exam. The nuclear medicine department
should be contacted to determine if the bone densitometry
exam is feasible.
• Is the patient wearing any objects in the scan area such
as an ostomy device, metal buttons or snaps, or
jewelry?
This may affect the position of the patient as well as
interfere in the scanning of the patient.
• Has the patient had any surgery in the area being
scanned?
If surgery was performed in the area of examination a
decision whether to perform the examination must be
made. If the patient had surgery on a hip or forearm, then
the uninjured hip or forearm should be scanned.
• Does the patient have any internal objects that could
interfere with the scan such as:
– Pacemaker leads
– Radioactive seeds
– Metal implants
– Surgical staples
– Foreign bodies, e.g., shrapnel
– Radio-opaque catheters or tubes
Patient Preparation
The next step is to prepare the patient for the examination:
• Instruct the patient to remove or adjust their clothing in
the area to be scanned. Be sure that any metal, e.g., zipper,
snap, belt, etc., is out of the scan field. If necessary, ask
the patient to change into a gown for the examination.
• For AP lumbar spine, hip, or whole body examinations,
instruct the patient to remove their shoes as they may
interfere with some scans. This also helps reduce wear on
the table mat.

• Measure and record the patient’s height and weight. The

weight limit of the table is 450 pounds for Discovery, 350
pounds for Explorer and 300 pounds for Delphi and QDR
4500. If a patient exceeds the weight limit you may scan
the forearm with the patient seated in a chair.
Creating/Retrieving a Patient Biography

Note: Remember that daily QC Information concerning the patient is stored in a database on the
must be performed before computer and is called the Patient Biography. This information is
acquiring the first scan of the day.
entered into the computer on the patient’s first examination and
For more information about QC
refer to Chapter 5. can be retrieved on subsequent visits.
A patient record can be created or retrieved after selecting the
Perform Exam button.
Creating a Patient Biography

A new Patient Biography must be created for a new patient on
their first examination. Refer to the Creating a Patient Record in
Chapter 6 to create the patient biography and optional insurance
information.
Retrieving a Patient Biography

Prior to retrieving the patient’s biography, weigh and check the
height of the patient. This information, as well as the operator’s
identification, will be entered during this procedure.
Each patient must have a record of biographical information that
is stored in the computer database. Every time the patient returns
for an examination, this information can be recalled.
To retrieve a patient’s file:
Click the Perform Exam button.

The Select a Patient for this Exam window appears with the Select
A Patient tab displayed.
KP1035A-0309

Note: For information on the

Worklist tab refer to“Using the
Worklist Tab” on page 7-8.
KP1035A-0702
Using the Select A Patient Tab
1 Click on the patient’s name.

Patient’s name is highlighted.
2 Click OK.
The Patient Confirmation window displays.
Searching for a Patient’s Name

If the patient’s name is not in the Select a Patient window, type in
the patient’s name using the computer keyboard. If the name is in
the computer database it will appear highlighted at the top of the
Select a Patient window.
If the patient’s name is not found in the computer database then
this is a new patient and a patient biography must be created, refer
to Creating/Editing a Patient Record in Chapter 6.

Confirming the Patient Information

Once a patient’s name is selected the Patient Confirmation
window will appear.
Note: Accession number label and

data entry field appears on the
dialog box only when the DICOM
option is installed on your QDR
system.
Note: HL7 Field 1, HL7 Field 2,
and HL7 Field 3 are user
definable label names. These
labels and their data entry fields
appear on the dialog box when
enabled in System Configuration.
See “HL7 Tab” on page 18-34 of
Chapter 18 for details.
The Patient Confirmation window is used to confirm the patient’s

name, ID and date of birth. This window is also used to update the
patient’s biography for height and weight, to identify the operator
performing the examination and the referring physician, and to
enter the DICOM accession number and up to three user
definable data entries when those fields are present on the dialog
box.
Body Mass Index is automatically calculated as height and/or
weight is entered or changed.
This window also allows the user to enter information into the
patient Questionnaire and to edit the patient’s biography and
insurance information.
To update the patient’s height, weight and the operator ID via
the Patient Confirmation window:
Step Action
1 Verify the patient name, ID and date of birth.
2 Enter the height and weight of the patient, operator’s
identification, and enter or select referring physician’s
identification.
3 Click the OK button.
The Select Scan Type window displays.

Step Action
4 Continue with “Selecting the Scan Type and Mode” on
page 7-21
To edit the patient’s biography and insurance information via

the Patient Confirmation window:
Step Action
1 Click Edit Patient.
The Patient window displays.
Note: Refer to pages 6-4 and 6-6 2 Click the Biography tab, enter the patient’s biography
for field descriptions of the information.
3 Click the Insurance tab, enter the patient’s insurance
information, and click OK to return to the Patient
confirmation window.
The Select Scan Type window displays.
5 Continue with “Selecting the Scan Type and Mode” on
page 7-21
Filling out the Patient Questionnaire

installed.
The Patient Questionnaire (see Figure 7-1) is a method of
electronically entering and saving bone density related patient
information.
Figure 7-1 Header
The Questionnaire Widow Today’s Date
Patient
information
Questionnaire
Update Header button
The Header comes from the Header Block placed on Reports (see
“To configure the Header Block” on page 18-21).

Patient Information comes from the Patient Biography screen (see

“Confirming the Patient Information” on page 7-6). If the Patient
Biography has been changed then the patient information (as well
as the Header) can be updated by clicking on the Update Header
button.
To fill out a New or Existing Patient Questionnaire
Step Action
1 On the Patient screen Biography tab click on the
Questionnaire button.
The Questionnaire window appears (see Figure 7-1).

Questionnaire:
• Clear button. Updates the Header, Patient
information, and changes the date to today while
clearing answers to all questions.
• Update Header. Updates the Header, Patient
information and changes the date to today.
• Print button. Prints the current questionnaire.
• Cancel button. Exits the Questionnaire without
saving data and returns to the previous window.
3 Click OK to save the Questionnaire and return the to
previous screen.
Using the Worklist Tab
After the Modality Worklist has been configured by the HIS/RIS
administrator, the operator can use the Modality Worklist through
this interface.
Use the following procedure to display the Modality Worklist tab.
Step Action
1 Click Perform Exam.
The Select a Patient for this Exam window appears with
the Select A Patient tab displayed.
KP1035A-0309

Step Action
Note: For information on the 2 Click on the Worklist tab.
Select A Patient tab refer Worklist tab
to“Using the Select A Patient
Tab” on page 7-5 in this user’s
guide.
KP1043A-02
The Worklist tab appears (Figure 7-2) with studies for

different patients to be performed on the QDR System.
Figure 7-2
Modality Worklist Patient studies
The labels across the top of the task list include:

Note: Clicking on any of these Patient Name
labels will sort the task list Patient ID
according to that column (an
Start Date
asterisk indicates the current
sort column). Clicking the Study Name
column label will toggle the sort Procedure Code
between ascending and Accession Number
descending order.

The modality worklist for the operator contains the following

areas:
Patient Name
KP1043A-17
This is a text box search engine that allows the operator to find
any patient’s name, within the list of tasks, by typing it into the
text box.
Query
KP1043A-18
Clicking on this button will update the worklist database on the

QDR System. The Query may take a while (during this time the
database is updated). The following screen appears.
KP1043A-22
The Abort button stops the query.

Display Range
KP1043A-19
The list of tasks shown on the worklist tab are contained in a

database on the QDR System. This database is controlled by how
worklist is configured.
The Display Range controls how much of the database is
displayed in a range of days. The operator can set this range of
days by using the Days Back and Days Forward spin counters.
• Days Back spin counters - this control sets the limit of
days in the past to display, 0 stands for today’s date. The
range for the spin counter is 100 days.
• Days Forward spin counters - this control sets the limit of
days in the future to display, 0 stands for today’s date. The
range for the spin counter is 100 days.
An example: If the Days Back spin counter is set to 7 and the
Days Forward spin counter is set to 0 (zero) then the list will
display only those entries that fall within this date range.
Clicking Apply will activate the settings in Days Back and Days
Forward.
Manual Study
KP1043A-20
This check box determines if the QDR system will perform

manual examinations, or is programmed to perform examinations
determined by studies, on patients in the task list. If there is a
check mark in the box then manual examinations will be
performed (see “Confirming the Patient Information” on page 7-
6); if the check box contains no check mark, then the QDR
System will perform examinations determined by studies in the
task list (see “Study Tab” on page 18-68).
Use Default Mode
KP1043A-21
This check box determines if the QDR system uses the default
scan mode for the selections in the study. If there is no check

mark in the box, the operator must enter the scan mode for the
scan (see Selecting the Scan Type and Mode in the appropriate
chapter of the User’s Guide for the scan being performed); if the
check box contains a check mark, the QDR System will
automatically select the default scan mode.
For a manual examination (see Manual Study on page 7-11) the
“default scan mode” is the default mode for that scan type. For a
study the “default scan mode” is the scan mode from the scan
definition.
Extended Details
Clicking on this button displays extended details pertaining to the

exam selected in the patient studies list.
Click Additional Data to display additional data pertaining to the

exam selected in the patient studies list.

Click Close to return to the Select a Patient for this Exam -

Worklist tab.
Using Modality Worklist with a Study

Use the following procedure to perform a task from the worklist.
Step Action
Note: If the worklist indicates 1 Highlight the patient’s name on the worklist.
that the patient is new, go to
Adding a Patient on page 7-17.
Note: If the worklist tries to
match another patient because
information is different, go to
Matching an Existing Patient
on page 7-18.
KP1043A-23
Note: If the patient’s name is not 2 Click OK.

in the QDR database, see The Patient Confirmation window appears. (Refer to
“Adding a Patient” on page 7-
“Confirming the Patient Information” on page 7-6 for
17.
details.)
3 Enter the patient’s weight and height and your operator’s
number (if necessary) then click OK.
Note: If an error message 4 The Study will begin by displaying the Scan Parameter
appears stating that the study is window of the first scan type in the study. (The following
not defined, go to Adding a
is an example.)
Study on page 7-18.
KP1043A-36

Step Action
5 The scan type examination will start. The examination is
the same as described in the User’s Guide for the scan
type being performed. When the examination is complete
the Exit Study window appears.
KP1043A-37
The operator has four choices from this window.

• Analyze Scan - This is described in “Performing
the Analysis” on page 7-24.
• New Scan - This is described in “Selecting the
Scan Type and Mode” on page 7-21.
• Exit Study - This button has two functions:
If this is the last examination of the study. This is
described in “Exiting the Examination” on
page 7-23.
If this is not the last examination of the study, the
follow confirmation message appears.
KP1043A-38
• Add Scan Comments - This is described in

“Adding Scan Comments” on page 7-24.

Step Action
6 From the Exit Study window select Analyze Scan to
continue the study. The Analysis of the examination will
begin. The analysis is the same as described in the User’s
Guide for the scan type being performed. When the
analysis is complete the Exit Study Analysis window
appears.
KP1043A-39

• Report - If this is not the last examination in the
study, initiating a report will force exiting from
the study and the following confirmation window
will appear:
KP1043A-38
• Analyze Another Scan- This selection is grayed

out.
• Next Scan - This starts the next examination in
the study.
• Exit Study- If this is not the last examination of
the study, the follow confirmation message
appears.
KP1043A-38

Step Action
7 The study will continue, repeat steps 4 through 6 for each
examination in the study.
8 When the analysis of the final examination of the study is
complete, the Exit Analysis window appears.
KP1043A-40

• Report - A report for each examination of the
study will be developed.This is described in
“Generating and Printing Reports” on page 7-32.
• Analyze Another Scan- This selection is grayed
out.
• Next Scan - This is described in “Selecting the
Scan Type and Mode” on page 7-21.
• Exit - This will exit the study. This is described in
“Exiting the Examination” on page 7-23.
Modality Worklist Operations

Using modality worklist, the operator can perform the following
operations:
• Adding new patients to the QDR database
• Adding new studies to the Study Tab under System
Configuration
• Matching an Existing Patient

Adding a Patient
If the operator selects a patient that is not in the QDR System
database, the following screen appears:
Clicking New Patient adds the patient to the QDR System

database using the HIS/RIS information for that patient. The
KP1043A-26
Patient window opens so the operator can verify information or
add missing data.
Click OK.
The Patient Confirmation window appears.
Enter the patient’s weight and height and your operator number
(if necessary) and click OK.

The study will continue.
Adding a Study
If the study in the task list is not defined in the QDR database the
following message appears:
KP1043A-28
The parameters of the study must be placed into the database on

the QDR System. This information is provided by the physician
or HIS/RIS. Once the information has been acquired, the operator
can manually enter it into the database (see “Study Tab” on
page 18-68).

If the patient clicks on a patient whose name is not in the database
of the Patient Biography, a screen similar to the following will
appear.
Information concerning new patient
The operator should proceed with caution before performing the

following procedure because if information from the HIS/RIS
database is accepted, it will overwrite information in the Patient
Biography database. Even if the HIS/RIS information is incorrect
(such as a misspelled name), if all other information matches, the
operator must accept the HIS/RIS information in order to run the

study. The operator can contact the HIS/RIS administrator later to

have the information changed.
Use the following procedure to match an existing patient:
Step Action
1 When the Select/Create Patient for Exam window
appears, it will highlight one patient in the Patient
Biography that it believes is the closest match to the
patient name from the HIS/RIS study.
Matching names
2 The operator now has a choice:

• If this is a new patient the operator should click
on the New Patient button and go to Adding a
KP1043A-26
Patient on page 7-17.
• If the operator believes that there is a match
between the two patients, click on the OK button.
KP1043A-32
A window appears that provides QDR Patient
Info and the Worklist Patient Info information.
QDR Patient Info
Worklist Patient Info

Step Action
3 The operator should check each field in the QDR Patient
Info with each entry in the Worklist Patient Info,
• If the information the QDR Patient Info does not
match the Worklist Patient Info then these are
KP1043A-34
not the same patient, click on the Reject button to
return to the Select/Create Patient for Exam
window to select another patient to match or
create a new patient.
• If most of the fields match and it is determined
that the patient in the Worklist Patient Info is the
KP1043A-32
patient in the QDR Patient Info, click OK. A
confirmation window appears.
KP1043A-35
4 This confirmation window is that last warning before

information in the Patient Biography database is changed.
If the information in the QDR Patient Info matches the
information in the Worklist Patient Info, click OK.
The information in the Worklist Patient Info will
overwrite the information in the Patient Biography and
the study will continue.

Selecting the Scan Type and Mode

Note: If using a Study for the The scan type and mode are specific to the examination being
examination and the analysis refer performed. Refer to the Selecting the Scan Type and Mode
to Using a Study on page 7-28.
heading in the chapter indicated:
AP Lumbar Spine—Chapter 8
Hip—Chapter 9
Forearm—Chapter 10
Whole Body—Chapter 11
AP Lateral—Chapter 12
IVA and QM—Chapter 13
Positioning the Patient and C-arm

Except for the Forearm examination, the first step in positioning
the patient is to place the patient on the table. Once the patient is
on the table, positioning for the specific examination can be
performed.
Placing the Patient on the Table

Follow the procedure below to maximize patient comfort and
safety while assisting the patient onto the table.
Figure 7-3
Patient On/Off Position
KP1068A-0704

To place the patient on the table:

Step Action
1 Press the Patient On/Off switch on the Control Panel.
This moves the C-arm to the far left position, and extends
the table out from the base, making it easier for the
patient to get on the table.
2 After the C-arm and table stop moving, seat the patient on
the table pad so that their right shoulder is adjacent to the
C-arm (see Figure 7-3).
3 Lay the patient back with their head at the right end of the
table.
4 Continue with positioning the patient for the specific
examination.
Positioning for the Specific Examination

Positioning the patient and the C-arm are specific to the
examination being performed. Refer to the Positioning the
Patient and C-Arm heading in the chapter indicated:
Hip—Chapter 9
Performing the Examination

Performing the examination is specific to the examination being
performed. Refer to the Performing the Examination heading in
the chapter indicated:
Hip—Chapter 9

Note: When performing the examination, the Scan Parameter

window and the Scan and Reposition screens display baseline
scan. If the patient has a baseline scan of the same type as the
currently selected scan, that baseline scan will be displayed. If
the patient does not have a baseline scan of the selected scan
type a default scan of the scan type is displayed. For
information on selecting baseline scans refer to “Managing
Patient Baseline Scans” on page 19-17.
Exiting the Examination

After acquiring an acceptable scan, the Exit Exam window
displays.
KP0886-0705
This window provides four options for the operator.

Option Description
Analyze Scan This button continues with the exam by
performing the analysis (see
Performing the Analysis in this
chapter).
Note: If the analysis of the scan New Scan This button starts a new examination
is postponed to a later time, the on the same patient by displaying the
scan can be searched for in the
Select Scan Type window. The
Scan Drawer. Refer to Chapter 6
for information about the scan previous scan is stored on the computer
drawer. and can be analyzed at a later time.
Add Scan Comments This button allows the operator to

insert comments into the computer
database which will remain with the
scan and be printed on the report. A
Comment window will display (see the
instructions that follow).

Adding Scan Comments

Comments can be added to a scan and stored with the scan and
patient’s record.
KP0886-0706
To add scan comments:

Step Action
Note: To locate comments on a 1 Click the Add Scan Comments button.
scan report, refer to Chapter 15. A comments window displays.
2 Place the cursor in the comments field, and type the
comment, up to 50 characters.
3 Clicking the Add patient comment to scan comments
button will cause any comments previously placed in the
Patient Comments of the Patient Biography to appear.
4 If more than one scan exists for this patient, clicking the
<< Previous Scan or Next Scan >> buttons will show
comments on the other scan(s).
5 Click OK to save the comment.
Exit Exam window displays.
Performing the Analysis

Performing the analysis is specific to the examination
being performed. Refer to the Performing the Analysis
heading in the chapter indicated:

Hip—Chapter 9
Contrast and Brightness

The contrast and brightness of the image can be adjusted to obtain
the best definition of important anatomical features. Adjusting the
contrast and brightness has no effect on calculations; it is used to
KP0886-0817 optimize the display and for visual adjustments only.
When the Sun/Moon button is clicked, the Image Toolbox

(Figure 7-4) displays. From this toolbox the operator can:
• Change the contrast and brightness of the image.
• Invert the image.
• Change the image from dual energy to single energy, or
from single energy to dual energy.
• Change the zoom of the image.
Figure 7-4 Black dot
Image Toolbox
Length
Default Width
KP0886-0707

To adjust the contrast and brightness:

Note: Contrast and brightness are The contrast and brightness of the image is represented by the
at the preference of the operator, location of the black dot in the Image Toolbox triangle (see
there are no right or wrong
Figure 7-4). The contrast level is represented by the number in the
settings.
L box (L stands for Length), and the brightness level is
represented by the number in the W box (W stands for Width).
The operator can change the contrast and brightness in the

following ways:
• Click and drag the black dot in the triangle. Dragging the
dot to the right or left in the triangle adjusts brightness,
and dragging it up or down in the triangle adjusts the
contrast. The numbers in the W and L boxes change as the
black dot is moved.
• Click in either the W or L boxes and highlight the number.
Change the value to a number between 0 and 100. Repeat
this action in the other box. The black dot moves inside
the triangle to the point represented by the number(s)
entered.
The D button is the default button. Clicking the D button places
the black dot in the center of the triangle and changes both the L
KP0886-0708
and W box numbers to 50.
To Invert the Image:

The Invert button inverts the colors of the scan image, white
becoming black, and black becoming white. To invert the image,
KP0886-0709
click the Invert button.
To change the image to/from Single or Dual Energy:
The SE/DE button is used to switch between single and dual
energy views of the scan image. To toggle the image between
KP0886-0710
single and dual energy, click the SE/DE button
The SE/DE button is not available for Forearm or Whole Body
scans, and this button does not appear in the Image Toolbox for
those scans.
To Zoom in and out on an Image:
The Zoom tool is used to either shrink or enlarge the scan image.
Use the button to enlarge the image. Use the button to
KP0886-0711 shrink the image.

Exiting the Analysis

After performing the analysis, the Exit Analysis window displays.
KP0886-0712
To continue:
To ... Click on the ...
Select a report type and Report button
print.
Select a different scan to Analyze Another Scan button
analyze.
Perform another scan on New Scan button
the same patient
Exit and return to the main Exit button
window.
When Exit is select, if the Dose Area Product (DAP) Meter

option is installed on the system, the following window displays
the radiation dose applied to the patient during the exam:

Using a Study
Note: Studies must first be When a study (or studies) have been added to the APEX software,
configured before they can be the operator can select a study on the Select Scan Type window
used, see “Study Tab” on page 18-
instead of a specific scan type. The QDR system proceeds directly
68 of Chapter 18.
to the scan types listed in the study.
Using a Study
Step Action
1 When you are finished entering patient data or
confirming patient data, the Select Scan Type window
appears.
KP1035A-1753
The Studies that have been entered for this QDR system
appear at the top of the list of scan types.
Highlight the desired study and click the Next>> button.
2 To start the first scan type of the study, the system
prompts you first to place the patient on the table, then to
take the scan.

Step Action
3 When the scan is completed, the Exit Study window
appears.
KP1035A-1754
The Exit Study window contains the following buttons:

The Analyze Scan button continues with the
examination by analyzing the scan just taken.
The Next Scan button continues with the next
scan in the study. If this is the last scan of the
study then this button becomes New Scan (see
New Scan button in “Exiting the Examination”
on page 7-23).
The Exit Study button has two functions:
1. If the study has not completed all scans,
clicking the Exit Study button brings up
the following window asking you to con-
firm exiting the study.
KP1035A-1759
2. Click Yes to exit the study and return to

the main window, or No to return to the
Exit Study window.
The Add Scan Comments button allows com-
ments to be added to the scan (see “Adding Scan
Comments” on page 7-24).

Step Action
4 Click the Analyze Scan button to continue the
KP1035A-1755 examination. When you click the Close button from the
analysis, the Exit Study Analysis window appears.
KP1035A-1760
The Exit Study Analysis window contains 4 but-

tons:
The Report button generates a report (see “Gen-
erating and Printing Reports” on page 7-32).
1. If this is not the last scan in the study, gen-
erating a report exits the study. The fol-
lowing window appears asking
confirmation of generating a report.
KP1035A-1762
2. Click the Yes button to generate a report

and exit the study, or the No button to
return to the Exit Study Analysis window.
The Analyze Another Scan button is grayed out
and inactive.

Step Action
The Next Scan button starts the next scan in the
study.
The Exit Study button has two functions:
1. If the study has not completed all scans,
clicking the Exit Study button brings up
the following window asking you to con-
firm exiting the study.
KP1035A-1766
2. If this is the last scan in the study, clicking

the Exit Study button returns to the main
screen.
5 Click the Next Scan button to continue with the next scan
KP1035A-1764
in the study.
6 When the analysis of the last scan in the study is
complete, the Exit Analysis window appears.
6
KP1035A-1766
The Exit Analysis window contains 4 buttons:

The Report button generates a report of each scan
in the study (see “Generating and Printing
Reports” on page 7-32).
The Analyze Another Scan button is grayed out
and inactive.
The New Scan button returns to the Select Scan
Type window to start a new scan on the same
patient.
The Exit button exits the study and returns to the
main window.

Generating and Printing Reports

After completing analysis, the Report button is available on the
Exit Analysis window. Click Report to display the Print window.
KP0886-0713
Note: Refer to “Report Tab” on A variety of report types may be printed singly or as multiple
page 18-10 for more information copies. Reports can be uniquely configured, or chosen from a list
about configuring reports.
of default reports already set up on the system.
To generate a report:
Step Action
1 Click the Report button.
The Print window displays.
Note: Refer to “DICOM 2 Select the type of report by clicking its associated check
Reports” on page 15-18 for box. Multiple report types can be selected.
information on generating and
A check mark is displayed in the box next to each selected
sending DICOM reports.
report type.
3 Select the number of copies by clicking om the up or
down arrows. The increases the number of copies, the
decreases the number of copies.
The number of copies to be printed displays in the text
area.
4 Click the Print button.
The report prints.
5 Click the Close button.
The Print window closes, returning to the main window.
Configuring the Report

Refer to “Report Tab” on page 18-10 in Chapter 18, for
procedures on how to configure the report according to the type
of examination.

Editing Physician’s Comments

Refer to “Physician’s Comment” on page 15-5 for procedures to
edit any physician’s comments to be included on the report.


Chapter 8
Performing and Analyzing the
AP Lumbar Spine Scan
This chapter provides procedures to perform an AP Lumbar Spine
scan and analysis on the QDR Series systems. It also provides
information about scanning patients that exhibit lateral curvature,
or scoliosis of the spine, and low density spine analysis.
Content
Subject Page
The AP Lumbar Spine Examination 8-2
Alternate Scan Modes 8-27
Evaluating the Image 8-28
Scoliotic Spine Scans 8-30
8-1
The AP Lumbar Spine Examination

The AP Lumbar Spine examination includes all activities that
begin when the patient enters the exam room, and ends when an
acceptable image is obtained. The activities involved in
performing the exam include:
• Preparing the Patient
• Creating/Retrieving a Patient Biography
• Selecting the Scan Type and Mode
• Positioning the Patient and the C-arm
• Performing the Examination
• Exiting the Examination
• Performing the Analysis
• Exiting the Analysis
• Generating and Printing Reports

Note: Remember to ask the Prepare the patient by asking the pre-examinations questions and
patient if they are, or might be, ensuring that they are not wearing anything that will interfere
pregnant. Postpone the exam
with the scan. Refer to Preparing the Patient on page 7-2 of
until pregnancy is ruled out.
Chapter 7 for detailed instructions.

If this is a new patient, create a new patient biography (refer to
Creating/Editing a Patient Record on page 6-9 of Chapter 6 for
detailed instructions). If this patient already has a biography,
retrieve it now (refer to Retrieving a Patient Record on page 6-7
of Chapter 6).

After a patient biography has been created, or retrieved, the Select
Scan Type window displays.
8-2 Performing and Analyzing the AP Lumbar Spine Scan

KP0886-0801
The scan type for the AP Lumbar Spine scan is AP Lumbar

Spine, selected in the Select Scan Type window. A check mark
() in the Use Default Scan Mode box designates the Express
mode for Discovery-A, -SL, -W, -C models, Fast Array mode for
Discovery-Wi, Ci models, or Explorer mode for Explorer.
Choosing the Scan Mode

To choose an alternate scan mode:
To perform the scan in a different mode, remove the check mark
and a window will display that allows selection of an alternate
mode.
To choose the default scan mode (check mark in box):
Step Action
1 Click on the AP Lumbar Spine in the scan type list.
The scan type is highlighted.
2 Click the Next >> button.
The Scan Parameters window displays.
Confirming Scan Parameters

The only scan parameter that can be modified is the scan length
(see Figure 8-1). The scan length for an AP Lumbar Spine exam
is approximately 8 inches (20 cm). If the patient is taller than six
feet, it may be necessary to increase the scan length to 9.4” (23.9
cm). The system may change the number entered to match the
pre-programmed step size of the scanning mechanism.
Performing and Analyzing the AP Lumbar Spine Scan 8-3

Figure 8-1
AP Lumbar Spine
Scan Parameters
KP1035-0802
Verify scan parameters:

Step Action
1 Verify the patient name and scan type in the upper left
corner.
2 To change scan length, place the cursor in the Scan Length
field and type the new length.
3 Stop here and position the patient and the C-arm.
KP0886-stop

The goal for positioning the patient on the table is to ensure that
the spine is as straight as possible for the scan (refer to Figure 8-
2). Notice that the figure shows the patient straight on the table
with their lower legs on the positioner (helping to keep the spine
flat). Also note that the area to be scanned starts at about one inch
below the iliac crest.

Figure 8-2
Patient Positioning Goal
C C
Knee positioner Iliac Crest
L5
L4
L3
L2
L1
1 inch Area to be scanned
KP0886-0803
The remainder of this section provides detailed information for

positioning the patient, the table, and the C-arm for an AP
Lumbar Spine exam. It is important to follow each set of
directions carefully since they are designed to help acquire an
ideal scan by describing:
• How to maximize patient comfort and safety.
• How to assist the patient onto the table for proper alignment.
• Suggestions for correct positioning techniques.
• Proper use of positioning aids.

Note: Refer to Chapter 7, page Press the Patient On/Off switch on the Control Panel and seat
7-21, for a detailed description the patient on the table between the scan field indicators on the
of placing the patient on the
table pad. Their right shoulder should be adjacent to the C-arm.
table.
Continue with positioning the patient below.
Positioning the Patient

Positioning the patient for an AP Lumbar Spine scan involves
using the positioner (see Figure 8-1), supplied by Hologic. This
positioner helps to reduce the lordotic curve of the patient’s spine
on the table pad by keeping the femurs vertically aligned. The
positioner accommodates three different patient heights (short,
medium, or tall). For example, if the patient is short, place the
positioner to the shorter side to adjust to the size of the patient’s
legs.

A pillow can be used under the patient’s head to make them more
comfortable.
To position the patient:
Step Action
1 Lie the patient on their back with their head at the right end
of the table (see Figure 8-1).
2 Position the patient’s body so that the spine is straight on
the table pad.
The patient’s shoulders should be at the upper scan limit
line.
3 Verify that the patient’s pelvis and shoulders are aligned
straight on the table pad and centered to the marks on the
table pad.
Note: On Explorer the Center 4 Press the Center Table button on the Control Panel.
Table button must be held and only The table and C-arm move to the center.
the table moves.
5 Place the positioner under the patient’s lower legs.
6 Adjust the positioner by rotating it until the femurs are as
vertical as possible. This will help reduce the lordotic curve
of the lumbar spine.
o
90
KP0886-0805
7 Place patient’s arms in the most comfortable position,

either by their sides or up over their head.
8 Instruct the patient to remain still and to breathe normally.
Positioning the C-arm

The C-arm and table drive motors provide the table and C-arm
motion required to scan the X-ray beam along the patient’s spine.

To position the C-arm using the Laser:

Step Action
1 Determine the position of the patient’s iliac crest.
2 Press the Laser button on the Control Panel.
3 Use the C-Arm Controls on the Control Panel to place the
cross hair of the laser 1” to 2” below the iliac crest and
centered in the mid-line of the patient.

An acceptable AP Lumbar Spine scan (see Figure 8-3) includes
the following:
• The scan starts in the middle of L5.
• The iliac crest is evenly displayed in both lower corners of
the image area.
• The AP Lumbar Spine is centered in the middle of the
scan window.
• There are even amounts of soft tissue on each side of the
spine.
• The scan stops where ribs are attached to T12 (usually the
middle of T12).
Figure 8-3
AP Lumbar Spine Scan
KP0886-0806

Starting the AP Lumbar Spine Scan

Once the patient and C-arm are positioned correctly, return to the
computer to start the AP Lumbar Spine scan. At this time, the
Scan Parameters window should be displayed.
To start the AP Lumbar Spine scan:
Step Action
Note: If the Control Panel X-ray 1 Click the Start Scan button
lamp fails to extinguish within 10 The Scan window displays with the image appearing on the
seconds after the end of the scan,
left side. Flashing X-rays On indicator at the top of the
press the red Emergency Stop
button on the Control Panel window continues until the scan stops.
immediately. Then call Hologic
Service before resuming operation.
2 Inspect the image.
3 When you see where ribs are attached to T12 on the image,
click the Stop Scan button
Exit Exam window displays.
While the scan is being acquired the operator has four options:
Option Description
(let the scan complete) The scan completes the length

designated on the Scan Parameters
window and then the Exit Exam
window displays.

Option Description
Stop Scan button Terminates the scan at the point at

which the button is pressed and the
KP0886-0808 Exit Exam window displays.
Abort Scan button Exits the scan immediately. An exit

window displays then proceeds to
KP0886-0809 the main window. To start another
scan the C-arm must be
repositioned.
Reposition Scan button Stops the scan in progress and

enables the operator to reposition
KP0886-0810 either the window image or the
patient. Refer to the following
instructions.
Repositioning the Scan

If the scan is positioned correctly (see Figure 8-3) it will not be
necessary to reposition. If it needs to be repositioned, follow the
procedure below.
Two basic activities of repositioning include:
• Repositioning the image
If the image starts too far above or below L5 or is not
centered, move the image up, down, left, or right using the
scroll bars or cursor hand to reposition the scan for the
correct starting point. Refer to “Evaluating the Image” on
page 8-28 of Chapter 8 for image positioning examples.
• Repositioning the patient
If the spine is not straight, move the patient’s upper torso
either left or right to straighten the spine.
To reposition the image:
Step Action
Note: In order to reposition the 1 Click the Reposition Scan button
scan, the Reposition Scan button The image acquired so far displays with scroll bars on the
must be clicked before the scan is
right and bottom.
completed.
Note: You can also use the scroll 2 Position the cursor over the spine image.
bars to reposition the image. The arrow cursor changes to a hand.

Step Action
Cursor
Hand
Vertical
Positioning
Lines
Horizontal
Positioning
Scroll
Lines
Bars
KP0886-0811
Note: On Explorer, the scan can be 3 To reposition the lumbar spine:

repositioned a maximum of 1 inch
(2.54 cm.) towards the foot end of • Click and drag the image so that the iliac crest is at
the table and any distance towards or below the blue horizontal positioning line and
the head end. within the lower portion of the scan field.
• The center of the lumbar spine should be aligned
with the blue vertical positioning line.
4 When the spine is positioned correctly, click the Restart
Scan button.
Note: If the Control Panel X-ray 5 Click the Start Scan button to start a new scan at the new
lamp fails to extinguish within 10 position.
The Scan window displays with a flashing X-rays On
button on the Control Panel message. The image displays.
immediately. Then call Hologic 6 When you see where the ribs are attached to T12 on the
image, click the Stop Scan button.
When the scan completes, the Exit Exam window displays.

While repositioning the scan the following buttons are displayed

in the window.
Button Description
Restart Scan button Proceeds to the Scan Parameters
window to commence X-ray scan
KP0886-0909
from the new position.
Accept Scan button Saves the scan in progress without
KP0886-0910
repositioning the scanner.
Cancel Scan button Cancels the exam and returns to the
KP0886-0911
main window.

After acquiring an acceptable image, the Exit Exam window
displays. To perform the analysis of the scan just completed, click
the Analyze Scan button in the Exit Exam window. Refer to
Exiting the Examination on page 7-23 in Chapter 7 for detailed
instructions.

Note: If the analysis of the scan The analysis of the AP Lumbar Spine scan includes the
is to be postponed to a later following:
time, the scan can be retrieved
• Choosing the analysis method
from the Scan Drawer. Refer to
Chapter 6 for information about Note: If the patient has an AP Lumbar Spine baseline
the scan drawer. scan, the software proceeds directly to the manual
compare analysis function instead of choosing the
analysis method. Compare analysis is discussed in detail
in Chapter 14. Manual AP Lumbar Spine scan analysis is
discussed beginning on page 8-16.
• Performing the analysis
Choosing the Method of Analysis

The first analysis activity involves selecting the analyze method.
The analyze method is the method that the system uses to perform
the analysis. It can perform the analysis either as a single new
scan, or as a comparison to one that has been previously
performed.
If this scan is the patient’s first visit, select the default method
(Spine) and the system presents a single scanned image for
analysis. If this scan is a follow-up visit, select the Compare to
Previously Analyzed Scan radio button. The system then
presents two images. The left image is the unanalyzed scan, and

the right image is a previous scan with the region of interest

(ROI) defined.
Compare allows the system to perform the new analysis on the
same ROI as the previous one and maximizes accurate reporting
of the rate of change. Compare and follow-up visits are discussed
in detail in Chapter 14.
To select analyze setup for a first visit:
Step Action
1 From the Exit Exam window, click the Analyze Scan
button.
The Analyze Setup window displays.
Note: The Analyze Setup window 2 Click the Choose Analysis Method radio button, if
displays with the Choose Analysis necessary.
Method radio button selected as
the default. Comparison is covered
in detail in Chapter 14.
3 Verify the analysis method (see Methods of Analysis
below).
The Analysis window displays.
Methods of Analysis
The Spine analysis is the standard method for analyzing AP
Lumbar Spine scans. It includes an automatic low density
analysis (unless disabled).
To select a method of analysis (other than default):
Step Action
1 Click the drop down list arrow on the Analyze Setup
window.
List of methods displays.

Step Action
Note: Subregion Array Spine
analysis is available as an option.
2 Click on the desired method.

List disappears, and selected method displays in field.
3 Click the Next >> button to continue.

Unless disabled, once the method of analysis is chosen the
software will automatically perform the analysis (excluding
Subregion Array Spine analysis). This is called One-Time™ Auto
Analysis and is a feature of all models in the QDR Series.
After the One-Time™ Auto Analysis is completed the operator
can choose to perform a manual analysis of the acquired scan.
Both analysis methods are described below.

One-Time™ Auto Analysis

Note: Hologic’s auto-analysis The AP Lumbar Spine scan auto analysis includes all activities
algorithms have been optimized that begin with a satisfactory image and ends with the calculation
for use on patients. You may be
and summary of the results of the scan. After completing a scan,
required to manually analyze
scans of phantoms that were the system automatically saves the scan, in the Scan Drawer, for
scanned as if they were patients. analysis.
Once the method of analysis is selected, the system will
automatically perform an analysis of the scan (excluding
Subregion Array Spine analysis). While this operation is being
performed, no operator interaction is allowed. If system software
determines it is needed, an Automatic Low Density Spine
analysis will be used (unless disabled). Upon completion of Auto
Analysis, analysis results are displayed. If the Automatic Low
Density Spine analysis was used, it will be noted in the analysis
results label.
Note: Legacy spine scans that
used the older version of Low If the system was upgraded from an older version of operating
Density Spine software may software in which Low Density Spine was listed in the analysis
continue to use this software. If menu, that option can be turned on by changing the Analysis
the compare mode is used on
follow-up scans the Low Density
Configuration in the Utilities Tool Bar. This is only
Spine software will be applied to recommended for patient spine scans that used this option
the newer scan. previously. All newly acquired spine scans should be analyzed
with One-Time Auto Analysis.
Figure 8-4
AP Lumbar Spine
One-Time Auto Analysis
Results
Note: Evaluate the analysis for

correct placement of regions and
bone outline. It may be
necessary to adjust the image
display.
KP1068_002-0814
Analysis results

Manual Analysis
The operator may perform a manual analysis of the lumbar spine
scan after the auto analysis is completed. In most cases it will not
be necessary to perform manual analysis. However, upon
examination of the auto analysis results, if one of the following
conditions is seen, manual analysis may be required:
• regions are positioned incorrectly
• poor bone mapping
To perform manual analysis after auto analysis:
Step Action
1 Click on the Global ROI button (Figure 8-4).
2 Perform the Manual Analysis starting with Performing the
Manual Analysis (page 8-16).
A specific set of tools, the Analysis Step Buttons, located on the

left side of the window (see Figure 8-5), allow the operator to
proceed step-by-step through each task. These tools can
maximize image quality and accuracy, preventing the need for re-
scanning.
Figure 8-5 Step buttons
AP Lumbar Spine Analysis
Window
Toolbox KP1035A-0816_1
Brightness/Contrast button

Performing the Manual Analysis

To perform manual analysis from the Analyze Window, click on
the Global ROI button. The steps to manually analyze an AP
Lumbar Spine include:
1. Adjusting the image display brightness and contrast (Bright-
ness/Contrast button).
2. Defining the Global Region of Interest (Global ROI button).
3. Viewing/editing the bone map (Bone Map button).
4. Marking the Intervertebral spaces (Vertebral Line button).
5. Labeling the Vertebral bodies and view analysis results
(Results button).
6. Exiting the Analysis window (Close button).
Adjusting the Image Display

The contrast and brightness of the image can be adjusted to
obtain the best definition of important anatomical features.
Adjusting the contrast and brightness has no effect on
KP0886-0817 calculations; it is used to optimize the display and for visual
adjustments only. Refer to Contrast and Brightness on page 7-
25, in Chapter 7, for detailed instructions.
Defining the Region of Interest (ROI)

The global ROI refers to the defined boundaries of the image that
is being analyzed. The ROI appears on the image as a box: the
dashed line is active and can be adjusted; the solid lines are
KP0886-0818
inactive and cannot be adjusted.

Figure 8-6 Dashed yellow Line Area to be analyzed

ROI Image in the
Analysis Window
KP0886-0819
Solid red lines
A properly positioned Global ROI includes:

• The spine centered within the ROI.
• A preset width of 116 lines (automatically preset).
• The top line of the ROI positioned between T12 and L1.
The bottom line of the ROI positioned between L4 and L5

The Global ROI Toolbox

The Global ROI Toolbox is used to define the region of interest:
• Line Mode
When selected, one line on the ROI box initially displays
as a dashed yellow line. Any of the ROI box lines can be
selected and then moved. Top or bottom (horizontal) lines
can be moved up or down. Side (vertical) lines can be
moved left or right.
• Whole Mode
When selected, the entire ROI box initially displays as a
dashed yellow line. This allows the entire box to be
moved to center the spine while maintaining the 116 line
width.
• Point Mode
When selected, a plus sign displays in each corner of the
ROI box, as well as at the center of the top and bottom
lines. A corner or center point can be selected to angle the
top and bottoms lines to match lateral curvature or
KP0886-0820 scoliosis (explained in Scoliotic Spine Scans on page 8-
30 of this chapter).
To define the ROI in Line Mode:

Step Action
1 Click the Global ROI button in the top left corner of the
window, if not already selected.
The ROI box displays in the image area.
2 The Line Mode button is the default and should be active
(click if not already selected).
The top line of the ROI box displays as an active line
(dashed yellow).
Note: Dashed yellow lines are 3 Click and drag the top line to its position between T12 and
active and can be edited. Solid red L1 intervertebral space. (Evenly spaced, if possible).
lines are inactive.
Note: The top line remains dashed 4 Click and drag the bottom line to its position between L4
until the bottom line is clicked. and L5 Intervertebral space. (Evenly spaced, if possible.)
To define the ROI in Whole Mode:

Step Action

Step Action
2 Click the Whole Mode button in the Global ROI Toolbox.
The ROI box displays as active lines (dashed yellow).
3 Position the cursor arrow anywhere within the ROI box.
The crossed arrows cursor displays.
4 Center the ROI box over the spine by clicking and
dragging it to the correct position.
Point Mode
The point mode is used to adjust the ROI to match the lateral
curvature or scoliosis of the spine. This is explained in the
Scoliotic Spine Scans on page 8-30 of this chapter.
Viewing/Editing the Bone Map

The system creates a yellow bone map of the spine over the ROI
defined in the previous steps. It automatically fills holes in the
yellow bone map and removes bone artifacts.
KP0886-0821
To view the bone map:

Step Action
1 Click the Bone Map button.
The bone map displays in yellow.
KP0886-0822
2 Verify whether the bone map is acceptable or needs to be

edited.

Evaluate the bone map:

It is strongly recommended that the operator not alter the bone
edges of the spine that are displayed in yellow. This degrades the
reproducibility of the spine image. If large areas of the bone map
are automatically excluded, the operator must edit the bone map.
To edit the bone map:
To add or delete bone from the image, use the Bone Map Toolbox
portion of the Analysis window. The operator can also adjust the
cursor size, fill holes, undo changes, or reset the image to the
original bone map if unintentionally changed.
KP0886-0823
To add bone to the bone map:

Step Action
Important: Do not alter the bone 1 Click the Add Bone radio button.
edges of the spine, as it degrades The cursor displays as a small green rectangular paint
the reproducibility of the scan. If
brush when placed inside the global ROI on the image.
necessary, use the optional Low
Density method to improve bone 2 Select the cursor size using the Cursor Size tool.
mapping. See the Scanning Special Hologic recommends the default paint brush (size 2) be
Conditions section of this chapter.
used.
3 Move the cursor to the starting point.

Step Action
Note: Be careful to follow the bone 4 Click and drag the cursor to connect outside edges to
edge to bridge all gaps. If there are complete the bone map.
any gaps, the Fill Holes function
will not work. 5 To automatically fill the remaining holes, click the Fill
Holes button.
To delete bone from the bone map:
Step Action
Note: For spurs or prominent 1 Click the Delete Bone radio button.
Transfers Processes, retain the The cursor displays as a small green rectangular paint
image as painted by the software
to maintain the reproducibility of
the scan. 2 Select the cursor size using the Cursor Size tool.
Hologic recommends the default paint brush (size 2) be
used.
Note: Be careful to delete a 4 Click and drag the cursor to erase a line through the yellow
complete line through the bone bone map.
map until the image separates.
This creates a small island—an isolated section of bone.
Note: If you leave any connection, 5 To automatically remove the small island, click on the Sink
only the line you deleted is Islands button.
removed.
Small island is removed.
Marking Intervertebral Spaces

Marking each intervertebral space with a line allows each
individual vertebra to be analyzed separately. The Vertebral
Lines button is used to mark the intervertebral spaces within the
KP0886-0824
region of interest. Up to three lines appear on the image that can
be used to mark the spaces. You may insert up to three lines or
delete lines as necessary.
To mark intervertebral lines using Line Mode:

Step Action
1 Click the Vertebral Lines button, if not already selected.
Three horizontal lines display in the image area.
Note: Dashed yellow lines are 2 The Line Mode button is the default and should be active
active and can be edited. Solid red (click if not already selected).
lines are inactive.
The top line displays as an active line (dashed yellow).
Note: The yellow dashed line is 3 Click and drag the top dashed yellow line and place it in
active until the next line is the L1/L2 space, evenly spaced between vertebrae.
selected.
The top line displays as active until you select the next line.

Step Action
Note: Active yellow dashed lines 4 Then click and drag the middle line and place it in the L2/
can not cross a solid line except in L3 space, evenly spaced between vertebrae.
point mode.
The middle line displays as active until you select a
different line.
5 Click and drag the lowest intervertebral line and place it in
the L3/L4 space, evenly spaced between vertebrae.
The lowest line displays as active until you select a
different line.
KP0886-0825
To remove a line:
Step Action
Note: Use if analysis is three 1 Click on the line.
vertebrae or less. Line displays as active (dashed yellow).
2 Click the Delete Line button.
Line disappears.
To insert a line:
Step Action
Note: A maximum of three 1 Click the Insert Line button.
vertebral lines can appear on the A new line displays as active (dashed yellow), just above
image.
the previous active line, if any.

Point Mode
Point mode is used to mark intervertebral spaces of the Scoliotic
space and is explained in Scanning Special Conditions in this
chapter.
Labeling The Vertebral Bodies

The Results button is used to automatically label the marked
vertebral bodies. Vertebra labels are automatically placed in
areas outside the bone region when possible.
KP0886-0825
Labeling Guidelines
Use the following guidelines to verify labels:
• Labels are automatically assigned numbers starting at the
top with L1.
• The top-most vertebra within the ROI is always labeled
L1.
Including or Excluding Vertebrae from Analysis

Once the operator verifies that the labels correspond to the correct
vertebral bodies, specific vertebrae can be included or excluded
from the analysis. Some reasons for excluding vertebral bodies
include: foreign objects (artifacts) within the scan area, the scan
area is a surgical location, or a physician requested the exclusion
(physician’s discretion).
To automatically label vertebrae
Step Action
1 Click the Results button, if not already selected.
The vertebral bodies are automatically labeled starting
with L1.
2 Verify that the labels correspond correctly to the anatomy.
Usually no changes are necessary.

KP1035A-0826
To change vertebrae labels:

Step Action
1 To change the label numbering, click the or arrows in
the First Label area of the Label Toolbox.
The label numbering on the image increments or
decrements accordingly. The first (top-most) label displays
in the First Label box.
2 To include or exclude a vertebra, click anywhere within the
boundary of the labeled vertebra on the image.
The ROI boundary for the selected vertebra displays as
active (dashed yellow).
3 To exclude, click the Exclude button.
The label on the image turns red indicating that the
vertebra has been removed.
4 To include previously excluded vertebra, click the Include
button.
The label on the image turns yellow indicating that the
vertebra has been included.

Viewing Results
Results of the analysis display in the lower right portion of the
Analysis window (see Figure 8-7).
KP0886-0827
The spine results area of the Analysis window shows:

• Pertinent Statistical Information
The headings of the results section indicate the statistical
figures that are used in maintaining accuracy and
diagnostic precision for this machine, and are set at the
factory.
• Regions
Indicates individual vertebra included in the analysis and
points to the results.
• Area
Area expressed in cm² (centimeters squared).
• BMC
Bone mineral content expressed in grams.
• BMD
Bone mineral density expressed in g/cm² (grams per
centimeter squared).
• Auto Low Density Spine Analysis
The scan is labeled Auto Low Density Spine Analysis if
the auto low density analysis software was used.

Figure 8-7 Results button

AP Lumbar Spine
Analysis Window
Auto Analyze button KP1068_002-0828
Results area
To view results:
Step Action
1 The Results button should have already been selected
when labeling vertebrae. (Click if not already selected).
The results display in lower right corner of the Analysis
window.
To reanalyze the current scan with different settings:
Step Action
Note: Once an Analysis Step 1 Click the appropriate Analysis Step Button (see Figure 8-
Button is modified, each 5) and modify.
subsequent button (analysis step)
must be performed or results will 2 Repeat for each subsequent Analysis Step Button in the
not be accurate. Global ROI Toolbox.
To reanalyze a scan using Auto Analysis:
Step Action
1 Click the Auto Analyze button.
Auto Analyze overrides any manual changes made and
uses the original scan data.
2 Evaluate the image.

To reanalyze the current scan from the main window:

Step Action
1 Click the Analyze Scan button.
2 Click on the Analyzed Scans tab.
3 Select the desired scan.
5 Continue with analysis as described earlier in this
chapter.

To exit the analysis:
Step Action
Note: This applies to both auto 1 Click the Close button in the lower left corner of the
and manual analysis of the scan. Analysis window.
The Exit Analysis window displays. Refer to Exiting the
Analysis in Chapter 7 for detailed instructions.

A variety of reports can be generated from the results of the
analysis, customized to fit the needs of the examination. Generate
and print the desired report. Refer to Generating and Printing
Reports on page 7-32 of Chapter 7 for more information.
Alternate Scan Modes

You may need to use an alternate scan mode if:
• The patient was previously scanned using a scan mode
other than the default.
• The patient is very large (a longer scan time may improve
the image quality).
To choose a specific scan mode from the Select Scan Type
window:
Step Action
1 Click on the AP Lumbar Spine exam type in the list.
The selected scan type is highlighted.
2 Remove the default scan mode check mark by clicking in
the check box.
Check mark removed.

Step Action
The Select AP Lumbar Spine Scan Mode window displays.
KP0886-0829
4 Click on the desired scan mode in the list.

The selected mode is highlighted.
The Scan Parameters window displays. Continue with
Confirming Scan Parameters on page 8-3.
Evaluating the Image

This section provides examples that illustrate unacceptable scans
Figure 8-8
Unacceptable Lumbar Spine
Scan: Off Center
KP0886-0830

Figure 8-9
Unacceptable
Lumbar Spine Scan:
Starting Point Too Low
and Scan Stopped Too Soon
KP0886-0831
Figure 8-10
Unacceptable Lumbar Spine
Scan: Starting Point Too High
KP0886-0832

Scoliotic Spine Scans

Some patients may exhibit lateral curvature or scoliosis of the
spine on the scan image. Analysis of the AP Lumbar Spine with
scoliosis may require two modifications to the standard AP
analysis.
Note: Be sure to maintain the 1. The yellow ROI box may need to be angled along the top or
automatically preset distance of bottom of the box, possibly both, depending on the curva-
“116” between the left and right
ture.
lines.
2. The intervertebral line may need to be “tilted” to match the
angle of the intervertebral spaces.
Adjusting the ROI Box

Auto Analyze does not adjust for spine curvature, so manual
analysis must be performed.
The point mode button allows the operator to adjust the ROI to
match the curve of the patient’s spine. Adjust the ROI box so that
the top-most and bottom-most angled lines are parallel to the
desired inter-space, making sure that both vertical lines and
portions of the top and bottom lines remain straight.

Figure 8-11
Scoliotic Spine: ROI
KP0886-0833
To define the ROI for a scoliotic spine in Line Mode (top line):
Step Action
1 Click Line Mode in the Global ROI Toolbox.
2 Click the top line of the ROI box, and slide it to the
highest point of L1, or the highest vertebra included in
the analysis.
3 Click the bottom line of the ROI box and slide it to the
lowest point of L4, or the lowest vertebra included in the
analysis.
KP0886-0834

Figure 8-12
Scoliotic Spine: Point Mode
KP0886-0835
To define the ROI for a Scoliotic Spine in the Point Mode:

Step Action
Note: Do not bend sides of ROI 1 Click Point Mode in the Global ROI Toolbox.
box.
Note: Make sure there is at least 2 Click and drag the middle point on the top line left or
one 90o corner on top and right to the higher side of L1. Do not drag the point up or
bottom of the ROI. down.
3 Click and drag the corner point of the lower side of L1
down so that the line is placed in the intervertebral space,
parallel to the vertebral bodies. Do not drag this point left
or right.
4 Click and drag the bottom middle point, left or right, to
the lower side of L4. Do not drag this point up or down.
5 Click and drag the corner point of the higher side of L4 so
that the line is placed in the intervertebral space, parallel
to the vertebral bodies. Do not drag this point left or right.

Marking Intervertebral Spaces of Scoliotic Spines

Marking intervertebral spaces of scoliotic spines is similar to
marking spaces in normal spines except you must tilt the line to
keep the intervertebral lines parallel to the spaces.
Pivoting an Intervertebral Line

To pivot an Intervertebral Line use the Point Mode button to
match the intervertebral lines to the curve of the spine. A line can
be pivoted at either end, but cannot be bent in the middle.
Make sure the lines are kept in their original order and they do not
pass over one another.
Figure 8-13
Scoliotic Spine:
KP0886-0836
To mark the intervertebral lines of a scoliotic spine:

Step Action
1 Click the Vertebral Lines button to mark the
intervertebral spaces within the ROI.
The system automatically inserts three lines.
KP0886-0824

Step Action
2 Click and drag to select and move the line up or down
close to the intervertebral space. Start with the bottom
line and move up.
3 Click the Point Mode button to change to point mode.
Two points appear, one at each end of the 3 lines.
Note: An intervertebral line 4 Drag the point up or down to match the angle of the
cannot completely cross over intervertebral space. You can pivot the line from either
another line or it will mislabel at
end, but you cannot bend the line in the middle.
the next step.
5 Click the Delete Line button to delete a line.
6 Click the Insert Line button to insert a new active line
above a previous line (max 3 lines).
7 Repeat steps 3 through 7 to mark each space.
Figure 8-14
Scoliosis Spine: Marking
Intervertebral Spaces in Point
Mode
KP0886-0837

Chapter 9
Hip Scan
This chapter provides procedures to perform a Total Hip DXA
scan and analysis for the QDR systems. The anatomical sites that
are measured for the Total Hip scan are: the femoral neck, the
greater trochanter, the intertrochanter and the Ward’s triangle.
Content
Subject Page
The Hip Examination 9-2
Modifying Other Regions of the Hip 9-33
About the Midline 9-33
About Ward’s Triangle 9-35
About the Trochanter Region 9-35
Hip Structure Analysis® 9-38
9-1
The Hip Examination

The Hip examination includes all activities that begin when the
patient enters the exam room, and end when an acceptable image
is obtained. The activities involved in performing the exam
include:
• Positioning the Patient and C-arm

Note: Remember to ask the Prepare the patient by asking the pre-examination questions and

of Chapter 6).
9-2 Performing and Analyzing the Hip Scan


Note: Hologic suggests scanning

the patient’s non-dominant hip
(does not apply to Dual-Hip
scans).
KP0886-0901
The scan type for the Hip scan is either Left Hip or Right Hip
and is selected in the Select Scan Type window. A check mark
() in the Use Default Scan Mode box designates the Express
mode for Discovery-A, -SL, -W, -C models, Fast Array mode for
Discovery-Wi, Ci models, or Explorer mode for Explorer.

If you need to perform the scan in a different mode, remove the
check mark and a window displays allowing you to select an
alternate scan mode.
Left or Right Hip

To choose the default scan mode for Left or Right Hip (check
mark in box):
Step Action
1 Click Left Hip or Right Hip in the scan type list.
The Scan Parameters window appears.
Performing and Analyzing the Hip Scan 9-3

Dual-Hip
In Dual-Hip mode, you must position the patient before you
select the scan mode (see Positioning the Patient and C-arm on
page 9-6).
To choose the default scan mode for Dual-Hip (check mark in
box):
Step Action
1 Click Dual-Hip in the scan type list.
KP0886-0902

A massage appears telling you to center the laser on the
patient.
3 Center the laser on the patient by moving the table in or
out.
You can position the laser anywhere on the midline of the
patient.
4 Click Continue.
The Scan Parameters window appears.


(see Figure 9-1 for left hip or Figure 9-2 for right hip). The scan
length for a hip exam is approximately 6 in. (15cm). The system
may change the number entered to match the pre-programmed
step size of the scanning mechanism.
Figure 9-1
Left Hip Scan Parameters
KP1035A-0903
Figure 9-2
Right Hip Scan Parameters
KP1035A-0903a
To verify the scan parameters:

Step Action
corner.

Step Action
KP0886-stop

The goal for positioning the patient on the table is to ensure that
the hip is as straight as possible for the scan (refer to Figure 9-3).
Figure 9-3 Left Hip Patient Positioning Goal
Hip Patient Positioning Goal
Foot Positioner
Area to be scanned
KP0886-0904
The remainder of this section provides detailed information on

positioning the patient, foot positioner, table, and C-arm for a hip
exam. It is important to follow each set of directions carefully
since they are designed to help acquire an ideal scan by
describing:
• How to assist the patient onto the table for proper
alignment.
• Proper use of positioning aids.


table.

Note: The Dual-Hip scan begins Positioning the patient for a hip scan involves using the Foot
with a scan of the left hip. Positioner (see Figure 9-1 for left hip or Figure 9-2 for right hip),
supplied by Hologic. This positioner helps to align the patient’s
hip and holds the foot firmly in place.
A pillow can be used under the patient’s head to make them more
comfortable.
Step Action
Note: Patient must remove their 1 Lie the patient on their back on the table with their head at
shoes. the right end of the table (see Figure 9-1).
Table button must be held and only The table and C-arm move to the center.
the table moves.
3 Place the Foot Positioner under the patient’s legs, and

align the center of the positioner with the patient’s midline.
Note: The foot should not be 4 Rotate the patient’s entire leg to be scanned (from hip
elevated above the positioner nor socket to foot) 25° inward and place the medial edge of the
hanging off the edge.
foot against the triangle. The foot should be flexed towards
the ceiling (see Figure 9-1).
5 Adjust the Velcro® strap to hold the foot in the correct

position.
Velcro
Strap 6 Align the femur to be parallel with the table edge to
KP0886-0906 provide adequate space for the neck box. Abduct the leg
from the midline of the body in order to straighten the
femur.
To ensure the femur is parallel with the long axis of the
table, you can offset the foot positioner while keeping it
parallel with the front edge of the table pad, if necessary.


Note: There are different The C-arm and table drive motors provide the table and C-arm
procedures for the Left Hip and motion required to scan the X-ray beam along the patient’s hip
Right Hip scans versus the Dual-
area.
Hip scan (see below).
Positioning for the Left Hip or Right Hip Scan

To position the C-arm and align the Laser:
Step Action
Tips: To help identify the greater 1 Press the Laser button on the Control Panel.
trochanter: The laser cross-hair indicators display on the table pad.
• Place your thumb on the
iliac crest, spread your
fingers. Direct your little 2 Use the Arm Controls on the Control Panel to place the
finger toward the knee. cross hair of the laser 3 inches below the greater trochanter
The greater trochanter is and 1 inch medial to the shaft of the femur.
located under your little
finger.
• Palpate for the symphysis
pubis. The greater
trochanter is at the same
level.
Positioning for the Dual-Hip Scan

To position the C-arm and align the Laser:
Step Action
1 Turn on the laser and position the C-arm over the center of
the patient.
2 Click Continue.
Note: In Dual-Hip mode, the left 3 Palpate the patient’s left leg to identify the greater
hip is always scanned first. trochanter (see Tips above).
4 Use the Arm Controls to place the cross hairs of the laser
3 inches below the greater trochanter and 1 inch medial to
the shaft of the femur.
5 Click Continue.

An acceptable hip scan (see Figure 9-4) includes the following:

• The femoral shaft is straight and parallel to the edge of the

scan image.
• The greater trochanter is centered vertically in the
window.
• The entire femoral head is visible.
• A 25° internal rotation of the hip showing minimal or no
lesser trochanter on the scan image.
• For Hip Axis Length (HAL) or Hip Structure Analysis
(HSA) options, ensure that a small amount of pelvic inlet
is shown on the scan image.
Figure 9-4
Right Hip Scan
KP0886-0907
Starting the Hip Scan

computer to start the Hip scan. At this time, the Scan Parameters
window should be displayed.

To start the Hip scan:

Step Action
Note: If the Control Panel X-ray 1 Click the Start Scan button.
immediately. Then call Hologic 2 Inspect the image as it is generated.
• If the hip is positioned correctly, allow the scan to
complete.
The Exit Exam window displays.
• If the hip is not positioned correctly, click the
Reposition Scan button.
The scan stops to allow repositioning (see
Repositioning the Scan below).
Option Description
window displays.
Abort Scan button Exits the scan immediately. An exit
window displays then proceeds to
KP0886-0809 the main window. To start another
scan the C-arm must be
repositioned.
instructions.

If your scan is positioned correctly (see Figure 9-4) it is not
necessary to reposition. If you need to reposition, follow the
procedure below.
Reposition the image up, down, left or right using the

scroll bars or cursor hand to reposition the scan to include

the entire femoral head, neck, and approximately 3 inches
of the shaft.
If the femoral shaft is not straight and parallel with the
edge of the scan image, move the patient’s leg away from,
or towards, the midline (as appropriate).
Re-rotate the leg if it is over or under rotated depending on the
lesser trochanter visibility.
Step Action
right and bottom.
completed.
Note: You can also use the scroll 2 Position the cursor over the hip image.
Vertical
Positioning
Line
Greater
Trochanter
Horizontal
Positioning
Line
Scroll
Cursor Bars
Hand
KP0886-0908
Note: On Explorer, the scan can be 3 To position the hip, click and drag the image to the
repositioned a maximum of 1 inch intersection of the two blue positioning lines so that:
(2.54 cm.) towards the foot end of
• The vertical positioning line touches the outer edge
the table and any distance towards
the head end. of the Greater Trochanter
• The horizontal position
4 When the hip is positioned correctly, click the Restart
Scan button.
5 Click the Start Scan button to start a new scan at the new
position.
message. The image displays.
in the window:

Button Description
KP0886-0909
KP0886-0910
Cancel Scan button Cancels the exam and returns to

KP0886-0911
the main window.
To reposition the patient:

Step Action
Note: In order to reposition the 1 Click the Reposition Scan button.
scan, the Reposition Scan button The image acquired so far displays.
must be clicked before the scan
is completed. 2 If the femoral shaft is not straight and parallel with the
edge of the scan image, move the patient’s leg away
from, or towards, the midline (as appropriate).
3 When the hip is positioned correctly, click the Restart
Scan button.
lamp fails to extinguish within position.
10 seconds after the end of the
scan, press the red Emergency
Stop button on the Control Panel message. The image displays.
immediately. Then call Hologic 5 Evaluate the image as it displays. If the image is
Service before resuming
satisfactory, allow the scan to complete.
operation.
When the scan completes, the Exit Exam window
displays.
Additional Steps for the Dual-Hip Scan

If you are performing a Dual-Hip scan, the scanner automatically
moves from the left hip to the right hip after finishing the first
scan.
As the scanner moves to the right hip, the following message box
appears on the computer screen.

KP0886-0912
When this happens, do the following:
Step Action
1 Move the foot positioner from the left foot to the right
foot.
2 Align the patients hip, leg and foot as you did for the left
hip scan.
3 Fasten the patients foot in the foot positioner.
4 Turn on the laser and make sure that the scanner is
properly positioned over the patient’s right hip.
5 Click Continue.
6 Verify an acceptable right hip scan has been acquired. If
not, reposition the image or the patient as necessary and
rescan.
When the scan has finished, exit the exam.

instructions.


Note: If the analysis of the scan The analysis of the Hip scan includes the following:
is to be postponed to a later • Choosing the analysis method
time, the scan can be retrieved
Note: If the patient has a respective (left or right) Hip
from the Scan Drawer. Refer to
“Scan Drawer” on page 6-16, baseline scan, the software proceeds directly to the
for information about the scan manual compare analysis function instead of choosing
drawer. the analysis method. Compare analysis is discussed in
detail in Chapter 14. Manual Hip scan analysis is
• Performing the analysis

The first analysis activity involves selecting the analysis method.
The analyze method is the method that the system uses to perform
the analysis. It can perform the analysis either as a single new
scan, or as a comparison to one that has been previously
performed.
(Hip) and the system presents a single scanned image for
analysis. If this scan is a follow-up visit, select the Compare to
(ROI) defined.
Compare allows the system to perform the new analysis on the
same ROI as the previous scan and maximizes accurate reporting
of changes. Follow-up visits are discussed in detail in
“Performing the Follow-up Scan” on page 14-7 of Chapter 14.


Step Action
button.
displays with the Choose necessary.
Analysis Method radio button
selected as the default. 3 Verify the analysis method (see Methods of Analysis
The Comparison method is below).
covered in detail on page 4 Click the Next >> button.
“Performing the Follow-up
Scan” on page 14-7 of Chapter
14.
Methods of Analysis
The Hip analysis is the standard method for analyzing Hip scans.
Step Action
Note: Subregion Array Hip is 1 Click the drop down list arrow on the Analyze Setup
available as an option. window.



Note: Refer to “Analyze Tab” on Unless disabled, once the method of analysis is chosen the
page 18-5 of Chapter 18 on how software will automatically perform the analysis (excluding
to disable One-Time™ Auto
Subregion Array Spine analysis). This is called One-Time™
Analysis.
Auto Analysis and is a feature of all models in the QDR Series.

Note: Hologic’s auto-analysis The Hip scan auto analysis includes all activities that begin with
algorithms have been optimized a satisfactory image and ends with the calculation and summary
for use on patients. You may be
of the results of the scan. After completing a scan, the system
required to manually analyze
scans of phantoms that were automatically saves the scan, in the Scan Drawer, for analysis.
scanned as if they were patients. Once the method of analysis is selected, the system will
automatically perform an analysis of the scan (excluding
Subregion Array Hip analysis). While this operation is being
performed, no operator interaction is allowed. While the analysis
Note: Refer to “Analyze Tab” on
page 18-5 of Chapter 18 on how
is being performed, system software will use an automatic low
to disable Auto Low Density Hip density hip analysis (unless disabled) if it is needed. Upon
analysis. completion of Auto Analysis, analysis results are displayed. If
the software determined automatic low density hip analysis was
required, it will be noted in the analysis results label.
Figure 9-5
Hip Auto Analysis Results

Manual Analysis
The operator may perform a manual analysis of the Hip scan after
the auto analysis is completed. In most cases it will not be
necessary to perform manual analysis. However, upon
Step Action
1 Click on the Global ROI button (Figure 9-6).
2 Perform the Manual Analysis (see “Performing the
Manual Analysis” on page 9-17 of this chapter).
Figure 9-6
Step buttons
Hip Analysis Window
Note: Refer to “Hip Structure
Analysis®” on page 9-38 for
details pertaining to the optional
HSA step button.
Toolbox

Once the setup method has been selected, continue to the
Analysis window to adjust the quality of the image and properly
define the area of analysis called the region of interest (ROI).

A specific set of tools called the Analysis Step Buttons, located

on the left side of the window (see ), allow the operator to
scanning.
The steps to analyze the hip scan include:
4. Adjusting the Neck box (Neck button).
5. Viewing analysis results (Results button).


KP0886-0818

Figure 9-7
ROI Image in the Analysis
Window
KP0886-0818

• Proximal femur in its entirety
• Lesser trochanter
• Top of the femoral head
• Lateral side of the greater trochanter


The Global ROI Toolbox includes tools to help define the region
of interest:
• Line Mode
• Whole Mode
moved. This tool is usually used during a compare scan.
KP0886-0819

Step Action
active and can be edited. Solid (click if not already selected).
red lines are inactive. Dashed
blue lines are analysis aids.
(dashed yellow) and blue dashed lines as analysis aid
lines.
3 Using the mouse pointer, drag the top yellow line so that
the blue analysis aid line is just above the femoral head.
This indicates the landmark that the system uses to place
the actual line a set distance away from the landmark.
4 Select the right vertical line (for a left hip), then click and
drag it so that the blue analysis aid line is just touching
the lateral side of the greater trochanter.
The line selected in step 3 appears as a solid line a set
distance away from your original line.

Step Action
Note: If the lesser trochanter can 5 Select the bottom line, then click and drag it so that the
not be identified, place the blue analysis aid line is at the base of the lesser
bottom line two times the
trochanter.
distance of the greater
trochanter.
6 Select the left line (for a left hip), then click and drag it so
that the blue analysis aid line is just lateral to the femoral
head.
Step Action
2 Click the Whole Mode button in the Global ROI
Toolbox.
4 Click and drag the ROI to the correct position.

The system creates a yellow bone map of the hip over the ROI
yellow bone map.
KP0886-0821

Step Action
The Bone map displays in yellow.
edited.

Step Action
KP0886-0820

Evaluate the image to determine if any erroneous bone mapping
should be excluded or any excluded bone should be added.
• Unacceptable Bone Map
Look for any bone that was erroneously excluded from the
bone map, such as holes or edges that the bone map
process did not properly fill. If this is the case, proceed to
To Edit the Bone Map below.
• Acceptable Bone Map
The bone map should include the entire hip region, as
specified during the process of defining the ROI. There
are no holes, or divots, or sections that should be filled in.
If the bone map is acceptable, proceed to Positioning the Neck
Box.
The “Edit Bone Map Feature” is intended to correct small, local
aberrations in the bone map. Some examples include small holes
in the bone that did not fill in properly or irregular regions of soft
tissue that were misidentified as bone. It should not be used to fill
in significant portions of the bone map. As a general rule no more
than about 5% of the bone in a given region should be filled in
manually.

If significant portions of the bone in the femur were not

identified, increase the global ROI height by clicking on the
“Global ROI” button and moving the upper global ROI up 10-20
lines toward the top of the image. Then click the “Bone Map”
button and verify that the resulting bone map has improved.
Usually, increasing the ROI height by 10-20 lines will generate an
acceptable bone map but sometimes further adjustments are
necessary.
In some cases, it may be necessary to delete bone from the bone
map. It may be necessary to delete the pelvis (ischium) if it is too
close to the femoral shaft. Otherwise, there may be difficulty
placing the Neck box in the next step of the analysis.
KP0886-0821
To Add bone to the Bone Map:

Step Action
1 Click the Add Bone radio button.
The cursor displays as a small green rectangular paint
2 Select the cursor size using the Cursor Size tool.
used.

Step Action
Note: Be careful to follow the 4 Click and drag the cursor to connect outside edges to
bone edge to bridge all gaps. If complete the bone map.
there are any gaps, the Fill
Holes function will not work.
5 To automatically fill the remaining holes, click the Fill
Holes button.
How to determine a starting point when deleting bone
If the pelvis (ischium) is too close to the femoral shaft, it
interferes with the next step, which is placing the Neck box. To
delete the pelvis, you need to draw a line starting from the inside
edge of the femoral shaft where it joins with the femoral neck and
trace a line up to the level of the base of the femoral head.
Continue the line horizontally (laterally) to the edge of the ROI.
Step Action
1 Click the Delete Bone radio button.
used.
Note: Refer to How to determine 3 Move the cursor to the starting point.
a starting point when deleting
bone for information on the
starting point.
Note: Be careful to delete a 4 Click and drag the cursor to erase a line through the
complete line through the bone yellow bone map.
Note: If you leave any 5 To automatically remove the small island, click on the
connection, only the line you Sink Islands button.
deleted is removed.
Positioning the Neck Box

This step of the analysis allows the operator to position the
femoral Neck Box, which is usually the only adjustment for a hip
scan, other than placing the ROI.
KP0886-0822
In this step, verify the following:

• The Neck Box covers only the femoral neck.

• The box should not include any area of the ischium

femoral head, or greater trochanter.
When positioning the Neck Box, move the box as a whole along
the midline until the upper outer corner is positioned at the notch
of the greater trochanter. The remaining three corners of the Neck
Box should remain in soft tissue.
KP1035A-0823
To recalculate the locations of all hip regions after manually

editing the global ROI or bone map:
Step Action
1 Click the Neck button, if not already selected.
The femoral Neck Box and related lines display in the
image area.
2 Click the Auto Position button.
The system recalculate all hip regions based on the
current bone map.

To position the Neck Box in Whole Mode:

Step Action
image area.
Note: Dashed yellow lines are 2 The Whole Mode button is the default and should be
active and can be edited. Red active (click if not already selected).
lines are inactive.
The Neck Box displays as active lines (dashed yellow).
3 Click and drag the Neck Box along the femoral midline
(dashed red line) until the upper outer corner of the box is
positioned at the edge of the inside curve of the greater
trochanter. The remaining three corners should remain in
soft tissue. The two lower corners should not overlap the
ischium.
Adjusting the Neck Box

There are two reasons why it would be necessary to adjust the
Neck Box:
• The Neck Box overlaps the ischium.
• The Neck Box overlaps the femoral head.
To move the Neck Box away from the ischium in Line Mode:
Step Action
image area.
Note: Dashed yellow lines are 2 Click the Line Mode button, if not already selected.
active and can be edited. Red One of the Neck Box lines displays as active (dashed
lines are inactive.
yellow).
3 Select the line on the short side of the Neck Box that is
between the femoral shaft and the ischium.
The selected line displays as active (dashed yellow).
4 Click and drag the selected line towards the neck (the
midline) until the two lower corners of the Neck box are
in tissue (the dark area of the image between the ischium
and femoral shaft). This shortens the length of the box.

Step Action
5 If the two lower corners clear the ischium, it is not
necessary to perform steps 6-8 below. If the two lower
corners cannot clear the ischium, click the Undo button
to undo the last move. It is not necessary to edit the bone
map and delete the ischium from the bone map image.
Note: Refer to To Edit the Bone 6 Click the Bone Map button and edit the bone map.
Map for instructions.
7 Perform steps 1-3 of the To Position the Neck Box in
Whole Mode procedure on page 9-26.
8 Repeat steps 2-4 of this procedure.
To move the Neck Box away from the femoral head in Line
Mode:
Step Action
image area.
Note: Dashed yellow lines are 2 Click the Line Mode button, if not already selected.
active and can be edited. Red lines One of the Neck Box lines displays as active (dashed
are inactive.
yellow).
3 Select the top line (long line) on the Neck Box.
The selected line displays as active (dashed yellow).
Note: This is done as a last resort. 4 Click and drag the selected line down the midline until the
By making the box narrower, the Neck Box clears the femoral head.
bone sample is smaller reducing
The Neck Box becomes narrower as you drag the line.
the accuracy of the results.
Viewing Results
KP0886-0825
The hip results area of the Analysis window shows:

factory.

• Regions
Indicates individual regions of the hip included in the
analysis and points to the results.
• Area
• BMC
• BMD
• Auto Low Density Hip Analysis
The scan is labeled Auto Low Density Left, or Right, Hip
Analysis if auto low density analysis software was used.
Analysis Window
KP1068_002-0824
Analysis results
To view results:
Step Action
1 Click the Results button.
window.


Step Action
Note: Once an Analysis Step 1 Click the appropriate Analysis Step Button (see on page
Button is modified, each 9-17) and modify.
subsequent button (analysis
step) must be performed or 2 Repeat for each subsequent Analysis Step Button in the
results will not be accurate. Global ROI Toolbox.

Step Action
chapter.

For All Scans Except Dual-Hip
After performing the analysis, click Close and the Exit Analysis
window displays. To select a report type to print, click on the
Report button in the Exit Analysis window. Refer to Exiting the
Analysis on page 7-27 of Chapter 7 for detailed instructions.
For Dual-Hip Scans

After performing the analysis on the right hip, click Close and the
Exit Analysis window displays. To analyze the left hip just
scanned (as part of the Dual-Hip exam), click Analyze Another
Scan. The software chooses the left hip from the Dual-Hip exam.




the image quality).
window:
Step Action
1 Click on the Left Hip or Right Hip exam type in the list.
the checkbox.
Check mark removed.
The Select Left or Right Hip Scan Mode window displays.
KP1068A-0834

The Scan Parameters window displays. Continue with
Confirming Scan Parameters on page 9-5.

This section provides examples that illustrate unacceptable scan
images.

Figure 9-9
Unacceptable Hip Scan: Clipped
the Head
KP0886-0826
Figure 9-10
Unacceptable Hip Scan: Started
Too Low
KP0886-0827

Figure 9-11
Unacceptable Hip Scan: Poor
Interior Rotation
KP0886-0828
Figure 9-12
Unacceptable Hip Scan: Shaft
not Parallel to Edge of Scan
Window
KP0886-0829

Modifying Other Regions of the Hip

This section provides instructions for modifying other regions of
the hip. When the Neck button is first pressed, there are two
buttons in the Neck Toolbox: the Neck button and the Other
Regions button. By clicking on the Other Regions button, the
Neck Toolbox expands with additional buttons that allow the
following regions to be modified:
Note: In most cases, it is not • Midline (Midline button)

necessary to adjust these
regions. • Ward’s Triangle (Ward’s Triangle button)
• Trochanter (Trochanter button)
Clicking the Reset button causes the Neck Toolbox to display

only the Neck and Other Regions buttons.
About the Midline

The femoral midline is computed from the outline of the femoral
neck. The system locates the narrowest portion of the neck and
draws the midline midway between the sides of the neck at that
point. The femoral midline is aligned so it is parallel to the long
axis of the femoral neck.
KP0886-0830
KP0886-0831

To adjust the midline

Step Action
Note: Complete the Global ROI 1 Click the Other Regions button in the Neck Toolbox, if
and Bone Map procedures prior necessary.
to performing this procedure.
The Neck Toolbox displays with additional buttons for
adjusting the midline, Ward’s triangle, and the trochanter.
2 Click the Midline button.
The Neck Toolbox displays additional buttons (Whole
Mode and Line Mode) for adjusting the midline.
active and can be edited. Solid active.
red lines are inactive.
The midline displays as an active line (dashed yellow).
4 Use the following buttons to select a method for
modifying the midline:
• Whole Mode to move the line left or right of the
midline.
• Point Mode to pivot the midline by selecting
either end (the upper or lower point).
5 Adjust the midline according to the method selected.

About Ward’s Triangle

Ward’s triangle is the area of initial bone loss in the femoral
neck. It can be identified on standard radiographs once bone loss
has become significant.
The system automatically locates Ward’s triangle, and places a
small box at the area of minimum density in the femoral neck.
The system can search for this region (approximately 2.7 by 3.5
cm) by centering on the lower edge of the femoral neck box to
locate the area of minimum density.
For some patients (especially young patients), it is difficult to
locate an area of minimum density. When this occurs, the Ward’s
triangle is automatically centered at the intersection of the
femoral midline and the initial position of the bottom edge of the
femoral neck box.
KP0886-0832
KP0886-0833
To adjust Ward’s triangle:

Step Action
Note: Complete the Global ROI 1 Click the Other Regions button in the Neck Toolbox, if
and Bone Map procedures prior necessary.
The Neck Toolbox displays with additional buttons for
adjusting the midline, Ward’s triangle, and the trochanter.

Step Action
2 Click the Ward’s Triangle button.
The Neck Toolbox displays additional buttons specific to
the Ward’s Triangle tool.
active and can be edited. Solid active.
The Ward’s Triangle displays as active (dashed yellow
lines).
4 Use the following buttons to select a method for
modifying the midline:
• Click the Search radio button and then the Whole
Mode button to have the system search for the
lowest amounts of bone density and automatically
position Ward’s triangle.
• Click the Search radio button and then the Line
Mode button to manually adjust Ward’s Triangle.
• Click the Auto Position button to have the system
automatically locate the position of Ward’s
triangle.
5 If manually adjusting Ward’s Triangle, select one of the
sides of the Ward’s Triangle Box.
The line displays as active (dashed yellow line).
6 Click and drag the line to the desired position. Repeat as
necessary for the other sides of the box.

About the Trochanter Region

The system automatically identifies the greater trochanter region.
This is a triangular region whose boundaries are defined as the
bottom edge of the Neck Box and a solid line connecting the
intersection of the bottom edge of the Neck Box and femoral
midline to the point where the edge of the femur changes
curvature below the trochanter. You can only adjust the lower
end of this line.
KP0886-0834
KP0886-0835
To adjust the trochanter region:

Step Action
Note: Complete the Global ROI 1 Click the Trochanter button.
and Bone Map procedures prior A movable yellow plus sign appears at the lower end. A
fixed red plus sign appears at the origin.
2 Click the Trochanter button.
A movable yellow plus sign appears at the lower end. A
fixed red plus sign appears at the origin.
3 Click on the yellow plus sign and drag to the correct
position.

Hip Structure Analysis®

The Hip Structure Analysis (HSA) option measures the
distribution of bone mineral mass at specific cross sections of the
hip and allows the physician to estimate structural properties of
the hip, such as CSA, CSMI, Z and Buckling Ratio.
HSA locates the following three analysis regions in their correct
positions on image:
1. Narrow Neck: located across the femoral neck at its narrow-
est point.
2. Intertrochanter: located across the bend of the femur along
the bisector of the neck and shaft axes.
3. Femur Shaft: across the femur shaft at a distance of 1.5 times
the narrowest diameter of the neck, distal to the intersection
of the neck and shaft axes.
The regions are automatically located by placing boxes around
them but each can be adjusted if necessary.
Figure 9-13
Hip Structure Analysis button
Hip Structure Analysis
Results
Note: Before performing Hip

Structure Analysis read “Tips for
Adjusting the HSA Region
Boxes” on page 9-40.
Hip Structure Analysis results

HSA Toolbox
The HSA Toolbox includes tools to manually adjust analysis
regions.
• Narrow Neck, Intertrochanter, Femur Shaft

Selects the respective region box.
• Auto Position
Returns position and size of all region boxes to original
setting.
• Whole Mode
When selected, the entire selected region box initially
displays as a dashed yellow line. This allows the entire
box to be moved as a whole unit.
• Line Mode
When selected, one line on the selected region initially
displays as a dashed yellow line. Any of the region lines
can be selected and then moved. Top or bottom
(horizontal) lines can be moved up or down. Side
(vertical) lines can be moved left or right.
• Select a line
Appears when Line Mode is selected. Click the
respective button to select the next clockwise or counter-
clockwise line of the selected region box.
• Recalculate
Recalculates results of NN, IT, FS (only active for Auto
Position).
Manually Adjusting the HSA Region Boxes

The automatically located Narrow Neck, Intertrochanter, or
Femur Shaft region boxes can be moved, resized or reshaped if
adjustment if necessary.
To undo all manual changes returning the position and size of all
region boxes to original setting click Auto Position.
To recalculate the structural properties of the hip after manually
adjusting any region click Recalculate.
To position a region box in Whole Mode:
Step Action
1 Click the respective region (Narrow Neck,
Intertrochanter, or Femur Shaft) button.

Step Action
2 The Whole Mode button is the default and should be
active (click if not already selected).
The respective region box displays as active lines (dashed
yellow).
3 Click and drag the selected region box to the desired
position.
To resize or reshape a region box in Line Mode:
Step Action
1 Click the respective region (Narrow Neck,
Intertrochanter, or Femur Shaft) button.
Note: Dashed yellow lines are 2 Click the Line Mode button.
active and can be edited. Red One of the selected region box lines displays as active
lines are inactive.
(dashed yellow).
4 Click and drag on the region box line to move.
Tips for Adjusting the HSA Region Boxes

Narrow Neck (NN) - Place the ROI in the middle of the femoral
neck with approximately 2mm of tissue on the short sides of the
NN ROI. The NN ROI usually is placed higher up the midline
then the neck box BMD measurement. In general, the NN should
not be widened.
Intertrochanter (IT) - Verify that the center of the IT ROI box
intersects the HAL (dotted yellow midline) and the solid red
vertical shaft line. If the medical (inside corner) of the IT ROI
box overlaps the lesser trochanter, press the Line Mode button, to
activate the short inside edge of the IT ROI, and move it up until
the ROI is above the less trochanter. This ROI moves as a
parallelogram (opposite sides stay parallel to each other). Verify
that there is approximately 2 mm of tissue on the short ends of the
IT ROI. If necessary, elongate to include the correct amount of
tissue. The IT ROI cannot extend outside the Global ROI and, in
general, should not be widened.
Femoral Shaft (FS) - Verify that the FS ROI is centered (left to
right) to the red vertical shaft line with approximately 2 mm of
tissue on both sides of the short sides of the ROI. This box can be
slightly skewed so that it stays perpendicular to the red vertical
shaft line. The red femoral shaft vertical line is automatically
placed and cannot be adjusted.

Viewing Results
Analysis window (see Figure 9-8). Click Recalculate to
recalculate the structural properties of the hip after manually
adjusting any region.
The Hip Structure Analysis results area of the Analysis window

shows:
• Regions
Indicates individual regions of the hip included in the
• CSA
Area of bone material in a given cross section of the bone
expressed in cm².
• CSMI
Cross Sectional Moment of Inertia Bone mineral content
expressed in cm4.
• Z (Section Modulus)
Indicator of bending strength for maximum bending stress
in the image 0plane expressed in cm3.
• CORT
Estimate of inside diameter of cortex expressed in cm.
• BR (Buckling Ratio)
Relative thickness of cortex as an estimate of cortical
stability in buckling.


Chapter 10
Forearm Scan
Note: Forearm is an option on This chapter provides procedures to perform a Forearm scan and
Explorer. analysis. The anatomical sites that are measured for the forearm
scan are: the distal portion of the radius and ulna, the wrist bones,
and the first row of carpal bones.
Content
Subject Page
The Forearm Examination 10-2
Prepare the Patient 10-2
Measuring the Patient's Forearm 10-2
10-1
The Forearm Examination

The Forearm examination includes all activities that begin when
the patient enters the exam room, and ends when an acceptable
image is obtained. The activities involved in performing the exam
include:
• Measuring the Patient’s Forearm
Prepare the Patient


of Chapter 6).
Measuring the Patient's Forearm

Measure and record the length of the patient's forearm in
centimeters. During analysis, the system uses this measurement to
determine the length of the global ROI.
10-2 Performing and Analyzing the Forearm Scan

Figure 10-1
Measuring the Left Forearm
Step Action
1 Place a chair that has no wheels, arms or cushions, in
front of the table.
For Left Forearm Scan patient faces the table's right
(head end)
For Right Forearm Scan patient faces the table's left
(foot end)
2 Place elbow on the table surface, holding the forearm
vertical (see Figure 10-1).
3 Place a ruler on the table surface and measure up to the
ulna styloid [A] in centimeters. Record the measurement.
Performing and Analyzing the Forearm Scan 10-3


KP0886-1001
The scan type for the Forearm scan is either Left Forearm or
Right Forearm and is selected in the Select Scan Type window.

Alternate scan mode:
Note: The Use Default Scan There are no alternate scan modes for the Forearm examination.
Mode check box cannot be
unchecked.
To choose the only scan mode:

Step Action
1 Click on Left Forearm or Right Forearm in the scan
type list.

The only scan parameter that can be modified is scan length. The
scan length for a forearm is approximately 6 inches (15 cm). The
system may change the number entered to match the pre-
programmed step size of the scanning mechanism.

Figure 10-2
Left Forearm Scan Parameters
Figure 10-3
Right Forearm Scan Parameters
To verify the scan parameters:

Step Action
corner.
2 To change scan length, double click in the Scan Length
KP0886-stop


The goal for positioning the patient is to ensure that the forearm
bones are as straight as possible for the scan.
For a Left Forearm scan, the scan begins from the mid-forearm to
the first row of carpal bones. For a Right Forearm scan, the scan
starts at the first row of carpal bones and scans up the forearm.
Figure 10-4
Patient Positioned for
Scanning the Forearm
Note: For a left forearm scan,

fingers point towards the right
side (head end) of the table. For
a right forearm scan, the arm Laser Position - Left Forearm
fingers point towards the left
side (foot end) of the table.
Laser Position - Right Forearm
Placing the Forearm in the Scan Field

Positioning the forearm is easiest when the table is centered.
To position the patient’s forearm:
Step Action
1 Press the Center Table button to center the table.
2 Press the Laser button on the Control Panel to activate
the laser cross-hair indicator.
3 Instruct the patient to lean into the table so that their rib
cage is resting against the table edge.
4 Align the long bones of the forearm with the long axis of
the laser.
5 Have the patient make a loose fist to flatten the wrist.
6 Bend the patient’s elbow to approximately 105°.


To position the C-arm and fine tune the starting point:
Step Action
Helpful Hint for aligning the 1 Press the Laser button on the Control Panel a second
laser with the left forearm: time to activate the laser cross-hair indicator.
• Position the laser in the
center of the patient’s
2 Use the Arm Controls on the Control Panel to fine tune
forearm. the starting point on the forearm.
• Press the C-arm 3 Verify the starting points:
buttons on the Control • Left Forearm Scan: Starts at the mid-forearm.
Panel and move the Verify that the first row of carpal bones are within
beam down to the wrist
6 inches (15 cm) of the starting point.
to verify the centering
position. If the beam is • Right Forearm Scan: Starts at the first row of
centered on the wrist, it carpal bones.
indicates the laser is
properly aligned.
• If the cross hairs are 4 Instruct the patient to remain still and breathe normally.
not centered on the
wrist, adjust the laser
using the Table buttons
on the Control Panel
and repeat the
alignment verification.
• Press the C-arm
buttons to move the
laser back to the
starting point.

An acceptable forearm scan (see Figure 10-5) includes the
following:
• The forearm appears straight and centered in the scan
image window.
• The image includes at least the first row of carpal bones.
• The ulna side contains at least enough air to equal the
shaft width of the ulna.

Figure 10-5
Forearm Scan
KP0886-1006
Starting the Forearm Scan

computer to start the scan. At this time, the Scan Parameters
To start the forearm scan:
Step Action
lamp fails to extinguish within The Scan window displays with the image appearing on
the left side. Flashing X-rays On indicator at the top of
Stop button on the Control Panel the window continues until the scan stops.
operation.
KP0886-1007

Step Action
2 Inspect the image as follows:
• The radius and ulna appear straight and centered.
• The image shows at least the first row of carpal
bones near the bottom for a right forearm, or near
the top for a left forearm.
• The ulna side of the scan contains at least enough
air to equal the shaft width of the ulna.
3 If the image is not acceptable, click the Reposition Scan
button.
4 If the image is acceptable, allow the scanning to
complete.
displays.
Option Description
window displays.
Abort Scan button Exits the scan immediately. An
exit window displays then
KP0886-0809 proceeds to the main window. To
start another scan the C-arm must
be repositioned.
instructions.

Use the mouse and scroll bars to center the image in the
window.


Adjust the patient’s forearm so that it presses against the
back of the Positioner.
Step Action
right and bottom.
is completed.
Note: You can also use the scroll 2 Position the cursor over the forearm image.
Carpal
Bones
Horizontal
Positioning
Line
Vertical
Positioning
Lines
Scroll
Cursor Bars
Hand
KP0886-1008
3 To position the forearm:

• Move the first row of carpal bones within the
horizontal blue positioning line and the outer limit
of the scan field.
• The radius and the ulna should be parallel
between the two blue vertical positioning lines.
4 When the forearm is positioned correctly, click the
Restart Scan button.
5 Click the Start Scan button to start a new scan at the new
position.
message. The image displays.


in the window:
Button Description
KP0886-0909
KP0886-0910

KP0886-0911
the main window.
To reposition the patient:

Step Action
Note: The patient’s forearm can 1 To reposition the patient if forearm is not straight on the
be moved up or down to include table, move the patient’s forearm so that it presses against
or exclude more of the carpal
the back of the Positioner.
bones.
2 When the forearm is positioned correctly, click the
Restart Scan button.
lamp fails to extinguish within position.
immediately. Then call Hologic 4 Evaluate the image as it displays. If the image is
satisfactory, allow the scan to complete.
operation.
displays.

instructions.


Note: If the analysis of the scan The Forearm analysis includes all activities that begin with a
is to be postponed to a later satisfactory image and ends with the calculation and summary of
time, the scan can be searched
the results of the scan. After completing a scan, the system
for in the Scan. Refer to Chapter
6 for information about the Scan automatically saves the scan, in the Scan Drawer, for analysis.
Drawer. The three parts of analysis include:
• Choosing the analysis method.
Note: If the patient has a respective (left or right)
Forearm baseline scan, the software proceeds directly to
the compare analysis function instead of choosing the
in Chapter 14. Forearm scan analysis is discussed
beginning on page 10-14.
• Performing the analysis.
• Generating a report.

The first analysis activity involves selecting the analyze setup.
The analyze setup determines the method that the system uses to
perform the analysis. It can perform the analysis either as a single
new scan, or as a comparison to one that has been previously
performed.
(Left or Right Forearm analysis) and the system presents a single
scanned image for analysis. If this scan is a follow-up visit, select
the Compare to Previously Analyzed Scan radio button. The
system then presents two images. The left image is the
unanalyzed scan, and the right image is a previous scan with the
region of interest (ROI) defined.
This allows the system to perform the new analysis on the same
ROI as the previous scan and maximize accurate reporting of
changes. Follow-up visits are discussed in detail in Chapter 13.


Step Action
button.
KP0886-1009
Note: The Analyze Setup window 2 Click the Choose Analysis Method radio button.
displays with the Choose
Analysis Method radio button 3 Verify the analysis method.
selected as the default.
4 Click Next >> button.
Comparison is covered in detail
in Chapter 13. The Analysis window displays.
Methods of Analysis
Step Action
window.
From the Exit Exam window, click the Analyze Scan
button.
Note: Subregion Forearm
analysis is available as an
option.
KP0886-1010


Performing the Forearm Analysis

Once the setup method has been selected, continue to the analysis
window to adjust the quality of the image and properly define the
area of analysis called the region of interest (ROI).
on the left side of the window (see Figure 10-6), allow the
operator to proceed step-by-step through each task. These tools
can maximize image quality and accuracy, preventing the need
for re-scanning.
Forearm
Analysis Window
KP0886-1011
Toolbox
The steps to analyze the forearm scan include:

1. Entering the patient’s forearm length, measured earlier, in
centimeters (Length Toolbox).
5. Adjusting the ultra distal region and divider (MID/UD but-
ton).
Exiting the analysis window (Close button).

Entering the Forearm Length

Enter the forearm length, measured during the patient
positioning, to proceed with the analysis.
KP0886-1012
KP0886-1013
To enter the forearm length:

Step Action
Note: The forearm length must 1 Click the Length button.
be between 12.0 and 42.0
centimeters. If a value is entered 2 Enter the forearm length in centimeters into Forearm
outside of this range, the system length (cm).
displays a message prompting a
correct value be entered. The
entered forearm length value is
displayed throughout the
analysis.



KP0886-0818
Figure 10-7
Left Forearm Scan Right Forearm Scan
ROI Image in the Analysis
Window
Note: The images show the Left

and Right Forearm scans with a
yellow dashed box around the
Global ROI. Note that the Right
Forearm scan is the reverse of
the Left Forearm scan because
of the positioning of the forearm
during the examination.
Hints for Identifying Soft

Tissue and Air: Soft tissue
displays as the lightly shaded
area surrounding the radius and
ulna. Air is the darker area
outside the forearm soft tissue. KP1068_002-1014
The system automatically calculates the length of the ROI box

based on the forearm length previously entered. It calculates the
box length by dividing the forearm length by 3 and adding 10mm
to allow for the 1/3 Distal Region.
The Forearm ROI should include:
• a small amount of air on the ulna side
• radius and ulna bones


The Global ROI Toolbox includes tools to help define the region
of interest.
• Whole Mode
dashed yellow outline with three horizontal solid red
lines. Use this mode to position the top or bottom lines of
the ROI on the Styloid Process. The ROI moves as a
whole unit.
• Line Mode
When selected, the left border line on the ROI box
initially displays as a dashed yellow line. Use this mode
to precisely position the left and right sides of the ROI
box on landmarks, as indicated in the Step/Action table.
• 1/3 Distal
When selected, the top or bottom border line on the ROI
box initially displays as a dashed yellow line. Use this to
adjust the size of the 1/3 Distal region if necessary (it is
KP0886-1015 rarely necessary to adjust this region).
To define the ROI using Whole and Line Mode:

Step Action
Note: This procedure is for a 1 After the length of the forearm is entered the program
Left Forearm scan, the will automatically select the Global ROI button and the
procedure for the Right Forearm
Whole Mode button (as defaults).
scan is the same except the
image of the scan is the reverse The system displays a yellow dashed box around the
(see Figure 10-7 on page 10-16), forearm image (see Figure 10-7 on page 10-16).

Step Action
KP1068_002-1033
Note: For a Right Forearm scan 2 Click in the yellow dashed box and hold the button to
the yellow dashed line would move the box. Position the top line on the ulnar styloid
position the bottom line on the
process.
ulnar styloid process.
3 Click the Line Mode button.

The ROI box outline displays with two dashed lines on
KP1068_002-1035
the left side, a line with large yellow dashes and a line
with small white dashes.

Step Action
Yellow Large Dashed Line
Blue Small Dashed Line
KP1068_002-1038
The distance between the two dashed lines has been

calculated for the proper analysis and cannot be changed.
The Yellow dashed line is active, it can be moved using
the mouse.
4 Click on the yellow dashed line and move it and the blue
dashed line until the blue dashed line is just touching
bone.
5 Click either button under Select a line.
The yellow and blue dashed lines now appear on the right
side of the scan.
KP1068_002-1039

Step Action
Yellow Dashed Line

Blue Dashed Line
6 Click on the yellow dashed line and move it and the blue
dashed line until the blue dashed line just touches bone.
KP1068_002-1041

About the 1/3 Distal Region

The system automatically sets this region based upon the
measured forearm length.
Use this adjustment for research applications only.
KP0886-1016
To adjust the 1/3 distal region:

Step Action
1 Click the 1/3 Distal button.
The Medial boundary of the global ROI displays as active
(dashed yellow line).

Step Action
KP1068_002-1041
2 Click and drag the dashed yellow line up or down to

increase or decrease the 1/3 region.
As the line moves, the parallel boundary of the 1/3 distal
region also moves.

The system creates a yellow bone map of the forearm over the
ROI defined in the previous steps. It automatically fills holes in
the yellow bone map.
KP0886-0821

Step Action
The Bone map displays in yellow.

Step Action
KP1068_002-1017

edited.
There must be air (dark area) beyond the soft tissue on the ulna
side of the ROI. If there is not enough air, the system displays a
poor bone map image. If this occurs, click the ROI button and
increase the amount of air beyond the soft tissue on the ulna side.
If there are no bone areas to be filled in (the vast majority of
forearm scans), proceed to Adjusting the Ultra Distal Region.

KP0886-1018

Step Action
1 Click the Add Bone radio button.
used.
Holes function will not work.
5 To automatically fill the remaining holes, click the Fill
Holes button.


Step Action
1 Click the Delete Bone radio button.
used.
deleted is removed.
Adjusting the MID/UD Regions

The next step in the analysis is adjusting the MID/UD regions.
The size of the regions and their position can be adjusted. The
KP0886-1019 UD (ultra-distal) default position is 10mm from the end of the
ROI. This position may have to be adjusted to exclude the end
plate of the radius (dense cortical bone). Cortical bone appears
much denser (lighter) on the monitor.

KP1068_002-1022
Although not usually necessary, the size of the UD (ultra-distal)

region can be increased or decreased to exclude as much cortical
bone as possible.
The MID/UD Toolbox
To check the MID/UD region
The MID/UD Toolbox includes tools that help define the MID/
UD regions:
• Whole Mode
Use this mode to move the UD (ultra-distal region) as a
whole.
• Line Mode
Use this mode to increase or decrease the size of the
MID/UD region.
To check the MID/UD region
Step Action
1 Click the MID/UD button.
The ROI box displays in the image area with the UD
region displayed as active (dashed yellow lines).
2 Verify that the UD region excludes the end plate of the
radius (dense cortical bone).
KP0886-1021

To adjust the MID/UD region:

Step Action
Note: The UD region is the area 1 The Ultra Distal button is the default and should be
between the two horizontal active (click if not already selected).
dashed yellow lines.
The Ultra Distal region displays as active (yellow dashed
lines).
Note: Cortical bone appears 3 Click and drag the UD region to exclude the end plate of
much lighter (denser). the radius (dense cortical bone).
About the Ulna/Radius Divider

The system automatically computes the division and no
adjustment is required under normal conditions. If no changes
are necessary, proceed to Viewing Results on page 10-28.
KP0886-1021
KP0886-1022
To automatically reposition the ulna/radius divider:

Step Action
1 Click the Divider button in the MID/UD Toolbox.
The Auto Position button displays.

Step Action
2 Click the Auto Position button.
The system recalculates the divider line position and
displays it on the image.
To manually reposition the ulna/radius divider:
Step Action
1 Click the Divider button in the MID/UD Toolbox.
The divider line displays as active (dashed yellow line).
Note: This line cannot be moved 3 Click and drag the line left or right.
outside of the ROI boundary.
4 Click the Point Mode button.
A plus sign appears at each end of the divider line.
5 Click a point on the divider line and drag as necessary to
separate the ulna and radius.
The selected point displays as active (yellow).
Viewing Results
KP0886-0825
The forearm results window shows:

factory.
• Radius/Ulna
Indicates regions of the radius and/or ulna included in the
• Area
• BMC
• BMD


Analysis Window
Analysis results KP1068_002-1023
To generate results:
Step Action
The Results Toolbox displays with three buttons: Radius
+ Ulna Results, Radius Results, and Ulna Results.
KP0886-1024

Step Action
2 The Radius + Ulna Results button is the default and
should be active (click if not already selected).
The system displays the combined radius and ulna
results.
KP1068_002-1025
3 To display only radius results, click the Radius Results

button.
The system displays the radius results only.
KP1068_002-1026

Step Action
4 To display only ulna results, click the Ulna Results
button.
The system displays the ulna results only.
KP1068_002-1027

Step Action
Note: Once an Analysis Step 1 Click the appropriate Analysis Step Button (see Figure

Step Action
chapter.


To select a report type to print, click on the Report button in the
Exit Analysis window. Refer to Exiting the Analysis on page 7-27
of Chapter 7 for detailed instructions.
To exit the Analysis window after obtaining results:
Step Action
1 Click the Close button in the lower left corner of the
Analysis window.
To exit the Analysis window before obtaining results:

Step Action
Note: The scan may be analyzed 1 Click the Cancel button in the lower left corner of the
at a later time from the main Analysis window.
window (see above).


This section provides examples that illustrate unacceptable scan
images.
Figure 10-9
Unacceptable Forearm
Scan: Crooked and Positioner
Seen on Image
KP0886-1028

Figure 10-10
Unacceptable Forearm Scan:
Clipped at the Top and Off
Center
KP0886-1029
Figure 10-11
Unacceptable Forearm
Scan: Started Too High
KP0886-1030


Chapter 11
Whole Body Scan
This chapter provides procedures to perform a Whole Body scan and
analysis.
The following models can perform scans of the whole body:
• Discovery-A
• Discovery-W
• Discovery-Wi
• Explorer (with Whole Body Option)
Content
Subject Page
The Whole Body Examination 11-2
Auto Whole Body 11-2
Positioning the Patient and C-Arm 11-4
11-1
The Whole Body Examination

The Whole Body examination includes all activities that begin
when the patient enters the exam room, and ends when an
Auto Whole Body

Note: Refer to “Analyze Tab” on The QDR system Auto Whole Body feature automatically
page 5 of Chapter 18 on how to adjusts the analysis for patients weighing from 17.6 lbs (8 Kg) to
disable the Auto Whole Body
88 lbs (40 Kg). Above 88 lbs, the Auto Whole Body analysis
feature.
provides results identical to previous whole body analysis
versions. The software has not been evaluated for patients
weighing less than 17.6 lbs and use on patients below this weight
is not recommended.
Because Auto Whole Body automatically provides an improved
analysis for patients less than 88 lbs (40 Kg), the Pediatric Whole
Body analysis method is no longer recommended. Patients
previously analyzed with Pediatric Whole Body should be re-
analyzed using Auto Whole Body. Note that while it is still
possible to use Pediatric Whole Body, reference database
comparisons and T and Z scores will not be valid.
Auto Whole Body is only available on systems that have the
body composition analysis option. If the QDR system acquiring
the scan does not have body composition option, then Whole
Body measurements on subjects less than 40 kg are not
recommended.

11-2 Performing and Analyzing the Whole Body Scan


of Chapter 6).

KP0886-1101
The scan type for the Whole Body scan is Whole Body or HP
Whole Body.

Alternate scan modes:
Note: The Use Default Scan There are no alternate scan modes for the Whole Body
Mode check box is grayed and examination.
cannot be unchecked.
To choose the scan mode:

Step Action
1 Click on Whole Body or HP Whole Body in the scan
type list.
Performing and Analyzing the Whole Body Scan 11-3


Note: Typically, it should not be The only scan parameter that can be modified is the scan length
necessary to adjust the scan (see Figure 11-1). The scan length for a Whole Body exam is
length unless performing a
approximately 77 inches (195 cm). The scan width is
Whole Body scan on a child.
approximately 27 inches (69 cm). The system may change the
number entered to match the pre-programmed step size of the
scanning mechanism.
Figure 11-1
Whole Body Scan
Parameters
KP1035A-1102
To verify scan parameters:

Step Action
corner.
Note: Typically, it should not be 2 To change scan length, place the cursor in the Scan
necessary to adjust the scan Length field and type the new length.
length unless performing a
Whole Body scan on a child.
KP0886-stop
Positioning the Patient and C-Arm

This section provides information for positioning the patient, the
table, and the C-arm for a Whole Body exam. It is important to
follow each set of directions carefully since they are designed to
help acquire an ideal scan by describing:


alignment.

table.

Positioning the patient for a Whole Body scan involves aligning
the patient’s body with the center lines at the right (head) and left
(foot) sides of the table pad (see Figure 11-1).

Step Action
1 Lie the patient on their back with the head at the right end
of the table. Instruct the patient to look at the ceiling to
maintain head position.
Table button must be held and The table and C-arm move to the center.
only the table moves.
Note: If the patient is taller than 3 Check the patient’s position on the table pad (see
6’6” (198 cm), extend the Figure 11-1), ensuring that the following conditions are
patient's feet beyond the end of
met:
the table. Instruct large patients
to place their hands vertically at • Body straight on the table pad using the center
their sides with the fifth finger on lines at the head and foot ends of the table pad as
the table pad. Their hands
the gauge.
should be next to the thighs to
ensure the hands and arms are • Body, including the feet, are positioned entirely
within the table limits. within the scan limit border line.
• Arms are at their sides, with the palms down,
separated from the thighs, and within the scan
limit border.
• Feet are pointing up.
4 Rotate the patient’s legs inward 25° until the toes touch,
then place tape around the feet to maintain position.
5 Instruct the patient to remain still and breathe normally.


An acceptable whole body scan includes the following:
• Entire body
For patients larger than 6’6”, the feet may be excluded
from the scan.
• Arms
For patients who may be larger than the width of the exam
table, parts of the arms may be excluded from the scan.
Starting the Whole Body Scan

Once the patient is positioned correctly, return to the computer to
start the Whole Body scan. At this time, the Scan Parameters
To start the Whole Body scan:
Step Action
operation.
2 Make sure the patient’s arms are included in the scan on

the first and last pass of the C-arm. The patient should
remain still until the scan is complete.

Step Action
Note: Discovery-A makes 3 3 Allow the scan to complete.
passes while Discovery-W, When the scan completes, the Exit Exam window
Discovery-Wi and Explorer (with
displays.
Whole Body option) make 7
passes to complete the Whole
Body scan.
While the scan is being acquired the operator has two options:
Option Description
window displays.
KP0886-0809 proceeds to the main window.

instructions.

Note: If the analysis of the scan The Whole Body analysis includes all activities that begin with a
is to be postponed to a later satisfactory image and ends with the calculation and summary of
time, the scan can be searched
for after clicking Analyze Scan.
automatically saves the scan in the Scan Drawer. The three parts
of analysis include:
Note: If the patient has a Whole Body baseline scan, the
software proceeds directly to the compare analysis
function instead of choosing the analysis method.
Compare analysis is discussed in detail in Chapter 14.
Whole Body scan analysis is discussed beginning on page
11-9.


The first analysis activity involves selecting the Method of
Analysis. Under method of analysis for whole body you have 2
selections:
• Whole Body Fan Beam. This method of analysis is used
to analyze scans acquired on an adult patient.
• Pediatric Whole Body. Although no longer
recommended, Pediatric Whole Body is available for
legacy purposes (see Auto Whole Body on page 11-2).

Step Action
button.
KP0886-1105
Note: The Analyze Setup window 2 Select the method of analysis appropriate for the age of
displays with the Choose the patient (either Whole Body Fan Beam or Pediatric
Whole Body).
selected as the default.
on page 14-8 of Chapter 14.
KP0886-1106


Choosing the Compare to Previous Analysis

If this scan is a follow-up visit, select the Method of Analysis
appropriate for the age of the patient then select the Compare to
(ROI) defined. This allows the system to perform the new
analysis on the same ROI as the previous scan and maximize
accurate reporting of changes. Follow-up visits are discussed in
detail on page 14-7 of Chapter 14.
Performing the Whole Body Analysis

on the left side of the window (see Figure 11-2), allow the
operator to proceed step-by-step through each task. These tools
can maximize image quality and accuracy, preventing the need
for re-scanning.
Figure 11-2 Analysis Step buttons
Whole Body
Analysis Window
KP0886-1107
Toolbox
The steps to analyze the Whole Body scan include:


2. Defining the Regions (Regions button).


25, in Chapter 7, for detailed instructions
Defining the Regions

The Regions are predefined as a template overlay and can be
adjusted to match the patient’s anatomy.
Figure 11-3
Regions Image in
the Analysis Window
KP0886-1108

Regions Toolbox
The Regions Toolbox includes tools to help define the regions of
interest.
• Line Mode
When selected, one line on the regions template initially
displays as a dashed yellow line. Any of the template
lines can be selected and then moved. Top or bottom
(horizontal) lines can be moved up or down. Side
(vertical) lines can be moved left or right.
• Whole Mode
When selected, the entire regions template initially
displays as a dashed yellow line. This allows the entire
template to be moved. This tool is usually used during a
compare scan.
• Point Mode
When selected, a plus sign displays at the end of each line
in the regions template. These end points can be moved in
any direction.
KP0886-1109

Figure 11-4
Positioning Horizontal Lines
KP0886-1110
To position horizontal template lines in the Line Mode:

Step Action
1 Click the Regions button in the top left corner of the
The regions template displays in the image area.
The middle top line of the regions template displays as an
active line (dashed yellow).
3 Click and drag the middle top line of the region (labeled
A on Figure 11-4) to just under the patient’s jaw.
Note: Dashed yellow lines are 4 Click and drag the small horizontal line in the spine
active and can be edited. Solid (labeled B on Figure 11-4) to the approximate level of
T12-L1.
5 Click and drag the horizontal line above the pelvis
(labeled C on Figure 11-4) to just above the iliac crest.

Figure 11-5
Positioning Vertical Lines
KP0886-1111
To position vertical template lines in the Line Mode:

Step Action
1 Click and drag the vertical line on either side of the chest
(labeled A on Figure 11-5) to bring each one close to the
chest.
2 Click and drag the vertical line on either side of the spine
(labeled B on Figure 11-5) to bring each one close to the
spine.
3 Click and drag the vertical line on either side of the legs
(labeled C on Figure 11-5) to bring each one close to the
leg.
4 Click and drag the bottom center vertical line (labeled D
on Figure 11-5) to separate the legs and feet.

Figure 11-6
Fine-tune the Vertical Lines
C
D
E
Note: Must scroll down to
see the 2 points for E
(not shown in figure).
KP0886-1112
To position and fine-tune template lines in the Point Mode:

Step Action
Plus signs display at the end of each line in the regions
template.
2 Click the point on the left shoulder (labeled A on
Figure 11-6) and drag so that it is positioned between the
head of the humerus and scapula at the glenoid fossa.
Repeat this step for the right shoulder (also labeled A on
Figure 11-6).
A total of two points will have been repositioned when
finished with this step (one on the left and one on the
right).
3 Click the left points along the spine (labeled B on
Figure 11-6) and drag them close to the spine, matching
the curvature if possible. Repeat this step for the spine’s
right side (also labeled B on Figure 11-6).
A total of six points will have been repositioned when
finished with this step (three on the left and three on the
right).

Step Action
4 If necessary, click the left point above the iliac crest
(labeled C on Figure 11-6) and drag it out at the sides to
include soft tissue of the chest and thighs. Repeat for the
right point (also labeled C on Figure 11-6).
finished with this step (one on the left and one on the
right).
5 Click and drag the lower point of the triangle below the
pelvis (labeled D on Figure 11-6) to bisect both femoral
necks.
A total of one point will have been repositioned when
finished with this step.
6 Use the scroll bar to scroll the image to the bottom of the
scan. Click and drag the points near the feet (labeled E on
Figure 11-6) to include as much of the soft tissue in the
thighs as possible without including the patient’s hand
and fingers.
finished with this step (one on the left leg and one on the
right leg).
Viewing Results
KP0886-0825
The whole body results area of the Analysis window shows:

factory.
• Regions
Indicates individual regions included in the analysis and
• Area
• BMC

• BMD
Analysis Window
Analysis Results KP1068_002-1113
While the analysis is being performed, an Automatic Low

Density analysis will be used (unless disabled) if system software
determines it is needed. Upon completion of Auto Analysis,
analysis results are displayed. If the software determined
Automatic Low Density analysis was required, it will be noted in
the analysis results label.
To view results:
Step Action
window.

Step Action
Note: If the Body Composition
Analysis (BCA) option is
installed on the QDR system
then a BCA report can be
generated.
KP1068_002-1114

Step Action
Note: Once an Analysis Step 1 Click the appropriate Analysis Step Button (see
Button is modified, each Figure 11-2) and modify.
results will not be accurate. Regions Toolbox.

Step Action
chapter.

Exit Analysis window. Refer to Exiting the Analysis in Chapter 7
for detailed instructions.



An acceptable image should show the patient’s entire body
including the hands and feet. If the patient exceeds the table
limits, the hands and feet can be excluded from the image:
• For patients taller than 6 ft. 6 in. (198 cm), an acceptable
image may not include the feet.
• For patients wider than the exam table scan field
indicators, an acceptable image may not show the arms in
their entirety.

Chapter 12
AP/Lateral Spine Scan
This chapter provides procedures to perform an AP/Lateral Spine
scan and analysis.
The following models can perform an AP/Lateral Spine scan and
analysis:
• Discovery-A
• Discovery-SL
The AP/Lateral Spine scan is used to perform a measurement of
the spine in the lateral view with a parent AP scan.
Content
Subject Page
The AP/Lateral Spine Examination 12-2
Placing the Patient on the Table 12-2
Positioning the Patient 12-4
Positioning the C-arm 12-5
Performing the AP Scan 12-7
Analyzing the AP Scan 12-9
Performing the AP Analysis 12-11
Performing the Lateral Scan 12-25
Analyzing the Lateral Scan 12-28
12-1
The AP/Lateral Spine Examination

The AP/Lateral Spine examination includes all activities that
begin when the patient enters the exam room, and ends when
acceptable images of the AP and Lateral spines are obtained. The
activities involved in performing the scans include:
• Placing the Patient on the Table
• Positioning the Patient
• Positioning the C-arm
• Performing the AP Scan
• Analyzing the AP Scan
• Performing the Lateral Scan
• Analyzing the Lateral Scan


of Chapter 6).
After creating or retrieving a patient biography, the Select Scan
Type window displays, but before selecting the scan type,
continue with Placing the Patient on the Table below.

This section provides instructions for placing the patient on the
table before beginning the AP/Lateral exam. Follow the
directions carefully to acquire the best possible scan.
12-2 Performing and Analyzing the AP/Lateral Spine Scan

To place the patient on the table:

Step Action
Note: Refer to Chapter 7 for a 1 Press the Patient On/Off switch on the Control Panel
detailed description of placing and seat the patient on the table between the scan field
the patient on the table.
indicators on the table pad. Their right shoulder should be
adjacent to the C-arm.
Note: Refer to Introducing the 2 Lie the patient on their back with their head at the right
Positioning Aids on page 1-11 of end of the table and place the Head Positioner under the
Chapter 1 for more information
patient’s head (see Figure 12-1).
about the positioning aids.
3 Press the Center Table button on the Control Panel.
The table and C-arm move to the center.
4 Continue with Selecting the Scan Type and Mode below.

After creating, or retrieving a patient biography, the Select Scan
Type window displays.
KP0886-1201
The scan type for the AP Lumbar Spine scan is AP/Lateral that is
selected in the Select Scan Type window. A check mark () in the
Use Default Scan Mode box designates the Express mode that
takes 10 seconds.

To perform the scan in a different mode, remove the check mark
and a window will display that allows selection of an alternate
scan mode. See “Alternate Scan Modes” on page 12-42.
Performing and Analyzing the AP/Lateral Spine Scan 12-3

To choose the default scan mode (check mark in box):

Step Action
1 Click on the AP/Lateral in the scan type list.
The Continuously Press ENABLE... message displays.
3 Press and hold the Enable button on the Control Panel
until motion is complete.
4 Continue with Positioning the Patient below.

When performing the AP scan, it is important to center the patient
on the table so that they do not have to move between the AP and
lateral scans. During the system setup for the AP scan, the table
will lock in the centered position. The operator will still have the
ability, however, to move the C-arm to the correct starting point
for the scan.
Figure 12-1
Contour Pillow
Knee Positioner
Area to be scanned
KP0886-1202


Step Action
1 Position the patient’s body so that the spine is straight on
the table pad.
The patient’s shoulders should be at the upper scan limit
line and the patient must be centered on the table.
2 Verify that the patient’s pelvis and shoulders are aligned
straight on the table pad and centered to the marks on the
table pad.
Note: Refer to Introducing the 3 Place the positioner under the patient’s lower legs.
Positioning Aids in Chapter 1
for more information about the
positioning aids.
4 Adjust the positioner by rotating it until the femurs are as
vertical as possible. This will help reduce the lordic curve
o
90
KP0886-1203
5 Place patient’s arms over their head and into the contour
pillow (see Figure 12-1 and Figure 12-2).
6 Instruct the patient to remain still and to breathe
normally.

Now that the patient and table are in position, and the scan type
has been selected, the next step is to position the C-arm and align
the laser.

To position the C-arm using the laser:

Step Action
Note: The table is locked in the 1 Press the Laser button on the Control Panel.
center position. You cannot use
the Table buttons on the control 2 Verify alignment of the patient’s midline, extending from
panel. the patient’s xiphoid process to symphysis, to the
Note: The horizontal line is the horizontal laser line. If necessary, center the patient’s
long line that extends head to midline to the horizontal laser line. There should only be
foot. minimal positioning required if the patient is centered
properly on the table.
3 Determine the position of the patient’s iliac crest.
4 Press the Laser button on the Control Panel.
5 Use the Arm Controls on the Control Panel to place the
cross hair of the laser 1 to 2” below the iliac crest and
centered in the mid-line of the patient.
6 Press the Continue button.

(see Figure 12-2). The scan length for an AP/Lateral exam is
approximately 8 inches (20 cm). If the patient is taller than six
feet, you may want to increase the scan length to 9.4” (23.9 cm).
The system may change the number you enter to match the pre-
programmed step size of the scanning mechanism.
Figure 12-2
AP/Lateral Scan Parameters
KP1035A-1205


Step Action
corner.
2 To change scan length, place the cursor in the Scan
Length field and type the new length.
Performing the AP Scan

An acceptable AP scan (see Figure 12-3) includes the following:
• The scan starts in the middle of L5.
• The iliac crest is evenly displayed in both lower corners of
the image area.
• The AP Lumbar Spine is centered in the middle of the
scan window.
• There are even amounts of soft tissue on each side of the
spine.
• The scan stops where ribs are attached to T12 (usually the
middle of T12).
Figure 12-3
AP Scan
KP0886-1206

Starting the AP Scan

To start the AP scan:
Step Action
operation.
KP0886-1207
2 Inspect the image and verify that the center of L2-L4 is

between the blue guide lines.
If not, the patient is not centered on the table and needs to
be repositioned and re-scanned.
3 When you see where ribs are attached to T12 on the
image, click the Stop Scan button.
Option Description
window displays.
KP0886-0809 proceeds to the main window. To
be repositioned.

Option Description
instructions.

If your scan is positioned correctly it will not be necessary to
reposition. If you need to reposition, refer to Repositioning the
Scan on page 8-9 of Chapter 8.
Analyzing the AP Scan

After acquiring an acceptable image, the system automatically
proceeds to the AP analysis.
The patient must remain in position on the exam table while
performing the AP analysis and setting up the computer for the
Lateral part of the exam.

The AP Lumbar Spine scan analysis includes all activities that
begin with a satisfactory image and ends with the calculation and
summary of the results of the scan. After completing a scan, the
system automatically saves the scan, in the Scan Drawer, for
analysis. The three parts of analysis include:
Note: If the patient has an AP Lumbar Spine baseline
scan, the software proceeds directly to the manual
compare analysis function instead of choosing the
in Chapter 14. Manual AP Lumbar Spine scan analysis is

performed.

(Lumbar Spine) and the system presents a single scanned image
for analysis. If this scan is a follow-up visit, select the Compare
to Previously Analyzed Scan radio button. The system then
(ROI) defined.
ROI as the previous one and maximize accurate reporting of
changes. Follow-up visits are discussed in detail on page 14-7 of
Chapter 14.
Step Action
1 After an acceptable image has been acquired, the Analyze
Setup window displays.
KP0886-1208
selected as the default. 3 Verify the analysis method (see Methods of Analysis
Comparison is covered in detail below).
on page 14-8 of Chapter 14.
Methods of Analysis
The Lumbar Spine analysis is the standard method for analyzing
AP scans. This method should be used first before trying Low
Density Spine analysis. The Low Density Spine analysis is used
when the Lumbar Spine analysis produces a poor yellow bone
outline.


Step Action
window.
Note: Subregion Array Spine
analysis is available as an
option.
KP1068_002-0813

Performing the AP Analysis

Note: Refer to “Analyze Tab” on Unless disabled, once the method of analysis is chosen the
page 18-5 of Chapter 18 on how software will automatically perform the analysis. This is called
to disable One-Time™ Auto
One-Time™ Auto Analysis and is a feature of all models in the
Analysis.
QDR Series.

The AP Lumbar Spine scan auto analysis includes all activities
that begin with a satisfactory image and ends with the calculation
and summary of the results of the scan. After completing a scan,
the system automatically saves the scan, in the Scan Drawer, for
analysis.
While One TimeAuto Analysis is being performed, no operator

interaction is allowed. Upon completion of Auto Analysis,
analysis results are displayed.

Figure 12-4
AP Lumbar Spine
OneTime Auto Analysis
Results
Note: Evaluate the analysis for

correct placement of regions and
bone outline. It may be
necessary to adjust the image
display.
KP1068_002-1210
Analysis results
Manual Analysis
The operator may perform a manual analysis of the lumbar spine
scan after the auto analysis is completed. In most cases it will not
be necessary to perform manual analysis. However, upon
Step Action
1 Click on the Global ROI button (see Figure 12-4).
2 Perform the Manual Analysis starting with Performing
the Manual Analysis (page 12-13).

scanning.


AP Lumbar Spine Analysis
Window
KP0886-1211
Toolbox

The steps to manual analyze the AP scan include:
4. Marking the Intervertebral spaces (Vertebral Line button).
5. Labeling the Vertebral bodies and view analysis results
(Results button).


Defining the Region of Interest

KP0886-0818
Figure 12-6 Dashed yellow line
AP ROI Image in the Area to be analyzed
Analysis Window
KP0886-1212
Solid red lines

• The spine centered within the ROI.
• A preset width of 116 lines (automatically preset).
• The top line of the ROI positioned between T12 and L1.
• The bottom line of the ROI positioned between L4 and L5


• Line Mode
• Whole Mode
moved to center the spine while maintaining the 116 line
width.
• Point Mode
ROI box, as well as at the center of the top and bottom
lines. The point mode should not be used when analyzing
KP0886-1213 an AP/Lateral pair.
Step Action
(dashed yellow).
Note: Dashed yellow lines are 3 Click and drag the top line to its position between T12
active and can be edited. Solid and L1 intervertebral space. (Evenly spaced, if possible.
Note: The top line remains 4 Click and drag the bottom line to its position between L4
dashed until the bottom line is and L5 Intervertebral space. (Evenly spaced, if possible.)
clicked.

Step Action
Toolbox.

Step Action
4 Center the ROI box over the spine by clicking and
dragging it to the correct position.

KP0886-0821

Step Action
KP0886-1214

edited.

KP0886-1215

Step Action
Important: Do not alter the bone 1 Click the Add Bone radio button.
edges of the spine, as it degrades The cursor displays as a small green rectangular paint
the reproducibility of the scan. If
necessary, use the Low Density
method to improve bone 2 Select the cursor size using the Cursor Size tool.
mapping. See the Scanning Hologic recommends the default paint brush (size 2) be
Special Conditions section of
used.
this chapter.
Holes function will not work. 5 To automatically fill the remaining holes, click the Fill
Holes button.


Step Action
Note: For spurs or prominent 1 Click the Delete Bone radio button.
Transfers Processes, retain the The cursor displays as a small green rectangular paint
image as painted by the system
to maintain the reproducibility of
the scan. 2 Select the cursor size using the Cursor Size tool.
used.
deleted is removed.

Marking each intervertebral space with a line allows each
individual vertebra to be analyzed separately. The Vertebral
Lines button is used to mark the intervertebral spaces within the
KP0886-0824
region of interest. Up to three lines appear on the image that can
be used to mark the spaces. You may insert up to three lines or
delete lines as necessary.
To mark intervertebral lines using Line Mode:

Step Action
1 Click the Vertebral Lines button, if not already selected.
Three horizontal lines display in the image area.
active and can be edited. Solid (click if not already selected).
The top line displays as an active line (dashed yellow).
Note: The yellow dashed line is 3 Click and drag the top dashed yellow line and place it in
active until the next line is the L1/L2 space, evenly spaced between vertebrae.
selected.
The top line displays as active until you select the next
line.
Note: Active yellow dashed lines 4 Click and drag the middle line and place it in the L2/L3
can not cross a solid line except space, evenly spaced between vertebrae.
in point mode.
The middle line displays as active until you select a
different line.

Step Action
5 Click and drag the lowest intervertebral line and place it
in the L3/L4 space, evenly spaced between vertebrae.
The lowest line displays as active until you select a
different line.
KP0886-1216
To remove a line:
Step Action
Note: Use if analysis is three 1 Click on the line.
vertebrae or less. Line displays as active (dashed yellow).
2 Click the Delete Line button.
Line disappears.
To insert a line:
Step Action
Note: A maximum of three 1 Click the Insert Line button.
vertebral lines can appear on the A new line displays as active (dashed yellow), just above
image.
the previous active line, if any.
Point Mode
Point mode is used to mark intervertebral spaces of the Scoliotic
space and is explained in Scoliotic Spine Scans on page 8-30 of
Chapter 8.

Labeling The Vertebral Bodies

The Results button is used to automatically label the marked
vertebral bodies. Vertebra labels are automatically placed in
areas outside the bone region when possible.
KP0886-0825
Labeling Guidelines
Use the following guidelines to verify labels:
• Labels are automatically assigned numbers starting at the
top with L1.
• The top-most vertebra within the ROI is always labeled
L1.
Including or Excluding Vertebrae from Analysis

Once the operator verifies that the labels correspond to the correct
vertebral bodies, specific vertebrae can be included or excluded
from the analysis. Some reasons for excluding vertebral bodies
include: foreign objects (artifacts) within the scan area, the scan
area is a surgical location, or a physician requested the exclusion
(physician’s discretion).
To automatically label vertebrae:
Step Action
1 Click the Results button, if not already selected.
The vertebral bodies are automatically labeled starting
with L1.
2 Verify that the labels correspond correctly to the anatomy.
Usually no changes are necessary.
KP0886-1217

To change vertebrae labels:

Step Action
1 To change the label numbering, click the ▲ or ▼ arrow in
the First Label area of the Label Toolbox.
The label numbering on the image increments or
decrements accordingly. The first (top-most) label
displays in the First Label box.
2 To include or exclude a vertebra, click anywhere within
the boundary of the labeled vertebra on the image.
The ROI boundary for the selected vertebra displays as
active (dashed yellow).
3 To exclude, click the Exclude button.
The label on the image turns red indicating that the
vertebra has been removed.
4 To include previously excluded vertebra, click the
Include button.
The label on the image turns yellow indicating that the
vertebra has been included.
Viewing Results
KP0886-0827
The spine results window shows:

factory.
• Regions
point to the results.
• Area
Results display in cm² (centimeters squared).
• BMC
• BMD
Bone mineral content expressed in g/cm² (grams per

To view results:
Step Action
1 The Results button should have already been selected
when labeling vertebrae. (Click if not already selected).
window.
AP Analysis Window
Results Area
KP1068_002-1218
Results area
Verifying the Start Position

The Start Position button allows the operator to verify the
starting point for the Lateral scan. The starting position is
calculated from the placement of the bottom of the ROI. If the
bottom line of the ROI is incorrectly placed, then the starting
position for the Lateral scan will be incorrect.
When the Start Position button is clicked, the system calculates
the centerline. If the patient positioning was incorrect, it may be
necessary to stop the analysis, reposition the patient, and repeat
the AP scan.
Centerline Warnings
The system displays the following warnings, depending on the
calculation of the centerline:

Centerline Angle
Note: If the centerline angle is
greater than 5 degrees the
system will not allow the
acquisition of a supine lateral
BMD scan.
KP0886-1219
The system displays this message if the centerline angle is greater

than the recommended maximum of 5 degrees from vertical. If
the system displays this warning message, decide whether to
reposition the patient and repeat the AP scan, or continue the
analysis.
• Click the Yes button to repeat the AP scan. If Yes is
selected, the system does not save the analysis and returns
you to the scan process.
• Click the No button to continue. If No is selected, the
system saves the analysis and returns to the Exit Exam
window.
Centerline Outside of Range
KP0886-1220
The system displays this message if the centerline extends outside

of the acceptable range. If this warning occurs, stop the analysis,
reposition the patient, and repeat the AP scan. Click the OK
button to return to the Exam setup window.

Centerline not Calculated
KP0886-1221
The system displays this message if it is unable to calculate the

centerline. If this warning message occurs, stop the analysis,
reposition the patient, and repeat the AP scan. Click the OK
button to return to the Exam setup window.
To check the start position:
Step Action
1 Click the Start Position button.
The system displays the Start Position Toolbox with a
Reset button. The scan image displays with a centerline
within L2 and L4 and an arrow indicating the start of the
Lateral scan.
Note: The start position of the 2 If the start position of the AP portion of the AP/Lateral
AP portion of the AP/Lateral scan is incorrect, reanalyze the AP to include the correct
scan should not be changed.
vertebrae.

Step Action
Note: Once an Analysis Step 1 Click the appropriate Analysis Step Button (see Figure

Step Action

Step Action
chapter.
To continue:
Step Action
Performing the Lateral Scan

Important: If the patient moves, The Lateral setup prepares the system for lateral scanning. It can
the AP setup and AP scan must only be performed after completion of the AP analysis for the
be repeated before performing
same patient, without the patient moving.
the lateral scan.
Performing the Lateral part of the AP/Lateral exam involves the
following activities:
• Rotating the C-arm to the lateral scan position
• Scanning
• Analyzing the Lateral scan
Rotating the C-Arm for the Lateral Scan

After completing the analysis of the AP scan by clicking the
Close button in the AP Analysis window, the system
automatically proceeds to the Lateral part of the exam and
displays the following message.
Continuously press ENABLE switch to move system into position
Abort
KP0886C-1222
Continuously press the Enable button on the Control Panel until

the C-arm has fully rotated to the lateral scan position.
Once the C-arm is in the correct position, the Scan Parameters
window displays.

Remind the patient not to touch the sides of the table during C-
arm rotation.
Table Safety Feature

Note: If the Table button does The Discovery-A and -SL provides a built-in safety feature. If
not turn back on, call the you or the patient touch the safety strips along either edge of the
Hologic Help desk.
table, the C-arm motion stops and emits a musical tone.
Once the tone stops, the Table button on the Control Panel turns
back on and you can continue. Press the Enable button to
complete the C-arm rotation.

(see Figure 12-8). The scan length for a Lateral spine exam is
approximately 6 inches (15 cm).
Figure 12-8
Lateral Scan Parameters
KP1035A-1223

Step Action
1 Verify patient name and scan type in the upper left corner
of the Scan Parameters window.
2 Verify the scan length.
Starting the Lateral Scan

computer to start the Lateral scan.

To start the Lateral scan:

Step Action
2 When the lateral scan begins, the system evaluates the
operation.
patient’s size and recommends the appropriate scan array
mode.
KP0886C-1224

4 As soon as L2–L4 are fully displayed, click the Stop
Scan button
Caution: The patient should be 5 Continuously press the Enable Lateral button on the
instructed to not touch the sides Control Panel until motion stops.
of the table during C-arm
The C-arm moves to the correct position.
rotation.
While the scan is being acquired the operator has three options:
Option Description
window displays.

Option Description
KP0886-0809 proceeds to the application main
window. To start another scan the
C-arm must be repositioned.
Removing the Patient From the Table

When an acceptable Lateral image has been obtained, perform the
following steps to allow the patient to get off the table.
Step Action
1 Continuously press the Enable Lateral button on the
Control Panel until motion stops.
The C-arm rotates and the table moves to the home
position.
2 Press the Patient On/Off button to move the C-arm and
table to permit the patient to get off the table.
3 Instruct the patient to get off the table.

Exiting the Examination on page 7-23 of Chapter 7 for detailed
instructions.
Analyzing the Lateral Scan

The Lateral scan analysis includes all activities that begin with a
satisfactory image and ends with the calculation and summary of
automatically saves the scan, in the Scan Drawer, for analysis.
The three parts of analysis include:

• Choosing the analysis method.

Note: If the patient has a Lateral baseline scan, the
software proceeds directly to the compare analysis
function instead of choosing the analysis method.
Compare analysis is discussed in detail in Chapter 14.
Lateral scan analysis is discussed beginning on page 12-
31.

performed.
(Lumbar Spine) and the system presents a single scanned image
for analysis. If this scan is a follow-up visit, select the Compare
to Previously Analyzed Scan radio button. The system then
(ROI) defined.
ROI as the previous one and maximize accurate reporting of
changes. Follow-up visits are discussed in detail in Chapter 13.

Step Action
button.
KP0886C-1226
selected as the default. 3 Verify the analysis method (there is only one choice).
on page 14-8 of Chapter 14. 4 Click the Next >> button.

Performing the Lateral Analysis

scanning.
Lateral ROI Image in the
Analysis Window
Toolbox KP0886C-1226
The steps to analyze the Lateral scan include:

3. Adjusting the Vertebral boundaries (Vertebral Boundaries
button).
4. Adjusting the Vertebral bodies (Vertebral Bodies button).


adjustments only. Refer to Contrast and Brightness, in Chapter 7,
for detailed instructions.

is being analyzed. The ROI appears on the image as a
parallelogram with a bisecting line running down the middle and
KP0886-0818
the top and bottom edges initially positioned according to the AP
scan: the dashed line is active and can be adjusted; the solid lines
are inactive and cannot be adjusted.
Figure 12-10
Lateral ROI Image in the
Analysis Window
Spinous
Process
5 Lines
KP0886C-1227

• The bisecting line positioned close to the vertebral bodies,
without touching their posterior edges.
• The right edge of the ROI positioned ½ of a vertebral
width anterior to the anterior edges of the vertebral
bodies.
• The left edge of the ROI positioned 5 lines to the right of
the posterior edge of the shortest spinous processes, inside
of the processes (see Figure 12-10).


• Line Mode
selected and then moved. To preserve the synchronization
of the AP and Lateral scans, all lines can only be moved
left or right.
• Whole Mode
moved as a unit.
• Point Mode
ROI box, as well at each end of the Posterior Boundary
line.
KP0886C-1228
Reanalysis Warning
If the AP scan has been reanalyzed, the system displays a warning
when the Global ROI button is selected. You have the option to
reset the ROI to match the new AP baseline scan analysis.
KP0886C-1229
If the lateral scan about to be analyzed was previously analyzed,

the system bypasses the Analysis Step Buttons and displays only
the Results button.
Step Action

Step Action
(dashed yellow).
Note: Dashed yellow lines are 3 Click and drag the top line until the bisecting line is
active and can be edited. Solid against the posterior edge of L2. Note, that the sides of
the ROI and bisecting line remain parallel.
Note: The top line remains 4 Click and drag the bottom line until it is against the
dashed until the bottom line is posterior edge of L4.
clicked.
5 Click and drag the left (posterior) line so that it is five
lines to the right of the shortest posterior edge of the
spinous processes, as shown in Figure 12-10.
Step Action
Toolbox.
Note: Be careful not to set the 3 Position the cursor arrow anywhere within the ROI box.
posterior edge of the ROI The crossed arrows cursor displays.
outside of the spinous process as
the inclusion of air in the ROI 4 Position the ROI so that the posterior boundary line
degrades the precision and includes as much of the posterior spinous process as
accuracy of the measurement. possible without including air in the ROI.
Adjusting the Vertebral Boundaries

Clicking the Vertebral Boundaries button allows the operator to
place the anterior boundary of the vertebral bodies and confirm
the vertebral lines that divide the vertebral bodies.
To adjust the Anterior Boundary:
Step Action
1 Click the Vertebral Boundaries button, then choose the
Ant. Boundary radio button in the Boundaries Toolbox.
The Anterior Boundary displays on the image as a
dashed yellow line, along with the Global ROI, Posterior
Boundary, vertebral bodies regions, Vertebral Spacer
lines and labels.

Step Action
2 Click the Line Mode button and move the dashed yellow
Anterior Boundary line to the most anterior point of L2-
L4.
3 Click the Point Mode button and adjust the anterior
points to match the curve of the spine.
4 Click the Vertebral Lines radio button to adjust the
spacer lines between the vertebrae. This step is not
usually necessary as the line placement is based on the
location of the AP scan.
Adjusting Vertebral Bodies

The Vertebral Bodies button allows the operator to mark the
boundaries of the vertebral bodies. The most important edge is
the anterior side. Be careful not to make the box larger than the
actual vertebral body.
To adjust the Vertebral Bodies in Whole Mode:
Step Action
Note: Line Mode is the default 1 Click the Vertebral Bodies button.
when the Vertebral Bodies The system displays three Vertebral Region boxes—one in
button is selected.
each vertebral body.
Note: It may be necessary to 2 Click and drag the active box (dashed yellow lines) just
adjust the size and shape of each inside the vertebral body.
vertebral body using Line and
Point Mode.
3 Repeat for each remaining vertebral body.
To adjust the Vertebral Bodies in Line Mode:

Step Action
The top line of the selected vertebral body displays as
active (dashed yellow line).

Step Action
2 Adjust each side of each box so that it fits just inside the
vertebral body.
KP0886C-1231
To adjust the Vertebral Bodies in Point Mode:

Step Action
A plus sign displays in each corner of the selected
vertebral body, one of which is active (yellow).
2 Adjust each corner of each box so that it conforms to the
shape of the vertebral body.
Confirming Lumbar Vertebrae Labels

The system automatically labels the lumbar vertebrae according
to the AP scan. Do not change the labels.
KP0886C-1230

If necessary, you can remove L4 from the analysis if the iliac

crest is overlapping all, or a portion of L4.
To exclude/Include from analysis:
Step Action
1 In Whole Mode, select the vertebral body to be excluded
or included in the analysis.
The vertebral body is highlighted with an interior dashed
box.
2 Perform one of the following:
KP0886C-1230a To remove the vertebral body from the analysis
click the Exclude button.
To add the vertebral body to the analysis click the
KP0886C-1230b
Include button.

KP0886-0821

Step Action
KP0886C-1232

Step Action
edited. If the image is unacceptable, click the Vertebral
Bodies button and re-adjust R2-R4 so that they are just
inside the bone edges.
If you properly adjusted the Vertebral Bodies in the previous step,
then you should not need to edit the bone map. For instructions on
editing the bone map, refer to the bone map editing topic in the
AP analysis section of this chapter. The bone map on a lateral
scan is not usually edited.
Adjusting the Mid Regions

If present, use the Mid Regions button to adjust the regions that
report the bone density in the interior (middle) of the vertebral
bodies.
To adjust the Mid Regions in Whole Mode:
Step Action
1 Click the Mid Regions button.
The Global ROI, Posterior, and Anterior Boundaries
display along with one mid region in each of the vertebral
spaces.
One of the mid regions displays as active (dashed yellow
lines).
3 Click on the desired mid region and adjust as needed.
Place the mid regions in the center and slightly anterior in
each vertebral body.

To adjust the Mid Regions in Line Mode:

Step Action
1 Click the Mid Regions button, if necessary.
spaces.
The top line of one of the mid regions displays as active
(dashed yellow line).
Note: Do not move any other 3 Click and drag each line of the mid region as necessary.
edge.
4 Repeat for each remaining mid region.
To adjust Mid Regions in Point Mode:

Step Action
1 Click the Mid Regions button, if necessary.
spaces.
Plus signs appear at the corners of one of the mid
regions.
3 Click and drag corner points to adjust the mid region as
necessary.
4 Repeat for each remaining mid region.
Viewing Results
KP0886-0825
The Lateral results window shows:

factory.

• Regions—Vertebral Bodies
• Area
• BMC
• BMD
Lateral Lumbar Spine
Analysis Window
Results area KP1068_002-1233
Results toolbox
To view results:
Step Action
Note: Information about Mid 1 Click the Results button.
Regions only displays if the Mid The system displays the Results Toolbox with two buttons:
Regions option is turned on.
BMD and WA-BMD.

Step Action
2 • Click the BMD button to display Bone Mineral
Density results.
KP1068_002-1234
• Click WA-BMD button to display Width-

Adjusted BMD results.
KP1035A-1235 -


Step Action
Note: Once an Analysis Step 1 Click the appropriate Analysis Step Button (see
Button is modified, each Figure 12-5) and modify.

Exit Analysis window. Refer to Exiting the Analysis on page 7-27
of Chapter 7 for detailed instructions.
To exit the Analysis window after obtaining results:
Step Action
Analysis window.
To exit the Analysis window before obtaining results:

Step Action
1 Click the Cancel button in the lower left corner of the
Analysis window.


the image quality).

The scan modes include:
Scan Mode Time

High Definition (h) 120 seconds
Array (a) 60 seconds
Fast Array (f) 30 seconds
Express (x) 1 10 seconds

1 Default

window:
Step Action
1 Click on the AP/Lateral exam type in the list.
the check box.
Check mark removed.
The Select AP Lumbar Spine Scan Mode for AP/Lateral
Exam window displays.
KP1068A-1236


Step Action
The Select Lateral Scan Mode for AP/Lateral Exam
window displays.
KP0886C-1237

8 Continuously press and hold the Enable button on the
Control Panel.
The C-arm moves to the center position and the table
locks into place.
9 Press the Continue button.
The system displays the following message, and turns the
laser on.
KP0886C-1238

Chapter 13
Instant Vertebral Assessment
and Quantitative Morphometry
This Chapter provides procedures to perform Instant Vertebral
Assessment (IVA HD and IVA) and Quantitative Morphometry
(QM) examinations on the QDR systems. IVA provides
functionality for the acquisition of scans that allow the
determining of the presence or absence of vertebral fractures. QM
provides the ability to analyze the shape of vertebra using
vertebral height measurements and calculations of those heights
to compute wedge ratios. The anatomical sites that are available
to view are the AP and lateral vertebral bodies from T4 to L4. The
process includes performing the scan and viewing the image.
IVA scans are intended for the visualization or quantitative
assessment of vertebral bone deformities. IVA also allows the
visualization of abdominal aortic calcification, and, if present,
clinical correlation may be advised since abdominal aortic
calcification may be associated with cardiovascular disease.
Contents
Subject Page
Introduction 13-2
The IVA Examinations 13-4
IVA Imaging on an A or SL System 13-4
IVA Imaging on a C, Ci, W or Wi System 13-21
IVA with BMD 13-38
IVA Image Viewer 13-55
Using Markers 13-61
Generating and Printing Images and Reports 13-69
Interpreting the IVA Image 13-74
13-1
Introduction
Quantitative Morphometry (QM) analyzes the shape of the
vertebra using vertebral height measurements and calculations of
those heights to compute wedge ratios. This information can be
used directly or compared over time.
Specification
IVA HD and IVA specifications are found in the Discovery Series
and Explorer Technical Specifications Manual.
Patient Position and Scanning

Positioning the patient is different on an A and SL system than on
a C, Ci, W and Wi system. See the description below for your
system.
Patient Positioning on A or SL System

To complete an AP and Lateral IVA examination on an A or SL
system, the patient is placed in the AP Lumbar Spine position
(Figure 13-1) and the AP IVA scan is performed. Between the AP
IVA scan and the Lateral IVA scan the patient must remain
motionless while the C-arm is rotated into the lateral position and
the Lateral IVA scan is performed.
Figure 13-1
Knee Positioner
Contour Pillow
Area to be
scanned
KP1068A-QM-01
13-2 IVA and QM

Patient Positioning on C, Ci, W or Wi System

Note: The patient’s head must be To complete an AP and Lateral IVA examination on a C, Ci, W or
towards the right side of the table. Wi system, the patient is placed in the AP Lumbar Spine position
and the AP IVA scan is performed. Between the AP IVA scan and
the Lateral IVA scan the patient must be repositioned from the
lumbar Spine scan position (on their back) to a lateral scan
position (on their side). The spine should remain in relatively the
same position on the examination table (Figure 13-2).
Figure 13-2 Patient in Lumbar Spine scan position
Patient Positioning
Lower limits for Spine should remain

scanning spine in the same relative
on the mattress. position for both scans.
Patient in Lateral scan position
IVA and QM 13-3

The IVA Examinations

The IVA option allows two types of IVA examinations to be
performed on the QDR systems:
• IVA Imaging
• IVA with BMD
IVA Imaging Exam

The IVA Imaging examination can be performed on any
Discovery A/SL/C or W system. The examination consists of
performing a Lateral IVA scan, an AP IVA scan, or both. A report
or an image of the scan and the analysis can be printed.
IVA with BMD Exam

The IVA with BMD examination can be performed on an A or SL
system only. The examination is the same as the IVA Imaging
examination except that it includes AP/Lateral pair BMD.
IVA Imaging on an A or SL System

The IVA Imaging examination includes all activities that begin
• Starting the Examination
• The AP IVA Scan
• The Lateral IVA Scan
13-4 IVA and QM


with the scan. Refer to “Preparing the Patient” on page 7-2 of
Chapter 7.

If this is a new patient create a new patient biography. If this
patient already has a biography, retrieve it now. Refer to
“Creating/Retrieving a Patient Biography” on page 7-4 of
Chapter 7.
Starting the Examination

To start the examination:
Step Action
1 On the Main Screen click the Perform Exam button.
The Select a Patient window will appear.
KP1068A-QM-07
KP1068A-QM-08
IVA and QM 13-5

Step Action
2 Highlight the name of the patient and click the OK
button.
The Patient Confirmation window will appear.
Note: The Accession Number 3 Fill in the information required (such as the Accession
must be present in order to use Number and other information) and click on the OK
DICOM.
button.
The Select Scan Type window will appear.

Scan Type window displays. The operator can select the IVA
Imaging examination and determine which IVA scans to acquire.
KP1068A-QM-10
13-6 IVA and QM

If the check mark () is not removed from the Use Default Scan
Mode check box the examination will continue using the scan
defaults. The default is Lateral IVA scan only, and takes 10
seconds.
To run the IVA Lateral only:
Step Action
1 Highlight IVA Imaging in the Scan Type window.
2 Click Next >>.
The system prompts the operator to continuously press
Enable.
3 Continuously press Enable until table motion stops. The
system prompts the operator to align the patient.
4 Align the patient the same way as if performing an AP
Lumbar Spine scan (“Positioning the Patient” on
page 12-4 in Chapter 12).
5 When the patient is properly positioned, press Continue.
Enable.
6 Continuously press Enable until C-arm motion stops.
Continue with Confirming Scan Parameters for AP IVA
Scan on page 13-10.
To select IVA Imaging AP/Lateral:
Step Action
1 Click to remove the mark in the Use Default Scan
Mode box.
The mark disappears.
IVA and QM 13-7

Step Action
The following window appears for the AP IVA scan (SE
AP Image):
The operator has two choices for the AP IVA scan:

None - do not perform an AP IVA scan (automatically
defaults to performing a Lateral IVA scan)
SE AP Image - perform an AP IVA Scan
KP1068A-QM-11
3 Make a selection from the above window and click

Next>>.
Selecting None means you do not want to perform an AP
scan (only a lateral scan will be performed).
If None is selected, continue with Confirming Scan
Parameters for AP IVA Scan on page 13-10.
Selecting SE AP Image means you want to perform an
AP scan.
If SE AP Image is selected, the following window will
appear for IVA Lateral scan (SE Lateral Image).
13-8 IVA and QM

Step Action
KP1068A-QM-12
The operator has two choices for the IVA Lateral scan:
None - do not perform an SE Lateral scan
SE Lateral Image - perform an SE Lateral Scan
Next>>.
Selecting None means you do not want to perform a
lateral scan (only an AP scan will be performed). For this
choice the scan parameters window for the AP IVA scan
will appear. Continue with Confirming Scan Parameters
for AP IVA Scan on page 13-10.
Selecting SE Lateral Image here means you want to
perform an AP scan and a lateral scan (both scans will
be performed). For this choice, the system prompts the
operator to continuously press Enable.
system prompts the operator to align the patient as
closely as possible with the laser.
6 Continue with Positioning the Patient for the AP IVA
Scan on page 13-10.
The AP IVA Scan

The activities involved in performing the AP IVA Scan include:
• Confirming Scan parameters for AP IVA Scan
• Positioning the Patient for the AP IVA Scan
• Performing the AP IVA Scan
IVA and QM 13-9

• Using the IVA Image Viewer for AP IVA Scan

• Exiting the IVA Image Viewer
Confirming Scan Parameters for AP IVA Scan

The only scan parameter for the AP IVA (f SE AP Image) scan
that can be modified is the scan length. The scan length is 16.1
inches (40.8 cm). Figure 13-3 is an example of the Scan
Parameter/Positioning screen.
Figure 13-3
Scan Parameters/Positioning
for Discovery-A and -SL
KP1068A-QM-14
To verify scan parameters

Step Action
corner.
KP0886-stop
Positioning the Patient for the AP IVA Scan

The procedure used to place the patient on the table for an AP
IVA scan is the same as for an AP Lumbar Spine examination and
is described in “Positioning the Patient” on page 12-4 of Chapter
12.
13-10 IVA and QM

Performing the AP IVA Scan

computer to start the AP IVA scan. At this time, the Scan
Parameters window is displayed.
To start the AP IVA scan:
Step Action
Note: If the Control Panel X-ray 1 Ask the patient to hold their breath during the ten second
lamp fails to extinguish within 10 scan time (single energy).
press the red Emergency Stop 2 Click the Start Scan button
button on the Control Panel The Scan window displays with the image appearing on the
immediately. Then call Hologic left side. Flashing X-rays On indicator at the top of the
window continues until the scan stops.

4 When you see L4 through T4 on the image, click the Stop
Scan button and then advise the patient that they may
breathe normally.
IVA Image Viewer window displays.
Option Description
window and then the IVA Image
Viewer window displays.
IVA and QM 13-11


KP1068A-QM-16
IVA Image Viewer window
displays.
KP1068A-QM-17
proceeds to the main window. To
be repositioned.
KP1068A-QM-18 either the window image or the
instructions.

If the scan is positioned correctly it will not be necessary to
reposition. Continue with “Using the IVA Image Viewer for AP
IVA Scan” on page 13-46.
If repositioning is required, follow the procedure below.
correct starting point.
Step Action
right and bottom.
completed.
13-12 IVA and QM

Step Action
Cursor
Scroll
Hand
Bars
KP1068A-1327
3 To reposition the lumbar spine:

• Click and drag the image so that the iliac crest is
within the lower portion of the scan field.
• The center of the lumbar spine should be straight
and centered within the scan field.
Scan button.
Note: If the Control Panel X-ray 5 Ask the patient to hold their breath, and click the Start
lamp fails to extinguish within 10 Scan button to start a new scan at the new position.
immediately. Then call Hologic 6 When you see L4 through T4 on the image, click the Stop
Scan button, and then tell the patient to breathe normally.
When the scan completes, the IVA Image Viewer window
displays.

in the window:
Button Description
KP1068A-QM-20
IVA and QM 13-13


KP1068A-QM-21

KP1068A-QM-22
the main window.
Using the IVA Image Viewer for AP IVA Scan

When the scan is complete the program will automatically go to
the IVA Image Viewer (Figure 13-4).
Figure 13-4 Control Bar Image Patient Data
IVA Image Viewer Window for
AP IVA Scan
For a description of the IVA Image Viewer and its controls refer
to “IVA Image Viewer” on page 13-55.
Continue with Exiting the IVA Image Viewer below.
Exiting the IVA Image Viewer

To exit the IVA Image Viewer click Cancel.
If Only AP IVA Scan Selected

If you are performing ONLY an AP IVA scan, the Exit Analysis
window displays. Click Exit to return to the main window.
If Both AP and Lateral IVA Scans Selected

If you are performing BOTH an AP IVA scan and a Lateral IVA
scan, the system prompts you to continuously press Enable.
13-14 IVA and QM

To perform the Lateral after AP scan:

Step Action
Important: The patient must 1 Continuously press Enable until C-arm motion stops.
remain motionless between scans. The C-arm rotates to the lateral position.
2 Continue with Confirming Scan Parameters for Lateral
IVA Scan below.
The Lateral IVA Scan

The activities involved in performing the Lateral IVA Scan
include:
• Confirming Scan parameters for Lateral IVA Scan
• Performing the Lateral IVA Scan
• Using the IVA Image Viewer for Lateral IVA Scan
• Returning the C-arm to the AP Position
Confirming Scan Parameters for Lateral IVA Scan

The only scan parameter for the Lateral IVA Scan (f SE Lateral
Image) that can be modified is the scan length. The scan length is
16.1 inches (40.8 cm). Figure 13-5 is an example of Scan
Parameters/Positioning for Lateral IVA scan.
Figure 13-5
for Lateral IVA scan
KP1068A-1325
IVA and QM 13-15


Step Action
corner.
Performing the Lateral IVA Scan

With the patient and C-arm positioned correctly, return to the
computer to start the Lateral IVA scan. At this time, the Scan
Parameters window should be displayed.
To start the Lateral IVA scan:
Step Action
1 Ask the patient to hold their breath during the ten second
scan time (single energy).
KP1068A-1326

Scan button and then tell the patient to breathe normally.
13-16 IVA and QM

Option Description
KP1068A-QM-16
displays.
KP1068A-QM-17
be repositioned.
instructions.

reposition. Continue with Using the IVA Image Viewer for AP IVA
Scan on page 13-29.
If repositioning is required, follow the procedure below.
Step Action
scan, the Reposition Scan button The image acquired so far displays with a scroll bar on
the right.
is completed.
IVA and QM 13-17

Step Action
Cursor
Scroll
Hand
Bars
KP1068A-1327
3 To reposition the lumbar spine, click and drag the image

so that the iliac crest is within the lower portion of the
scan field.
The center of the lumbar spine should be straight and
centered in the scan area.
Scan button.
Note: If the Control Panel X-ray 5 Ask the patient to hold their breath and click the Start
lamp fails to extinguish within Scan button to start a new scan at the new position.
operation.
displays.
13-18 IVA and QM


in the window:
Button Description
KP1068A-QM-20
KP1068A-QM-21

KP1068A-QM-22
the main window.
Using the IVA Image Viewer for Lateral IVA Scan

Figure 13-6
Lateral IVA Scan
to “IVA Image Viewer” on page 13-55. To perform the DE Scan
function refer to “DE Scan” on page 13-59.
Continue with Returning the C-arm to the AP Position below.
IVA and QM 13-19

Returning the C-arm to the AP Position

To return the C-arm to the AP position:
Step Action
1 From the IVA Image Viewer, click Cancel.
The system prompts you to continuously press Enable.
2 Continuously press Enable until C-arm and table motion
stops.
The C-arm rotates to the AP position and the Exit Analysis
window displays.
3 At the Exit Analysis window, click Exit to return to the
main window.
13-20 IVA and QM

IVA Imaging on a C, Ci, W or Wi System

• The AP IVA Scan

with the scan. Refer to the Preparing the Patient on page 7-2 of

patient already has a biography, retrieve it now. Refer to the
“Creating/Retrieving a Patient Biography” on page 7-4 of

Step Action
KP1068A-QM-07
KP1068A-QM-08
IVA and QM 13-21

Step Action
2 Highlight the name of the patient and click the OK
button.
Note: The Accession Number 3 Fill in the information required (such as the Accession
must be present in order to use Number and other information) and click on the OK
DICOM.
button.
The Select Scan Type window appears.

Scan Type window displays. The operator can select the IVA
Imaging examination and determine which IVA scans to acquire.
KP1068A-QM-10
13-22 IVA and QM

Mode check box the examination will continue using the scan
defaults. The default is the Lateral IVA scan and takes 10
seconds.
To run the IVA Imaging examination using defaults:
Step Action
1 Highlight IVA Imaging in the Scan Type window
Scan on page 13-25.
To select IVA Imaging scan modes:

Step Action
Mode box.
The following window appears for the AP IVA scan (SE AP
Image):
KP1068A-QM-11
The operator has two choices for the AP IVA scan:

IVA and QM 13-23

Step Action
Next>>.
Selecting None means you do not want to perform an AP
scan (only a lateral scan will be performed).
If None is selected, continue with Confirming Scan
Parameters for AP IVA Scan Scan on page 13-25.
Selecting SE AP Image means you want to perform an AP
scan.
If SE AP Image is selected, the following window will
appear for IVA Lateral scan (SE R/L Lateral Image).
KP1068A-QM-12
The operator has two choices for the IVA Lateral scan:
None - do not perform an SE R/L Lateral scan
SE R/L Lateral Image - perform an SE R/L Lateral
Scan.
Next>>.
Selecting None means you do not want to perform a lateral
scan (only an AP scan will be performed).
Selecting SE R/L Lateral Image here means you want to
perform an AP scan and a lateral scan (both scans will be
performed).
For either choice the scan parameters window for the AP
IVA scan will appear. Continue with Confirming Scan
Parameters for AP IVA Scan Scan on page 13-25.
The AP IVA Scan

13-24 IVA and QM

• Positioning the Patient for the AP IVA Scan

• Exiting the IVA Image Viewer

inches (40.8 cm).
Figure 13-7
for C, Ci, W and Wi
KP1068A-QM-13

Step Action
corner.
KP0886-stop
Positioning the Patient for the AP IVA Scan

The procedure used to place the patient on the table for an AP
Lumbar Spine examination and position the C-arm is described in
the Positioning the Patient on page 8-5 of Chapter 8.
IVA and QM 13-25


computer to start the AP IVA scan. At this time, the Scan
Step Action
press the red Emergency Stop 2 Click the Start Scan button.

Scan button and then advise the patient that they may
breathe normally.
Option Description
13-26 IVA and QM


KP1068A-QM-16
displays.
KP1068A-QM-17
be repositioned.
instructions.

reposition. If it needs to be repositioned, follow the procedure
below.
• Repositioning the Image
If the image starts too far above or below L5, or is not
• Repositioning the Patient
Step Action
right and bottom.
completed.
IVA and QM 13-27

Step Action
Cursor
Hand
Scroll
Bars
KP1068A-1319
3 To reposition the lumbar spine:

• Click and drag the image so that the iliac crest is
within the lower portion of the scan field.
• The center of the lumbar spine should be straight
and centered within the scan field.
Scan button.
Note: If the Control Panel X-ray 5 Ask the patient to hold their breath. Click Start Scan to
lamp fails to extinguish within 10 start a new scan at the new position.
Service before resuming operation. Scan button and then tell the patient to breathe normally.
displays.
13-28 IVA and QM


in the window:
Button Description
KP1068A-QM-20
KP1068A-QM-21

KP1068A-QM-22
the main window.

AP IVA Scan
to “IVA Image Viewer” on page 13-55.
Exiting the IVA Image Viewer

To exit the IVA Image Viewer click Cancel.
If both an AP and Lateral IVA scan are to be performed (i.e. SE
R/L Lateral Image was selected as a scan mode), the system
IVA and QM 13-29

displays the Scan Parameters screen. Continue with The Lateral

IVA Scan below.
If only an AP IVA scan was to be performed (i.e. SE R/L Lateral
Image was NOT selected as a scan mode), the scan is complete
and the system displays the Exit Analysis window. Click Exit to
return to the main window.

include:
• Positioning the Patient for the Lateral IVA Scan
• Using the IVA Image Viewer for Lateral IVA Scan
The only scan parameter for the Lateral IVA Scan (f SE R/L
Lateral Image) that can be modified is the scan length. The scan
length is 16.1 inches (40.8 cm). Figure 13-9 is an example of
Scan Parameters and patient positioning.
Figure 13-9
Lateral IVA Scan Parameters
and Patient Positioning for C, Ci,
W and Wi
13-30 IVA and QM


Step Action
corner.
KP0886-stop
Positioning the Patient for the Lateral IVA Scan

For an IVA Lateral scan on a Discovery-C or -W system the
patient is placed on their side (laterally) on the exam table. If the
patient is on their right side, facing the rear of the unit, their head
is to the right and their back is toward the front (Figure 13-9). The
spine should be straight and parallel to the long edge of the table.
The remainder of this section provides detailed information for
positioning the patient, the table, and the C-arm for an IVA
Lateral exam. It is important to follow each set of directions
carefully since they are designed to help acquire an ideal scan by
describing:
alignment.

If the patient is not already on the table, press the Patient On/Off
switch on the Control Panel. When all scanner motion has
stopped, seat the patient on the table between the scan field
indicators on the table pad. Their right shoulder should be
adjacent to the C-arm.

Position the patient as described below:
IVA and QM 13-31

Figure 13-10
Patient Positioning for an IVA Pillow
Spine Exam

Step Action
1 Lie the patient on their right side with their head at the right
end of the table.
Place pillow(s) under the head to square the shoulders and
to keep the spine parallel to the table.
2 Check to see that top of the shoulders are within the scan
area as marked on the table top.
Note: It is convenient to have the 3 Check to see that the patient’s back is parallel to the front
patient dressed in an open-backed edge of the scanner and that the midcoronal plane is near
gown so that the vertebral column
the center of the table.
is exposed and can be adjusted
properly. 4 Flex the patient’s hips and knees to a comfortable position.
Flex the knees about 90 degrees. Flex the hips enough so
that the patient does not have a tendency to roll over.
The C-arm and table drive motors provide the table and arm
motion required to scan the X-ray beam along the patient’s spine.
Move the C-arm and turn on the laser using the buttons on the
control panel.
To position the C-arm:
Step Action
1 Move the C-arm to the proximity of the patient’s spine.
2 Turn on the laser.
13-32 IVA and QM

Note: If interested in 3 Position the cross hairs of the laser 2” below the iliac
determining the presence of a crest and centered over the spine.
calcified abdominal aorta,
center over the spine to ensure 4 Move the laser cross hairs 1” toward the back of the
that the aorta is included. patient.
This is to include both the thoracic and lumbar part of the
spine in the scan field.
5 With the patient and C-arm positioned, the scan type and
mode can be selected on the computer.
6 Continue with Performing the Lateral IVA Scan below.

computer to start the Lateral IVA scan. At this time, the Scan
Parameters window should be displayed.
Step Action
IVA and QM 13-33


Option Description
KP1068A-QM-16
displays.
KP1068A-QM-17
be repositioned.
instructions.

reposition. If it needs to be repositioned, follow the procedure
below.
13-34 IVA and QM


Step Action
right and bottom.
is completed.
Cursor
Hand
Scroll
Bars
KP1068A-1334
3 To reposition the lumbar spine, click and drag the image

so that the iliac crest is within the lower portion of the
scan field.
The center of the lumbar spine should be straight and
centered in the scan area.
Scan button.
IVA and QM 13-35

Note: If the Control Panel X-ray 5 Ask the patient to hold their breath and click the Start
lamp fails to extinguish within Scan button to start a new scan at the new position.
operation.
displays.

in the window:
Button Description
KP1068A-QM-20
KP1068A-QM-21

KP1068A-QM-22
the main window.
Using the IVA Image Viewer for Lateral IVA Scan

Lateral IVA Scan
13-36 IVA and QM

to “IVA Image Viewer” on page 55. To perform the DE Scan
function refer to “DE Scan” on page 59.
Click Cancel to display the Exit Analysis window.
At the Exit Analysis window, click Exit to return to the main
window.
IVA and QM 13-37

IVA with BMD

Note: IVA with BMD is The IVA Imaging examination includes all activities that begin
available on A or SL systems for when the patient enters the exam room, and ends when an
AP/Lateral pair.

• The AP BMD Scan
• The Lateral BMD Scan

Chapter 7.

patient already has a biography, retrieve it now. Refer to Creating/
Retrieving a Patient Biography on page 7-4 of Chapter 7.
13-38 IVA and QM


Step Action
KP1068A-QM-07
KP1068A-QM-08
2 Highlight the name of the patient and click the OK button.

Note: The Accession Number must 3 Fill in the information required (such as the Accession
be present in order to use DICOM. Number and other information) and click on the OK
button.
The Select Scan Type window will appear.
IVA and QM 13-39


Scan Type window displays. The operator can select the IVA with
BMD Imaging examination and determine which IVA scans to
acquire.
KP1068A-1336
Mode then the examination will continue using the scan defaults.
The default is the AP BMD, followed by Lateral BMD, followed
by Lateral IVA.
To run the IVA with BMD examination using defaults:
Step Action
1 Highlight IVA Imaging in the Scan Type window.
2 Click Next >>.
Enable.
system prompts the operator to align the patient.
Lumbar Spine scan.
Enable.
13-40 IVA and QM

To select IVA Imaging scan modes:

Step Action
Mode box.
2 Click Next >>.
The following window appears for the AP IVA scan (SE
AP Spine):
KP1068A-1337
There are two choices:

3 Make a selection for the AP IVA scan and click Next >>.
For either choice the following screen will be displayed.
KP1068A-1338
Make a selection for the AP part of the AP Lateral pair

(screen above) and click Next >>.
The following screen will be displayed.
IVA and QM 13-41

Step Action
4 Make a selection for the AP part of the AP Lateral pair
(screen above) and click Next >>.
The following screen will be displayed.
KP1068A-1338
This screen is the scan modes for the lateral part of the
AP Lateral pair, the description of the scan modes is
found in Choosing the Scan Mode on page 12-3 of
Chapter 12.
5 Make a selection for the lateral part of the AP Lateral pair
(above window) and click Next >>. One of the following
will occur:
If None was selected for the AP IVA scan:
• The system prompts the operator to continuously
press Enable.
• Continuously press Enable until table motion
stops. The system prompts the operator to align
the patient.
• Align the patient the same way as if performing
an AP Lumbar Spine scan (described in
Positioning the Patient on page 12-4 of Chapter
12.)
The scan parameters for AP BMD appears,
continue with “Confirming Scan Parameters for
AP BMD Scan” on page 47.
If SE AP Image was selected for the AP IVA scan, the
following window appears for the Lateral IVA scan (SE
Lateral Scan).
13-42 IVA and QM

Step Action
KP1068A-1339
The operator has two choices for the Lateral IVA scan:
None - do not perform a Lateral IVA scan.
Selecting None means you do not want to perform a
lateral scan (only the BMD scan pair and an AP IVA
scan will be performed).
SE Lateral Image - perform a Lateral IVA Scan.
Selecting SE Lateral Image means you want to per-
form the BMD scan pair, and both the AP IVA scan and
lateral IVA scan.
Next>>.
For either choice, the system prompts the operator to
continuously press Enable.
system prompts the operator to align the patient as
closely as possible with the laser.
Lumbar Spine scan (described in Positioning the Patient
on page 13-38 of Chapter 12.)
Scan below.
The AP IVA Scan

IVA and QM 13-43


inches (40.8 cm). Figure 13-12 is an example of Scan Parameters
and Patient Positioning for an AP IVA Scan.
Figure 13-12
Scan Parameters and Patient
Positioning for AP IVA Scan
KP1068A-1341

Step Action
corner.

computer to start the AP IVA (f SE AP Image) scan. At this time,
the Scan Parameters window is displayed.
Step Action
press the red Emergency Stop 2 Click the Start Scan button.
13-44 IVA and QM


Scan button and then tell the patient that they may breathe
normally.
Option Description
KP1068A-QM-16
displays.
KP1068A-QM-17
be repositioned.
instructions.
IVA and QM 13-45

Repositioning
reposition.
If the scan is not positioned correctly the only option is to
reposition the patient. If the spine is not straight, move the
patient’s upper torso either left or right to straighten the spine.

the IVA Image Viewer (Figure 13-13)
AP IVA Scan
to IVA Image Viewer on page 13-55.
Press Cancel from the IVA viewer and the scan parameters screen
for AP BMD (f Lumbar Spine) scan appears. Continue with
Confirming Scan Parameters for AP BMD Scan below.
The AP BMD Scan

The activities involved in performing the AP BMD Scan include:
• Confirming Scan parameters for AP BMD Scan
• Performing the AP BMD Scan
• Analyzing the AP BMD Scan
• Exiting the AP BMD Analysis
13-46 IVA and QM

Confirming Scan Parameters for AP BMD Scan

The only scan parameter that can be modified is the scan length.
The scan length is 8 inches (20.4 cm). Figure 13-14 is an example
of Scan Parameters and Patient Positioning for an AP BMD Scan.
Figure 13-14
Positioning for an AP BMD Scan
KP1068A-1344

Step Action
corner.
3 Click Start Scan to start the AP Lumbar Spine Scan
Performing the AP BMD Scan

The procedure used to perform the AP Lumbar Spine
examination is described in Performing the AP Scan on page 12-7
of Chapter 12.
Analyzing the AP BMD Scan

The procedure to analyze the AP Lumbar Spine is described in
Analyzing the AP Scan on page 12-9 of Chapter 12.
Exiting the AP BMD Analysis

To exit the AP BMD Analyze window:
Step Action
1 From the AP BMD Analyze window click on the Close
button.
2 The system prompts the operator to continuously press
Enable to reposition the C-arm and table.
IVA and QM 13-47

Important: Remind the patient 3 Continuously press Enable until C-arm and table motion
not to move, or touch the sides of stops. The scan parameter window for the Lateral BMD
the table, during C-arm rotation.
scan appears.
4 Continue with Confirming Scan Parameters for Lateral
BMD Scan below.
The Lateral BMD Scan

The activities involved in performing the Lateral BMD Scan
include:
• Confirming Scan parameters for Lateral BMD Scan
• Performing the Lateral BMD Scan
Confirming Scan Parameters for Lateral BMD Scan

The only scan parameter for the Lateral BMD (f Lateral) that can
be modified is the scan length. The scan length is 6 inches (15.3
cm). Figure 13-15 is an example of Scan Parameters and Patient
Positioning for a Lateral BMD Scan
Figure 13-15
Positioning for Lateral BMD
Scan
KP1068A-1345

Step Action
corner.
13-48 IVA and QM

Performing the Lateral BMD Scan

Once the C-arm is positioned correctly, return to the computer to
start the Lateral BMD (f Lateral) scan. At this time, the Scan
To start the Lateral BMD scan:
Step Action

3 When you see where ribs are attached to T12 on the image,
click the Stop Scan button.
4 Depending upon whether or not a Lateral IVA scan will be
performed, one of the following screens displays:
• Continuously press Enable...
If no Lateral IVA scan is to be performed, (i.e.,
None was selected from the Lateral IVA scan mode
window), the system prompts the operator to
continuously press Enable to reposition the C-arm
and table.
Continue with Exiting the Lateral BMD Scan on
page 13-50.
IVA and QM 13-49

• Scan Parameters
If a Lateral IVA scan is to be performed, the system
displays the Scan Parameters window for that scan.
Continue with Confirming Scan Parameters for
Lateral IVA Scan on page 13-51.
Option Description
KP1068A-QM-16
displays.
KP1068A-QM-17
be repositioned.
instructions.
Exiting the Lateral BMD Scan

To exit the Lateral BMD scan:
Step Action
1 At the Continuously press Enable... screen, continuously
press Enable until C-arm and table motion stops.
The C-arm returns to the AP position and the Exit Exam
window appears.
2 At the Exit Exam window, click Analyze Scan to analyze
the lateral scan, or Exit Analysis to exit to the main
window.
The procedure to analyze the Lateral Spine scan is
described in Analyzing the Lateral Scan on page 12-28 of
Chapter 12.
13-50 IVA and QM


include:
• Using the IVA Image Viewer for the Lateral IVA Scan

After the Lateral BMD scan is complete, the scan parameter
screen for the Lateral IVA (f SE Lateral Image) will appear.
The only scan parameter for the Lateral IVA that can be modified
is the scan length. The scan length is 16.1 inches (40.8 cm).
Figure 13-16
Positioning for a Lateral IVA
Scan
KP1068A-1347

Step Action
corner.
IVA and QM 13-51


Step Action
operation.

The IVA Image Viewer window displays.
Option Description
13-52 IVA and QM


KP1068A-QM-16
displays.
KP1068A-QM-17
be repositioned.
instructions.
Using the IVA Image Viewer for the Lateral IVA Scan
Figure 13-17
Lateral IVA Scan
to IVA Image Viewer on page 13-55. To perform the DE Scan
function refer to DE Scan on page 13-59.
Continue with Returning the C-arm to the AP Position below.
IVA and QM 13-53

Returning the C-arm to the AP Position

To return the C-arm to the AP position:
Step Action
1 From the IVA Image Viewer, click Cancel.
The system prompts you to continuously press Enable.
2 Continuously press Enable until C-arm and table motion
stops.
The C-arm rotates to the AP position and the Exit
Analysis window displays.
3 At the Exit Analysis window, click Analyze Another
Scan to analyze the lateral BMD scan or Exit to return to
the main window.
The procedure to analyze the Lateral Spine scan is
described in the Analyzing the Lateral Scan on page 12-
28 of Chapter 12.
13-54 IVA and QM

IVA Image Viewer

The IVA Image Viewer allows the operator to view the IVA
image. There are controls on the Viewer to change viewing
modes, zoom, adjust the brightness and contrast of the IVA
image, place markers, print a report or image and perform a DE
Lateral Scan after running a SE Lateral Scan in an exam.
The IVA Image Viewer
Note: The IVA Image Viewer is The IVA Image Viewer window is divided into three areas:
used after completing an IVA
scan, or by selecting the Analyze • the Image
all Scans tab and then selecting
• the Patient Data
an IVA scan.
• the Control Bar
The Image
The scanned image is shown in the middle of the IVA window.
Figure 13-18 shows the scanned image for an AP IVA scan and
Figure 13-19 shows the scanned image for a Lateral IVA scan.
AP IVA Scan
IVA and QM 13-55


IVA Image Window for
Lateral IVA Scan
The Patient Data

The patient data, for the scan, includes patient name, ID, and
other biographical information and is shown on the right side of
the window.
The Control Bar

The control bar occupies the left side of the window. It remains
the same size, even if the operator changes the window size.
The following describes the controls and their uses:
Control Description
DE Scan button This button is used differently for
the AP and Lateral IVA scan:
KP1068A-1350
• AP IVA Scan. This button
is grayed out and not used.
• Lateral IVA Scan. This
button is active. See page
13-59 for a description of
DE Scan.
Markers button Click Markers to show and edit the
QM data markers. How to use the
KP1068A-1351 markers is described in Using
Markers on pages 13-61 to 13-68.
13-56 IVA and QM

W-L Control The Window-Level control allows

you to change contrast and
brightness-type parameters of the
image. You can select each value
and type in a new value. You can
also dynamically change the W-L
values by dragging the black dot
with the mouse until you reach the
desired image.
For finer adjustment control, use
W-L Adjust (see below).
KP1068A-1352
Revert button Disregards all changes and returns

all viewing parameters to their
KP1068A-1353 initial values. This includes:
• W-L values
• Flip
• Invert
• Zoom: goes to Fit to
Window
Invert button Inverts the gray scale value of each
pixel creating a negative of the
KP1068A-1354 image.
Flip button Flips the image about the center
vertical axis. When Markers are
KP1068A-1355 initialized you cannot flip the
image.
Zoom Control buttons Enlarges or reduces the image
about its center point.
KP1068A-1356
Print Image button Print the image on the selected

printer (see page 13-69).
KP1068A-1357
Print Report button Print the report on the selected

printer (see page 13-72).
KP1068A-1358
IVA and QM 13-57

Cancel button The Cancel button exits the

analysis window and returns to the
KP1068A-1359 main window.
Close button If you perform a rescan, the
Cancel button changes to the
KP1068A-1360
Close button. Close exits the
Important: Once you have made analysis window and returns to the
any edits or re-scanned, you main window, saving any changes
cannot cancel to discard any
changes. Any changes you made
made to the scan.
are saved. If DE is selected, it returns to scan.
Mouse Pointer Controls

Placing the mouse pointer in the image area and right-clicking
displays the image control selection menu. An explanation of
each selection follows:
Zoom and W-L Selection Click one of the choices to
Menu (upper section) activate.
See descriptions below.
KP1068A-1361
Drag Zoom Drag the magnifying glass over the

area of the image that you want to
enlarge. When you release the left
mouse button, the captured area
expands to fit the window.
KP1068A-1362
Drag Pan Click and drag the image to place

it anywhere in the window.
KP1068A-1363
W-L Adjust This W-L Adjust allows finer

control over the W-L control
described earlier. Move it in any
direction to change the W and L
values to the left, but at a finer rate.
KP1068A-1364
13-58 IVA and QM

Zoom Control (lower Select any of the zoom control

section) settings to enlarge or reduce the
image size in the window.
If the image becomes too large for
the width or height of the window,
scroll bars appear at the bottom or
right of the window.
KP1068A-1365
If you are analyzing existing IVA scans, make sure that the spine
is on the left before continuing.
DE Scan
If a more detailed scan is required of part of the spine or a
vertebrae, the operator can define a region on the IVA scan to be
re-scanned using Dual Energy. This region of the patient is re-
scanned at a higher resolution
To perform this rescan the patient must remain on the table and in
the same position as the Lateral IVA scan. If the patient has
moved, or been removed from the table, another Lateral IVA scan
must be acquired and the rescan taken immediately after the
Lateral IVA scan with the patient in the same position.
To rescan:
Step Action
1 Click DE Scan in the upper left-hand corner of the
window.
KP1068A-1366
Two horizontal green lines appear in the upper and lower
Note: If the image is magnified areas of the image.
larger than the window, you may
not see the green lines. Select
“Fit To Window” if you do not
see the lines.
KP1068A-1368
2 Place the mouse pointer over the upper line and drag it to
the top of the region that you want to rescan.
3 Place the mouse pointer over the lower line and drag it to
the bottom of the region that you want to rescan.
IVA and QM 13-59

Upper Rescan Line

Area to be rescanned
Lower Rescan Line
KP1068A-1367
4 Click Close.
Because the DE Scan button was pushed at the time the
Close button was selected, the system returns to the Start
Scan dialog box to start the Dual Energy scan.
Note: It is assumed that the 54 Start the new scan. The system scans the patient and
patient and the C-arm have not returns to the IVA analysis window when done.
been moved since the last scan.
The patient may breathe normally during the Dual Energy
scan.
13-60 IVA and QM

Using Markers
Quantitative Morphometry (QM) allows you to define the shape
of one or more vertebrae by placing markers on the posterior,
anterior and midpoints of the vertebrae.
QM Markers can be placed on the AP and Lateral IVA scans.
Hologic does not recommend placing markers on the AP IVA
scan, however if this is done see “QM Results Block for AP IVA
Scans” on page 13-68 concerning information on determining
tags for the markers.
The Object of QM Markers

The object is to place a marker in the superior and inferior of the
anterior, posterior and midpoints (Figure 13-20) in order to mark
the size and shape of the vertebrae.
Figure 13-20 Superior Posterior Superior Midpoint Superior Anterior
Marker Placement
Inferior Posterior Inferior Midpoint Inferior Anterior
The proper placement of these six markers can be found in “The

Appendix to Chapter 20: Point Placement in Vertebral
Morphometric X-ray Absoptiometry” by Jacqueline A. Rea in
‘The Evaluation of Osteoporosis: Dual Energy Absorptiometry
and Ultrasound in Clinical Practice, Second Edition’, pages 456-
457.
Using QM Markers
QM Markers are placed on the image in the IVA Image Viewer
(Figure 13-20). To start placing markers the operator clicks on the
Markers bottom, then places the cursor on the scan image and
right clicks the mouse. A menu will appear that will allow the
operator to place and label the markers (procedures to place, label
and change the markers are included in this section). As markers
are placed on the scan image, a results block reports information
on the markers.
IVA and QM 13-61

Figure 13-21 Markers button

The IVA Image Viewer
Window
Results Block
Flipping the Image

Note: The image cannot be The IVA scan image should initially display the vertebrae on the
flipped after Markers are added. left. Before adding QM Markers make sure that the spine is on
the left of the image, clicking the Flip button if necessary.
13-62 IVA and QM

Adding QM Markers
To perform Quantitative Morphometry, you must insert QM
markers.
To insert the markers:
Step Action
1 On Control Bar in the IVA Image Viewer Analysis
Window, click on the Markers button (Figure 13-21).
KP1068A-1351
2 Right click on the image and select Add Marker.
KP1068A-1371
The markers appear on the image in the area of the mouse

pointer.
KP1068A-1372
The QM data for L4 also appears at the bottom of the QM

area of the window.
KP1068A-1373
Note: The first set of markers The software limits the marker labels to L4-L1, and T12-
that you add is always labeled T4. The software also inhibits you from changing the
L4. If you rename this set of
label of a marker to one that already exists.
markers to T12, for example, the
software assumes that you want
to label from T12 upward.
Therefore, the next set of
markers that you create is
labeled T11, and so forth.
IVA and QM 13-63

Selecting Markers
To select markers for a vertebrae:
Step Action
1 Place the mouse pointer in the middle of the six markers
and click,
-or-
KP1068A-1374
select the marker data in the QM area of the window.
KP1068A-1375
Note: You can select multiple The selected markers appear yellow (red if image is
markers in both the QM area or inverted). The unselected markers appear red (cyan if the
on the image using combinations image is inverted).
of the left mouse button and the
control and shift keys.
Moving Markers
To move one or more sets of markers:
Step Action
1 Select one or more sets of markers.
2 Click in the area described by the six markers of any of
the selected set(s) of markers.
3 Drag the set(s) of markers to their desired position.
Editing Markers
You can edit only one set of markers at a time.
To edit a set of markers:
Step Action
1 Click anywhere within the set of markers to be edited.
The set of markers become yellow (active).
13-64 IVA and QM

2 Click on one of the six markers and drag it to its desired

position.
KP1068A-1376
3 Repeat Step 2 for the remaining markers.
Labeling Markers Sets

The marker set that you create may not have the correct label
associated with it.
To label a set of markers:
Step Action
1 Select the set of markers.
2 Right-click within the markers of the selected set.
3 Select Label Marker from the menu.
KP1068A-1377
4 From the Label Vertebra dialog box, select the desired

label from the list and click OK.
The label associated with that set of markers changes and
the vertebra moves to the proper position in the QM data
area.
KP1068A-1378
IVA and QM 13-65

Deleting Marker Sets

To delete a set, or sets, of markers:
Step Action
1 Select one or more sets of markers.
2 Right click in any of the selected sets of markers.
Note: You can select multiple 3 Select Delete Marker from the menu.
markers by using combinations
of the left mouse button and the
control and shift keys.
KP1068A-1379
4 When the “Delete selected Markers?” dialog box appears,

click OK.
Deleting markers on the image also deletes them in the
QM area of the window.
QM Result Block
The result box for the Lateral and the AP IVA scans must be
interpreted differently because of the positions of the spine in the
scan.
QM Results Block for Lateral IVA Scans

As QM markers are placed on the vertebrae a report showing the
heights (Hght) of the vertebrae appears in the lower right hand
section of the IVA Image Viewer (Figure 13-22).
13-66 IVA and QM

Figure 13-22
The QM Result Block
KP1068A-1380
The following are descriptions of the labels in the above results

block.
Label Description
Post The height of the vertebrae between the superior and
Hght inferior posterior markers in millimeters.
(mm)
Mid The height of the vertebrae between the superior and
Hght inferior midpoint markers in millimeters.
(mm)
Ant The height of the vertebrae between the superior and
Hght inferior anterior markers in millimeters.
(mm)
Wedge The distance in millimeters when the Ant Hght is
divided by the Post Hght.
Mid The distance in millimeters when the Mid Hght is
Wedge divided by the Post Hght.
The numbers following Std Dev are the standard deviation of the
number above. For example, the Post Hght (mm) has a standard
deviation of +/- 1 mm; the Wedge has a standard deviation of +/-
0.05 mm.
IVA and QM 13-67

QM Results Block for AP IVA Scans

Note: Hologic does not The Result Block for the AP IVA scan will appear the same as
recommend placing QM markers the above Lateral IVA scan but the labels are used differently
on the AP IVA scan.
because of the position of the spine. The Mid Hght, Wedge and
Mid Wedge are the same but the Post Hght must be interpreted
as the Right Side of the vertebrae and the Ant Hght must be
interpreted as the Left Side of the vertebrae according to the
following:
Lateral IVA Scan AP IVA Scan

Post Right
Hght Side
(mm)
(mm)
Ant Left
Hght Side
(mm) (mm)
The Left Side and Right Side labels will not appear in the AP IVA
scan Result Block report or be printed on any reports.
13-68 IVA and QM

Generating and Printing Images and Reports

On the IVA Image Viewer for both the IVA Imaging and IVA with
BMD examinations there are buttons that will print a report or an
image.
IVA reports can also be printed from the Reports button on the
Main screen (see below).
Printing IVA Images from the Reports Button

To print IVA Reports from the Reports Button:
Step Action
1 From the Main screen click on the Reports button.
The Select Patient window appears.
KP1068A-1392
KP1068A-1381
2 Highlight the name of a patient whose report is to be

printed then click on the Next >> button.
The Select Scan window appears.
KP1068A-1382
IVA and QM 13-69

3 Highlight the scan to be printed then click on the Next>>

button.
The Print window appears.
KP1068A-1383
4 Click on the DICOM/IVA Report button

The DICOM Report window appears.
5 To send the report (via DICOM) to the Physician’s

Viewer, click Send.
If an accession number was assigned, the report is sent. If
no accession number was assigned, the Accession No.
Entry window appears (see below).
To preview the report, click Preview,
The Accession No. Entry window appears.
13-70 IVA and QM

KP1068A-1385
6 Click on the OK button.

The DICOM Report Preview window appears.
7 Click on the Print button.

The IVA Report is printed.
See below for sample printouts.
IVA and QM 13-71

Sample Printouts
Sample Image
13-72 IVA and QM

Sample Report
IVA and QM 13-73

Interpreting the IVA Image

IVA images are to be interpreted by a physician or properly
licensed practitioner. IVA images are not intended for general
radiological diagnosis, but are intended to be used for evaluation
of vertebral deformities.
The anatomy of the spine is shown in Figure 13-23, including
vertebral level labels. IVA images typically include levels T4 to
L4. Following the classification scheme of Genant (see reference
below), Figure 13-24 shows examples of a typical vertebral body
shape and examples of deformed vertebral shapes.
Figure 13-23 C1
The Human Spine C1
7 cervical C2
C4
vertebrae C5
C6
C7
T1
T2
T3
T4
T5
12 thoracic T6
vertebrae T7
T8
T9
T10
The human spine usually consists T11
of 7 cervical, 12 thoracic, and 5 T12
lumbar vertebrae.
L1
L2
5 lumbar L3
vertebrae
L4
L5
Ossacrum
KP1068A-1389
13-74 IVA and QM

Figure 13-24
Vertebrae Deformities
Typical Vertebral Body
Typical vertebral body shown

with severely deformed Severe Wedge Deformity
vertebrae.
Adapted from Genant, H.K., C.Y.
Wu, et al. (1993). “Vertebral
fracture assessment using a
semiquantitative technique.” J.
Bone Miner Res 8(9): 1137-48. Severe Biconcavity Deformity
KP1068A-1390
For detailed information regarding vertebral deformity evaluation

and the utility of vertebral deformity assessment in clinical
osteoporosis evaluation, see the references and organizations
listed below.
For Information on Spine Anatomy, Vertebral Deformity
Evaluation, and Vertebral Deformity Classification:
• The Evaluation of Osteoporosis: Dual Energy
Absorptiometry and Ultrasound in Clinical Practice,
Second Edition; Blake, G. M., Walgner, H. W., Fogelman,
I., © Martin Duritz Ltd 1999, “The Appendix to Chapter
20: Point Placement in Vertebral Morphometric X-ray
Absoptiometry” Jacqueline A. Rea: 456-457.
• Genant, H. K., C. Y. Wu, et al. (1993). “Vertebral fracture
assessment using a semiquantitative technique.” J Bone
Miner Res 8(9): 1137-48.
• Genant HK, Jergas M, van Kuijk C (Eds.): Vertebral
Fracture in Osteoporosis. San Francisco, CA, University
of California Osteoporosis Research Group, 1995
• Merrill’s Atlas of Radiographic Positions and Radiologic
Procedures; P. W. Ballinger and Ed Frank, Eds.
(Mosby, New York) 1999
• Diagnosis of Bone and Joint Disorders; R. Resnick, Ed.
(W.B. Saunders Co., Philadelphia) 1995
IVA and QM 13-75

• Radiological Society of North America:

Phone: 30-571-2670
Website: http://www.rsna.org
For Information on Clinical Patient Evaluation and the
Relationship between Vertebral Deformities and Subsequent
Fractures:
• National Osteoporosis Foundation:
Phone: 202-223-2226
Website: http://www.nof.org
• International Osteoporosis Foundation:
Phone: +33 472 91 41 77 (France)
Website: http://www.osteofound.org
• International Society for Clinical Densitometry:
Phone: 202-828-6056
Website: http://www.iscd.org
• American Association of Clinical Endocrinologists:
Phone:
Website: http://www.aace.com
• Black DM, Arden NK, Palermo L, Pearson J, Cummings
SR (1999). “Prevalent vertebral deformities predict hip
fractures and new vertebral deformities but not wrist
fractures.” J Bone Miner Res 1999 14:890-902.
• Davis, J. W., J. S. Grove, et al. (1999). “Spatial
relationships between prevalent and incident spine
fractures.” Bone 24(3): 261-4.
• Melton, L. J., 3rd, E. J. Atkinson, et al. (1999). “Vertebral
fractures predict subsequent fractures.” Osteoporosis Int
10(3): 214-21.
• Nevitt, M. C., P. D. Ross, et al. (1999). “Association” of
prevalent vertebral fractures, bone density, and
alendronate treatment with incident vertebral fractures:
effect of number and spinal location of fractures. The
Fracture Intervention Trial Research Group.” Bone 25(5):
613-9.
13-76 IVA and QM

Chapter 14
Compare and Follow-up
This chapter provides information on using the Compare function of
the QDR system. Compare is an analysis of the current scan using a
previous scan of the same patient. The previous scan is used as a
reference to duplicate the region of interest.
Content
Subject Page
Introducing Compare 14-2
Restoring the Patient’s Baseline Scan 14-3
Evaluating the Patient’s Baseline Scan 14-4
Performing the Follow-up Scan 14-7
Analyzing the Follow-up Scan 14-8
Generating a Rate of Change Report 14-12
Rate of Change Report for Unlike Scan 14-13
Modes
Rate of Change Report for Spine Scans with 14-14
Different Regions
14-1
Introducing Compare
Compare allows comparison of the current scan to a baseline scan
to determine the BMD rate of change over a period of time. The
baseline scan is generally the first scan acquired for the patient.
All follow-up scans are compared to the baseline scan.
When following bone mineral density (BMD) in a patient over a
period of time, it is important to compare the same region of
interest each time. The system helps by displaying the current
scan next to the baseline scan of the same patient. It uses the bone
map of the baseline scan as an overlay on the current scan so you
can visually match the region of interest in the current scan
image.
It is important to duplicate the size, shape, and location of the
region of interest as closely as possible.
Steps
Comparing a scan to the baseline scan involves the following
steps:
1. Locating and Restoring the patient’s baseline scan.
2. Evaluating the patient’s baseline scan.
3. Performing the follow-up scan.
4. Analyzing the follow-up scan using the Compare function.
5. Generating a rate of change report.
The steps are the same for all scan types. This chapter uses the
spine scan as an example, but the Compare function procedures
described here can be applied to all scans.
If necessary, changes can be made to correct the regions.
However, if changes are made, the ROI template will disappear
because it is no longer a direct compare. Examples of when this
may be necessary include a child that has grown or a patient that
has lost vertebral body height. It is still recommended to use
Compare on the follow-up.
14-2 Compare and Follow-up

Restoring the Patient’s Baseline Scan

Before acquiring a new scan, it is necessary to restore the
patient’s baseline scan. The baseline scan is the first scan
conducted on the patient. Each subsequent or follow-up scan is
compared to this baseline scan to determine changes in bone
mineral density.
Restoring a Baseline Scan

Suggestion: At the start of the The patient’s baseline scan is either on the computer’s hard disk
workday, it may be desirable to drive or has been archived onto other media.
locate and restore the baseline
scans for all follow-up patients Use the method described below if the baseline scan is still
scheduled for exams during the located on the computer’s hard drive, that is, it has not yet been
day. As patients arrive, time can archived and deleted from the computer’s hard drive.
be spent updating their records
and taking their history instead If the baseline scan is not on the computer’s hard disk, locate and
of searching for scans. restore the archived scan (see Chapter 16, Archiving, Locating
and Restoring Scans, for detailed instructions).
KP1035A-0313
To restore a baseline scan from the computer’s hard drive:

Step Action
1 Click the Analyze Scan button in the main window.
The system displays the Select a scan to analyze window
with three tabs: Unanalyzed Scans, Analyzed Scans, and
All Scans.
Note: If the baseline scan is not 2 Click the Analyzed Scans tab.
on the computer’s hard disk, The system displays a list of scans sorted alphabetically
locate and restore the archived
by patient last name.
scan (see “Restoring Scans” on
page 16-16 of Chapter 16, for 3 Locate the patient’s name on the list using either or both
detailed instructions). of the following methods:
Note: Case (upper case, lower • Start typing the patient’s name (last name,
case) is ignored when typing a
patient’s name to search for it.
comma, space, first name, space, middle initial)
until the scans for that patient appear.
• Use the scroll bars to bring the patient’s scans into
view.
Compare and Follow-up 14-3

Step Action
4 Click the scan with the oldest date (this is the baseline
scan).
The scan becomes highlighted.
Note: Scans can be compared 5 Click the Next >> button on the Select a scan to analyze
even if they are not the same window.
scan mode.
Note: Do not change the 6 Click the Next >> button on the Analyze Setup window.
analysis method displayed in the to display the analysis window with the baseline scan
Analyze Setup window.
image.
Evaluating the Patient’s Baseline Scan

Before acquiring a new scan, an evaluation must be made of the
patient’s baseline scan. There are two objectives when evaluating
the patient’s baseline scan:
1. Ensure that patient positioning in the baseline scan is dupli-

cated as closely as possible in the follow-up scan. Changes,
even minor, can affect the precision of the BMD measure-
ments.
Note: If the baseline scan 2. Ensure that the baseline scan is analyzed correctly. If the
analysis is incorrect, all analysis is not correct, the baseline scan should be re-ana-
subsequent scans should be
lyzed and re-archived.
reanalyzed and archived.
Evaluating Baseline Scan Patient Positioning

Evaluate the baseline scan image to detect any abnormalities in
patient positioning during the baseline scan. For example:
• Before performing a spine scan, check to see if the spine
is straight and centered on the baseline image.
• Before performing a hip scan, check the baseline image. Is
the Lesser Trochanter clearly visible? How much of it is
visible? Is the leg straight? Evaluating the baseline hip
scan will help in gauging the amount of leg rotation
needed for the new scan.
When evaluating the baseline scan, review the operator or
physician comments, if any. When all of the information about
the baseline scan is known, determine if the baseline positioning
is acceptable.
Reviewing Operator or Physician Comments

The operator who performed the baseline scan may have entered
comments pertaining to positioning the patient. Review the scan

comments on the baseline scan to determine if there is any

information that may be helpful in positioning the patient, or that
may affect the comparison.
For example, the comments may state that the previous operator
was unable to elevate the patient’s legs due to patient discomfort.
You may need to duplicate this positioning in the new scan.
Baseline Positioning Acceptable

If the baseline positioning is acceptable, proceed to Evaluating
Baseline Scan Analysis on page 14-6.
Baseline Positioning Unacceptable

If the baseline positioning is unacceptable, one of the following
three options must be chosen. Consult with the physician to
determine which option to choose for this patient.
1. Take one new scan duplicating the incorrect baseline posi-
tioning.
2. Scan the patient twice. In the first scan, duplicate the incor-
rect baseline positioning. In the second scan, position the
patient correctly, and archive this scan as the new baseline
for future follow-up exams.
3. Take one new scan with correct positioning, and archive this
scan as the new baseline for future follow-up exams.
Scanning Once to Duplicate Incorrect Baseline Positioning

Duplicating the incorrect positioning of the baseline scan obtains
the best possible BMD rate of change. The disadvantage of this
option is that the incorrect baseline scan is not corrected for
subsequent follow-up exams. Consult with the physician before
choosing this option.
Scanning Twice
In the first scan, repeat the incorrect positioning of the baseline
scan. This allows a good BMD rate of change to be obtained for
this exam. In the second scan, position the patient correctly and
archive this scan as the new baseline for future follow-up exams.
The disadvantage of this option is that the patient must be
scanned twice. Consult with the physician before choosing this
option.
Scanning Once with Correct Positioning

Position the patient correctly and archive this scan as the new
baseline scan. This corrects the baseline scan for future follow-up
exams. The disadvantage of this option is that BMD rate of

change is compromised for this exam. Consult with the physician

before choosing this option.
Evaluating Baseline Scan Analysis

Note: If the baseline scan is Evaluate the baseline scan to determine if it must be re-analyzed.
reanalyzed, it must be Re-analysis of the baseline scan may be necessary for a number
rearchived as well. Also
of reasons:
reanalyze and rearchive all
subsequent scans. • The patient’s anatomy has changed since the baseline
scan. For example, a vertebra has collapsed, or there is
more space between vertebra in the new scan.
• The baseline analysis was performed incorrectly, or could
be improved upon.
To reanalyze the current scan:

Step Action
Note: If you need help in 1 Click the appropriate Analysis Step Button and modify.
reanalyzing the scan, refer to the
chapter on performing and 2 Repeat for each subsequent Analysis Step Button,
analyzing the scan for the ending with the Results button.
specific anatomy.

Performing the Follow-up Scan

In addition to the normal process of performing and analyzing a
scan, there are several important considerations, described below,
that could impact the follow-up scan report.
Updating the Patient’s Biography Record

In addition to the standard questions asked when taking the
patient’s history, ask the patient if they have had any injuries or
surgery in the exam area since the last exam.
Note: If the baseline scan is Some examples are:

reanalyzed and rearchived, all
subsequent scans should be • For a spine exam, verify that the patient has not had any
reanalyzed and rearchived. compression fractures since the baseline scan. If they
have, re-analyze the baseline scan and exclude that area.
• For a hip exam, if the patient has had surgery on their
right hip since the baseline scan, that hip can no longer
used as the baseline for comparison. Scan the left hip and
use that as the baseline from now on.
Any new or pertinent information may have to be included in the

patient record. Refer to Chapter 6 for instructions on retrieving
and updating the patient’s Biography file.
Performing the Follow-Up Scan

After retrieving the patient’s baseline scan and evaluating it,
perform the follow-up exam. To perform the appropriate scan
refer to the following:
Scan to be performed Refer to Chapter

Spine 8
Hip 9
Forearm 10
Whole Body 11
AP/Lateral 12

Analyzing the Follow-up Scan

After performing the follow-up scan on the patient, the Exit
Exam window displays.
Note: The steps for Compare

Analysis are the same for all
scan types. This section uses a
spine scan as an example, but
the procedures described here
can be applied to all scans.
KP0886C-1302
To Perform the Compare Analysis

Step Action
KP0886C-1303
Compare to Previously Analyzed
Scan radio button

Step Action
Note: Scans can be compared 2 Click the Compare to Previously Analyzed Scan radio
even if they are not the same button.
scan mode.
A list of scans for that patient will appear in the window
with the oldest scan highlighted. The oldest scan should
be the baseline scan, if it is not then click and highlight
the scan which is the baseline scan.
Baseline scan KP0886C-1304

The analysis window will appear with the baseline scan
on the right and the follow-up scan on the left.
KP0886C-1305
Follow-Up Scan Baseline Scan
A template consisting of the ROI border and bone map
outline displays on the follow-up scan as active (dashed
and solid yellow lines).

Step Action
Note: The ROI may not appear if Global ROI with template
the ROI on the compare scan is
too large, or if the point size and
line size do not match in the
scans.
KP0886C-1306

6 Position the cursor arrow anywhere within the ROI box
of the follow-up scan (to the left).
Note: For finer control in 7 Click and drag the template until it matches the anatomy
positioning the template, the on the baseline scan (to the right).
keyboard arrow keys may be
used to move the template one 8 Click the Bone Map button.
line at a time. The bone map is displayed on the follow-up scan (to the
left).
9 Click on the Vertebral Lines button.
Three horizontal lines display in the image area of the
follow-up scan (to the left).
10 Compare the Vertebral lines on the follow-up scan (to the
left) to those on the baseline scan (to the right). Adjust the
Vertebral lines in the follow-up scan to match those in the
baseline scan.

Step Action
Note: During the compare Results button
analysis it may be necessary to
make minor adjustments to
match the baseline analysis. If
so, return to the appropriate step
and adjust accordingly.
KP1068_002-1307
Current scan results

Analysis window.

Generating a Rate of Change Report

Note: Refer to “Rate of Change After a Compare analysis of the follow-up scan, a Rate of
Report” on page 15-15 of Change report can be generated that provides the change
Chapter 15 for more information
between the baseline analysis and the follow-up analysis.
on the Rate of Change report.
After performing the Compare analysis, the Exit Analysis
window displays. To generate and print a Rate of Change Report,
click the Report button in the Exit Analysis window.
To generate a Rate of Change report:

Step Action
1 Click the Report button in the Exit Analysis window.
Filing check box
KP0886C-1308
Rate of Change check box
2 Click the Rate of Change check box.

A check appears in the check box.
3 Select the number of copies to be printed in the number
box to the right of the Rate of Change check box.
4 Edit the physician’s comments, if desired.

Step Action
5 Click the Print button to print the Rate of Change Report
along with the default Filing Report (check box marked
“Filing”).
Note: Refer to Chapter 15 for
detailed information about
reports.
KP0886C-1309
T-Score
Rate of Change
Rate of Change Report for Unlike Scan Modes

Rate of Change reports for Unlike Scan Modes are generated the
same way as for any Compare Analysis (see Generating a Rate of
Change Report on page 14-12). Areas that are dissimilar on the
reports will be marked by an “*” (see Figure 14-1).

Figure 14-1
Unlike Scan Mode
Rate of Change Report
KP1035A-1314
Rate of Change Report for Spine Scans with Different Regions

When a Rate of Change report for Spine Scans with Different
Regions is generated, a message appears stating that only regions
that have been analyzed will be displayed (Figure 14-2).
Figure 14-2
Different Region Message
KP1068_002-1415

Click OK to generate a rate of change report for spine scans with

different regions.
In the following example (Figure 14-3) the most recent scan has
regions L1, L3-L4 while the prior scan had L1-L4. The Rate of
Change report shows the results for only L1, L3-L4 as indicated
by the graph title. The scan image will reflect the analyzed
regions of the most recent scan.
Figure 14-3
for a Spine Scan
with Different Regions
Note: The DXA Results

Summary table displays BMD
values associated with the
regions that have been analyzed
(circled).
Note: To avoid confusion, a

disclaimer is printed on the KP1068_002-1416
report (circled).


Chapter 15
Reports
This chapter provides information about the types of reports available
in the QDR system. It also includes instructions for printing and
configuring these reports.
Content
Subject Page
Introducing Reports 15-2
Printing Reports 15-6
Previewing Reports 15-11
Report Examples 15-13
DICOM Reports 15-18
Alternate Navigation 15-39
15-1
Introducing Reports
This section provides an overview of the types of reports
available and a description of the information contained on them.
Report Types
Note: DICOM is standard on The QDR system includes four basic types of reports, which can
Discovery-A, -SL, -W and -C be printed, previewed (viewed on the monitor screen), and
models, and available as an
configured to meet specific needs. An additional type of report is
option on other models.
available if the DICOM Option has been installed (refer to
DICOM Reports on page 15-18).
Filing Report
The Filing Report is used primarily for filing examination
information and includes:
• Detailed patient and scan information
• Area, BMC, BMD, and T & Z-score results for each
region
• Scan image with ROI and bone map outline
• BMD vs. Age reference curve graph
• k and D0 calculations
• Physician’s comments
• QDR system technical information
Interpreting Report
The Interpreting Report is primarily for the interpreting physician
and includes:
• Area, BMC, BMD and T & Z-score results for each region
• Scan image with ROI and bone map outline
• BMD vs. Age reference curve graph
Referring Report
The Referring Report is primarily for the referring physician and
includes:
• Summarized patient and scan information
15-2 Reports
• BMD and T-score results for the default region only (as
configured during system setup) for each scan image
• Scan images (up to three/page) with ROI and bone map
outlines
• BMD vs. Age reference curve graph for each scan image

The Rate of Change Report is primarily for tracking changes in
results over time and includes:
• Visit date, patient age, BMD, and T-score results for each
visit
• Changes in results vs. Baseline and previous scans
• Scan image with ROI and bone map outline for current
scan
• BMD vs. Age reference curve graph for each baseline and
subsequent scans
Report Information Blocks

Reports contain blocks of information which vary slightly
depending upon the type of report you choose. Refer to
Figure 15-1 and the following text for an explanation of report
blocks.
Reports 15-3
Figure 15-1
Report Blocks Header
Patient
Information
Scan
Information
Image
DXA
Results
Reference
Graph
Physician
Comment
KP0886C-1401
Header
The Header block displays at the top of each report. It includes
the name, address, telephone, and fax number of the institution or
facility generating the report.
Note: Refer to To configure the The header can be turned off if your facility prefers to print
Header Block on page 18-21 for reports on letterhead.
information on turning the
header off.
Patient Information
The Patient Information block displays information from the
patient biographical record, and any updated information added
on the day the scan was performed. This includes the patient’s
age, height, and weight.
Scan Information
The Scan Information block contains scan record information
about the analyzed scan(s) including scan date, scan type, date of
analysis, operator, model, and serial number of the scanner.
15-4 Reports
Image
Note: Reports printed within the The Image block displays the analyzed image of the scan with
United States include the the region of interest, bone map outline, and global dimension of
disclaimer statement “Image not
the ROI. If the scan has not been analyzed, the image displays
for diagnostic use.”
without the ROI and bone map outline.
DXA Results
The DXA Results summary displayed in this block include the
BMC and BMD of a particular scanned region, and the Z-score
and T-score. The Z-score is a measure of the difference between
the patient’s BMD and that of age, sex, and ethnicity-matched
peers. The T-score is a measure of the difference between the
patient’s BMD and young normals of the same sex and ethnicity.
Reference Graph
The Reference Graph allows comparison of patient data to young
normal adults, and to an age-matched reference population.
The standard deviations appear shaded in different colors. If the
patient’s data point is within the colored portion of the graph, it is
shown as a black cross inside a circle. If the patient’s data point is
outside the colored graph, it is shown as a red cross inside a
circle. The source of the reference curve and scores is shown
below the graph.
Rate of Change Graph

The Rate of Change Graph (not shown on Figure 15-1) identifies
the rate of change of the BMD for the patient at the chosen
anatomical site of the selected scans. Results are reported for the
individual regions, and for the total of the anatomical site. The
Rate of Change graph is used for Follow-Up exams and Compare
procedures and is shown on the Rate of Change Report.
Physician’s Comment
The Physician’s comment block displays any comments
authorized by the physician. Physician’s comments can be
selected when generating the report. They can be selected from a
predefined list, or a new comment can be entered.
Reports 15-5
Printing Reports
APEX allows the operator to access and print reports a number of
different ways. This section includes instructions for printing a
report after completing an analysis and printing a report using the
Report button on the main window.
Printing a Report After Analysis

Note: To preview a report prior After completing the analysis of a scan, one of the options on the
to printing, refer to page 15-11. Exit Analysis window is the Report button. Clicking this button
will bring up the Print window from which reports may be
printed singly or as multiple copies.
Refer to Generating and Printing Reports on page 7-32 for
information on generating a report immediately following the
analysis.
Printing a Report Using the Report Button

Use the Report button in the main window to retrieve a specific
scan and print a report. Clicking the Report button and selecting
the patient’s name displays a list of analyzed scans from which to
choose.
KP1035A-0315
15-6 Reports
Note: Refer to pages 16-12 and The analyzed scan must reside on the computer’s hard drive. If
16-16 for more information on the scan has been deleted, use the Locate and Restore functions
locating and restoring an
to load it back onto the computer’s hard drive.
archived scan.
To print a report using the Report button:

Step Action
Note: Alternate ways to access 1 Click the Report button in the main window.
and print reports are described in The system displays the Select Patient window with a list
the Alternate Navigation section
of patient records, sorted alphabetically by patient last
of this chapter.
name.
2 Click the patient’s name for whom report(s) are to be
printed, then click the Next >> button.
The system displays the Select Scans window with the
patient’s name and ID at the top.
Note: Multiple scans may be 3 Click the scan(s) for which report(s) are to be printed, then
selected by holding down the Ctrl click the Next >> button.
key while clicking each scan with
The system displays the Print window with the patient’s
the mouse.
name and ID at the top.
Note: One or more types of 4 Choose the type(s) of reports to be printed by clicking in
reports may be selected. the box next to the report type.
A check mark indicates that the specified report will print.
Note: The number of copies may 5 For each report type selected, choose the number of copies
also be entered directly into the
to print by clicking the adjacent number box button to
number box.
increase the number of copies, or the button to decrease
the number of copies.
6 To have comments appear on the printed report, click the
Edit physician comments... button (see directions
below).
Reports 15-7
Step Action
7 Click the Preview... button to display a preview of the
report before printing it (see the Previewing Reports
section of this chapter).
8 Click the Configure... button to change the settings of the
report (see “Report Tab” on page 18-10).
9 Click either:
• the Print... button to print the report;
• the << Back button to return to the previous
window; or
• the Cancel button to cancel the operation without
printing.
Printing the Patient Questionnaire

installed.
Printing the Patient Questionnaire
Step Action
1 From the Print screen, click on the Print Questionnaire
button.
The Print screen for the Questionnaire appears.

Questionnaire:
• Print button. Clicking this button prints the
questionnaire to the desired printer and returns the
user to the previous screen.
• Cancel button. Clicking this button returns the
user to the previous screen without saving
answers.
15-8 Reports
Editing the Physician Comment

The Edit physician comment window allows the operator to
choose from a list of predefined comments or enter a new one.
The predefined comments are created by the physician. Any one
of these comments can be added to the report being printed. If
necessary, a new comment can be entered.
The comment selected or entered is saved with the scan record
and displayed in the printed report(s).
KP0886C-1404
To add or change a physician comment:

Step Action
1 In the Print window, click the Edit physician comment...
button.
The system displays the Edit physician’s comment window
with information and results pertaining to the selected
scan(s).
Note: New comments are not 2 • To select from the list of predefined comments,
added to the list of predefined click the button in the Physician’s Comment text
comments.
box and click on the comment you want to include
• To enter a new comment, click in the Physician’s
Comment text box and type the new comment.
3 Click either:
• the Update button to update the scan with the new
comment; or
• the Close button to exit the Edit physician’s
comment window without changing the comment.
Reports 15-9
Print Dialog Box

When the Print... button is clicked, either from the Print window
or the Preview Report window, the system displays a standard
print dialog box for your printer, similar to the one shown below.
KP0886C-1405
Reports can only be printed in portrait mode and on either letter

size (8.5¨ x 11¨) or A4 size paper.
To select the Print dialog settings:
Step Action
Note: It is usually not necessary to 1 If it is necessary to change printer properties, click the
change printer properties or Properties button to display and select the properties for
printer type. This information is
the printer. The properties include settings such as Page
pre-configured.
and Graphics that apply to the selected printer. If printer
properties are changed by mistake, click the Restore
Defaults button to return to the default settings.
Note: If a radio button is grayed 2 To specify which pages to print:
(dimmer than the others), it • Click the All radio button to print all the pages
indicates that option is not
available. • Click the Pages radio button and enter the first and
last page of the range to print
• Click the Selection radio button to print only the
highlighted (selected) information from the report
3 Click the OK button to begin printing the report(s) on the
selected printer.
15-10 Reports
Previewing Reports
The system provides the opportunity to preview each report
before it is actually printed. Clicking the Preview... button in the
Print window displays the report preview window.
Function buttons for Preview
KP0886C-1406
To display a preview of the report:

Step Action
1 In the Print window, click the Preview... button.
The system displays the report preview window showing
the first page of the report.
2 Refer to the table below for a description of each button in
the Report window.
Button Function
Print... Displays the standard print dialog window to print
the selected report.
Next Page Displays the next page of the report, if more than
one page exists. If there is only one page to the
report, this button is inactive (gray).
Prev Page Displays the previous page of the report, if more
than one page exists. If there is only one page to
the report, this button is inactive (gray).
Two Pages Displays two pages in the window. If there is only
one page to print, this button is inactive (gray).
Reports 15-11
Button Function
Note: Clicking within the area of Zoom In Zooms in on the report. If already at maximum
the report causes it to zoom, this button is inactive (gray).
successively zoom in, centered on
the cursor location, until at Zoom Out Zooms out on the report. If already at minimum
maximum zoom. Clicking once zoom, this button is inactive (gray).
more resets the display to
minimum zoom.
Close Closes the print preview window without printing
the report, returning to the Print window.
In addition to using the Next Page and Prev Page buttons, you
can use the scroll bar to the right of the report to scroll through the
pages.
15-12 Reports
Report Examples
This section provides examples of reports for various scan and
report types.
Filing Report
The Filing Report, shown for a spine exam in the example below,
contains detailed information about the patient record and scan
record. The report displays one scan on each page.
Figure 15-2
Filing Report Example:
Spine Exam
KP0886C-1407
Reports 15-13
Interpreting Report
The Interpreting Report, shown for a forearm exam in the
example below, contains detailed information about the patient
record and scan record, and is used by the interpreting physician.
The report displays one scan on each page.
Figure 15-3
Interpreting Report Example:
Forearm Exam
KP0886C-1408
15-14 Reports
Referring Report
The Referring Report, shown in the example below, contains
summarized information about the patient and scan record. This
report is generally used by the referring physician. The report
displays at least three scans per page.
Figure 15-4
Referring Report Example
KP0886C-1409

The Rate of Change Report, shown in the example below,
contains the results of selected scans over a period of time. The
baseline scan is the oldest scan among the selected scans. The
report includes a column for change versus baseline scan, system
technical information and change versus the previous scan. The
most recent scan image is displayed.
Reports 15-15
Figure 15-5
Example: Left Hip
KP0886C-1410
15-16 Reports
The Patient Questionnaire is shown in the example below.
Figure 15-6
Example of the
Reports 15-17
DICOM Reports
Your APEX software treats a DICOM report as an additional

report type that complements its standard Filing, Interpreting
Physician, and Referring Physician report formats.
From the DICOM Report screen you can print the History
Questionnaire (Hx) report.
The DICOM Report screen is shown in Figure 15-7:
Figure 15-7
DICOM Report Screen
To Create and Send a DICOM Report:

Step Action
Note: Alternate ways to access 1 Click the Report button on the main window.
and print reports are described The Select Patient window displays.
in the Alternate Navigation
section of this chapter.
2 Click on the patient’s name for whom you want to create
and send a DICOM report, then click on the Next>>
button.
The Select Scan(s) window displays.
Note: Multiple scans may be 3 Click on the scans that you want to report using DICOM,
selected by holding down the then click on the Next>> button.
Ctrl key while clicking each scan
with the mouse.
15-18 Reports
Step Action
Note: If the DICOM / IVA 4 Click on the DICOM / IVA report button that appears
report button is not visible, the below the Edit physician’s comment… button on the
DICOM option may not have
right side of the Print window.
been properly installed in your
system. The DICOM Report window displays.
5 Select the scan(s) that you want to create DICOM reports

for by clicking on each scan. Use the Select All button to
select all of the scans that appear in the list of scans.
Note: Standardized BMD and 6 Select the DICOM Report Type.
Extended Spine single analysis
reports are available for AP • Single Analysis
Lumbar Spine scans only.
• Rate of Change Report
If you want remove private patient information from the
report, check the De-identify protected health
information check box.
If you want to include the Ancillary Report and/or
patient’s Questionnaire in the study, check the respective
check box.
Note: To preview a report prior 7 Click on the Send button to transmit the report(s).
to transmission, you must select
a single scan then click on the The DICOM Report(s) is (are) placed in the Send Queue
Preview button. for transmission over your network.
Note: You may be prompted to
enter Accession number and
other user defined entries. (see
“Sending a DICOM Report” on
page 15-29).
Choosing the Report Type

DICOM supports the Single Analysis and Rate of Change reports.
These reports are similar to printed reports, but generally contain
more information. DICOM also supports Standardized BMD
(sBMD) and Extended Spine.
Single Analysis reports provide all the quantitative results from a
single scan and analysis—including the scan image and reference
population curves. The Single Analysis Report includes all the
information you need to interpret a scan.
Rate of Change Reports simplifies comparing visit-to-visit rates
of change. Significant changes are noted on the report to facilitate
clinical management. The Rate of Change report also includes the
Single Analysis report for the most recent scan and analysis.
Reports 15-19
To Choose a Single Analysis Report Type:

Step Action
1 On the DICOM Report screen, click on the radio button
Single analysis for the single analysis report.
Note: Standardized BMD and 2 If you want a standardized BMD and/or extended spine
Extended Spine single analysis report, check the Standardized BMD and/or Extended
reports are available for AP
Spine check boxes.
Lumbar Spine scans only.
4 Click on Preview to view the report or Send to transmit
the report.
Note: The accession number and 5 When Send is clicked and the selected scan does not have
any additional user defined an accession number associated with it already, the
entries for a scan are listed in
Accession Number Entry dialog box will appear. Enter an
the scan list on the DICOM
Reports screen. accession number and click OK.
KP1068A-2017
Note: You may be prompted to enter additional user

defined entries. If so, additional entry dialog boxes will
appear. Enter the requested entry and click OK for each
dialog box. (User defined entries can be left blank.) See
“HL7 Tab” on page 18-34 for details on enabling/
disabling the display of these fields and defining their
label names.
15-20 Reports
Choose a Rate of Change Report Type:

Step Action
1 On the DICOM Report screen, click on the radio button
Rate of change for the most recent value report.
2 Click on Preview to view the report or Send to transmit

the report.
Note: The accession number and 3 When Send is clicked and the selected scan does not have
any additional user defined an accession number associated with it already, the
entries for a scan are listed in
Accession Number Entry dialog box will appear. Enter an
the scan list on the DICOM
Reports screen. accession number and click OK.
KP1068A-2019

defined entries. If so, additional entry dialog boxes will
dialog box. (User defined entries can be left blank.) Refer
to “HL7 Tab” on page 18-34 for details on enabling/
label names.
Reports 15-21
Step Action
Note: The Skip button will allow 4 The Select Rate of Change Scans dialog box will appear
you to skip the selection process with a list of matching scans.
for a particular scan. The
resulting DICOM report will be
similar to a Single Analysis
report.
KP1068A-2020
5 Select the scans to be included in the DICOM report.

Hold down the <Ctrl> key + click to select each scan.
6 Click on OK.
Viewing a Scan’s Details

The Scan Details button allows you to view a scan’s detail such
as the patient biography information, scan date, scan ID, etc. It
also allows you to enter/edit certain patient biography fields.
To View a Scan’s Details:
Step Action
1 Click on the scan whose details you want to view from
the scan list on the DICOM Reports screen.
2 Click on Scan Details.
The Scan Property dialog box will be displayed. There
KP1068A-2021
are 2 tabs for viewing the details: Details and
Identification.
3 Click on the Details tab to view the patient biography
information.
15-22 Reports
Step Action
Note: Accession Number label
and field appear on the dialog
box only if the DICOM option is
installed on your system.
Note: HL7 Field 1, HL7 Field 2,

and HL7 Field 3 are examples of
user definable label names.
These labels and their entry
fields appear on the dialog box
when enabled. See “HL7 Tab”
on page 18-34 for details on
enabling/disabling the
displaying of these fields and
defining their label names.
KP1068A-2022
4 On the Details tab, edits are allowed on the following

fields:
• Accession Number – 16 characters maximum
• HL7 Field 1 – 64 characters maximum
• Operator – 5 characters maximum
• Height – 5 characters maximum
• Weight – 5 characters maximum
• Scan Comment – 100 characters maximum
Note: The scan-related fields are 5 Click on the Identification tab to view the scan
not editable. information.
Reports 15-23
Step Action
KP1068A-2023
6 Click on OK to save any edits made on the Details tab

and close the Scan Property dialog box.
7 To close the Scan Property dialog box without saving any
changes, click on Cancel.
Entering the Accession Number and User Definable Entries

The Accession number is uniquely associated with a patient visit,
and is typically generated by a Radiological Information System
(RIS) or a Hospital Information System (HIS).
Three user definable entries may be available for adding
information to the DICOM file’s Comments field. These entries
are not required and there is no restriction on their content. See
“HL7 Tab” on page 18-34 for details on enabling/disabling the
displaying of these fields and defining their label names.
To Enter the Accession Number:
Step Action
1 Select a scan from the scan list on the DICOM Reports
screen.
2 Click on Save As or Send.
15-24 Reports
Step Action
Note: The accession number for 3 If the selected scan does not have an accession number
a scan is listed in the scan list on associated with it already, the Accession Number Entry
the DICOM Reports screen.
dialog box will appear.
Note: When sending multiple

scans to be included in a single
report, all scans must have the
same Accession Number.
KP1068A-2024
Note: The maximum length for 4 Enter the accession number, and then press Enter or click
the Accession Number is 16 OK.
characters.
For example, if the Accession Number is 7888123, type:
7888123 <Enter>
The scan now has the accession number and the selected
function will continue.
5 Click Cancel if the accession number is unknown or if it
is to be entered at a later time. However, the selected
function (Save As, Send) will not work unless the scan
has an accession number.
Notes: Any additional user 6 You may be prompted to enter additional user defined
defined entries for a scan are entries. If so, additional entry dialog boxes will appear.
listed in the scan list on the
Enter the requested entry and click OK for each dialog
DICOM Reports screen.
box. (User defined entries can be left blank.) See
The maximum length for the user “HL7 Tab” on page 18-34 for details on enabling/
defined entries is 64 characters
label names.
Previewing a DICOM Report

The Preview button allows you to view the DICOM report before
you save or send it.
Reports 15-25
To Preview a DICOM Report:

Step Action
1 Click on the scan you want to preview from the scan list
on the DICOM Reports screen.
2 Click on Preview.
KP1068A-2025
3 The DICOM Report Preview screen will be displayed.
4 Click and drag with the mouse or use the scroll bars to
view the report.
5 Press and hold the Shift key, then click with the mouse to
zoom/de-zoom the report.
6 Click on <<Back to close the DICOM Report Preview
screen.
Printing a DICOM Report

The Print button on the DICOM Preview screen allows you to
print the DICOM report to the local default printer.
To Print a DICOM Report:
Step Action
1 Click on the scan you want to print from the scan list on
2 Click on Preview.
15-26 Reports
Step Action
3 The DICOM Preview Report screen is displayed.
4 Click on Print.
The DICOM Report is sent to your default printer.
KP1068A-2028
5 Click on <<Back to close the DICOM Report Preview

screen.
Saving a DICOM Report

The Save As button saves a DICOM report as a file to your
desired location.
To Save a DICOM Report:
Step Action
1 Click on the scan you want to save from the scan list on
2 Click on Save As.
KP1068A-2029
Reports 15-27
Step Action
Notes: The maximum length for 3 If the scan does not have an accession number, the
the Accession Number is 16 Accession Number Entry dialog box will appear. Enter in
characters.
an accession number for the scan and click OK to
proceed.
KP1068A-2030
The maximum length for the user Note: You may be prompted to enter additional user
defined entries is 64 characters defined entries. If so, additional entry dialog boxes will
“HL7 Tab” on page 18-34 of Chapter 18 for details on
enabling/disabling the display of these fields and defining
their label names.
Note: DICOM files are 4 The Save As dialog box will be displayed with a default
automatically saved with a .dcm file name.
extension. The default file name
is composed of: Patient name,
date, and time of the scan. You
can save the report to a different
file name, if you wish.
KP1068A-2031
5 Select the drive and folder you wish to save the report.
The example above saves the report in folder Scan.
6 Click on Save.
A dialog box will be displayed to confirm that the
DICOM report has been successfully saved.
15-28 Reports
Step Action
KP1068A-2032
7 Click on OK.
Sending a DICOM Report

The Send Report button allows you to send the DICOM report to
your configured destination remote node(s).
To Send a DICOM Report:
Step Action
Note: Multiple scan selections 1 Select the scan(s) you want to send from the scan list on
are allowed for the Send the DICOM Reports screen.
function.
2 If two or more destinations are shown in the Destination
list, highlight the desired destination by clicking on its
name.
If you want to include the Ancillary Report and/or
patient’s Questionnaire in the study, check the respective
check box.
3 Click on Send.
KP1068A-2033
Reports 15-29
Step Action
Note: The Accession Number 4 If a scan does not have an accession number, the
Entry dialog box will be Accession Number Entry dialog box will appear. Enter in
presented for each selected scan
an accession number for the scan and click OK to
that does not have an accession
number associated with it. proceed.
The maximum length for the
Accession Number is 16
characters.
KP1068A-2034

The maximum length for the user defined entries. If so, additional entry dialog boxes will
defined entries is 64 characters appear. Enter the requested entry and click OK for each
“HL7 Tab” on page 18-34 of Chapter 18 for details on
enabling/disabling the display of these fields and defining
their label names.
5 For each selected scan, a DICOM report will be generated
and placed in the queue. DICOM then sends the report in
the order it was placed in the queue.
6 To view the send status of the report, see the sections
Viewing the Queue on page 15-32 and Viewing a History
of Sent Reports on page 15-32.
Sorting the Scan List

The scan list consists of: Scan ID, Scan Date, Scan Time,
Analysis Date, and Accession Number. If the scan list contains
more than one scan, it may be sorted by any heading in either
ascending or descending order.
15-30 Reports
To Sort the Scan List:

Step Action
1 Click on the title bar of the heading you wish to sort the
scan list by.
KP1068A-2035
Note: The default sort order for 2 Click on the title bar of the heading again to toggle the
the scan list is by Scan Date in sort order. For example, if the scan list is sorted by the
ascending order.
Scan ID in ascending order, clicking on the Scan ID title
bar again will sort the scan list by Scan ID in descending
order.
Selecting/Deselecting All Scans

The Select All button allows you select, with one click, all of the
scans that are currently in the scan list. The Deselect All button
will deselect all currently selected scans.
To Select/Deselect All Scans:
Step Action
Note: Multiple scan selections 1 Click on Select All.
will only work with the Send
function. All scans in the scan list will be highlighted.
KP1068A-2036
Note: When sending multiple scans to be included in a

single report, all scans must have the same Accession
Number. Therefore the selection shown above will cause
multiple reports to be sent when using the Send function.
Reports 15-31
Step Action
2 Click on Deselect All.
All highlighted scans in the scan list will be un-
highlighted.
KP1068A-2037
Viewing the Queue

The View Queue button allows you to view the scans in the
queue waiting to be sent.
To View the Queue:
Step Action
name.
2 Click on View Queue.
The View Queue dialog box is displayed.
KP1068A-2038
Note: The View Queue displays

the DICOM report name, the IP
address of the destination node,
and the submission timestamp.
3 Click on Close.
Viewing a History of Sent Reports

The View Log button on the View Queue dialog box allows you to
view a history of reports that had been previously sent.
To View a History of Sent Reports:
Step Action
name.
15-32 Reports
Step Action
Note: The View Log displays the 3 Click on View Log.

DICOM report name, the IP
address of the destination node, The View Log dialog box is displayed.
the transmission attempt
timestamp, and the transmission
status.
4 Click on Close to close the View Log dialog box.

5 Click on Close.
Refreshing DICOM Reports in the Queue

The Refresh button on the View Queue dialog box updates the
DICOM reports in the queue list box to reflect the current queue
status.
To Refresh DICOM Reports in the Queue:
Step Action
name.
Reports 15-33
Step Action
Note: In this example, there are 2 Click on View Queue.
two reports in the queue waiting
to be sent. The View Queue dialog box is displayed.
Note: Multiple report selections 3 Click on the DICOM report(s) in the queue to select it.
are allowed. Hold down the
<CTRL> key and click each
report you wish to select.
3 Click on Refresh.
The queue list box is updated and the transmitted report is
removed from the queue since it has been sent.
4 Click on Close.
Deleting a DICOM Report from the Queue

The Delete button on the View Queue dialog box allows you to
delete a DICOM report from the queue.
15-34 Reports
To Delete a DICOM Report from the Queue:

Step Action
name.
Note: Multiple report selections 3 Click on the DICOM report(s) in the queue to select it.
are allowed. Hold down the
<CTRL> key and click each
report you wish to select.
5 Click on Delete.
The DICOM report(s) will be deleted from the queue.
6 Click on Close.
Reports 15-35
Viewing a History of Sent Storage Commitment Reports

The View SC Log button on the View Queue dialog box allows
you to view a history of storage commitment reports that had
been previously sent.
To View a History of Sent Storage Commitment Reports:
Step Action
name.
Note: The View SC Log displays 3 Click on View SC Log.

the DICOM report name, the IP
address of the destination node, The View Log dialog box is displayed.
the transmission attempt
timestamp, and the transmission
status.
4 Click on Close to close the View SC Log dialog box.

5 Click on Close.
15-36 Reports
Printing the HxReport

HxReport is the patient Questionnaire filled out during the
patient’s examination. The report is automatically sent with the
DICOM Report.
To Print the HxReport
Step Action
1 On the DICOM Report screen click Preview Hx.
The DICOM Report Preview window appears.
2 To zoom in or out, shift click either left or right button on

the mouse.
Click and hold then drag to scroll up or down.
Questionnaire:
• Print button. Clicking this button prints the
questionnaire to the desired printer.
• << Back button. Clicking this button returns the
user to the previous screen.
Reports 15-37
Closing DICOM
The Cancel button and the <<Back button on the DICOM
Reports screen allows you to close the DICOM option.
To Close DICOM:
Step Action
1 Click on Cancel.
KP1068A-2048
The DICOM Reports screen is closed and you are
returned to the Main Menu screen.
2 – OR – Click on <<Back.
KP1068A-2049
The DICOM Reports screen is closed and you are
returned to the previous screen (i.e. the Reports Print
screen).
15-38 Reports
Alternate Navigation
This section describes alternate methods of accessing and printing
reports.
Drag and Drop Records

You can generate a report by selecting a patient record or scan
record, dragging it, and dropping it onto the Report button in the
main window.
This method is useful if you already have the patient or scan
record displayed and decide to print a report.
Drag and Drop Patient Records

This section provides instructions for dragging and dropping a
patient record onto the Report button.
To drag and drop a patient record:
Step Action
1 Click the Patients button in the main window.
The system displays an alphabetical list of patients.
KP0886C-1411
2 Click a patient name. While holding down the left mouse

button, drag the record and drop it (release the mouse
button) on the Report button.
The system displays the Select Scan window with the
patient’s name at the top, and a list of scans. Scans are
listed by date with the most recent scan at the top.
3 Continue with Step 3 of To print a report using the Report
button: on page 15-7. Or, continue with Step 3 of To
Create and Send a DICOM Report: on page 15-18.
From this point on the procedure is the same.
Reports 15-39
Drag and Drop Scan Records

This section provides instructions for dragging and dropping a
scan record onto the Report button.
To drag and drop a scan record:
Step Action
1 Click the Scans button in the main window.
The system displays the Scan Drawer window with three
tabs: Analyzed Scans, Unanalyzed Scans, and Both.
KP0886C-1412
2 Click the Analyzed tab and select the scan record to be

printed. While holding down the left mouse button, drag
the record and drop it (release the mouse button) onto the
Report button.
The system displays the Print window with the patient
name and ID at the top.
3 Continue with Step 4 of To print a report using the Report
button: on page 15-7. Or, continue with Step 4 of To
Create and Send a DICOM Report: on page 15-18.
From this point on the procedure is the same.
15-40 Reports
Chapter 16
Archiving, Locating and
Restoring Scans
This chapter provides information and instructions for archiving,
locating, and restoring scans, as well as managing the archive
locations. This chapter also provides a troubleshooting section if
you encounter a problem transferring scans from one location to
another.
Content
Subject Page
Overview 16-2
Archiving Scans 16-8
Locating Scans 16-12
Restoring Scans 16-16
Copying Scans 16-19
Query/Retrieve Scans 16-22
Managing Archive Locations 16-27
Troubleshooting Transfer Errors 16-28
16-1
Overview
This section provides an explanation of terms and concepts used
when archiving, locating, restoring, and copying scans. The
following definitions may be helpful when reviewing this
chapter:
• Archiving
The process of duplicating scans contained on the
computer hard drive and transferring them to uniquely
identified removable media, to a uniquely identified
directory on a computer network, or to a Picture Archival
and Communications System (PACS) server for
permanent storage.
• Locating
The process of determining the storage location(s) of
archived scans.
• Restoring
The process of duplicating archived scans and transferring
them to the computer hard drive.
• Copying
The process of duplicating scans contained on the
computer hard drive and transferring them to another
location without electronically recording the location to
which the scans data have been copied.
• Query/Retrieve
The process of locating and restoring scans archived to a
PACS server.
Note: See “Running the System It is extremely important to understand the difference between
Backup” on page 17-5 of archiving scans and performing a system back up. The archive
Chapter 16 for information on
process transfers a copy of the selected scans to removable
how to perform a System
Backup. media—such as a CD R/W—or to a directory on a computer
network. The system back up process transfers a copy of data
contained in the QDR system database, which is different from
scan data files —it does not save scan image files.
Handling Read/Write CDs

Formatting a Read/Write CD
Warning: To ensure the integrity The first time you use a read/write CD in the CD R/W it must be
of the data on a read/write CD, formatted. For information on formatting a CD refer to the
the CD must be formatted the
manual that came with the CD R/W.
first time it is used.
16-2 Archiving, Locating and Restoring Scans

Removing a Read/Write CD
If your CD does not eject by pressing the button on the front of
the CD R/W drive, perform the following.
To Eject a CD from a CD R/W
Step Action
1 Minimize the APEX software by pressing the minimize
button in the upper right corner.
Minimize button
KP1035A-1501
2 Start Windows Explorer.

3 Right click on the icon for the CD R/W.
A menu appears.
CD Drive icon
Menu
KP1035A-1502
Eject command
4 Click on the Eject command in the menu and wait for the
CD tray to open.
Archiving Scans
Archiving scans is the process of duplicating scans contained on
the computer hard drive and transferring them to uniquely
identified removable media, to a uniquely identified directory on
a computer network, or to a Picture Archival and
Communications System (PACS) server for permanent storage.
Scan image files consume a large amount of space on the
computer hard drive. Scans should be archived for permanent
storage on a daily basis. It is strongly recommended that scans be
archived to two different locations. For example, perform the
Archiving, Locating and Restoring Scans 16-3

initial archive to a CD R/W and the second archive to a network

server or read/write CD. Two separate archive locations for each
scan will help to ensure that these scans will be accessible for use
during future patient visits.
Note: See Chapter 6 for Once scans have been archived, they can be deleted from the
information on how to delete computer hard drive to free up space.
scan files from your system.
Scans may be automatically deleted after they have been
archived (“Archive Tab” on page 18-31).
Locations
The archive process duplicates scans that are in the system
location and transfers the duplicates to an archive location, as
described below:
• System Location
Scans that are in the system location reside on the
computer hard drive and are available for analysis and
reporting. Use the Scans button in the main window to
view the list of scans that are currently on the system (that
is, in the system location). The system location is the point
of origin for the archive process.
• Archive Location
This is the destination location for the archive process.
There can be two archive locations for each scan—
primary and secondary. Archive locations can be on
removable media such as CDs or 3-1/2 inch diskettes.
They can also be in different directories on a computer
network or on a Picture Archival and Communiction
System (PACS) server. The APEX software will keep
track of two separate archive locations for each scan. An
archive location for removable media or a network drive
consists of two pieces of information:
• A fully qualified directory path (different for
PACS server)
The directory path is the complete specification of
a single file storage location. Fully qualified
means that the path starts with a drive
specification (such as a:) and ends with the name
of the directory that contains the file. For example,
a:\ is a directory path that instructs the system to
place archive files on a 1.44MB, 3.5 inch diskette.
• An archive label (not used for PACS)
The archive label is used to uniquely identify the

archive location. Removable media should be

marked with the archive label immediately.
Archive Labels
Warning: A read/write CD can The first time a scan is archived to a removable media location,
be damaged if you do not use a the system creates an archive label from the date (of the archive),
fine-point permanent ink CD
a sequence number (to identify the number of removable storage
marker or a CD label when
labelling the CD. media needed for the archive) and the Serial Number of the
machine (see Figure 16-1). This label uniquely identifies the
removable storage media for future reference in locating and
restoring scans. The system will prompt you to write the archive
label using a fine-point permanent ink CD marker on a read/write
CD or on the label affixed to the storage media (such as a
1.44MD diskette). Figure 16-1 illustrates the archive label
information for a QDR serial number 80231.
Figure 16-1
Archive Label Sequence Number
092603-01-SN80231
Date (mmddyy) QDR

Serial Number
00158-002
Locating Scans
Locating scans is the process of determining the storage
location(s) of archived scans. Use the Locate Scans button to
locate scans. The Locate function provides the following
information about each scan:
• Analysis time and date
• Archive time and date
• Archive location
• Archive label
Note: Scans archived to a Picture Archival and Communications
(PACS) server can be located using the Query/Retrieve Scans
function. (Refer to “Query/Retrieve Scans” on page 16-22).

Restoring Scans
Note: New patients may bring Restoring a scan is the process of duplicating an archived scan
electronic copies of Hologic and transferring it to the computer hard drive. The normal
scans performed at another
method for restoring a scan is to first locate the archived scan
facility. These scans should be
restored, viewed and archived. using the Locate function, which enables the Restore function.
The alternate method for restoring a scan is to select Restore
Scans from the Archive pull-down menu. Use this method to
restore a scan whose archive location is not contained in the
system’s database (for example, a new patient who has an
electronic copy of a scan performed at another facility). Once a
scan has been restored to the system, you can reanalyze it, create
a new report for the scan, and/or use the scan as the basis for
comparison with another scan.

(PACS) server can be restored using the Query/Retrieve Scans
Copying Scans
Copying a scan is the process of duplicating a scan without
electronically recording the location to which the scan has been
copied. The Copy function should be used whenever custody of
the copied scan is not being retained. For example, use the Copy
function to provide a patient with an electronic copy of their
scan(s) or to submit scans to a third party for review.
About Archiving and Restoring Scans

This section provides an explanation of terms and concepts used
when archiving or restoring scans from one location to another.
To simplify the explanation of these processes, they will be
referred to as data transfer processes.
How Scans are Transferred

There are several data files associated with each scan, and they
must always be transferred as a set. Scans are transferred one at a
time, even when transferring multiple scans. The transfer of each
scan is not affected by the transfer of other scans.
When the system is in the process of transferring scans, it
prevents other operators from accessing the location to which the
scans are being transferred. If an operator tries to access a locked
location, their system will display a message prompting them to
chose another location or to try again later. Once the scan transfer

has been completed, normal access will be restored to that

location. This feature is extremely important for scans that have
been archived to a directory on a computer network.
Transfer Progress Message
While scans are being transferred, the system displays a progress
message and provides the ability to cancel the transfer process.
The progress message displays the progress of the transfer.
Canceling a Transfer
The transfer process may be stopped at any time. The archiving of
the scan being transferred at the time the process was stopped is
canceled. All other pending transfers are canceled as well. Scan
transfers that were completed prior to the time the process was
stopped are not affected.
Errors During Transfer
If an error occurs during the transfer, the system cancels the
current transfer and all pending transfers, and displays an error
message. Refer to Troubleshooting Transfer Errors on page 16-28
for more information.
Notification of Successful Transfers
When the entire transfer has been successfully completed, the
system displays a message stating that the transfer is complete.
How the System Handles Data Inconsistencies

When the Locate or Restore function is used, the patient’s
biographical information and other data contained in the scan
being restored is compared to the information in the system
database. If the system detects inconsistencies, it automatically
corrects the information. For patient information, the data in the
scan file will be updated to agree with the system data. For
example, if the last name of a patient has changed from the date
of their last exam, the system will automatically update the
archive location data to reflect the patient’s new last name. When
data pertaining to the scan or analysis is inconsistent, the data in
the system database will be updated to agree with the data in the
scan file.
How the System Handles Archive Data
The system database keeps track of the two most recent archive
locations for a given scan. The database contains archive data
including the location, label, archive date, and analysis date. If an
attempt is made to archive a scan that has already been archived
to two locations, the system automatically alerts the operator that

they are about to overwrite the archive information for the oldest
archive. The operator is then prompted to either manually record
the archive location that is about to be overwritten or cancel the
archive process.
Archiving Scans
Archiving a scan is the process of duplicating the scan contained
on the computer hard drive and transferring it to uniquely
identified removable media or to a uniquely identified directory
on a computer network for permanent storage. Once a scan has
been successfully archived, it may deleted from the system
(computer hard drive) to make space for new scans.
Archive Location
The archive location can be any of the following, depending on
which type(s) of device have been installed on the system:
• Read/write CD
• 3.5 inch diskette
• Optional Magneto-Optical or JAZ® cartridge
• A directory on a network to which the system is connected
• A Picture Archival and Communiction System (PACS)
server using the Report - DICOM Send function before
exiting and exam or accessing Reports from the Main
screen (refer to “DICOM Reports” on page 15-18).
Archive Process
The process of archiving scans is as follows:
1. Select the archive location
2. Select the scan(s) to archive
3. Start the archive function

To archive scans:
Step Action
Warning: If the Archive 1 Click the Archive Scans button in the main window.
procedure was interrupted by a The Archive Selected Scan(s) window displays.
power failure the Archive may
not be complete on the storage
media. Check the media and
repeat the Archive if necessary.
KP1035A-0321
KP0886C-1503
Note: If you use a removable 2 Determine whether the path shown in the Archive
archive media that has never Location field at the top of the window is the location
been used for archiving scans,
(path and archive label) to which the scans should be
the Label field will be blank.
archived. To change the archive location, do the
Note: Refer to Managing following:
Archive Locations on page 16-
27 for information on adding • Click the down arrow on the Path pull-down box
archive locations. to display the available archive locations.
• Drag down and click the desired archive location.
The selected location appears in the pull-down box and
the associated label appears in the Label field.
Note: The Unarchived tab is the 3 Click one of the following tabs:
default selection.
• Unarchived to display a list of unarchived scans
Note: Once a scan has been
archived, it appears on the • Archived Once to display scans that have been
Archived Once tab, even if archived at least one time
archived again, to a secondary
location. • All Scans to display all scans (both Unarchived
If using new media for the first and Archived Once)
time, format the media from A list of scans of the selected type displays.
Windows Explorer.
4 Select the scan(s) to be archived using one or more of the
following techniques:

Step Action
Note: Daily QC Phantom scans • Click the Select All button to select all the scans
provide information about your appearing on the list.
system that can be used if
problems occur. Archive all • Locate the scans either by
daily QC Phantom scans with
patient scans to provide a Using the scroll bars to bring scans into view; or
history of your system’s Typing the patient’s name (last name, comma,
operation.
space, first name, space, middle initial) until the
scans for that patient appear.
Note: To deselect individual • To select multiple scans that are not adjacent to
scans that have been selected, each other, depress and hold down the Ctrl key
depress and hold down the Ctrl
while clicking on each scan to be archived.
key, then click on the scans to be
deselected. Use the Deselect All • To select a range of adjacent scans, click on the
button to deselect all selected first scan in the range, depress and hold down the
scans.
Shift key, then click on the last scan in the range.
The selected scans display as highlighted (white text on a
blue background).
Note: The system will notify the 5 Click the Archive Scans button.
operator if there is no archive
media installed in the archive If using removable archive media that has never been
location, or if a network location used before for archiving, the system will prompt the
is not accessible. operator to manually record on the media label the
archive label name assigned by the system.
The Scan Transfer in Progress window is displayed while
the selected (highlighted) scans are duplicated and
transferred to the archive location specified in the
Archive Location field. The progress of the transfer
operation is displayed in this window.
KP0886C-1504
6 To stop the transfer process before it completes, click the

Cancel Transfer button in the Scan Transfer in Progress
window.
The archiving of the scan being transferred at the time
the Cancel Transfer button was clicked is canceled. All
other pending transfers are canceled as well. Scan
transfers that were completed prior to the time the button
was clicked are not affected.

Step Action
7 When the Transfer results window displays, click OK.
8 It is highly recommended that you do an immediate
second archive of these scans to another cartridge or disk.
This second archive protects from loss of scans in the
event of damage to the first cartridge or disk.

Locating Scans
The Locate function allows the operator to search the system
database for specific scans that have been archived. The Locate
function typically precedes the Restore function. Once a scan has
been located, it may be restored from its archive location to the
system location on the computer hard drive.
Use the Locate Scans button to search for and restore scans.
(PACS) server may also be located using the Query/Retrieve
Scans function. (Refer to “Query/Retrieve Scans” on page 16-
22).
To locate and restore scans:
Step Action
1 Click the Locate Scans button in the main window.
The Select Patient for Scan Location window displays.
KP1035A-0311
KP0886C-1506

Step Action
Note: To view the patient’s 2 Find the name of the patient for which scans are to be
biographical information, click restored either by
on the Details button in the
upper right corner of the • Using the scroll bars to bring patient names into
window. view; or
• Typing the patient’s name (last name, comma,
Click on the patient’s name to select the patient, then
click the Locate Scans button.
The system displays the Locate Selected Scan(s) window
with the patient’s name and ID at the top.
KP0886C-1507
Note: You should always select 3 The Primary Archive tab window will appear with a list
scans to restore from the of scans for the selected patient.
Primary Archive tab, the
Secondary Archive tab can be The system displays a detailed list of scans of the selected
used if you cannot restore scans patient that includes the Scan Date, Scan Type, Scan ID,
from the Primary Archive tab. Analysis Date and Label (of the media) for each scan.
Note: To switch between the
Primary Archive Tab screen and
the Secondary Archive Tab
screen use Ctrl-Tab or the
mouse.

Step Action
Note: To deselect individual 4 Select the scan(s) to be restored using one or more of the
scans that have been selected, following techniques:
key, then click on the scans to be • Click the Select All button to select all the scans
deselected. Use the Deselect All appearing on the list.
button to deselect all selected
• Click on a single scan to select it.
scans.
• To select multiple scans that are not adjacent to
each other, depress and hold down the Ctrl key
while clicking on each scan to be restored.
• To select a range of adjacent scans, click on the
first scan in the range, depress and hold down the
blue background).
5 Note: Skip this step when the archived scan(s) are located on a
network drive or a Picture Archival and Communications (PACS)
server.
Locate and place the cartridge or disk with the correct
Label into the disk drive.
Label
KP0886C-1508

Note. If you can not restore 6 Click the Restore Scans button.
scans from the Primary Archive
media screen, contact the If the list of selected scans includes removable media
Hologic Help Desk before using archive locations with different archive labels, the system
the Secondary Archive media. will automatically prompt the operator to insert
specifically labeled archive media as necessary.
transferred to the system location. The progress of the
transfer operation is displayed in this window.
KP0886C-1509

window.
The restoration of the scan being transferred at the time

Restoring Scans
The Restore function differs from the Locate function in that it
allows the operator to search for and restore scans by specifying
the location. This includes importing archive scans that may or
may not be resident in the system (that is, on the hard drive). For
example, the Restore function would be used for a new patient
who has an electronic copy of a scan performed at another
facility. When the Restore function is started, the archive location
from which the scans are to be restored must be specified. The
system searches that location and displays a list of all scans stored
there. One or more scans can be selected and restored from that
archive location to the system location on the computer hard
drive.
(PACS) server can be restored using the Query/Retrieve Scans
To restore scans from a specified archive location:
Step Action
Note: A new patient’s scans 1 Click the Archive pull-down menu on the main window,
restored onto the system should then drag down to select Restore Scans.
be reviewed and then archived
The Restore Selected Scan(s) window displays.
onto the system’s archive media.
KP0886C-1510

Step Action
Note: If the current path name is 2 Determine whether the path shown in the Archive
for a removable media drive, the Location field at the top of the window is the location
system will check the drive and
(path and archive label) from which the scans should be
prompt for a cartridge or
diskette to be inserted, if restored. To change the archive location, either:
necessary. • Click the down arrow on the Path pull-down box
to display the available archive locations, then
drag down and click the desired archive location;
or
• Click the Browse... button and navigate to the
directory that contains the archived scans to be
restored.
The selected location appears in the pull-down box and
the associated label appears in the Label field.
3 Select the scan(s) to be restored using one or more of the
following techniques:
• Click the Select All button to select all the scans
appearing on the list.
• Locate the scans either by
Using the scroll bars to bring scans into view; or
Typing the patient’s name (last name, comma,
Note: To deselect individual each other, depress and hold down the Ctrl key
scans that have been selected, while clicking on each scan to be archived.
key, then click on the scans to be
deselected. Use the Deselect All first scan in the range, depress and hold down the
button to deselect all selected Shift key, then click on the last scan in the range.
scans. The selected scans display as highlighted (white text on a
blue background).

Step Action
4 Click the Restore Scans button.
If the list of selected scans includes removable media
archive locations with different archive labels, the system
will automatically prompt the operator to insert
specifically labeled archive media as necessary.
transferred to the system location. The progress of the
transfer operation is displayed in this window.
KP0886C-1511

window.
The restoration of the scan being transferred at the time

Copying Scans
The Copy Scans function allows the operator to copy scans that
currently reside on the computer hard disk to a specified location.
This function should be used whenever custody of the copied
scans is not being retained. For example, use the Copy Scans
function to provide a patient with an electronic copy of their
scan(s) or to submit scans to a third party for review. The system
will copy the selected scans to the specified location without
recording the location in the system database.
Any scans copied to an offline location can be later restored using
the Restore Scans function.
To copy scans:
Step Action
1 Click the Archive pull-down menu on the main window,
then drag down to select Copy Scans.
The Copy Selected Scan(s) window displays.
KP0886C-1512
Note: The Copy Location is 2 Determine whether the path shown in the Copy Location
where the selected scans will be field at the top of the window is the location to which the
copied.
scans should be copied. To change the Copy location,
either:
• Click the down arrow on the Path pull-down box
to display the available copy locations, then drag
down and click the desired copy location; or
• Click the Browse... button and navigate to the
directory that contains to which the scans are to
be copied.
The selected location appears in the pull-down box.

Step Action
Note: The Unarchived tab is the 3 Click one of the following tabs:
default selection.
• Unarchived to display a list of unarchived scans
Note: Once a scan has been
archived, it appears on the • Archived Once to display scans that have been
Archived Once tab, even if archived at least one time
archived again, to a secondary • All Scans to display all scans (both Unarchived
location. and Archived Once)
A list of scans of the selected type displays.
Note: To deselect individual 4 Select the scan(s) to be copied to the specified location
scans that have been selected, using one or more of the following techniques:
key, then click on the scans to be • Click the Select All button to select all the scans
deselected. Use the Deselect All appearing on the list.
button to deselect all selected
• Locate the scans either by
scans.
Using the scroll bars to bring scans into view; or
Typing the patient’s name (last name, comma,
each other, depress and hold down the Ctrl key
while clicking on each scan to be archived.
first scan in the range, depress and hold down the
blue background).
Note: The system will notify the 5 Click the Copy Scans button.
operator if there is no archive
media installed in the archive The Scan Transfer in Progress window is displayed while
location, or if a network location the selected (highlighted) scans are copied to the location
is not accessible. specified in the Archive Location field. The progress of
the transfer operation is displayed in this window.
KP0886C-1513

Step Action
window.
The copying of the scan being transferred at the time the
Cancel Transfer button was clicked is canceled. All other
pending transfers are canceled as well. Scan transfers
that were completed prior to the time the button was
clicked are not affected.

Query/Retrieve Scans
The Query/Retrieve function allows the operator to locate and
retrieve scans meeting given parameters and filters from a
configured PACS server into the QDR system. Scans are stored
on PCAS servers using the DICOM Send functionality. (See
“DICOM Reports” on page 15-18.)
(PACS) server may also be restored using the Locate Scans
function. (Refer to “Locating Scans” on page 16-12).
When the Query/Retrieve function is started, the PACS server

must be specified. The system queries that server and displays a
list of all scans meeting the given parameters and filters stored on
that server. One or more scans can be selected and retrieved from
that server to the system location on the computer hard drive.
To locate and retrieve scans from a PACS server
Step Action
1 Select Query/Retrieve from the Archive drop-down
menu on the main screen.
DICOM Query/Retrieve Studies displays.
2 Complete Query parameters as desired. (See “Query

Parameters for details.)
3 Click Optional Filters to add study level filters to the
query or go to Step 5.
4 Complete Study level filters as desired.

Step Action
5 If more than one active location is configured, select
archive location (Destination). Click Destination field
down arrow and click desired destination.
6 Click Query. All studies meeting the query parameters
and filters archived on the destination PACS server
display in the Retrieve section of the DICOM Query/
Retrieve Studies window.
7 In the Retrieve section, select the study or studies to
retrieve.
• Select a single study by clicking on it.
• Select multiple studies that are not adjacent to each
other by holding the CTRL key down while clicking
on each study to be retrieved.
• Select a range of studies adjacent to each other by
clicking on the first study in the range, depressing and
holding down the Shift key, then clicking on the last
study in the range.
8 Click Retrieve.
9 Click View Queue to check status of current retrieve
requests. (See “Retrieve Queue” on page 16-25.)
Query Parameters
Patient ID Identification data such as medical record

number, social security number, etc.
Last Name, Last Name can include suffix where
First Name, applicable.
Middle Initial
Birth Date To include birth date as a parameter, first
check the checkbox. Change month, day and
year by clicking the respective section and
over typing.
Monthly calendar can be displayed for the
given month/year by clicking down arrow.

Date Range Date range to query. Change month, day and

year by clicking the respective section and
over typing. Monthly calendar can be
displayed for the given month/year by
clicking down arrow.
Destination Archive location to query.
Study Level Filters
Accession Identifies a patient visit.

Number
Study ID Identifies a study.
Study Time To include study time as a filter, first check
the checkbox. Change hour, minute, second
and AM/PM by clicking the respective section
and over typing or clicking up/down arrow.
Study Instance Unique identifier for this study instance.
UID
Modalities in Type of system recognized by the HIS/RIS.
Study Since “bone densitometer” is not a standard
defined type, the QDR system is defined as
“OT” for “Other”.
Referring Name.
Physician

Retrieve Queue
Allows the user to check status and delete current retrieve
requests, and view a log file of all retrieve requests.
Queue list Selection list of retrieve request

information that can be filtered to display
all requests or requests with a selected
status depending on the radio button
selected in the Display section.
Display Filters the selection list depending on the
button selected.
Select All/Deselect Toggles between Select All and Deselect
All All - Selects all Retrieve requests listed in
the Queue List.Deselect All - Deselects all
Retrieve requests listed in the Queue
Delete Deletes the selected Retrieve request(s).
View Log Displays the Retrieve Queue Log. See
“Retrieve Queue Log” on page 16-26
OK. Closes window. Returns to DICOM
Query/Retrieve Studies window.

Retrieve Queue Log

Displays detailed information regarding the processing of
DICOM retrieve requests in reverse chronological order (most
recent entries first).
Click OK to return to the Retrieve Queue window.

Managing Archive Locations

This section provides information and instructions on configuring
the system to manage archive locations.
An archive location for removable media or a network drive
consists of two pieces of information:
• A fully qualified directory path (different for PACS
server)
The directory path is the complete specification of a single
file storage location. Fully qualified means that the path
starts with a drive specification (such as a:) and ends with
the name of the directory that contains the file. For
example, a:\ is a directory path that instructs the system to
place archive files on a 1.44MB, 3.5 inch diskette.
• An archive label (not used for PACS)
The archive label is used to uniquely identify the archive
location. Removable media should be marked with the
archive label immediately.
These two pieces of information are entered in the system
database each time a scan is archived. For each scan, the system
keeps a record of the location of the two most recent archive
operations.
Archive locations are managed through the System Configuration
function located on the Utilities menu at the top of the main
window. The Archive tab of this window provides the tools
necessary to modify the following archive location information:
• Add a New Archive Location
Adds a new fully qualified path specification to the Path
pull-down box.
• Set the Default Archive Location
The default location is the path that initially appears in the
Path pull-down box when a window opens.
• Delete an Archive Location
Deletes an archive path from the Path pull-down box list.
• Include Raw Data Files
When checked, causes raw data files to be included when
transferring scans. Raw data files should not be
transferred with the scan files unless you have been
instructed to do so by Hologic, Inc.
The “Archive Tab” on page 18-31 section of Chapter 18 contains
detailed instructions on adding a new location, setting and
changing the default location, and deleting a location.

Troubleshooting Transfer Errors

This section lists and describes the types of messages that the
system may display if it encounters problems when transferring
scans.
Problems Accessing an Archive Location

When scans are being restored and the system is unable to access
an archive location, it may display one the following messages,
depending on the circumstances.
Message Meaning Action

The archive Another operator is Click the OK
location at <Path> using that archive button. Select
is in use; Please location and it is another location, or
chose another locked to prevent try accessing the
location or try later. duplicate transfers. archive location
later.
The archive loca- The archive loca- Click the OK
tion at <Path> can- tion is not accessi- button. Verify the
not be accessed. ble. validity of the
Please choose archive location.
another location. Select a valid
location.
Transferring Scans
There are a number of reasons for encountering problems with
scan transfers. Reasons may be due to operating system errors, or
insufficient space on the removable media. Refer to the following
table for information on specific messages.
Unable to An error occurred Click the OK
<Archive/Restore> while attempting to button and follow
scan due to an archive or restore instructions as
operating system the scan. The sys- prompted by the
error. tem will provide system.
specific informa-
tion about the error.


A file for scan The file is missing Click the OK
<Scan ID> is miss- from the directory button.
ing. Pending trans- but the system will
fers of other scans continue to transfer
will continue. other scans.
Cannot archive data The data at the Click the OK
at this location; specified archive button and contact
please contact your location is corrupt your service
service representa- and cannot be read. representative or
tive. the Hologic Help
desk.
Archive Locations
If the system encounters problems trying to transfer scans to an
archive location, it will display a message depending on the
circumstances.
Unable to archive The location the Try archiving the
scan to <Path>; system is attempt- scan(s) to a
The selected ing to transfer to different location.
location is out of does not have
space; try another enough space to
location. accommodate the
data.
The cartridge or The removable Click the Cancel
diskette in drive media diskette or button to stop the
<drive letter> is cartridge is full. transfer and insert a
out of space; Please new diskette or
insert a different cartridge. Note: If
cartridge or diskette transferring a large
and click ‘OK’ to volume of data, try
continue. Click using a read/write
‘Cancel’ to stop the CD instead of a 3.5
archive process. inch diskette.
The archive loca- The specified Click the Yes
tion at <Path> archive location button to create a
does not exist. Cre- does not exist. The new location and
ate? system prompts the resume the transfer,
operator to create a or click the No
new location. button to cancel the
operation.


Cannot create an The system is Click the OK
archive location at unable to create an button. Refer to the
<Path>; please archive at the speci- specific error
choose another fied location. message for more
location and try information.
again.
Unable to access The system cannot Click the OK
<Path>. Please access the speci- button. Select
choose another fied archive loca- another location, or
location. tion. It may be in wait a few minutes
use by another and try again.
operator.
Scans produced by The specified Click the OK
an older version are archive location button.
archived at location contains a legacy
<Path>. Cannot archive.
create a new
archive. Please
choose another
location.
The location speci- The specified Click OK. Choose

fied by <Path> is a archive location is a valid location and
file and cannot be actually a file and continue.
used as an archive not a directory.
location; please
choose another
location.
Advanced User Information

To simplify the locate and restore process, the APEX software has
been set up to generate a single archive label (the name of an
archive location) for each removable storage media diskette or
cartridge containing scan archives. It is possible to use separate
folders (directories) within a single removable storage media
diskette or cartridge to organize the scans. Each folder (and sub-
folder if used) will be assigned a unique archive label which must
be recorded on the physical label of the storage media. It will be
extremely difficult to locate and restore scans that have been
archived within a folder in removable storage media without
having recorded on the storage media label each archive label and
the folder with which it is associated.

To create a folder containing scan archives within a removable

storage media diskette or cartridge:
Step Action
Note: The folder must first be 1 Click the Utilities pull-down menu in the main window,
created on the archive then drag down to select System Configuration.
removable storage media
The System Configuration window displays.
diskette or cartridge.
2 Click on the Archive tab.
The archive configuration settings display.
3 Click in the Add New Location text box and type the
drive letter and folder name using the following format:
drive letter, colon, backslash, folder name, backslash.
Example: e:\foldername\
4 Click the Add button.
The removable media drive letter and folder name
appears in the Location Pool list.
5 Repeat steps 3 and 4 to add additional folders within the
same removable storage media diskette or cartridge.
6 Click the OK button to save the changes.
The main window displays.
Note: Refer to the Archiving 7 The new archive locations may now be used by following
Scans section of this chapter. the standard procedures for archiving scans.


Chapter 17
System Backup and Recovery
Content
Subject Page
Overview 17-2
Running the System Backup 17-5
Errors and Exceptions 17-6
System Recovery 17-8
17-1
Overview
System Backup is the function used to periodically save your
system files in case there is a system failure such as a hard drive
failure.
System Recover is the function used to restore your system
configuration files and database files (needed to rebuild your
system) if a system failure should occur.
Files Saved
System Disk
CD R/W
Or Or Or
SuperDisk TM
Floppy Disk
Calibration files
Patient scan database
Reference database
Reports database
Step phantom info
Network Disk
QDR registry info
Computer
KP1068A-1601
System Backup saves the following files, compressing them into

one file.
• Calibration files
• Patient scan database
• Reference database
Note: The files saved during • Report database
System Backup cannot be
selected. The system always • Step phantom information
saves the same files from a list
• APEX registry information
internal to the software.
System Backup does not overwrite any files, such as older backup
files. If a duplicate file name is found at the backup location, the
backup will not continue until one of the files is renamed.
17-2 System Backup and Recovery

Media Formatting
Note: System Backup permits If the media is not formatted, the program aborts. System Backup
backup to the hard drive (C:), does not format any media. This must be done by the operator
but this would defeat the purpose
prior to System Backup using the Windows operating system.
of saving files on other media, so
is not recommended.
Management of Media
Backups should always be done to multiple sets of diskettes or
cartridges. If one should become unreadable or get misplaced, the
other can be used to recover files.
Floppy Diskette
Note: Remember that all files If backing up to 3.5 inch diskettes, it is recommended that a set of
must be removed from the four diskettes be used. Label them #1 through #4. The first week,
diskette or cartridge before it
backup to the first diskette. The second week, backup to the
can be used for backup.
second diskette, and so forth. On the fifth week, erase all files on
diskette #1 and backup to it again. On the sixth week, erase all
files on diskette #2 and backup to it again, and so forth.
Because 3.5 inch diskettes wear out, they should be replaced with
new ones annually.
SuperDisk™
SuperDisk diskettes hold at least 120 Megabyte (MB) of data and
System Backup can save multiple backups on them. It is good
practice, however, to use at least two SuperDisk diskettes,
alternating them at each backup.
Read/write CD
Warning: To ensure the integrity When backing up to a CD R/W drive, the CD may contain other
of the data on a read/write CD, files (backup files or system archives).
the CD must be formatted the
first time it is used.
Network Drive
Note: Using multiple media and If network disks are available, a backup can be made to any of
replacing them periodically does them. These disks are usually backed up by your IS department
not apply here.
periodically.
When to Run System Backup

System Backup should be run at least once a week. If it has been
longer than one week since the last system backup, a message
System Backup and Recovery 17-3

similar to the following displays when you the system is turned

on.
KP0886C-1602
Click the Yes button to begin backing up your system. If you click
the No button, the system begins normal operation. During
normal operation, a message is displayed in the ticker tape area
that the system needs to be backed-up. Also, the System Backup
button (shown below) on the right side of the main window
blinks. These events continue during normal operation until you
run System Backup.
KP1035A-0323
Naming the Backup File

System Backup saves all files in a compressed format in one file.
The file name is in the format YYYYMMDDCCBB.CAB, where:
YYYYMM DD CC BB. CAB
Year Day This file extension indicates that
this file is stored in CAB
Month compression format.
This number indicates the number of
pieces of media needed to backup your
system files.
This number starts at 01 and increments
every time you perform a backup in a given
day.
KP0886C-1603a

For example:
If... The file name becomes...
Note: If it is necessary to use two Today is June 16, 2002 200206160101.CAB
3.5 inch diskettes for the backup,
do not use the next diskette in the You ran System Backup a sec- 200206160201.CAB
four diskette set. Instead, create ond time today
four more diskettes and label You ran System Backup on 200207290101.CAB
them Disk#1A, 2A, etc. The
July 29, 2002
system backup will now consist
of a set of eight 3.5 inch Your backup requires 2 floppy 200207290101.CAB (1st disk)
diskettes. diskettes
200207290102.CAB (2nd disk)
Running the System Backup

To run the System Backup:
Step Action
Warning: If the System Backup 1 Click the System Backup button on the main window.
procedure was interrupted by a The System Backup window displays.
power failure the System Backup
may not be complete on the
storage media. Check the media
and repeat the System Backup if
necessary.
KP1035A-0323
MAN-00214-1705

Step Action
2 Select the location (path) to which the system files are to
be backed-up. The location text box displays the default
location. It can be changed by deleting the current
location and typing the new one, or by clicking the
Browse button and navigating to the desired backup
location (illustrated below).
KP0886C-1605
Note: Changing the backup file 3 Accept the default backup file name (preferred), or enter
name makes restoring the a different backup file name (not recommended).
correct file difficult.
The backup process starts.
Errors and Exceptions

This section describes some of the error messages that may be
encountered while running System Backup, and explains what to
do to continue.
Backup file with the same name

If the backup file name already exists at the backup location, the
following warning displays:
KP0886C-1606

Either select a new location, delete the existing file, or change the
backup file name.
Drive is not accessible

If an attempt is made to backup to a drive containing no media
(for example, there is no 3.5 inch diskette in the drive or another
process is using the drive) the following warning appears:
KP0886C-1607
Put a diskette in the drive or wait for the other process to finish
using the drive.
Drive does not have enough space

If the backup diskette does not have enough free space, the
following warning displays:
KP0886C-1608
3.5 inch diskette

When backing up to a 3.5 inch disk drive, the diskette must be
formatted, blank (contain no files or directories), and have no
bad sectors (1,457,664 bytes available).
SuperDisk™ diskette
When backing up to a SuperDisk™ drive, the diskette may
contain files (usually other backup files).
Read/write CD
When backing up to a CD R/W drive, the CD may contain files
(other backup files or system archives).
Network drive
When backing up to a network disk, there is no issue with files.

Drive is not accessible

If an attempt is made to backup to a drive that is not accessible
(for example, a drive that is read-only), a warning similar to the
following displays:
KP0886C-1609
The problem must be corrected before continuing. In the example

shown above, click the Cancel button and choose another backup
location.
System Recovery
It is not necessary to do a System Recover unless there is a
serious problem with the hardware or software. If this happens,
contact Hologic Customer Support for help. Do not attempt to do
a System Recover yourself.
No additional information about System Recover is presented in
this guide.

Chapter 18
Configuring the System
APEX lets you change system configuration settings for a variety
of system parameters. You do this by setting default parameters
which stay in the system even after exiting and restarting the
software. You can change the default information at anytime the
software is running. You can also change parameters while
running different functions. If you do, they become the new
default parameters.
Content
Subject Page
Introduction to System Configuration 18-2
System Tab 18-3
Analyze Tab 18-5
CAD BMD Tab 18-8
Report Tab 18-10
Archive Tab 18-31
HL7 Tab 18-34
Scan Conversion 18-39
History 18-41
DICOM Tab 18-44
Modality Worklist 18-44
DICOM Send Destinations 18-53
DICOM Storage Commitment Destinations 18-59
DICOM Query/Retrieve Destinations 18-63
Host 18-66
Privacy Tools 18-67
Study Tab 18-68
18-1
Introduction to System Configuration

Your QDR system and APEX software come from the factory
with certain settings (for analysis, reports, archive, etc.) preset so
you can begin scanning and developing reports immediately.
However, you may change these settings at any time from the
System Configuration dialog box.
To enter System Configuration:
Step Action
1 Select System Configuration from the Utilities drop-down
menu on the main window.
2 Select the category (tab) that you want to change and

following the instructions below for that category.
Clicking on any of the tabs under System Configuration (see
Figure 18-1) displays the options that you can change.
Figure 18-1
System Configuration
Tabs
18-2 Configuring the System

System Tab
Select the System tab to configure system information. Not all
information on the System tab can be changed by the operator.
Some informational fields are automatically updated when
software is installed, system backup is performed, or service is
performed.
The three buttons on the lower right of the System tab perform the
following:
• OK button. Select to close this dialog box, save any
changes you may have made, and return to the main
window.
• Cancel button. Select to close this dialog box without
saving any changes you may have made, and return to the
main window.
• Help button. Select to display help information pertinent
to this dialog box.
Date Format
This field allows you to change the format of the date from US to
international (or vice versa).
The present format is identified by a dot in the radio button. To
change to a different format click either on the words or the radio
button, the dot in the radio button will appear in the selected field.
Patient Biography
This field allows you to change how the values are recorded on
the Patient Biography, as either US (inches, pounds) or
international (cms, kilograms). To change format, click the
appropriate radio button.
Autopositioning for Hip Scans

If checked, hip scans are automatically positioned (applies only to
Discovery systems).
Report Dose Area Product

If checked, reports total x-ray dosage applied to a patient when
the entire scan flow is completed (applies only to systems with
DAP Meter Option installed).
Configuring the System 18-3

Language
This field allows you to select the language the system will run
(applies only to systems with Language option installed).
Customer
This field allows you to enter the name of your firm, clinic or
hospital. Click in the text field, erase any information there and
type in the name of your firm, clinic or hospital. This text field is
limited to 32 characters.
Default Ethnicity
This field allows you to select the default ethnicity that displays
when entering biography for new patients.
Model, S/N, System ID

These fields provide information about your system that was
recorded during software installation. The fields cannot be
changed by the operator.
Data Directory
This field displays the location of the system database. This field
cannot be changed by the operator.
Software
This field is informational only and cannot be changed by the
operator. This field displays the version of the software installed
on your system. Also, to display a drop down list showing all the
software options installed on your system, click the down arrow.
Last System Backup Date

The date and time when you last ran the System Backup utility.
This field is updated each time you run the System Backup utility.
Last Service Date

The date and time when Hologic Customer Service last serviced
your system. The software sets it when service personnel run the
Service utilities.

Analyze Tab
Select the Analyze tab to configure the methods of analysis on
your system. The Analyze tab is broken into various areas
according to the type of analysis. These are explained below.
Default
When you first select the Analyze tab the system will have
choices already selected. These are indicated by a check mark, or
radio button selection, and are the system defaults. You can
change the system defaults at any time, and your new entries will
then determine how your system will handle analysis.
The system defaults are:
• Prevent vertical motion of ROI under the Lateral
Options.
• Image Pro and Display Hip Axis Length under the
Image Display Options.
• Enable Body Composition Analysis under the General
Options (this default displays only if the Body
Composition option is loaded on your machine).
• Never under the Analysis Options - Disable Auto Low
Density
• Discovery under Image Style.
To change a configuration selection or a default setting:
Step Action
1 Click on the title of the selection you want
A check mark appears in the selected box (or dot in the
radio button).
2 If you want to remove a presently selected item
(including defaults), click on the selection name
The check mark (or dot) is removed and the selection is
removed.
3 Click OK.
The system returns to the Main window with your choices
programmed to handle the tasks selected.
To revert back to the system default at any time click on the
Defaults button.

General Options
There are two General Options.
Display Region of Interest Coordinates

Select this option to display the region of interest (ROI)
coordinates and show the ROI values under the image. The
default is not to display region of interest coordinates.
Enable Body Composition Analysis

Select this option to calculate body composition whenever you
analyze a whole body scan.
Image Display Options

There are five Image Display Options.
Initially display unanalyzed Lateral Image as Single Energy

Select this option to initially display unanalyzed lateral images as
single energy images.
Initially display unanalyzed Hip image as Single Energy

The default for the hip is dual energy (the box is checked).
Display pseudo color image
To view pseudo color on the scan image when the analysis is in
the results step, check this box. The default is not to view pseudo
color.
Image Pro
The default is to use an enhanced image processing algorithm to
analyze IVA images. This feature can be overridden when an IVA
image is selected to be analyzed.
Display Hip Axis Length

When checked, hip axis length is displayed in the Analysis
Results screen and in hip reports.

Lateral Options
There are two Lateral Options.
Display MID regions

Select this option to display the MIDs for lateral analysis. With
this option selected, you can also edit the MIDs. The default is not
to display MIDs.
Prevent vertical motion of ROI

Select this option to prevent vertical motion while adjusting
lateral ROI. If not selected, you can adjust the vertical size of the
lateral ROI. The default is to prevent vertical motion.
Analysis Option
There are four Analysis Options.
Disable Auto Low Density

Select Next Scan to disable the automatic low density calculation
for the next spine or hip analysis. Select Always to disable the
automatic low density calculation for all spine or hip analysis.
Select Never to enable auto low density analysis if needed by the
software during analysis. Default is to enable.
Disable Auto Analysis

Select this option to disable the Auto Analysis of the AP Spine,
the Hip or the AP Spine portion of the AP/Lateral. Default is to
enable Auto Analysis on the AP Spine and Hip.
Disable Auto Whole Body

Select this option to disable the Auto Whole Body. Default is to
enable the Auto Whole Body.
Enable NHANES BCA

Select this option to apply a correction factor to the lean tissue
results at the end of Whole Body - Body Composition and correct
the fat and percent fat results accordingly. When enabled,
NHANES BCA will be noted in the BCA results section.
Image Style
Select the desired style for image display.

CAD BMD Tab

The CADBMD tab allows the user to select CADBMD messages
that may be displayed during analysis of scans. These messages
are designed to alert the user to any possible errors that can be
made during the analysis.
There are five CADBMD messages that may be selected for
display and one used to automatically compare the baseline scan,
if available, during analysis of scans:
Check vertebral Z-scores
When checked, displays a CADBMD message during analysis of
spine scans if any of the vertebrae have different Z-scores.
Check vertebral labels
spine scans if any of the vertebrae have inconsistent labels as
compared to the compare scan.
Check vertebral regions
spine scans if the regions differ than that of the compare scan.
Check analysis methods
any type scan if the selected analysis method is different than that
of the compare scan.
Check midline angles
hip scans if the midline angle is different than that of the compare
scan.
Auto compare with baseline scan
When checked, during analysis of any type scan the baseline
scan, if available, shall automatically be used to do a compare
analysis if it is configured.
Any CADBMD setting with a check mark is selected for display if

the error exists during the analysis of scans. The default for the
CADBMD tab is that all settings are selected for display (have a
check mark).
Press OK when done with the CADBMD tab.

Figure 18-2
Typical CADBMD Dialog
CADBMD dialogs can be manually closed by the user clicking the

close button.

Report Tab
Refer to Chapter 15 for a description of the various reports that
can be generated using the APEX software.
Each report is made up of a series of blocks such as the Header,
the Patient Information, Results, etc. (see Figure 18-3) which
contain various pieces of information. This section describes how
to configure that information to customize the various reports.
Figure 18-3
Report Blocks Header
Patient
Information
Scan
Information
Results
Physician
Comment
KP0886C-1705
System Configuration - Report provides three tab selected

dialogs: General, WHO Criteria, and Least Significant Change.
Report - General Tab

The Report - General dialog is used to set default selections that
are used when running the Report function. Any values changed
here become the new default settings and will display on the Print
window accessed form the Reports button.
To view the appearance of a report:
Click on the report name. A preview of the report's appearance
displays on the right.
To configure a report:
1. Click on the report name.

2. Click Configure. The selected configure window appears.

Refer to “Configuring Reports” on page 18-14 for details.
To specify display of color fracture risks graphs:
Check the “Display colored Fracture risk” check box.
Checking this box will display the fracture risk graph in three
colors across the graph indicating normal risk (top color),
increased risk (middle color), and high risk (bottom color). The
colors in DICOM reports will be displayed in shades of gray.
To specify reports are to be ISCD:
Check the “Display ISCD Reports” check box.
Checking this box sets:
• Display T-scores for the patient above age” to 50.
• T-score based on to Caucasian.
• Default values for the “WHO criteria” page as follows:
Hip checked
Report Based on Lowest T-score of neck or total checked
AP checked
Lateral unchecked
Forearm checked
• Default values for the Reference Block Hip configuration.
(Refer to “Reference Block Hip Configuration” on page
18-27)
• Default values for the Reference Block Forearm
configuration. (Refer to “Reference Block Forearm
Configuration” on page 18-28)
To specify ancillary reports are to be included when printing
and previewing reports:
Check the “Display Ancillary Report” check box.
Ancillary reports display selective graphs and corresponding
results which plot any data verses any data that QDR can
measure. Data from the reference curve database is used for
graphing. Ancillary reports are previewed and/or printed in
addition to the selected reports (interpreting, filing, referring, and
rate of change) on one or more pages.
To specify the minimum age for displaying T-scores in both
Report and analysis results:
In the “Display T-Scores for patients above age” field, highlight
the number and enter a new one.

If “Display ISCD Reports” check box is selected the default age

shall be set to 50.
Changing the default setting in this section will cause the
“Display ISCD Reports” checkbox to be unchecked.
To specify reference curves T-score will be based on:
In the “T-score based on” section, click Ethnicity matched or
Caucasian:
Caucasian marks the ISCD reference curves as current for use in
the report.
Ethnicity matched marks the classic Hologic curves as current for
use in the report.
If “Display ISCD Reports” check box is selected this section
defaults to Caucasian.
Changing the default setting in this section will cause the
“Display ISCD Reports” checkbox to be unchecked.
Report - WHO Criteria Tab

The Report - WHO Criteria dialog is used to specify which
reports will display the WHO criteria for each scan.
Automatically set to the following default values when the
“Display ISCD Reports” checkbox on the General tab is checked.
Hip checked
Report Based on Lowest T-score of neck or total checked
AP checked
Lateral unchecked
Forearm checked
Changing any setting on this dialog will cause the “Display ISCD
Reports” checkbox on the General tab to be unchecked.
To change setting(s):
1. Position insertion pointer in respective checkbox and click to
check or uncheck.
2. Click OK
Report - Least Significant Change Tab

The Report - Least Significant Change dialog is used to change
the values used when calculating the significant changes for
reporting rate of change results.

If any values are changed from their default setting, and it is used
in the Rate of change report, the report will indicate “Site
Specific” LSC.
To change value(s):
1. Position insertion pointer in respective field, highlight the
existing value, and type new value.
2. To return all values to their default setting, Click Restore
Defaults.
3. Click OK.

Configuring Reports
The Report - General tab allows the operator to configure all four
types of reports (Filing, Interpreting, Referring and Rate of
Change) as well as common data on all reports (references,
header and physician’s comments).
These are explained below.
Configuring the Reports

Depending upon the changes you want to make, configuring a
report type will consist of one, or more, of the following
procedures:
• Configure the Patient, Scan and Results Blocks
• Configure the Optional Reports
• Configure the Common Block
Configure the Patient, Scan and Results Blocks

The four report types (Filing, Interpreting, Referring and Rate of
Change) consist of various blocks which contain information that
the operator can include or exclude on reports. The reports consist
of four blocks of information: Patient, Scan, Results and Optional
Reports (the scan block does not apply to the Referring and Rate
of Change reports) as shown in the following table:
Blocks You Can Configure

Optional
Report Type Patient Scan Results Reports
Filing X X X X
Interpreting X X X X
Referring X X X
Rate of Change X X X
Instructions for configuring the Patient Block, Scan Block,

Results Block, and Optional Report Block are identical for all
types of reports listed below.

To configure the blocks on a report type:

Step Action
1 Click on the AP Lumbar Spine in the scan type list.
KP0886C-1707
2 Click on the Configure button

A window displays which contains four tabs: Patient
KP0886C-1708
Block; Scan block; Results Block and Optional Reports.
Note: This report is using the
Filing Report type as an example
but the procedure is the same for
all report types.
Note: For a detailed description of
the tabs refer to:
Details of the Patient Block on
page 18-23
Details of the Scan Block on
page 18-24
Details of the Results Block on
page 18-25
KP0886C-1709
3 Click on any of the items under Add to: to highlight the

item.
The << Remove button will highlight.

Step Action
Note: Any Item in the Select 4 Click on the << Remove button.
From: box is excluded from the The item is removed from the Add To: box and placed in
report block.
the Select From: box. The Add >> button will highlight.
Note: If more than one item is in 5 Continue to remove items you want to exclude.
the Select From: box then the Add The items are removed from the Add To: box and placed in
All: button will highlight.
the Select from: box.
6 If you want to return any item to the Add To: box,
highlight the item and click on the Add >> button
or
If you want to return all items in the Select From: box
click the Add All >> button.
Note: The Scan Block does not 7 When finished with the Patient Block, click on the Scan
apply to the Referring and Rate of Block tab and repeat steps 3-6 above.
Change report types.
8 When finished with the Scan Block, click on the Results
Block tab and repeat steps 3-6 above.
9 If you have not completed the task of configuring the
report types go to Configure the Optional Reports on page
18-16 or Configure the Common Block on page 18-19.
or
If you have completed configuring the report types, click
on the OK button to save all your changes.
Configure the Optional Reports

The Optional reports for all report types consist of the following,
their names describe their function:
• Combined AP/Lateral Report
• Extended AP Lumbar Spine Report
• Standardized BMD Report
• Body Composition Report
• Body Composition with BMD Report
• Hip Structure Analysis® Report

To configure the Optional Reports of a report type:

Step Action
1 On the Report Tab, click on the Report type you want to
configure to place the dot in the radio button.
KP0886C-1707
2 Click on the Configure button

A window displays that contains four tabs: Patient Block;
KP0886C-1708
Scan block; Results Block and Optional Reports.
Note: This procedure uses the
Filing Report type as an example
but the procedure is the same for
all report types.
KP0886C-1709

Step Action
3 Click on the Optional Reports tab.
The Optional Reports tab displays.
Note: The Configure Rate of Change - Optional Reports

tab provides only one optional report, the Extended Hip
Rate of Change Report.
4 Click on the reports you want.
A check mark appears in the box next to the report name.
report types go to Configure the Patient, Scan and Results
Blocks on page 18-14 or Configure the Common Block on
page 18-19.
or

Configure the Common Block

To configure the Optional Reports of a report type:
Step Action
1 On the Report Tab, click on the Common block
configuration to place the dot in the radio button.
KP0886C-1711
2 Click on the Configure button.

The Configure Common block options window displays.
KP0886C-1708
KP0886C-1712
The Configure Common block option window consists of three

tabs or options:
• Reference Block
• Header Block

Each of these options can be configured separately or in any

combination.
To configure the Reference Block:
Step Action
Note: A detailed description of the 1 On the Configure Common block option window, click
Reference blocks can be found on the Reference Block tab.
starting on page 18-26.
The Reference Block window displays.
KP0886C-1713
2 Click on and highlight the part of the anatomy you want to

configure (hip, forearm or lateral).
3 Click on the Edit button.
An Edit window displays with various options for the part
KP0886C-1714 of the anatomy you want to configure.
4 Select the options you want to include in the report by
clicking on them and placing a dot in the radio button.
common areas go to Header Block on page 18-21 or
Physician’s comments on page 18-22.
or

To configure the Header Block

Step Action
1 On the Configure Common block option window, click
on the Header Block tab.
The Header Block window displays.
KP0886C-1715
2 Complete each text field on this window as you want it to

appear on the header of the reports. All text fields are self
explanatory by their titles.
Note: If a check mark is not in this 3 After finishing all text fields, ensure that there is a check
box your system will not use the mark in the box next to Use this header information. If
information on this window in the
there is no check mark then click on the box and the
header of your reports.
symbol will appear.
KP0886C-1716

common areas go to Reference Block on page 18-20 or
Physician’s comments on page 18-22.
or

To configure the Physician’s comments

Step Action
Note: The Physician’s comment 1 On the Configure Common block option window, click
block is used to create on the Physician’s comments tab.
predetermined comments that can
The Physician’s comment window displays.
be selected when generating the
report.
KP0886C-1717
2 The following are the different operations that can be used

on the list of items in the display window (represented by
the three button under the window):
Add. Add a new comment.
Delete. Delete the selected comment (an item must be
selected in the window).
Edit. Edit selected comment (an item must be selected in
the window).
You can add a new item that will become a predetermined
comment on the report; you can delete an item which will
eliminate it from the report; or you can edit a comment and
change it.
common areas go to Reference Block or Header Blocks.
or

Details of the Patient Block

The Patient Block (Figure 18-4) deals with information on the
patient biography. By configuring information on the Patient
Block you can remove items of information from the report and
later add them back in.
Figure 18-4
The Patient Block
KP0886C-1718
The items listed in the window named Add To: are the items
printed on your report. Three buttons are provided to control
these items:
Adds a highlighted item in the Select From:
window to the Add To: window. This item
KP0886C-1719
is included in the printing of your report.
Removes an item from the Add To: window
and places it in the Select From: window.
KP0886C-1720
This item is excluded from printing on your
report.
Takes all items from the Select From:
window and moves them to the Add To:
KP0886C-1721
window.
The Patient Block consists of the following items:

Name
Age
Ethnicity
Menopause Age
Height

Weight
Patient ID
Referring Physician
DOB
Sex
Details of the Scan Block

Note: The Scan Block does not The Scan Block (Figure 18-5) deals with information used when
apply to the Referring or Rate of taking the scan. By configuring information on the Scan Block
Change Reports.
you can remove items of information from the report and later
add them back in.
Figure 18-5
Scan Block
KP0886C-1722
these items:

KP0886C-1719
KP0886C-1720
report.
KP0886C-1721
window.

The Scan Block consists of the following items:

Analysis
Comment
Model
Operator
Protocol
Scan Date
Scan Type
Details of the Results Block

The Results Block (Figure 18-6) deals with information on the
result block of the report. Configuring information on the Results
Block you can remove items of information from the report and
later add them back in.
Figure 18-6
The Results Block
KP0886C-1723
these items:


KP0886C-1719
KP0886C-1720
report.
KP0886C-1721
window.
The Results Block consists of the following items:
Region
BMC
BMD
Fat
%Fat
Lean+BMC
Lean
T-Score
Z-Score
Fracture Risk
Area
Details of the Reference Block for Configure Common Block Option

The Reference Block (Figure 18-7) is used for setting up the
default region and range for the different scan types. This block is
common to all report types.
Figure 18-7
The Reference Block
KP0886C-1724

The Reference Block allows you to chose the default region and
range on the Hip, Forearm and AP/Lateral scans.
Reference Block Hip Configuration

Highlighting Hip in the Reference Block window and clicking on
the Edit button displays the following Edit window:
The Edit window for Hip contains two sections. The Reference
Region section designates a reference region for all reports. The
Reported Regions selects one or more regions for reporting.
For ISCD compatible reports the default settings for the Hip
Reference Region is Neck (radio button contains a dot) and the
Reported Regions are Total and Neck (both check boxes contain
check marks). These default values are set by checking “Display
ISCD Reports” on the Reports - General tab dialog.
You can change these default by clicking on any of the other
items in the respective section. Selecting a Reference Region
automatically disables it in the Reported Regions section.
Changing any setting from its default value unchecks “Display
Click the OK button when finished to exit and save the changes,
or the Cancel button to exit without saving the changes.

Reference Block Forearm Configuration

Highlighting Forearm in the Reference Block window and
clicking on the Edit button will display the following Edit
window:
For ISCD compatible reports the default setting for the Forearm
Region is 1/3 and the Range is Radius (the radio buttons are
marked with a dot). These default values are set by checking
“Display ISCD Reports” on the Reports - General tab dialog.
You can change this default by clicking on any of the other items
on the edit window (a dot will appear in that radio button).
Changing any setting from its default value unchecks “Display
Click the OK button when finished to exit and save the changes,

Reference Block Lateral Configuration

Highlighting Lateral in the Reference Block window and clicking
on the Edit button will display the following Edit window:
KP0886C-1727
The default setting for the Lateral is VB (the radio button is

marked with a dot). You can change this default by clicking on
any of the other items on the edit window (a dot will appear in
that radio button).
Click the OK button when finished to exit and save the changes

Configuring the Ancillary Report

Configuring the Ancillary Report consists of selecting the
graph(s) to include in the report:
Step Action
1 On the System Configuration - Report tab, check the
“Display Ancillary Report” check box and click
Configure.
The Configure Ancillary Report window displays.
Note: Refer to “Reference Curve” 2 Check the Include check box for the graphs to include in
on page 19-42 for details on the report, and uncheck the check box for the graphs that
adding additional custom values
are not to be included.
for reporting.

Archive Tab
The Archive Tab under System configuration allows you to setup
locations to store information when you use the archive menu
item. You can set up various locations with one being the primary,
or default, location that is used automatically when data is
archived.
This default location is also used by the Locate Menu on the Main
Screen. When Locate is selected, the location displayed is the
default location chosen when you configured Archive.
The default location is shown on the Archive Tab. You can
change the default location by adding a new location or by
selecting a location on the list on the Archive Tab and setting it as
the default.
Adding a New Location

To add a new location to the archive list:
Step Action
1 On the Archive Tab, type a new location in the Add new
Location text box.
or
Press the Browse button to the right of the text window and
a window displays showing locations on your computer
and network (if one is present). Select a location and press
the OK button to display the location in the text window.
KP0886C-1729

Step Action
2 Click on the Add button next to the text window.
A message displays asking if you want to make the new
location the default location.
KP0886C-1730
If you click the OK button then the new location is

designated as the new default location and shown as such
on the Archive Tab, and the location is added to the archive
list. If you click the No button the location is added to the
archive list.
Changing the Default Location

Use the following procedure to change the default location to the
archive list of locations:
To change the default location
Step Action
1 In the list of locations in the window on the Archive tab,
click on the location you want as the new default.
The location is highlighted.
2 Click on Set Default Location button.
The highlighted location is designated as the new default
and the location is placed in the Default Location area on
the Archive Tab.
Deleting a Location from the Archive List

Use the following procedure to delete a location from the achieve
list:
To delete a location from the archive list:
Step Action
1 In list of locations in the window on the Archive tab, click
on the location you want to delete.
The location is highlighted.

Step Action
Note: If the location to be deleted 2 Click on Delete button.
is the default location a message The highlighted location is deleted from the archive list.
appears informing the operator.
Including Raw Data Files

When this option is checked, raw data files will be included when
transferring scans. Raw data files should not be transferred with
the scan files unless you have been instructed to do so by
Hologic, Inc.
Automatically Deleting Scans After Archiving

In the Delete Scans After Archiving section:
Click the Do Not Delete Scans button to disable automatically
deletion of scans after archiving.
Or
Click the Delete All Scans or the Delete Only Non-Baseline
Scans button to automatically delete the respective scans after
archiving, and then click the Delete After Archiving Once or the
Delete After Archiving Twice button to specify the number of
times the scans are to be archive before they are deleted.

HL7 Tab
The HL7 Tab allows the user to enter additional fields of
information for tracking patient accounts for the Hospital
Information System (HIS). The HL7 Tab allows you to place up
to three additional fields that appear on the Patient Confirmation
window (see Refer to “Confirming the Patient Information” on
page 7-6 of Chapter 7).
The information entered in these fields will be passed back to the
HIS through the Physician’s Viewer (see the Physician’s Viewer
manual for additional information).
Entering HL7 Fields

Use the following procedure to enable/disable displaying of HL7
fields:
To enter a HL7 field:
Step Action
1 From the menu bar select Utilities → System
Configuration and click on the HL7 Tab.
2 On the HL7 Tab, click on the box to the left of Display
Label 1.
Box
KP1035A-1732
A check mark appears in the box and the area to the right
of Display Label 1 turns from gray to white.

Step Action
3 In the white area to the right of Display Label 1 type in
the desired name of the label.
The label “Billing Code” is used as an example below.
KP1035A-1733
Note: If you click OK without 4 Click OK.

entering a label the software The system returns to the Main window.
removes the 3 and no HL7 field
will appear on the Patient
Confirmation window.
5 To confirm that the HL7 label was created, click the
Perform Exam button.
Select any patient and click OK.
KP1035A-0309
The Patient Confirmation window appears with the HL7
field enabled (in this example “Billing Code”).

Changing HL7 Fields

To Change a HL7 field:
Step Action
2 In the white area to the right of Display Label 1 type in
the name of the new label.
In the example below “Insurance Code” replaces
“Billing Code.”
KP1035A-1735
3 Click OK and the following window appears.
KP1035A-1736
4 Click Yes to return to the main window.

Step Action
5 To confirm that the new label is enabled, click the
Perform Exam button, select a patient and the Patient
Confirmation window appears with the new label.
Removing HL7 Fields

To Remove a HL7 field:
Step Action
2 In the white area to the right of Display Label 1 remove
the label from the field.
KP1035A-1738

Step Action
3 On the HL7 Tab, click on the box to the left of Display
Label 1.
KP1035A-1739
The check mark is removed and the box to the right of

Display Label 1 turns from white to gray.
4 Click OK and the following window appears.
KP1035A-1740
5 To confirm that the new label has been removed, click the
Perform Exam button, select a patient and the Patient
Confirmation window appears with the label removed.

Scan Conversion
The Scan Conversion tab allows the QDR system to except a scan
acquired on another manufacturer’s system. Once the data
(coefficients) for the other manufacturer’s scan are entered into
the database, the QDR will automatically accept scans from that
manufacturer.
The QDR system contains the Scan Conversion for Hologic,

Norland and Lunar scans (as shown in the Manufacturer drop
down list).
KP1068_002-1808
When any of these manufacturers (including Hologic) are

selected, their coefficients appear in the Input Coefficients boxes
for the spine and hip. The Input Coefficients are grayed out and
cannot be changed. The values for the Input Coefficients were
derived from the following studies:
• Hui SL, Gao S, et al 1997 Universal Standardization of
Bone Density Measurements: A Method with Optimal
Properties for Calibration Among Several Instruments. J
Bone Miner Res 9:1463-1470.
• Lu Y, Fuerst T September 6, 1996 Summary of Femur
Standardization: Generation of Formulas for Standardized
BMD (sBMD) and Inter-Manufacturer Cross-Calibration.
(A report from the UCSF Osteoporosis Research Group).
These results were confirmed by the University of
Indiana. Presented to the Subcommittee for standardizing
hip DXA, ASBMR Annual Meeting, Seattle, WA, Sept. 7,
1995.
• Genant HK, Grampp S, et al 1994 Universal
Standardization for Dual X-ray Absorptiometry: Patient
and Phantom Cross-Calibration Results. J Bone Miner
Res:9:1503-1514.
The system manager can add additional manufacturers to the drop
down list. To do so they must have access to a study or studies

that provide the Input Coefficients for that manufacturer versus

Hologic.
To Add Additional Manufacturers
Step Action
1 Enter the name of the manufacturer in the Manufacturer
window.
KP1068_002-1806
Note: All “m” values must be 2 Within the Input Coefficients section add the value of m
within the range of 0.5 to 2.0. for the Spine Total.
KP1068_002-1807
Note: All “b” values must be 3 Within the Input Coefficients section and the value of b
within the range of -0.9 to +0.9. for the Spine Total.
4 Within the Input Coefficients section add the value of m
for the Hip Total.
5 Within the Input Coefficients section add the value of b
for the Hip Total.
for the Neck.
for the Neck.
for the Trochanter.
for the Trochanter.
10 When all coefficients have been entered, click OK.
The new manufacturer will appear in the drop down menu
with data entered into the Input Coefficients.

History
This tab appears if the Mobility option is installed.
The History tab of the System Configuration window allows the
user to configure the patient questionnaire.
The following describes the fields for configuring the History
Questionnaire.
Default Questionnaire Template
MAN-00175_003-1834
This is an edit box for the location of the Default Questionnaire

Template. This box is filled in at install and points to the template.
The default is C\QDR\HxQuestionnaire\template\HologicHx.xml
(located under the install directory).
Clicking Browse button and a window opens that allows the
selection of a path to another questionnaire template on your
system or network.
MAN-00175_003-1834

Location of Completed Questionnaire
MAN-00175_003-1836
This box provides an edit box for the location of completed

Questionnaires. This is filled in at install time and points to the
location to store Questionnaires that are filled out. The default is
C\install directory\HxQuestionnaire\Results (located under the
QDR directory).
Clicking the Browse button and a window appears that allows
selection of a path to another location to store the completed
questionnaires.
MAN-00175_003-1837
Port
MAN-00175_003-1838
This is an edit box for the communication Port. This port

communicates with the Questionnaire Application and accepts
numeric data only. The default is 106.

Print Patient Name and ID
MAN-00175_003-1837
This is a checkbox that prints the patient name and ID on multiple

page reports. A checkmark in the box prints the Patient Name and
ID on pages 2 until the last page of the questionnaire (this is the
default). Clicking in this area will remove the checkmark and the
Patient Name and ID will not print.

DICOM Tab
Digital Imaging and Communications in Medicine (DICOM) is a
powerful tool that provides:
• Interpreting physicians with the ability to view electronic
QDR bone density scan and analysis results on a Picture
Archiving and Communications System (PACS) viewer. The
DICOM option allows results to be transmitted automatically
over a facility’s network directly to a physician’s DICOM
viewing station for interpretation and report dictation. The
results can also be archived on the PACS, making them avail-
able for future reference and for distribution to others on the
PACS network.
• The QDR system with the ability to retrieve schedule and
patient demographic information when the Modality Worklist
option is installed on the system.
• Locating and retrieving of scans that have been previously
archived to a remote storage system (PACS) when the Query/
Retrieve option is installed on the system.
The following sections describe Settings for DICOM functions are controlled using the System
how to configure the Modality Configuration – DICOM tab found under the Utilities pull
Worklist; add, edit, and delete
down menu in the main window.
DICOM Report Send remote
destinations; add, edit, and delete The DICOM tab contains four tabs used to configure:
DICOM Report Storage • Modality Worklist option (when installed)
Commitment remote destinations;
• DICOM report send destinations (when installed)
add, edit, and delete Query/
Retrieve remote destinations; and • DICOM report storage commitment destinations (when
configure the Host Machine (local installed)
system). • Query/Retrieve option (when installed)
• Host machine
Modality Worklist
The modality worklist option adds two tabs to the APEX
software:
• A Worklist tab is added to the System Configuration -
DICOM window to allow the configuration of the
modality worklist.
• A Worklist tab is added to the Select Patient for Exam
window to allow the operator to receive schedules from
the HIS/RIS to perform tasks on the QDR system.

Configuring Modality Worklist
Caution: Changing information Modality Worklist is configured by selecting System

that configures the modality Configuration – DICOM tab – Worklist tab found under the
worklist can cause serious
Utilities pull down menu in the main window.
communication disruptions with
the HIS/RIS. Only authorized
personnel should change settings.
The Worklist tab is divided into 8 areas used to control

communication to and from the HIS/RIS and one area providing
an option for obtaining worklist data from an input file rather
than from a remote worklist provider.
• Query Parameters
• Auto Query Interval
• Query Retry Parameters
• Purge Interval
• Input from File
• Enable Detailed Query
• Configure Worklist Provider
• Map Worklist Fields
• Confirm network and PACS connection
Each of these areas is explained below.

Query Parameters Use controls in this area to perform the following:

• Filter the query by modality and AE Title.
• Determine a limit of entries to the Worklist database over a specified
period of time.
• Determine if “Detailed Query” and “Extended Details” buttons will
appear in the Select a Patient for this Exam - Worklist dialog.
Days Back and This provides the valid time range of the query. There are a pair of drop
Forward down menus labeled Back and Forward. If both of these are set to 0
(zero) then the valid range is for today’s date only. If the Back drop-
down menu is set to 7 and the Forward drop-down menu is set to 0
(zero) then the valid range of the query is one week, starting with today’s
date going back seven (7) days. The range for the drop-down menu for
Back is 0 to 9 and the range for the drop-down menu for Forward is 0 to
8. Both Back and Forward drop-down menus can manually be set from
0 to 99.
Modality Modality is the type of system recognized by the HIS/RIS. Since “bone
densitometer” is not a standard defined type, the QDR System is usually
defined as “OT” for “Other.”
AE Title AE stands for Application Entity. This is a text entry box that provides a
unique name for the QDR system. Every QDR system will (or should)
have an AE name that uniquely identifies that specific system.
Maximum Hits This is an entry box that accepts a numeric value only. The number is the
Per Query maximum number of query hits that will be passed to the QDR system
specified in the Days Back and Forward. If there are more hits than the
maximum, only the number specified in this box are passed to the QDR
system.
Enable Detailed A check box determining if an “Detailed Query” button and an
Query “Extended Details” button will appear in the Select a Patient for this
Exam - Worklist dialog when performing an exam.
When checked both buttons will appear.

Auto Query Use controls in this area to set up a specific time interval during which
Interval the QDR system queries the provider to update the worklist.
Auto Query Interval area contains three radio buttons, only one of which
may be selected.
Note: These controls remain enabled when Input From file is enabled.
Every Day At This entry provides two drop-down menus labeled HR and Min that
specify a specific time each day that the QDR system will query the
provider to update the worklist. The HR drop-down menu has a range of
0 to 23. The Min drop-down menu can be set to 0, 10, 20, 30, 40 or 50.
Every This entry provides a drop-down menu labeled Hours that specifies an
hourly interval at which the QDR system will query the provider to
update the worklist. The drop-down menu has a range of 1 to 12 (manual
entry is also possible).
Never If Never is selected, the QDR system will not automatically query the
provider to update the worklist. With this selected, queries must be done
manually by the operator.
Query Retry If the provider did not respond to a query to update the worklist for some
Parameters reason (e.g., busy, off-line), controls in this area will determine how long
the QDR system will wait for a response and give a specific time before
trying the query again.
This entry contains a checkbox and three drop-down menus that control
how long the QDR system will wait for the provider to respond to a
query.
Query Retry In order for the QDR system to perform a retry after a time-out period,
Checkbox they must be a check mark in this box. If there is no check mark in this
box then the QDR system will continue to wait until the provider
responds to the query to update the worklist. To place a check mark in
the box, click in the box.
Query Timeout This is a drop-down menu labeled Min. The value in this drop-down
menu tells the QDR system how long it can wait before retrying the
query. Min has a range of 0 to 60 minutes in 5 minute intervals. The
operator can enter a number from 0-99 manually.
Retry Number This is a drop-down menu labeled Times that tells the QDR system how
many times it may issue a retry. This drop-down menu allows a selection
of 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 for the number of retries.The operator
can enter a number from 0-99 manually.

Retry Interval This is a drop-down menu labeled Min that tells the QDR system how
long to wait between retries.This drop-down menu has a range of 10 to
90 minutes in 10 minute intervals.The operator can enter a number from
0-99 manually.
Purge Interval Each time the provider responds to a query from the QDR system the
worklist entries are stored in a database on the QDR system. Use
controls in this area to allow the database to be automatically purged
(data removed) at a specific time.
Used Entries This is a drop-down menu labeled Days. The value in this drop-down
menu provides a limit for storing those studies that have already been
performed. The studies are purged (deleted) after the specified number
of days. The range for Used Entries drop-down menu is 0 to 9 days. The
Used Entries drop-down menu can be set manually to any number of
days from 0 to 999.
Unused Entries This is a drop-down menu labeled Days. The value in this drop-down
menu provides a limit for storing those studies that have not been
performed. These are purged (deleted) after the specified number of
days. The range for the drop-down menu for Unused Entries is 0 to 9
days. The Unused Entries drop-down menu can be set manually to any
number of days from 0 to 999.
Input From File Provides an option for obtaining worklist data from an input file
generated by an electronic Medical Reporting System rather than from a
remote Worklist provider.
Enable A check box determining whether or not the Input from File feature is
enabled. When checked, worklist data is obtained from an input file.
All controls on the Worklist tab not used for the Input from File feature
are disabled when this box is checked.
Input File Name Displays a full path to the current worklist file. This field is populated or
changed using Browse to select a file path.
... (Browse) Displays a “File Open” dialog allowing the user to locate a worklist
input file on the local system or network.
Configre Worklist Click Configure Worklist Provider to define the worklist provider. The
Provider worklist provider supplies worklist entries for the QDR system.
Refer to “Configure Worklist Provider” on page 18-49 for details.

Map Worklist Different hospitals and clinics may use the same DICOM attributes in
Fields various ways to identify their patients. Map Worklist Fields is used to
ensure that data in the QDR system and in the HIS/RIS are addressing
the same patient.
Click Map Worklist Fields, on the Worklist Tab, to display a window
called Map Worklist Keys that allows fields to be selected for patient
verification by the QDR system and the HIS/RIS database. Once these
entries are made, they will be checked on each study to verify that the
QDR system and the HIS/RIS have identified the same patient.
Refer to “Map Worklist Fields” on page 18-51 for details.
Local Ping Confirms if the local system is connected to a network.
Configure Worklist Provider

Clicking Configure Worklist Provider displays a window used
to define the worklist provider. The worklist provider supplies
worklist entries for the QDR system.
Worklist Provider Use controls in this area to define the worklist provider.
AE Title This is the Application Entity title of the worklist provider.
Remote Host This is the host name or IP address of the worklist provider.
The host name or IP address must be on the same network as the QDR
workstation.
Accepts up to 120 alphanumeric characters.
Remote Port This is the port number of the worklist provider.
Number
Performed This area provides an option to automatically respond to a performed
Procedure Step procedure provider once a specific task is performed in the worklist.
Use Performed When checked, each time a study is completed a response is sent to the
Procedure Step provider indicating that the task has been completed. To place a check
mark in the box, click in the box.
Provider Use controls in this area to define the performed procedure step provider.
The performed procedure provider may be the same as the worklist
provider or different.
Use Worklist When checked, the performed procedure step provider is the same as the
Provider Data worklist provider.

AE Title This is the Application Entity title of the performed procedure step
provider when Use Worklist Provider Data is unchecked.
Remote Host This is the host name or IP address of the performed procedure step
provider when Use Worklist Provider Data is unchecked.
The host name or IP address must be on the same network as the QDR
workstation.
Remote Port This is the port number of the performed procedure step provider when
Number Use Worklist Provider Data is unchecked.
Remote Ping Confirms if the configured Worklist provider or Performed Procedure
Step provider system is connected to the same network as the local
system.
C-ECHO Confirms if the configured Worklist provider or Performed Procedure
Step provider system is a Picture Archival and Communications system
(PACS).

Map Worklist Fields

Clicking Map Worklist Fields on the displays the following
window:
Caution: Do not change settings
in the Map Worklist Fields
without specific directions from
your HIS/RIS department.
KP1043A-11
This window consist of 15 different drop-down menus with

specific labels on the left. The labels indicate data that is in the
Patient Biography on the QDR systems (some information, such
as HL7 fields, may not apply to each QDR system). The
information in the drop-down menus is information that may
appear in the HIS/RIS database for the patient. The goal is to find
information in the Patient Biography that matches information in
the HIS/RIS database to be used as a key to verify that the patient
in the Patient Biography is the same as the patient in the HIS/RIS
database.
This task of matching information must be performed by
someone with knowledge of both the QDR system and the
operations of the HIS/RIS.
There are two sets of drop-down menus:

• Patient Matching Keys - six drop-down menus for

Patient Matching
• Other Keys - nine drop-down menus for Key Mapping
The Patient Matching drop-down menus allow specific data in the
Patient Biography of the QDR system to be mapped to data in the
HIS/RIS database. These drop-down menus have check boxes to
the left of the label. A check mark in any of these boxes means
that the information in the Patient Biography must match the
information in the HIS/RIS database to identify the same patient.
The Key Mapping drop-down menus provide data from the HIS/
RIS database that can be mapped to specific information in the
Patient Biography.
“Not Mapped” in any drop-down menu indicates that the field in
the Patient Biography will not be mapped with any field in the
HIS/RIS database.

DICOM Send Destinations

Send destinations define destinations to which the DICOM
reports are transmitted when the Send function is used.
This section describes how to Send destinations are configured by selecting System
configure, add, edit, and delete a Configuration – DICOM tab – Send tab found under the
destination remote nodes and how
to configure all Send destinations.
Configure DICOM Selection list of existing DICOM Send destinations configured on the
Send Destinations local system.
Add Destination Displays a dialog that allows configuring a new Send destination
Edit Destination Enabled when one destination is selected.
Displays a dialog that allows changing the selected Send destination’s
configuration.
Delete Destination Enabled when one or more destinations are selected.
Deletes the selected Send destination(s).
Local Ping Confirms whether or not the local system is connected to a network.
Remote Ping Enabled when one destination is selected.
Confirms whether or not the configured Send destination system is
connected to the same network as the local system.
C-ECHO Enabled when one destination is selected.
Confirms whether or not the configured Send destination system is a
Picture Archival and Communications system (PACS).
Configure Click Configure Parameters to define the Send destination auto retry
Parameters parameters and when to purge log entries.
Refer to “Configure DICOM Send” on page 18-57 for details.

Using the System Configuration - DICOM - Send tab:

Step Action
1 To add a new destination: click Add Destination,
complete the Add / Edit DICOM Send Destination dialog
fields (refer to “Add / Edit DICOM Send Destination
Dialog” on page 18-55 for details), and click OK.
To reconfigure an existing destination: select the
destination in the selection list, click Edit Destination,
edit the Add / Edit DICOM Send Destination dialog box
as required (refer to “Add / Edit DICOM Send
Destination Dialog” on page 18-55 for details), and click
OK.
To enable/disable a destination for use: click the check
box in the Active column of the selection list for the
destination to check/uncheck (check to enable).
To verify the local system is connected to a local
network: click Local Ping. Click OK to close the
resulting message.
To verify the destination is connected to the same
network as the local system: select the destination in the
selection list and click Remote Ping. Click OK to close
the resulting message.
To verify the destination is a PACS: select the destination
in the selection list and click C-ECHO. Click OK to
close the resulting message.
To delete a destination: select the destination in the
selection list and click Delete Destination.
To define auto query parameters for all configured Send
destinations: click Configure Parameters, edit the
Configure DICOM Send dialog box as required (refer to
“Configure DICOM Send” on page 18-57 for details) and
click OK.
2 Click OK to return to the main screen.

Add / Edit DICOM Send Destination Dialog
AE Title Application Entity. Provides a unique name for the destination system.
Note: To add the QDR workstation as a destination node, type local in
the AE Title box.
Host Name or IP Name or IP address of destination.
Address The host name or IP address must be on the same network as the QDR
workstation.
Note: To add the QDR workstation as a destination node, type localhost
in the Host Name or IP Address box.
SCP Port Port number on destination.
The default for the Service Class Provider Port number is 104.
Accepts up to 5 numeric characters in the range of 1 - 65535.
Destination Name Provides an alias name used for selecting a destination.
Interpreting An optional entry that provides the name of the physician interpreting
Physician the scan.
Accepts up to 120 characters.

Grayscale Only When checked, DICOM reports are converted into grayscale when
sending to the selected destination.
When unchecked, images for all report types that may contain graphs
will be created in color. Images for all other report types (IVA,
questionnaire, etc) will be created in grayscale.
Presentation File When checked, a DICOM GSPS file will be sent along with an image
DICOM file if needed for IVA scan.
If checked and the node is also marked for storage commitment, then the
commitment request will be issued for both image and GSPS DICOM
files.
IVA Results File When checked, a DICOM IVA Results file will be sent along with an
image DICOM file if needed for IVA scan.
If checked and the node is also marked for storage commitment, then the
commitment request will be issued for both image and IVA Results
DICOM files.
Unicode When checked, DICOM files are sent with Unicode coding.
When using Unicode, an Extended Character Set attribute will be
present in DICOM files. Text attributes will be populated with single
byte strings converted from double byte strings using UTF-8 encoding.
When not using Unicode, an Extended Character Set attribute will not be
present in DICOM files. Text attributes will be populated with single
byte strings converted from double byte strings using UTF-8 encoding.
Storage When checked, designates the destination is committed to storing
Commitment information sent to it.
Provider When checked a storage commitment provider must be designated. To
designate a storage commitment provider, select an existing provider
from the drop-down list, or click Add New Provider to designate add a
new storage commitment provider (refer to “Add / Edit Storage
Commitment Destination Dialog” on page 18-61 for details on adding a
new provider). Storage commitment providers can also be added using
the System Configuration - DICOM tab - Commit tab (refer to “DICOM
Storage Commitment Destinations” on page 18-59 for details).

Scan Archive Displays if the Enterprise Data Management option is installed.

Location When checked, designates the destination is a scan archiving location
and will implement the inclusion of P&R files to the DICOM file.
P files are QDR scan files that contain processing data for the scan.
R files are QDR scan files that contain the raw data for the image.
When checked, the Select Existing Provider field can be left blank to
indicate the Send destination is also the scan archive location. Or, an
existing scan archiving location can be selected from the drop-down list,
or click Add New Provider to designate add a new scan archive location.
Scan archive locations can also be added using the System
Configuration - DICOM tab - Query/Retrieve tab (refer to “DICOM
Query/Retrieve Destinations” on page 18-63 for details).
OK Validates data. If validation passes, the dialog is closed and the configure
DICOM Send Destinations selection list is updated with new or changed
data. If validation fails, a warning message displays.
Cancel Ignores all edits and closes the dialog.
Configure DICOM Send
Query Retry If the Send destination did not respond to a request for some reason (e.g.,
Parameters busy, off-line), controls in this area will determine how long the QDR
system will wait for a response and give a specific time before trying the
query again.
Retry Number This is a entry box labeled Times that tells the QDR system how many
times it may issue a retry. The Retry Number entry box can be set
manually to any number of days from 0 to 99.

Retry Interval This is a entry box labeled Min that tells the QDR system how long to
wait between retries.The Retry Interval entry box can be set manually
to any number of minutes from 1 to 1440.
Purge log entries This is a entry box labeled days. The value in this box provides a limit
after for storing DICOM Send log entries. The entries are purged (deleted)
after the specified number of days. The Purge log entries after entry
box can be set manually to any number of days from 0 to 99.

DICOM Storage Commitment Destinations

Storage commitment destinations define destinations to which the
DICOM reports can be transmitted and stored when the Send
function is used.
Storage Commitment destinations must be defined before
defining DICOM Send destinations as storage commitment
destinations.
This section describes how to Send destinations are configured by selecting System
configure, add, edit, and delete a Configuration – DICOM tab – Commit tab found under the
storage commitment destination
remote nodes and how to
configure all Storage Commitment
destinations.
Configure DICOM Selection list of existing DICOM Storage Commitment destinations

Send Destinations configured on the local system.
Add Destination Displays a dialog that allows configuring a new Storage Commitment
destination
Displays a dialog that allows changing the selected Storage Commitment
destination’s configuration.
Deletes the selected Storage Commitment destination(s).
Confirms whether or not the configured Storage Commitment
destination is connected to the same network as the local system.
Confirms whether or not the configured Storage Commitment
destination is a Picture Archival and Communications system (PACS).
Configure Click Configure Parameters to define the Storage Commitment
Parameters destination auto retry parameters, when to purge log entries, and how
DICOM storage commitment files are sent to a destination.
Refer to “Configure Storage Commitment” on page 18-62 for details.

Using the System Configuration - DICOM - Commit tab:

Step Action
complete the Add / Edit Storage Commitment dialog
fields (refer to “Add / Edit Storage Commitment
OK.
edit the Add / Edit Storage Commitment dialog box as
required (refer to “Add / Edit Storage Commitment
OK.
resulting message.
To define auto query parameters for all configured
Storage Commitment destinations: click Configure
Parameters, edit the Configure Storage Commitment
dialog box as required (refer to “Configure Storage
Commitment” on page 18-62 for details) and click OK.

Add / Edit Storage Commitment Destination Dialog
Note: To add the QDR workstation as a destination node, type local in
the AE Title box.
workstation.
Note: To add the QDR workstation as a destination node, type localhost
in the Host Name or IP Address box.
Destination Name Provides an alias name used for selecting destinations.
OK Validates data. If validation passes, the dialog is closed and the configure
DICOM Storage Commitment Destinations selection list is updated with
new or changed data. If validation fails, a warning message displays.

Configure Storage Commitment
Query Retry If the Storage Commitment destination did not respond to a request for
Parameters some reason (e.g., busy, off-line), controls in this area will determine
how long the QDR system will wait for a response and give a specific
time before trying the query again.
Retry Number This entry box labeled Times tells the QDR system how many times it
may issue a retry. The Retry Number entry box can be set manually to
any number of days from 0 to 99.
Retry Interval This entry box labeled Min tells the QDR system how long to wait
between retries.The Retry Interval entry box can be set manually to any
number of minutes from 1 to 1440.
Mode DICOM files can be sent to a storage commitment destination as one file
or all files per request.
Image-by-image This radio button, when selected, tells the QDR system to issue a single
storage commitment request for all DICOM files to be sent.
Batch This radio button, when selected, tells the QDR system to issue a storage
commitment request for each DICOM file to be sent.
Purge log entries This is a entry box labeled days. The value in this box provides a limit
after for storing DICOM Send log entries. The entries are purged (deleted)
after the specified number of days. The Purge log entries after entry
box can be set manually to any number of days from 0 to 99.

DICOM Query/Retrieve Destinations

Query/Retrieve allows the operator to query a remote location
(PACS) for scans meeting given parameters and filters and to
retrieve selective scans into the current computer. The scans must
have been stored to that remote location prior to using the Query/
Retrieve function.
This section describes how to Query/Retrieve destinations are configured by selecting System
configure, add, edit, and delete a Configuration – DICOM tab – Query/Retrieve tab found
destination remote node.
under the Utilities pull down menu in the main window.
Configure DICOM Selection list of existing DICOM Query/Retrieve destinations

Query/Retrieve configured on the QDR system.
Destinations
Add Destination Displays a dialog that allows configuring a new Query/Retrieve
destination
Displays a dialog that allows changing the selected Query/Retrieve
destination’s configuration.
Deletes the selected Query/Retrieve destination(s).
Confirms whether or not the configured Query/Retrieve system is
connected to the same network as the local system.
Confirms whether or not the configured Query/Retrieve system is a
Picture Archival and Communications system (PACS).

Using the System Configuration - DICOM - Query/Retrieve tab:

Step Action
complete the Add DICOM Query/Retrieve Destination
dialog fields (refer to “Add / Edit DICOM Query/
Retrieve Destination Dialog” on page 18-65 for details),
and click OK.
edit the Edit DICOM Query/Retrieve Destination dialog
box as required (refer to “Add / Edit DICOM Query/
Retrieve Destination Dialog” on page 18-65 for details),
and click OK.
resulting message.

Add / Edit DICOM Query/Retrieve Destination Dialog
workstation.
OK Validates data. If validation passes, the dialog is closed and the
Configure DICOM Query/Retrieve Destinations selection list is updated
with new or changed data. If validation fails, a warning message
displays.

Host
Host Machine defines your system when DICOM functions are
used.
Important: If changes are made to either the AE Title or
Listening Port data, the APEX application must be restarted for
the changes to take effect.
This section describes how to The Host Machine is configured by selecting System
configure a Host Machine. Configuration – DICOM tab – Host tab found under the
AE Title Application Entity. Provides a unique name for the QDR system.
Station Name Name of the QDR system.
Listening Port Port number on which the QDR system listens.
The default port number is 104.
OK Validates data. If validation passes, the System Configuration window
closes returning to the main screen. If validation fails, a warning
message displays.
Cancel Ignores all edits, closes the System Configuration window, and returns
to the main screen.
Using the System Configuration - DICOM - Host tab:

Step Action
1 To add or edit your QDR system information, complete
the Host fields as required.

Privacy Tools
The Privacy Tools tab allows the user to select QDR data fields
for privacy information. There are eight QDR data fields that may
be selected for privacy:
• Patient’s name
• Patient ID
• Patient ID2
• Patient Date of Birth
• Patient Address
• Patient Insurance Information
• Scan Data
• All Comments (including scan comments, physician
comments and patient comments)
Any comment marked with a check mark () is selected for
patient privacy and will be removed from DICOM Reports,
copied scans and exported database. The default for the Privacy
Tools tab is that all fields have a check mark, all are selected for
privacy.
Click on the check mark in the box to remove it and allow this
information to be added to DICOM Reports, copied scans and
exported database.
The button marked Restore Defaults will place a check mark in
all eight QDR Data Fields.
Press OK when done with the Privacy Tools tab.

Study Tab
Note: If the worklist option is The Study Tab is used to develop a study that has multiple
installed on your QDR system, examinations attached to it. The studies are saved on the QDR
refer to “Using Modality
system and can be used from the Select Scan Type window.
Worklist with a Study” on
page 7-13.
Adding a Study
To Add a Study
Step Action
Configuration and click on the Study Tab.
2 Click New and the following Scan Add window appears.
In the following example a study will be developed using
KP1035A-1743
the AP/Lumbar Spine, Forearm and Left Hip
examinations and be called “Test01.”
3 On the Scan Add window, in the field next to Study

Name, enter the name of the study. This name may have
a maximum of 16 characters (spaces count as a
character).
In our example, the study is named “Test01”.

Step Action
4 Click Add and the Select Scan Type window lists the
examinations on your QDR system.
KP1035A-1745
KP1035A-1746
Cancel returns to the Scan Add window.

5 If you are using a Scan Mode other than the default, click
on the check mark next to the Use Default Scan Mode.
The check mark is removed.
6 Highlight the scan type to be included in the study,
KP1035A-1747
The OK button becomes active.

Cancel returns to the Scan Add window.
7 Click OK.

Step Action
Note: Some scan types have only 8 If you did not remove the check mark in step 5 above, go
one scan mode (the default), if to step 9.
one of these scan types is part of
a Study then this step will not If you removed the check mark in step 5 above, the
appear, go to step 9 (for more following window appears to allow selection of the scan
information refer to the mode (for the scan type selected in step 7).
appropriate chapter of this
manual for the scan type and see
“Selecting the Scan Type and
Mode”).
Note: Some scan types have
more than one scan mode, if one
of these scans is selected as part
of a study this step may appear a
number of times to satisfy the
conditions of the examination
(for more information refer to KP1035A-1748
the appropriate chapter of this Select the scan mode and click OK.
manual:
9 The Scan Add screen appears with the selected scan type
Chapter 8 for AP Lumbar
listed.
Spine
Chapter 9 for Hip
Chapter 10 for Forearm
Chapter 11 for Whole Body
Chapter 12 for AP/Lateral
Spine
See “Selecting the Scan Type
and Mode”).
KP1035A-1749
Note: You may add up to 10 scan 10 Repeat steps 4 through step 9 for each additional scan
types per study. type to be added to the study.
Note: Clicking the Cancel 11 To change the order of examinations, highlight the
button will return to the Study examination to be moved.
Tab window and abort the study.
In our example the Left Hip examination will be done
last.
Arrows
KP1035A-1750a

Step Action
Use the arrow keys to move the examination up or down.
In the example the down arrow is used to move the Left
Hip Examination after the Left Forearm examination.
KP1035A-1750b
Click OK to accept the study.

In the example, the study Test01 now consists of an AP/
Lumbar Spine, Left Forearm and Left Hip examination,
performed in that order.
Click Cancel to reject changes to the order of
examinations
12 When the study is complete, click OK and the Study Tab
appears with the study name listed along with all scan
KP1035A-1751
types for that study.
13 Click OK to accept the study and return to the main

screen.

Editing an Existing Study

Adding Items to an Existing Study
Adding Items to an Existing Study
Step Action
2 Highlight the study to be changed and click the Edit
button.
Edit button
3 The Scan Add window lists the scan(s) for the study.
KP1035A-1770

Step Action
4 Click the Add button and the Select Scan Type window
lists the examinations on your QDR system.
KP1035A-1747
5 Highlight the scan type to be added to the study and click

on the OK button.
In the example a Dual Hip Examination is added as the
third part of the study named “Test02”.
6 The Scan Add window appears with the new scan type
added to the list.
KP1035A-1771
7 Repeat steps 5 and 6 of this step for each new scan type to
be added to the study.

Step Action
8 When you have added all the scan types to the study,
click OK on the Scan Add window. The Study Tab
window appears listing the Studies and all scans
associated with the studies.
Deleting Items from an Existing Study

Deleting Items from an Existing Study
Step Action

Step Action
2 Highlight the study to be changed and click the Edit
button.
In our example the Dual Hip scan will be deleted from
the study named “Test02”.
Edit button
The Edit and Delete buttons become active.

3 The Scan Add window lists the scans for the study.
KP1035A-1774

Step Action
4 Highlight the scan type to be deleted from the study.
In the example
KP1035A-1775
The Delete button becomes active.

5 Click Delete and the highlighted scan type is deleted
from the Study.
KP1035A-1776
KP1035A-1777
6 On the Add Scan window, click OK and the Study Tab

window appears listing all Studies and scans associated
with the studies.

Step Action
Deleting a Study
To Delete a Study
Step Action
2 On the Study Tab window, highlight the study to be
deleted.
In the example study named “Test05” will be deleted.
The Edit and Delete buttons become active.

Step Action
3 Click Delete and a confirmation screen will appear
asking you if you want to delete the study.
KP1035A-1780
Click Yes and the study is deleted from the Study Tab
window.
Renaming a Study
To Rename a Study
Step Action

Step Action
2 On the Study Tab window, highlight the study to be
changed.
In the example study “Test03” is renamed to “Test05”.
3 Click on the Edit button and the Scan Add window will
appear.
KP1035A-1783
KP1035A-1784

Step Action
4 In the window with the Study name, highlight the scan
name and type in the new name.
In the example “Test03” was highlighted then “Test05”
was typed.
Change name in this window
KP1035A-1785
5 Click OK to return to the Study Tab.

The name of the Study has been changed.
KP1035A-1751

Locating a Study from a Long List

If there are more that 15 studies on the Study Tab window then
you will have to use the side scroll bar to view any studies not on
the window.
Side
Scroll
Bar
In a long list of studies on the Study Tab window, the operator

can use the Scan Name search engine to locate a specific study.
KP1035A-1788
Typing the name of the study into the text box will find that study
and highlight it in the window.


Chapter 19
Utilities
Utilities are programs that find, move, store, and edit patient
biographies, patient scans and data, as well as system
information. Utilities are a subset of the main functions of the
system that do the “cleanup” work after the scanning and analysis
are done.
Content
Subject Page
Starting a Utility 19-2
System Configuration 19-2
Usage 19-3
Database Tools 19-9
Patient Management 19-9
Export/Import 19-25
Export 19-27
Import 19-29
Reconcile 19-31
Patient Callback 19-33
Scan File Look 19-36
Scan File Plot 19-36
Emergency Motion 19-40
AP Reposition 19-40
Reference Curve 19-42
To start the Reference Curve Editor: 19-43
Creating New Reference Curve Records 19-44
Copying a Reference Curve Record 19-49
Editing Reference Curve Records 19-51
Deleting Reference Curve Records 19-52
Adding New Ethnic Groups 19-53
Rebuild Archive Index 19-55
Install Options 19-57
Utilities NOT covered in this chapter
Some utilities may appear on the pull-down menu but are not
available to the user. These utilities are intended for
manufacturing and service personnel.
19-1
Starting a Utility
This section describes how to access the utilities available in the
System software.
To access the Utilities menu:
Step Action
1 Move the pointer to the Main Window Menu Bar and
click on Utilities.
A pull-down menu appears listing the available utilities.
2 Using the mouse, move the pointer down to highlight the

desired utility.
3 Click on the utility to start the operation.
System Configuration
The system software lets you change system configuration
settings for a variety of system parameters. You do this by setting
default parameters that are applied to your system and stay in
effect even after exiting and restarting the software.
The procedures for setting the system configuration are described
in Chapter 18, Configuring the System, in this User’s Guide.
19-2 Utilities
Usage
Note: Usage is for Strategic Usage is an application that displays and prints billing
Alliance Program (SAP) information captured on your QDR system. It allows you to view
customers only.
and print a summary graph or detailed list of the usage history of
your QDR system.
Hologic’s Strategic Alliance Program requires users of QDR X-

ray bone densitometers who are in the program to report
equipment usage each month. Usage reports for the month must
be faxed to Hologic at (781) 280-0158, no later than the eighth
calendar day of the following month.
The Usage utility is accessed through the Utilities pull-down
menu.
To start Usage:
Step Action
1 Select Utilities from the Menu Bar of the main window.
A list of utilities displays.
Utilities 19-3
Step Action
2 Select Usage from the pull-down menu.
The Usage program menu displays.
KP1068A-1803
Usage Program Menu

The Usage Program menu, shown above, allows you to select
one of two Usage functions as well as set the Start and End dates
that apply to those functions.
• Show Summary
Show Summary displays a graph showing the number of
studies for a specified period. The summary is the primary
usage report; the Strategic Alliance Program requires that
the report be faxed to Hologic each month.
• Show Detail
Show Detail displays a detailed report for a specified
period. This report lists the patient’s name, date of scan,
type of scan, and study number for each scan performed
during the specified period. The list is grouped by scan
date. Use this report to claim credit for studies that are
technically unacceptable.
Both functions allow you to print the information displayed.
Usage Summary Report

To display the Summary Report, follow the procedure below.
To display the Summary Report:
Step Action
1 Select the Show Summary radio button.
2 Enter the start and end date for the period the report will
cover, and click OK.
The following message displays.
19-4 Utilities
Step Action
KP0886C-1804
3 Click Yes to show the Summary Report. Clicking No

returns to the Usage program menu.
KP0886C-1805
Print the Usage Summary Report, shown above, to report QDR

system usage for the Strategic Alliance Program. To print the
report, click the Print button.
The Usage Summary Report displays a graph showing the count
of studies for the period specified in the Start and End Date
fields. It also displays the minimum number of studies required
by the Strategic Alliance Program, and additional information,
described below.
• Your institution’s name.
• A line graph showing the number of studies performed
during the specified period. The number of studies is
presented on the vertical axis while the time is shown on
the horizontal axis.
A study may comprise several scans on a single patient
conducted on the same day (for example, spine and hip).
• The date the report was run.
• The model and serial numbers of the scanner.
• The version number of the APEX software.
• A control code for use by Hologic, Inc.
Utilities 19-5
• The version number of the Usage software.

• The start and end dates of the summary.
• A running monthly average of the number of studies
performed over the most recent six months. If the period
specified in the start and end date is less than six months,
the average number of studies is computed over the
selected time span.
• A total count of the last month of studies.
If the end date is not the default date (i.e. last day of the
previous month) the last month count is left blank.
• Space is provided on the report to enable the user to
request credit for technically unacceptable studies (see
below). The number of technically unacceptable studies
must be hand written or typed on the printed copy.
• A Net Scans space is provided to enable the user to
calculate net scans for billing by subtracting the quantity
of technically unacceptable studies.
Technically Unacceptable Studies

A technically unacceptable study is one that has no diagnostically
usable scans. To request credit for technically unacceptable
studies, write the number of such studies in the Technically
Unacceptable field on the printed report. Subtract this number
from the monthly total of studies to determine the net study count
and write the result in the Net Scans field on the printed report.
In order for Hologic to issue credit for technically unacceptable
studies you must FAX a copy of the detailed report, with all the
technically unacceptable studies marked (circled or underlined)
together with the summary report. Hologic may request a copy of
these studies on diskette.
See the section Claims for Technically Unacceptable Studies on
page 19-8 of this chapter for the fax number and address.
Usage Detail Report

To display the Detail Report, follow the procedure below.
To display the Detail Report:
Step Action
1 Select the Show Detail radio button.
19-6 Utilities
Step Action
2 Enter the start and end date for the period the report will
cover, and click OK.
KP0886C-1804
3 Click Yes to show the Detail Report. Clicking No returns

to the Usage program menu.
KP0886C-1806
The Usage Detail Report, shown above, is a detailed report of the

studies performed during the period you specified in the Start and
End Date fields. To print the report, click the Print button.
The Usage Detail Report lists the patient’s name, date of scan,
type of scan, and study count number. Note that multiple scans of
a patient performed on one day are all assigned the same study
count number. The list is sorted in chronological order.
The Usage Detail Report also includes the following:
• The date the report was run.
• Your institution’s name.
• The date the detailed list was prepared.
• The start and end dates of the summary.
Utilities 19-7
• The total number of studies performed during the given

period (excluding phantom scans).
Claims for Technically Unacceptable Studies

To request credit for unacceptable studies, you must:
• Produce a hard copy of the Usage Detail Report.
• Mark (circle or underline) any studies in which there are
no diagnostically usable scans.
• Fax a marked copy of the Usage Detail Report along with
the Monthly Summary Report to Hologic at (781) 280-
0158.
Hologic may request a copy of all scans in the unacceptable
studies on a diskette. Use the procedure describe in Archiving
Scans on page 16-8 of this user’s guide to produce the copy. Send
the diskettes containing the unacceptable studies in a diskette
mailer to:
Hologic, Inc.
35 Crosby Drive
Bedford, MA 01730
Attention: Strategic Alliance Program
19-8 Utilities
Database Tools
Database tools are used to move patient, reference, and QC data
to and from other databases. The database tools also allow you to
manage data created by earlier versions of the Hologic QDR
software.
Patient Management
You can manage patient and scan data using the Patient
Management database tool. With Patient Management you can:
• select a baseline scan for each type of scan in the database
for a selected patient
• move scan records from one patient to another.
• delete scan records.
• delete patient records.
• edit patient biographies.
• edit patient insurance information.
• list scan details and edit some entries.
• list scan identification information.
Starting Patient Management

To start Patient Management:
Step Action
1 Select Utilities>Database Tools>Patient Management
from the Menu Bar of the main window.
Utilities 19-9
Managing Patients
Database Manager dialog box (shown below) displays all the
patient and scan data on the system. The display has several
navigation and control tools to move and edit data. The following
table lists these and their function:
Name Function
Patient Name Any input from the keyboard is displayed in
Text Box this text box. You can select a patient by
typing part or all of the name.
Patient Name This column lists the patients in ascending
alphabetical order.
Patient ID This column lists the patient’s ID number.
Click on Patient ID to sort the list in
ascending numerical order.
Birth Date This column lists the patient’s birth date.
Click on Birth Date to sort the list in
descending chronological order.
Sex This column lists the patient’s sex. Click on
Sex to sort the list by female and then by male
Ethnicity This column lists the patient’s ethnicity. Click
on Ethnicity to sort the list in ascending
alphabetical order.
Referring This column lists patient’s referring physician.
Physician Click on Referring Physician to sort the list in
ascending alphabetical order.
19-10 Utilities
Name Function
Edit Click on this button to edit the patient’s
biography and insurance information. You
must first select the desired patient (see Item
9). You can also edit by double clicking on the
patient’s name.
Patient Select a patient by:
Selection • Clicking on the patient’s name or any
information to the right of the patient’s
name.
• Entering the name in the Patient Name
text box (see Item 1).
• Select the patient using the
<UpArrow> and <DownArrow> keys.
The patient is selected when a blue
background appears behind it.
Manage Scans This button enables if the selected patient has
button scan data in the system. Click on this button to
see a list of all the patient’s scans. The Select
Scans window appears and you can begin
scan management.
Manage Click this button to select a baseline scan for
Baseline button each type of scan in the database for a selected
patient. Refer to “Managing Patient Baseline
Scans” on page 19-17.
The selected baseline scan displays on the
Scan Parameters window and the scan and
reposition screens when another exam of that
type scan is performed for that patient.
Erase Patient Click on this button to delete the selected
button patient. If the selected patient has scan
information in the system, you can not delete
the patient–you must delete the scan(s) first
(see Item 10 above).
Refer to “Removing a Patient From the
System” on page 19-18.
Close button Click on this button to close the Database
Manager dialog box.
Utilities 19-11
Managing Patient Information

When you select a patient, the Edit button enables (Item 8 above).
Click this button (or double-click the selection) to enable the
Patient dialog box. The dialog box has two tabs, you can select
Biography and Insurance.
Biography
In the Biography dialog box, you can change any entry by
selecting it either by using the Tab key or the mouse, and
changing the information.
The fields and buttons in this box are:
1
2
3 11
4 12
5 13
6 14
7 15
8 16
9 17
10
18
19
20
Item Name Function

1 Biography The patient dialog box has two tabs–the
Tab Biography tab and the Insurance tab. The
Biography tab displays the items listed
below.
19-12 Utilities
Item Name Function

Note: If you change the First 2 First Name These fields display the patient’s first and
Name, Last Name, Middle last name and middle initial. You can
Initial, and DOB information so 3 Last Name
change this information by selecting it
that they are identical to a
4 Middle using the mouse pointer or the Tab key
patient that already exists on the
system, a warning appears (see Initial and typing in the new information.
below). Select the appropriate
5 Ethnicity You must select the ethnicity from the
action.
drop list which is generated by the system.
If the appropriate ethnicity is not
available, you can select the blank in the
KP0886C-1810
list.
Note: If you change the Patient 6 Patient ID You can change this filed using a string of
ID information so that it is up to 64 characters.
identical to a patient that
already exists on the system, a 7 Identifier 2 Enter a string of up to 15 characters.
warning appears (see below).
Select the appropriate action. 8 Referring This field is a combination drop list and
Physician text box. You can select any system
generated name from the list or select the
text and enter a string of up to 25
characters.
KP0886C-1811
9 Menopause If the sex of the patient is male, this field
Age is disabled. Otherwise, enter a number
from 00 to 99, or leave blank.
10 Patient Enter a string of up to 100 characters.
Comment
11 Sex Select the sex (F or M) from the drop list.
Note: If you enter inappropriate 12 DOB: Select the month from the drop list.
information for the day and/or Month Select the day and year from the spin
year, an error message appears
controls to the right of the field; or select
(see below). Select OK and 13 DOB: Day
correct the error or select the information in the field and enter the
Cancel to discard any changes. 14 DOB: Year new information.
15 Weight Enter the patient’s weight in lb. (for USA)
or kg (for Europe).
16 Height Enter the patient’s height in inches (for
KP0886C-1812
USA) or centimeters (for Europe).
17 Body Mass Automatically calculated from Height/
Index Weight entries.
18 OK Select OK to save any changes you have
button made and return to the Database Manager.
Utilities 19-13
Item Name Function

19 Cancel Select Cancel to ignore any changes you
button may have made and return to the Patient
Manager.
20 Help Select Help to display information about
button using this dialog box.
Insurance
Select the Insurance tab to display any insurance information for
the selected patient.
1
2
3
5
6
7
8
9 11
10 12
13
KP0886C-1813
Item Name Function

1 Name The box displays the patient’s name and
ID. You cannot change these fields here.
2 Patient ID
19-14 Utilities
Item Name Function

3 Plan You can change all these fields by
selecting them and entering the new
4 Group
information. The system limits each field
5 Insurance to a string of characters of an appropriate
6 Address1 length.
7 Address2
8 City
9 State
10 Postal Code
11 OK button See the descriptions of these buttons under
Biography above.
12 Cancel
button
13 Help button
QC Phantom Details
In the Patient Management dialog box, if you select a Phantom
scan and click on the Edit button, the “QC Phantom Details”
dialog box appears.
KP0886C-1814

Name Function
Phantom Name This is a concatenation of the information
in the Phantom Type field and the
Phantom Number field. You cannot
change the information in this field.
Utilities 19-15
Name Function
Phantom Type The system defines the phantom types.
You can change the Phantom Type using
the drop list. The types are limited to
Spine, Block, Hip, and Other. You cannot
enter a type that is not already defined.
Phantom Number You can enter or change this field using a
string of 6 characters or less.
Comment You can enter a comment up to 100
characters.
OK button See the descriptions of these buttons under
Biography above.
Cancel button
19-16 Utilities
Managing Patient Baseline Scans

Manage Baseline Scans allows the user to select a baseline scan
for each type of scan in the database for a selected patient.
The selected baseline scan displays on the Scan Parameters
window and the scan and reposition screens when an exam of that
type scan is performed for that patient.
This window displays a list of all scan types and a list of all scans
of a selected scan type in the database for the patient that you
selected on the Database Manager window. Use it to:
Select patient baseline scans:
1. In the Select Scan Type list box, click on the desired scan
type. The scan list populates with a list of all scans of a
selected scan type in the database for the selected patient.
The selected baseline scan is designated by a superscript 1 in
the Scan Type column.
2. In the scan list, click on the scan to designate as the baseline
scan and click Set As Baseline.
View a selected scan's details:
1. In the Select Scan Type list box, click on the desired scan
type.
2. In the scan list, click on the scan to designate as the baseline
scan and click Scan Details. The Scan Property window
appears.
Utilities 19-17
Removing a Patient From the System

You can remove a patient (or a phantom) from the system by:
Step Action
1 Select (highlight) the patient using the mouse or the
arrow keys.
Note: If the selected patient has
no associated scans in the
system, the Erase Patient button
is enabled.
Note: If the Erase Patient button

is not enabled then there are
scans associated with the
patient. All scans listed under
the patient name must be deleted
before the patient can be
removed from the system.
KP0886C-1815
2 Click on the Erase Patient button.

A warning message displays.
KP0886C-1816
3 Select Yes to remove the patient from the database.

The screen updates the patient records minus the patient
just erased.
Managing Scans
If you select a patient in the Patient Management dialog box with
associated scans, the Manage Scans button enables. Select this
KP0886C-1817
button to enable the following dialog box:
19-18 Utilities
1 2 3 5 6 7 8
KP0886C-1818
9 10 11 12 13 14
The Select Scans dialog box has several editing and navigation
tools to manage the scans. The following table lists these and
their functions:
Item Name Function

1 Patient Name This field indicates the patient’s name.
It can not be changed here.
2 Scan Date This indicates the creation date of the
(button) corresponding scan. You can click on
this button to arrange all the scans in
reverse chronological order. An
asterisk (*) appears after “Date” to
indicate that all the scans listed are
sorted by this field.
3 Scan Type This indicates the type of the
alphabetical order. An asterisk (*)
appears after “Type” to indicate that all
the scans listed are sorted by this field.
Utilities 19-19
Item Name Function

4 Scan selection Select the desired scan(s) by using the
Up Arrow and the Down Arrow keys or
the mouse pointer. A blue background
highlights the scan(s) when you select
them. You can double-click on the
selected scan to get scan details. You
can also highlight the desired scan(s)
and select the Scan Details button to
get the details of that scan.
5 Scan ID This indicates the ID of the
descending alpha-numerical order. An
asterisk (*) appears after “ID” to
6 Analysis Date This indicates the date that the
(button) corresponding scan was analyzed. You
can click on this button to arrange all
the scans in chronological order. An
asterisk (*) appears after “Date” to
7 Patient ID This field indicates the patient’s ID. It
can not be changed here.
8 Scan Details This button remains inactive until you
button select a scan. When you select this
button, the Scan Property dialog box
for that scan appears.
9 << Back button Select this button to return to the
Patient Management dialog box.
10 Move Scans>> This button enables only if you select
button one or more scans. Select this button
when you want to move one or more
scans to another patient.
11 Select All This button enables only when you
button select all the scans. Selecting this
button selects all the scans.
12 Deselect All This button enables only when you
button select one or more scans. Selecting this
button deselects all the scans.
19-20 Utilities
Item Name Function

13 Erase Scan This button enables only when you
button select one or more scans. Selecting this
button deletes the selected scans after
warning you that it will do so.
Selecting Yes deletes the scans from
the system permanently. Selecting No
returns you to the Patient Management
dialog box.
14 Cancel button Select this button to end this session
and return to the Hologic Main
Window.
Moving Scans
Scans can be moved from the one patient’s drawer to another
using the following procedure. Use this procedure if the operator
has forgotten to enter a new patient into the system and stored the
scans under the wrong patient by mistake.
To move scans:
Step Action
Shortcut: <Alt>udm 1 Select Utilities > Database Tools > Patient
Management from the Menu Bar of the main window.
2 From the Database Management dialog box, highlight

(select) the patient name that contains the scans to be
moved.
Utilities 19-21
Step Action
KP0886C-1819
Manage Scans button
Note: If this button is not active, 3 Click on the Manage Scans button.
there are no scans under this A Scan tab will be displayed showing all scans under the
person’s name to move.
patient’s name.
KP0886C-1820
4 Highlight (select) the scans to be moved.

The Move Scans>> button will become active.
19-22 Utilities
Step Action
5 Click on the Move Scans>> button.
The Select Target Patient screen is displayed.
KP0886C-1821
KP0886C-1822
6 Highlight (select) the destination (patient name) where

the selected scans are to be moved.
The Finish button will become active.
7 Click the Finish button.
A message is displayed.
KP0886C-1823
8 Click Yes to move the selected scans.

The Database Management dialog box is displayed.
Erasing Scans
Note: Once a scan is erased it is Scans can be erased (deleted) from the patient’s drawer using the
permanently deleted from the following procedure.
system.
To erase (delete) scans:

Step Action
Shortcut: <Alt>udm 1 Select Utilities > Database Tools > Patient
Management from the Menu Bar of the main window.
Utilities 19-23
Step Action
2 From the Database Management dialog box, highlight

(select) the patient name that contains the scans to be
deleted.
KP0886C-1819
Manage Scans button
Note: If this button is not active, 3 Click on Manage Scans button.
there are no scans under this A Scan tab will be displayed showing all scans under the
person’s name to delete.
patient’s name.
19-24 Utilities
Step Action
KP0886C-1820
4 Highlight (select) the scans to be deleted.

The Erase Scans button will become active.
5 Click on the Erase Scans button.
A message is displayed.
KP0886C-1824
KP0886C-1825
6 Click Yes to erase the selected scans.

The Database Management dialog box is displayed.
Export/Import
The Export/Import utilities move data to or from any storage
device available to your system. You select the type of data that
you want to move.
Export/Import allows incremental data transfers (new data only).
This saves time and disk space. The data can also be moved to
and from another system. It can be moved to a new or an existing
database.
Utilities 19-25
Types of Databases
Export/Import allows you to transfer the current data (MS
Access,.mdb extension) or data from an earlier version of Hologic
software (dBase,.dbf extension). Export/Import allows you to
move data:
• to/from any storage device.
• to/from another system.
• from an earlier version of Hologic software (Import only).
Types of Data
Export/Import allows you to move the following types of data:
Patient Data Data in the system that pertains to real

patients (not phantoms). This includes the
patient’s biography and any scan data.
Scan Data Data in the system that pertains to the
scanning of a patient or a phantom.
QC Scan Data All the phantom scan data and the
corresponding QC parameters.
Reference Data Collection of data grouped by age,
ethnicity, and sex. A patient’s scan data is
compared with the reference data from the
same group for evaluation.
Types of Transfers
Note: You can only move Export/Import lets you:
incremental data to/from • choose to add new data to existing data or
previously Exported /Imported
data on the current system. • overwrite the existing data.
Caution: If you elect to move all
the data, you may overwrite
newer data with older data. The
system prompts you if this is
about to happen.
19-26 Utilities
Export
To export data:
Step Action
Shortcut: <Alt>ude 1 Select Utilities>Database Tools>Export from the Menu
Bar of the main window.
The Export dialog box appears.

Note: You cannot select scans 2 In the Export Data field, click any or all of Patient Data,
without first selecting patients. Scan Data, QC Data and Reference Data for the data to
be exported.
Within the Patient Data and Scan Data fields, click the
check box, or boxes, to filter data as desired.
KP1068_002-1904
3 In the Export Options field:

• click De-identify protected health information
if de-identification is desired
• click All the Data or New Data Only for the files
to be exported.
Utilities 19-27
Step Action
Note: The software stores files 4 Click Export when done.
as MS Access Files with a.mdb A “Save As” window (similar to the following) appears:
extension. If you want to change
the format, you must do it
directly through the MS Access
application.
KP0886C-1829
Warning: Do not select QDR 5 Double click on the location (folder) that is the
data as a storage folder for your destination for the exported database.
data. The system reserves this
The Save in: window changes to the destination (“Temp”
folder for storing the system
data. in the following example):
Destination location
KP0886C-1830
Note: If an error occurs stating 6 In the “File name” text box, enter a name for the
that the name already exists, database.
type in another name for the
data file.
7 Click on Save button.
The window displays the progress of the database being
saved, when completed the Close button will be active.
8 Click on the Close button to exit Export.
The main window is displayed.
If you choose Reference Data along with QC and/or Patient/Scan

Data, Export prompts you twice for the desired database. This is
19-28 Utilities
because the software exports and stores the reference data

separately from the other data.
Import
To import data:
Step Action
Shortcut: <Alt>udi 1 Select Utilities>Database Tools>Import from the Menu
The Import dialog box appears:
KP0886C-1832
2 Select the data types from the Data Sets that match the
data files to be loaded (click on the radio button).
3 Select either All the Data or New Data Only
(incremental data) under the Options heading.
Utilities 19-29
Step Action
Note: Import also restores data 4 Click the Import button when done.
from earlier QDR operating The “Open” window is displayed (similar to the
systems. This data has the.dbf
following:
extension and can be selected by
dropping the Save as type: list
and selecting DOS SCANS...
from the list.
KP0886C-1833
5 Double click on the folder that contains the database files

to be imported
The Look in: part of the window displays the databases
that exist in that folder (as seen in the following
example):
KP0886C-1834
6 Highlight (select) the database to be loaded and click on

the Open button.
The window displays the progress of the database being
loaded. When completed the Close button will be active.
7 Click on the Close button of the Import Dialog box.
19-30 Utilities
If you choose Reference Data along with QC and/or Patient/Scan

Data, Import prompts you twice for the desired database. This is
because the software imports and stores the reference data
separately from the other data.
Reconcile
Reconcile is a helpful database tool that automatically compares
the system database with the scan files in your system directory.
Any discrepancies are automatically corrected by your system.
To perform the Reconcile function:
Step Action
1 Select Utilities>Database Tools>Reconcile from the
Menu Bar of the main window.
The following warning appears:
KP0886C-1836
Utilities 19-31
Step Action
2 Click on the Continue button to start the database
reconciliation.
The Database Reconcile window appears showing the
progress of Part 1 of the program.
KP0886C-1837
Cancel button - click to stop Reconcile procedure
Upon completing Part 1, a window appears showing the

progress of Part 2 of the program.
KP0886C-1838
Cancel button - click to stop Reconcile procedure
When Part 2 is complete the Close button is active.
KP0886C-1839
3 Click on the Close button

19-32 Utilities
Patient Callback
Patient Callback provides a list of patients matching specified
criteria to be used for scheduling follow-up exams. The criteria
for this list can be a scanned date range, a T-score range or both
for the following scan types:
• Total Hip
• Femoral Neck (Hip
• Total Spine
To perform the Patient Callback function:
Step Action
1 Select Utilities>Database Tools>Patient Callback from
the Menu Bar of the main window.
The Patient Callback screen appears:
KP1068_002-1911
Utilities 19-33
Step Action
2 Enter a start and end date ranges into Date Range field,
KP1068_002-1912
or,
enter a minimum and maximum T-Score range into the T-
Score Range field.
KP1068_002-1913
or,
input ranges into both of the fields.
3 Click Generate List and a message appears stating that
KP1068_002-1914
the Callback Query is in progress.
KP1068_002-1915
A list of patients appears that fall within the ranges of

date, T-Score or both.
KP1068_002-1916
19-34 Utilities
Step Action
4 Click on any patient to add that patient to the Callback
list,
or,
use the Ctrl key to select multiple patients,
or,
click Select All to select all of the patients in the list.
KP1068_002-1917
5 After selecting the patient, you can provide the

information as follows:
• Print the list by clicking Print.
KP1068_002-1918
• Export the list as a text file by clicking Text File

Export (you will be prompted to name the file).
KP1068_002-1918
• Export the list as an Access database file by

clicking DB Export (you will be prompted to
name the file).
KP1068_002-1919
6 The Cancel button has two functions:

1. Clicking this button before performing step 5 above
KP1068_002-1920 returns to the main screen and any patients selected
for a list will be lost.
2. Clicking this button after performing step 5 above
returns to the main screen.
Utilities 19-35
Auto Baseline Utility

Sets the baseline scan of all restored scans (patients and scan
types) to the oldest scan.
To perform the Auto Baseline Utility function:
Step Action
1 Select Utilities>Database Tools>Auto Baseline Utility
from the Menu Bar of the main window.
A message displays when the function is completed.
2 Click OK.
Scan File Look

Data in scan files is stored in records.
Scan File Look displays records in any of the three types (P, R,
and A) of scan files and data contained in a record can be
displayed. It is a tool intended for use by people performing
research and Hologic personnel performing system diagnostics.
To perform the Scan File Look function:
Step Action
1 Select Utilities>Scan File Look from the Menu Bar of
the main window.
A scan file selection window displays.
19-36 Utilities
Step Action
2 Select a scan file in the selection list, select the file type
from the File Type drop-down field, and click OK.
The scan file viewer window displays a summary of all

records in the selected scan file.
Utilities 19-37
Step Action
3 To view the data contents of a record, click on the desired
record in the record selection list.
4 To print the data contained in the selected record, click

the print button or select Print from the File menu.
5 To copy text contained in the data view area for pasting

into another application, select (highlight) the desired
text, and click the copy button or select Copy from the
Edit menu.
6 To view the records in a different file type for the same
scan file, click the down arrow on the Open Scan File
button and select a corresponding file type.
7 To view the records in a different scan file, click Open

Scan File, located and select the desired scan file, and
click Open.
19-38 Utilities
Scan File Plot

Scan File Plot displays the bone image contained in a scan R file
and a graph representing the data in the lines of the scan. It is a
tool intended for use by people performing research and Hologic
personnel performing system diagnostics.
To perform the Scan File Plot function:
Step Action
1 Select Utilities>Scan File Plot from the Menu Bar of the
main window.
The Plot dialog appears.
2 Select a scan file in the selection list and click OK.
Utilities 19-39
Emergency Motion
The Emergency Motion utility should only be used under the
supervision of Hologic personnel or its authorized representative.
This utility allows the operator to move the table and the C-arm
independently. It is available in the unlikely event that your table
and/or C-arm are positioned outside of their normal operating
range.
To perform the Emergency Motion function:
Step Action
1 Select Utilities>Emergency Motion from the Menu Bar
of the main window.
Follow Hologic Help Desk instructions.
AP Reposition
The AP Reposition utility is available on Discovery-A and -SL,
systems only. It should only be used under the supervision of
Hologic personnel or its authorized representative. This utility
allows the operator to return the C-arm from the lateral position to
the AP position in the unlikely event that a scan is aborted during
the lateral portion of an AP/Lateral scan.
19-40 Utilities
To perform the AP Reposition function:

Step Action
1 Select Utilities from the Menu Bar of the Main Window.
Select AP Reposition from the drop-down menu.
Utilities 19-41
Reference Curve
Standard reference curves are provided by Hologic based on
studies performed on Hologic QDR bone densitometers.
References curves are sets of data points for a given sex,
ethnicity, and scan type/region and specify standard deviation and
skew value for the point.
Reference Curve allows users to setup and manipulate custom
reference curve data.
Using Reference Curve you can:
• view reference curve record data
• create new reference curve records
• modify reference curve records (Hologic supplied
reference curve records cannot be modified)
• delete reference curve records (Hologic supplied
reference curve records cannot be deleted)
• create new ethnicity groups
• restore database to Hologic-supplied reference curves
Hologic-supplied reference curves cannot be edited or deleted.
However, Hologic-supplied curves can be marked as current or
non-current and they can be copied and edited to create a new
reference curve.
19-42 Utilities
Starting Reference Curve Editor

To start the Reference Curve Editor:
Step Action
1 Select Utilities>Reference Curve>Editor from the Menu
KP0886C-1863
Note: An “H” in the Hologic field 2 Click OK to continue. The Reference Curve Editor dialog
indicates a Hologic provided box displays.
reference curve record that cannot
be modified or deleted.
Utilities 19-43
Viewing Reference Curve Data

To view reference curve data:
Step Action
1 Start the Reference Curve Editor (refer to “Starting
Reference Curve Editor,” on page 19-43).
2 Locate and click on the reference curve record line to view.
The line is highlighted.
3 Click View. The View Reference Curve dialog box appears.
Note: No changes can be made
from this screen. Refer to Editing
Reference Curve Records on Page
19-51 for details on editing curves.
Note: Refer to the Reference

Curve Description Fields table on
Page 19-47 for descriptions of the
fields on this screen.
The upper section contains the reference curve description

information. The lower section contains the reference
curve point data. No changes can be made on this dialog
box.
6 Click Close to return to the Reference Curve Editor dialog
box.
7 Click Close to return to the main screen.
Creating New Reference Curve Records

Note: New reference curve records can be easily created by
copying an existing reference curve record where most of the data
is to be the same as that of the existing record. Refer to Copying a
Reference Curve Record on Page 19-49.
To create new reference curve records:
Step Action
19-44 Utilities
Step Action
2 Click New.
A message similar to the following appears.
KP0886C-1849
3 Click OK to continue.The New Reference Curve dialog box

appears.
The upper section contains fields to enter the reference

curve description information. The lower section lists the
reference curve point data as it is added.
4 Complete the reference curve description information in
the upper section. Use the drop-down lists where available.
Use the tab key to move between fields.
Utilities 19-45
Step Action
5 Click Select X, Y Labels. The following dialog appears.
6 Expand the label selection trees as required.

7 Click on one label in both the X Label and Y Label section.
8 Click OK.
9 Click Input to add a new set of points to the reference
curve.
Input Record dialog box similar to the following appears.
10 Complete the information fields, S.D. (standard deviation),

and L (skew value for the point) fields and click OK.
The point set appears in the lower section sorted by the X-
axis selection.
11 Repeat Step 10 as required to add additional point sets. Or
click Cancel to close the Input Record dialog box and
continue.
19-46 Utilities
Step Action
12 If necessary, edit a point set by clicking on the desired
point set and clicking the Edit button.
The Edit Record dialog box appears.
13 Change the information fields as required and click OK.

The point set appears in the lower section sorted by the X-
axis selection.
14 If necessary, delete a point set by clicking on the desired
point set and clicking the Delete button.
A warning message appears.
15 Click Yes to continue.
The point set is removed from the lower section.
16 Repeat Steps 14 and 15 as required to delete additional
point sets.
17 When you have completed adding the reference curve,
click Close to record the curve data and return to the
Reference Curve Editor dialog
The message similar to the following appears.
KP0886C-1855
Reference Curve Description Fields

Field Description
Sex Select from drop-down list.
Ethnicity Select from drop-down list.
Utilities 19-47
Field Description
Date Set by the system when a curve is created
or modified. Cannot be edited.
Author Identifier for person creating or
modifying curve. Enter up to five
characters.
Source Identifier for supplier providing the
reference curve data. Enter up to 61
characters.
Comment Comments pertaining to the reference
curve.
Select X, Y Labels This button brings up the Select X, Y
Labels window.
X-Axis
Label X-axis label to display on reports.
Display from - to Range of X-axis data to display on
reports between which the reference
curve is considered to be valid. This does
not necessarily correspond to the low and
high points that define the curve.
Y-Axis
Label Y-axis label to display on reports.
Display from - to Range used for the Y-axis in the
graphical display. Does not effect the
operation of Normals.
Is this curve current? Lets more than one reference curve (for
the same sex, ethnic group, scan type,
and bone region) on the system at the
same time. Only one of these curves can
be marked as current. Only current
curves are used by Normals.
Method Analysis method for the curve. Select
from drop-down list.
Scan Type Set by the system depending on the X, Y
label selection when a curve is created or
modified. Cannot be edited.
19-48 Utilities
Field Description
Age Peak BMD Age of maximum bone density used to
compute T-score. Visible when X-axis
label is selected as “Age” and Y-axis
label is selected as “BMD”.
Copying a Reference Curve Record

Copying an existing reference curve record makes it easy to
create a new curve record where most of the data is to be the same
as that of the existing record.
To create new reference curve records from existing records:
Step Action
2 Locate and click on the reference curve record line to copy.
3 Click Copy.
A message similar to the following appears:
KP0886C-1859
Utilities 19-49
Step Action
4 Click OK.
The Copy Reference Curve dialog box appears:
The upper section contains fields to enter or change the

reference curve description information. The lower section
lists the current reference curve point data.
5 Change the reference curve description information in the
upper section as required. Use the drop-down lists where
available. Use the tab key to move between fields.
6 Please refer to Creating New Reference Curve Records -
Steps 5 through 8 beginning on Page 19-46 for selecting
X, Y labels.
Steps 9 through 16 beginning on Page 19-46 for adding,
editing, and/or deleting reference curve point data.
Then continue with the following steps.
8 When you have completed changing the copied reference
curve, click Close to record the curve data and return to the
Reference Curve Editor dialog.
KP0886C-1855
19-50 Utilities
Editing Reference Curve Records

Note: With the exception of the Is the curve current? field in the
reference curve description section, Hologic provided reference
curve records cannot be modified.
To edit existing reference curve records:
Step Action
2 Locate and click on the reference curve record line to edit.
3 Click Edit.
The Edit Reference Curve dialog box appears.
The upper section contains fields to enter or change the

reference curve description information. The lower section
lists the current reference curve point data.
4 Enter or modify the reference curve description
information in the upper section. Use the drop-down lists
where available. Use the tab key to move between fields.
Steps 5 through 8 beginning on Page 19-46 for selecting
X, Y labels.
Steps 9 through 16 beginning on Page 19-44 for adding,
editing, and/or deleting reference curve point data.
Then continue with the following steps.
Utilities 19-51
Step Action
7 When you have completed changing the copied reference
curve, click Close to record the curve data and return to the
Reference Curve Editor dialog.
KP0886C-1855
Deleting Reference Curve Records

Note: Hologic provided reference curve records cannot be
deleted.
To delete existing reference curve records:
Step Action
2 Locate and click on the reference curve record line to edit.
3 Click Delete.
The following message appears:
KP0886C-1870
4 Click Yes to delete the selected record and return to the

Reference Curve Editor dialog box.
5 Repeat Steps 2 through 4 to delete additional records. Or
click Close to return to the main screen.
19-52 Utilities
Adding New Ethnic Groups

To add new ethnic groups:
Step Action
1 Select Utilities>Reference Curve>Add Ethnicity from
the Menu Bar of the main window.
3
The following message appears.
4 Click OK to continue.
The Add New Ethnicity dialog box appears:
KP0886C-1873
Utilities 19-53
Step Action
5 Type name and code (two alphanumeric characters) for the
new ethnicity group into their respective fields and click
OK to add the group and return to the Main screen.
Warning: If you plan to exchange scan data with other

users, make sure your new ethnicity code does not match
any of their ethnicity codes unless you are actually using
the same reference curves for that ethnicity.
Restoring Reference Curve Database

Note: This option restores the reference curve database to the
original state as supplied by Hologic. Any changes that may have
been made are lost.
To restore the reference curve database:
Step Action
1 Select Utilities>Reference Curve>Restore from the
Menu Bar of the main window.
The following message appears.
KP0886C-1875
2 Click Yes to restore the database. Or click No to stop the

restore. The system returns to the Main screen
19-54 Utilities
Rebuild Archive Index

Rebuild Archive Index is used to rebuild the index on an archive
media if it is corrupted.
To rebuild archive index:
Step Action
1 Select Utilities>Rebuild Archive Index.
Rebuild Archive Index window appears.
KP1068_001-1977
2 In the text box to the left of the Browse button, type in

the location of the archive
or
click Browse to select the location from the Browse for
Folder window.
KP1068_001-1978
Utilities 19-55
Step Action
3 Click Rebuild Index.
A window appears showing the index being rebuilt.
KP1068_001-1979
4 When the index has been rebuilt the following window

appears:
KP1068_001-1980
Click OK to return to the main screen.
19-56 Utilities
Install Options
Installs a selected APEX option on the QDR system. Before
installing an option, obtain a license key from Hologic for that
option.
To perform the Install Options function:
Step Action
1 Select Utilities>Install Options from the Menu Bar of
the main window.
2 Type the license key obtained from Hologic in the

License Key field.
3 Click Install Option.

4 Follow instructions on the screen.
5 Select another option to install or click Close
Utilities 19-57
19-58 Utilities
Chapter 20
Digital Imaging and
Communications in Medicine
(DICOM)
Digital Imaging and Communications in Medicine (DICOM) is a
powerful tool that provides interpreting physicians with the
ability to view electronic QDR bone density scan and analysis
results on a Picture Archiving and Communications System
(PACS). The DICOM option allows results to be transmitted
automatically over a facility’s network directly to a physician’s
DICOM viewing station for interpretation and report dictation.
The results can also be archived on the PACS, making them
available for future reference and for distribution to others on the
PACS network.
Contents
Subject Page
DICOM Selections 20-2
Configuring DICOM 20-4
Using DICOM 20-4
Troubleshooting 20-5
20-1
DICOM Selections
The following table shows the different scan types and options for
generating a DICOM report.
Scan Type
Group Lumbar Hip Forearm Whole AP/
Spine Body1 Lateral2
Report Type
Most Recent Value
Rate of Change
Range
Radius + Ulna
Radius
Ulna
Region for Normal Plot
Neck
Trochanter
Inter
Ward’s
Total
1/3
MID
UD
VB
MVB
Note Availability
1 A and W models only
2 A and SL models only
The DICOM report displays all of the information necessary for
interpreting BMD results on a single screen. The report consists
of the radiographic image, detailed analysis results and
summaries, reference population graphs, patient demographic
data, referring physician information, and details about each scan
and analysis. Refer to Figure 20-1 for an example of a DICOM
report.
20-2 DICOM
Figure 20-1
DICOM Report Example
KP1068A-2001
DICOM 20-3
Configuring DICOM
DICOM is configured using the System Configuration –
DICOM tab found under the Utilities pull down menu in the
main window.
For details on configuring DICOM, refer to “DICOM Tab” on
page 18-44.
Using DICOM
DICOM can be used to:
• Send reports to remote destinations (refer to “DICOM
Reports” on page 15-18).
• Locate and retrieve patient studies previously archived to a
PACS server using the DICOM Send functionality (refer to
“Query/Retrieve Scans” on page 16-22).
• Select a patient for examination from a worklist schedule
received from the HIS/RIS (refer to “Using the Worklist Tab”
on page 7-8).
20-4 DICOM
Troubleshooting
This section covers frequently asked questions and answers.
Q When I click on Send, I get the error message: “Please

select a destination node.” What does this mean?
A You were trying to send a DICOM report to an undefined
destination node. Please refer to the Configuring DICOM
section for more details on setting up a destination node.
Q I sent a report a while ago, but the report is still waiting in
the queue. Why wasn’t the report transmitted?
A Make sure that your destination is configured properly.
The AE Title, IP Address, and SCP Port you entered in
the Add/Edit Remote Node dialog box must match those
of the DICOM receiver you are sending to. Check with
your System Administrator for the correct values.
Verify that the DICOM receiver you are sending to is
active. The destination machine must be running in order
for you to send a report successfully.
Check with your Network Administrator to make sure
that there are no network problems. If the network is
down, the DICOM software attempts continuously to
send the report until it succeeds.
Q I sent a report to a destination with an incorrect IP
address, and the report is still in the queue. How do I
delete it?
A Delete the report from the queue using the Delete button
on the View Queue dialog box.
Tip: Clicking on the View Queue button on the DICOM
Reports dialog box displays the View Queue dialog box.
Q When I send or save a report, an error message is
displayed: “Accession number already in use.” What
does this mean?
A The Accession number is uniquely associated with a
patient visit. You were trying to enter an accession
number for a scan. The accession number that you were
using is already being used by another scan. Enter a
different accession number or double-check the accuracy
of the accession number.
DICOM 20-5
Q My Send, Save As, Preview, and Scan Details buttons

are inactive (dimmed). How do I activate them?
A Highlight only one scan from the scan list on the DICOM
Reports screen. The Save As, Preview, and Scan Details
buttons only work with single scans.
The Send button can be used with multiple selected
scans.
Q The Standardized BMD check box is active (dimmed).
How do I activate it?
A The Standardized BMD (sBMD) report is only an option
for Single Analysis reports. Click on the Single Analysis
radio button to activate the Standardized BMD check
box.
Q How come the BMD reference curve graph is missing
from my Rate of Change DICOM report?
A The Skip button was pressed when the Select Rate of
Change Scans dialog box appeared. This skips over the
scan selection process to include in the report. When the
Select Rate of Change Scans dialog box appears, make
sure you select at least one scan to include and click OK.
Another reason could be that the scan that you selected
for the Rate of Change report does not have any other
matching scans for that patient. Select a scan that has
matching scans for the Rate of Change report.
20-6 DICOM
Appendix A
Options
This appendix provides information on the standard features and options available on QDR
systems.
Content
Subject Page
Options List A-2
Forearm A-2
IVA A-3
IVA HD A-3
DICOM Store A-3
DICOM Modality Worklist A-3
General Region of Interest A-3
Body Composition Analysis A-3
Decubitus Lateral A-3
Small Animal A-3
Prosthetic Hip A-4
Enterprise Data Management A-4
Hip Axis Length A-4
Infant Whole Body A-4
Low Density Spine A-4
International A-4
DAP Meter A-4
Hip Structure Analysis® (HSA) A-4
Mobility A-4
A-1
Options List
A listing of standard and optional features for QDR systems is presented in the table below. A
brief description of each software option has also been provided for your information. Note that,
in this Appendix, models shown only as A, SL W and C refer collectively to Discovery, QDR
4500 and Delphi models A, SL, W or C. Models Wi and Ci refer to Discovery only.
Features Models Work-

station 1
A SL W Wi C Ci Ex2
Forearm S S S S S S O S
IVA3 S S S O S O NA S
IVA HD3 S S S NA S NA NA S
DICOM Store S S S O S O O O
DICOM Modality Worklist O O O O O O O O
General Region of Interest O O O O O O O O
Body Composition Analysis O NA O O NA NA O O
Decubitus Lateral BMD NA NA O O O O O O
Small Animal O O O O O O NA O
Prosthetic Hip O O O O O O O O
Enterprise Data Management O O O O O O O O
Hip Axis Length O O O O O O O O
Infant Whole Body O NA O O NA NA NA O
Low Density Spine O O O O O O O O
International O O O O O O O O
DAP Meter O O O O O O O O
Hip Structure Analysis O O O O O O O O
Mobility O O O O O O O O
S: Standard O: Option NA: Not Available
1
QDR Workstations are unable to scan patients (reference to standard features)
2
Explorer
3
Requires DICOM option
Forearm
Hologic’s Forearm option provides the ability to perform a Forearm scan and analysis. The
anatomical sites that are measured for the forearm scan are: the distal portion of the radius and
ulna, the wrist bones, and the first row of carpal bones.
A-2 Options
IVA
The IVA (Instant Vertebral Assessment) option provides functionality for the acquisition of scans
that allow the determining of the presence or absence of vertebral fractures.
IVA HD
The IVA HD (Instant Vertebral Assessment - High Definition) option provides functionality for
high definition imaging for the determination of the presence or absence of vertebral fractures.
DICOM Store
Hologic’s DICOM Store allows the QDR system to transfer DICOM files to a PACS or Physician
Viewer.
DICOM Modality Worklist

Hologic’s DICOM Worklist allows the QDR system to retrieve schedule and patient demographic
information using the DICOM Modality Worklist service.
General Region of Interest

Hologic’s General Region of Interest option, which is sometimes referred to as Subregions,
provides the ability to use a nonstandard region of interest to analyze a scan. This feature is
available for spine, hip and forearm scan types but not for supine lateral scans.
Body Composition Analysis

Hologic’s Body Composition Analysis option provides the ability to analyze the soft tissue
composition of the entire body and to follow the changes in soft tissue composition over time in
response to intervention such as diet and exercise. Analysis of fat mass, lean mass, and percent fat
mass can be reported for the entire body and head, arms, trunk, pelvis and legs.
Decubitus Lateral
Hologic’s Decubitus Lateral option allows the acquisition, display and analysis of scans of the
lateral view of the spine on the W, Wi, C, Ci, and Explorer models.
Small Animal
Hologic’s Small Animal option provides the ability to perform two types of small animal
measurements:
• You can perform whole body bone mineral and body composition measurements in rats.
This software is optimized for adult rats weighing between 200 and 750 grams.
• You can also perform BMC and BMD measurements of small animal bones using regional
high resolution. The regional high resolution software is optimized for excised rat femurs
and spines but may also be used to measure these bones in vivo.
Options A-3
Prosthetic Hip
Hologic’s Prosthetic Hip option provides the ability to scan and analyze prosthetic hips and
anatomy that includes metal, for example a femur with a prosthesis. Changes in bone mass
surrounding metal implants can be assessed by using the specially designed algorithm. The metal
components of the implant is removed from the bone mass measurement.
Enterprise Data Management

Hologic's Enterprise Data Management option allows the QDR system to archive, locate and
query/retrieve raw scan data from a configured PACS server.
Hip Axis Length

Hologic's Hip Axis Length option measures the distance along the femoral neck axis, extending
from the bone edge at the base of the trochanter to the bone edge at the inner pelvic rim.
Infant Whole Body

Hologic’s Infant Whole Body option allows the acquisition, display and analysis of scans of
infants on the A, W and Wi models.
Low Density Spine

Hologic’s Low Density Spine option is available for legacy customers who have used this
function in the past and wish to continue using it. For all other users, this function is replaced by
the Auto Low Density analysis feature.
International
Hologic’s International option allows the QDR system to utilize and display metric units as well
as international date and time conventions.
DAP Meter
The Dose Area Product (DAP) Meter displays the radiation dose applied to a patient when a scan
is performed.
Hip Structure Analysis® (HSA)

The Hip Structure Analysis (HSA) option is a proprietary program for computing the structural
properties of various cross sections of the proximal femur.
Mobility
Includes generation and filling in of a History Questionnaire on a remote Tablet PC, electronic
sending from Tablet PC to QDR, inclusion with scans sent via DICOM to the Physician's Viewer
and inclusion of data from the questionnaire into the DxReport.
A-4 Options
Appendix B
Operator Maintenance
This appendix provides information and instructions for maintaining the QDR systems.
Content
Subject Page
Periodic Cleaning B-2
Periodic Visual Inspection B-3
Cleaning Accidental Spills B-4
B-1
Periodic Cleaning
This section provides instructions for periodically cleaning the QDR system and its components.
Cleaning the QDR and Computer Components

It is important to keep the exterior of the QDR system and the computer components clean.
To clean the system exterior and computer components:
Step Action
1 Switch off the power at the main breaker.
2 Use a soft, damp cloth to wipe the surfaces. If necessary,
use a mild detergent to remove caked-on dirt or debris.
3 Restore power at the main breaker.
The table pad is the area of the QDR system where the patient lies during an exam. It is important
to keep the pad clean.
Cleaning the Table Pad

Step Action
Note: Do not remove the cover 1 Use a simple solution of neutral soap and lukewarm
from the table pad to clean or water or a diluted (10 to 1) bleach solution.
disinfect.
Note: If cleaning does not 2 Let dry thoroughly before scanning.
produce satisfactory results,
contact your Hologic
representative to order a
replacement table pad.
Disinfecting the Table Pad

Step Action
Note: Disinfectants applied at 1 Use a phenolic, or quaternary type disinfectant in the
full concentration, or in highly concentration recommended by the manufacturer.
concentrated solutions may
damage the fabric. Do not use Idophor or any iodine bearing disinfectants.
2 Let dry thoroughly before scanning.
B-2 Operator Maintenance

Periodic Visual Inspection

It is important to periodically inspect the QDR system for proper clearance of moving parts, wear
and tear, and parts that may need to be replaced.
Visual inspections include:
• Checking for Adequate Clearance Around the Unit
• Checking Cables and Outlets
• Inspecting the Table Pad
Checking for Adequate Clearance

Warning: Obstructions can The QDR system incorporates moving parts. Check to make sure
cause a hazardous condition to there is enough clearance around the unit so that all parts move
the patient and unit.
freely.
Checking Cables and Outlets

Warning: Overloading the outlet Make sure that only computer equipment and accessories
strip can cause a hazardous supplied by Hologic are connected to the outlet strip.
condition and/or damage to the
equipment. Check all cables for worn and/or damaged insulation. Each cable
should be positioned so as not to constitute a hazard to the patient
or operator. Contact Hologic to replace worn or damaged cables.
Inspecting the Table Pad

Note: A damaged or stained Periodically inspect the table pad for damage, such as rips or
table pad can distort X-ray tears, and stains. Use a mild detergent to clean the pad, and a
transmission and produce
10% (or less) bleach solution to disinfect the pad.
erroneous results in the analysis.
Refer to page B-3 for Contact Hologic if you need to replace the table pad.
instructions on cleaning the
table pad.
Operator Maintenance B-3

Cleaning Accidental Spills

It is important to discourage liquids (such as coffee, water, or soft drinks) in the vicinity of the
QDR system to avoid accidental spills.
To clean accidental spills:
Step Action
Note: Contact the Hologic Help 1 In the event of a liquid spill, wipe the spill immediately
Desk if you need assistance. with a slightly dampened sponge. If the spill penetrates the
QDR system’s interior, shut off power at the main breaker
immediately.
Note: Moisture on the table pad 2 Allow the table pad to dry thoroughly before performing
can distort X-ray transmission and patient scans.
produce erroneous results in the
analysis.
3 If you turned off power at the main breaker in Step 1,
restore power when the unit is thoroughly dry.
B-4 Operator Maintenance

Glossary
This section provides an alphabetical listing of terms and acronyms, used in this User’s Guide,
with explanations.
Content
Glossary of Terms
G-1
Acetabulum A hollow area or socket in the pelvis in which the femoral head
fits.
Accuracy Ability of an instrument to measure the same bone mineral
content of an object as measured by another independent method
or “gold standard.”
Archive Process of transferring scan files, including the scan’s raw data,
onto removable media as permanent storage. The scans can then
be retrieved at a later date, and can also be re-analyzed.
ASIS Anterior Superior Iliac Spine. A palpable bone projection found
about one inch below the iliac crest of the pelvis.
Biography Contains a patient’s name, date of birth, and other demographic
information. Each patient must have only one entry within the
database, or else rate of change calculations are not possible.
Biochemical Blood and urine tests that can measure the rate of bone resorption
markers and formation. It provides physicians with information on how
quickly bone is lost by resorption, and is used to evaluate the
patient’s response to treatment.
BMD Bone Mineral Density
BMC Bone Mineral Content
Bone Map A yellow computer generated overlay, representing a region or
regions of bone, that is identified by the system during analysis.
Calcitonin A naturally occurring hormone secreted by the thyroid gland,
responsible for inhibiting bone resorption. Synthetic salmon
Calcitonin, an injectable drug treatment, is used to slow the bone
resorption rate in patients.
Cortical bone Compact dense bone that makes up eighty percent of the skeletal
mass.
CV Coefficient of variation is the standard deviation expressed as a
percentage of the mean.
(CV = 100 x (SD/Mean))
Database A set of unique HOLOGIC system files that include Biography,
QC, Locate, and reference database information.
Dbarchive Copies all the internal database files onto a floppy disk to protect
against data loss after a computer failure. This procedure should
be performed weekly.
G-2 Glossary
Detector Converts light into electrical impulses that are sent to the
computer for processing.
DEXA See DXA
Diskette A flexible, magnetized plastic disk, used to store system data,
and patient scan data.
DPA Dual-Photon Absorptiometry. The first dual energy clinical
densitometer that was capable of measuring the spine and hip
using a radioactive source, such as Gd 153. This radioactive
source naturally emits photons of two significantly different
energies (40 and 100 KeV).
DXA Dual energy X-ray Absorptiometry. A bone density system that
uses two X-ray energies to measure bone density, with a low
patient exposure and a fast scan time. Replaces DPA technique.
Epiphysis Endplate or growth plate. Located at the ends of the long bones
of the skeleton.
Foramen Naturally occurring hole or opening found in a bone.
e.g. Ischial foramen found in the pelvis.
Fosamax® Nonhormonal treatment for post menopausal women with low

bone density, using an aminobisphosphonate or alendronate
sodium.
Greater Trochanter A protuberance located on the lateral aspect of the femur. It is
palpable on the outer region of the thigh by rotating the leg.
Hard Drive The hard drive of the computer contains the system’s operating
software, the HOLOGIC patient database, and patient scans. In
order to view patient scans, the actual data must be present on the
hard drive.
HRT Hormone Replacement Therapy
Internal Reference Patented continuous pixel by pixel calibration throughout the
System scan, as it interposes bone and tissue equivalent material into the
beam. This ensures data compatibility and system stability.
IVA Instant Vertebral Assessment
IVA HD Instant Vertebral Assessment High Definition
Magneto Optical A high capacity device to store scan images, with a storage
Disk capacity of approximately 7,500 scans per disk.
Main Menu Appears on the system’s computer screen after the system is
turned on or boots up. From this menu, the operator has access to
all system functions.
Glossary G-3
Miacalcin® Nasal spray (calcitonin-salmon) manufactured by Sandoz

Pharmaceutical Corporation. see calcitonin
Normals Male and Female reference population curves used to compare
patient measurements with young and age matched normal
values.
Osteomalacia General term that defines a group of disorders in which there is
defective mineralization of bone.
Osteopenia Any condition of reduced bone mass.
Osteoporosis “A disease that is characterized by an absolute decrease in the
amount of bone to a level below that required for mechanical
support of normal activity and by the occurrence of non
traumatic skeletal deformities. Aging, menopause, lifestyle, local
factors regulating bone turnover, genetic factors, and additional
sporadic factors are considered to contribute to this bone loss.”1
Parathyroid Group of six small glands situated around the thyroid gland
Glands concerned with calcium and phosphorus regulation in the body.
Diminished function or removal of the parathyroid glands may
result in low calcium levels in the blood.
Parathyroid Potent stimulator of bone resorption. Increases bone formation
Hormone and activity.
Patient database Part of the internal HOLOGIC database containing patient
biographical information, scan results, and archive location for
each scan.
Precision Ability of an instrument to reproduce the same results in repeat
measurements.
QC Quality Control procedure used to monitor the stability of the
system.
QCT Quantitative Computed Tomography. Requires software
modification to an existing CT scanner to enable measurement
and quantitative determination of trabecular bone mineral
content in the lumbar spine. It requires the patient to lie on top of
a phantom, containing imbedded known reference material
during the scan.
QDR® Quantitative Digital Radiography. Uses an X-ray tube as a

source of dual energy photons, pulsing the X-rays on and off, to
measure the bone mineral content within a region. QDR is a
registered trademark of HOLOGIC.
Radius Large bone of the forearm, located on the thumb side.
G-4 Glossary
Region of interest User defined region surrounding the area of interest on a hip or
spine scan.
Scan Method of acquiring an areal measurement of a specific region
for bone mineral evaluation.
SPA Single Photon Absorptiometry. The first clinical type of bone
densitometer, using a sealed radionuclide source (I125) for a
single energy measurement. Scan time was almost fifteen
minutes and measured only the forearm.
SXA Single energy X-ray Absorptiometry. Modification of the SPA
forearm scanner, using X-rays instead of a radioactive source.
Supine Lateral Provides assessment of vertebral bone mass, without the
Spine influence of cortical bone posterior elements, or other artifacts
present in an AP spine scan.
T Score Indicates the amount of bone loss, by quantifying the difference
between the patient’s BMD at her/his current age, and the peak
bone mass achieved by young normal individuals.
Trabecular bone Spongy bone, comprising twenty percent of the skeletal mass and
very metabolically active.
Ulna Small bone of the forearm, located on the fifth finger side.
Vitamin D Active metabolite produced in the kidney. Primary effects
exerted on the gut where it increases calcium and phosphorus
absorption. Required for normal bone mineralization.
Wrist Two rows of small bones found between the hand and the
forearm.
Xiphoid Bottom of the sternum, that is palpable in the patient’s midline, at
the junction of the left and right side of the rib cage.
Z score Normalizes the patient’s BMD by assessing the amount of bone
loss compared to the expected loss for age matched peers.
1.
The evaluation of osteoporosis: Dual energy X-ray absorptimetry in clinical practice, H. Wahner and I.
Fogelman, 1994, Martin Dunitz, Ltd.
Glossary G-5
G-6 Glossary
Index
This section provides an alphabetical index of subjects with page number(s) indicating where
information on the subject can be found,
Content
Alphabetical index of Subjects
For Accessing and Printing Reports , 15-39 to

15-40
For Finding Records , 6-3
Numerics Alternate Scan Modes
AP Lumbar Spine Examination , 8-27 to 8-29
4500A, Control Panel , 1-7 Hip Examination , 9-29 to 9-30
4500C, Control Panel , 1-7 Lateral Scan , 12-42 to 12-44
4500SL, Control Panel , 1-7 Analysis
4500W, Control Panel , 1-7 Exiting , 7-27
Performing , 6-23
Performing the , 7-24
A Window
Abdominal aortic calcification , 13-1 AP Lumbar Spine Analysis , 8-11
About 1/3 Distal Region, forearm examination , Forearm Analysis , 10-12, 10-29
10-21 to 10-22 Hip Analysis , 9-14
Accessing window
Records , 6-2 AP scan , 12-22
Lateral scan , 12-31
Reports , 15-39 to 15-40
Whole Body examination , 11-9, 11-16
Add Quality Control Phantom, window , 5-15
Analysis Reports, Descriptions , 6-2
Field Descriptions , 5-16
Analysis Setup, Window
Adding
AP Lumbar Spine Examination , 8-12
New Ethnic Group , 19-53
Forearm Examination , 10-13
Scan Comments , 7-23 to 7-24
Hip Examination , 9-15
Adjusting the MID/UD Regions, Forearm
Analyze Scan Button , 3-8
Examination , 10-25 to 10-27
Analyzing
Adjusting Trochanter Region, His Examination , 9-
AP Lumbar Spine Analysis , 8-11 to 8-27
37
Manual Analysis , 8-15
Adjusting, Image Contrast and Brightness , 7-25 to
One-Time Auto Analysis , 8-14
7-26
Forearm Analysis , 10-12 to 10-31
Alternate Methods
Hip Analysis , 9-14 to 9-29
Manual Analysis , 9-17 Labeling Vertebrae , 8-23

One-Time Auto Analysis , 9-16 Marking Intervertebral Spaces , 8-21 to 8-23
Analyzing the Follow-up Scan, See Compare, Inserting a Line , 8-22
Analyzing the Follow-up Scan Line Mode , 8-21
Aortic calcification, abdominal , 13-1 point Mode , 8-23
AP Lumbar Spine Removing a Line , 8-22
Examination , 8-7 to 8-11 Selecting the Setup , 8-12
Steps to Performing Manual Analysis , 8-16
Vertebral Bodies
Defining the ROI for Scoliotic Spine, Line
Excluding , 8-23
Mode , 8-31
Including , 8-23
Defining the ROI for Scoliotic Spine, Point
Labeling , 8-23
Mode , 8-32
Viewing Results , 8-25 to 8-27
Editing a Bone Map , 8-20 to 8-21
Viewing the Bone Map , 8-19 to 8-21
Evaluating the Bone Map , 8-20
Reanalyzing Current Scan from the Main Performing the Examination , 8-7 to 8-11
Window , 8-27 Placing Patient on Table , 8-5 to 8-6
Reanalyzing Current Scan using Auto Positioning Patient and C-Arm , 8-5 to 8-7
Analysis , 8-26 Positioning the C-Arm , 8-6
Reanalyzing Current Scan using Different Preparing the Patient , 8-2
Settings , 8-26 Reports
Viewing the Bone Map , 8-19 Generating , 8-27
AP Lumbar Spine Examination Printing , 8-27
Alternate Scan Modes , 8-27 to 8-28 Reposition the Image , 8-9 to 8-10
Analysis , 8-11 to 8-27 Reposition the Scan , 8-9 to 8-11
Manual Analysis , 8-15 Repositioning the Scan
One-Time Auto Analysis , 8-14 Reposition the Patient , 8-9
Analysis Setup Window , 8-12 Scan, Window , 8-8
Analysis, Window , 8-26 Select AP Lumbar Spine Scan Mode, Window ,
Auto Analysis Window , 8-14 8-28
Choosing a Scan mode , 8-3 Select AP Lumbar Spine Scan Type, Window ,
Choosing an Alternative Scan Mode , 8-3 8-3
Configuring Scan Parameters , 8-3 to 8-4 Select Scan Type and Mode , 8-2 to 8-3
Creating/Retrieving a Patient Biography, See Special Scanning Conditions , 8-28 to 8-34
Patient Biography Starting the AP Lumbar Spine Scan , 8-8 to 8-9
Evaluating the Image , 8-28 to 8-29 Windows
Exiting the Analysis , 8-27 Analysis , 8-14, 8-26
Exiting the Examination , 8-11 Analysis Setup , 8-12
Generating a Report , 8-27 Select AP Lumbar Spine Scan Mode , 8-28
Global ROI Toolbox , 8-18 to 8-19 Select Scan Type , 8-3
Manual Analysis , 8-15 AP Lumbar Spine Scan, Performing and Analyzing
the , 8-2 to 8-34
Method of Analysis , 8-12
One-Time Auto Analysis , 8-14 AP Reposition, function , 8-9 to 8-11
AP Scan
Performing Manual Analysis , 8-16
Analysis Setup window , 12-10
Adjusting the Image Display , 8-16 ANalyzing the AP Scan , 12-9
Changing Vertebral Labels , 8-24 Method of Analysis , 12-9 to 12-11
Choosing the Method of , 8-11 to 8-13 Performing the AP Scan , 12-7 to 12-9
Defining the ROI , 8-11 Performing the AP Scan Analysis , 12-9 to 12-25
Editing a Bone Map , 8-19 to 8-21 Adjusting the Image Display , 12-13
Adding to the Bone Map , 8-20 Analysis Window , 12-22
Deleting a Bone Map , 8-21 Bone Map , 12-16 to 12-18
Editing a Bone Map , 8-20 Add Bone to the Bone Map , 12-17
I-2 Index
Deleting Bone from the Bone Map , 12-18 Managing Archive Locations , 16-27
Editing the Bone Map , 12-16 Overview , 16-2 to 16-8
Evaluating the Bone Map , 12-16 About Archiving and Restoring Scans , 16-6
Viewing the Bone Map , 12-16 Canceling a Transfer , 16-7
Defining the ROI , 12-14 to 12-16 Errors During Transfer , 16-7
Global ROI Toolbox , 12-15 How Scans are Transferred , 16-6
Line Mode, 12-15 How the System Handles Archive Data , 16-
Whole Mode, 12-15 7
Labeling the Vertebral Bodies , 12-20 to 12-21 How the System Handles Data
Including and Excluding Vertebrae from Inconsistencies , 16-7
Analysis , 12-20 Notification of Successful Transfers , 16-7
Changing Vertebrae labels, 12-21 Transfer Progress Message , 16-7
To Automatically Label Vertebrae, 12-20 Archiving Labels , 16-5
Making Intervertebral Spaces , 12-18 to 12-19 Archiving Scans
Line Mode , 12-18 to 12-19 Locations , 16-4
Inserting a Line, 12-19 Archive Location, 16-4
Removing a Line, 12-19 System Location, 16-4
Point Mode , 12-19 Copying Scans , 16-6
Verifying the Start Position , 12-22 to 12-25 Handling Read/Write CDs
Adjusting the Start Position , 12-24 Formatiing a Read/Write CD , 16-2
Centerline Warnings , 12-22 to 12-24 Hnading Read/Write CDs
Centerline Angle, 12-23 Removing a Read/Write CD , 16-3
Centerline not Calculated, 12-24 Locating Scans , 16-5
Centerline Outside of Range, 12-23 Restoring Scans , 16-6
Reanalyzing the Current Scan from the Restoring Scans , 16-16 to 16-18
QDR Main Window , 12-24 Restoring Scans from a Specified Archive
Reanalyzing the Current Scan with Differ- Location , 16-16 to 16-18
ent Settings , 12-24 Troubleshooting Advanced User Information ,
Viewing Results , 12-21 to 12-22 16-30 to 16-31
Viewing Results , 12-22 Troubleshooting Transfer Errors , 16-28 to 16-31
AP scan Problems Accessing an Archive Location , 16-
Analysis 28
window , 12-22 Transferring Scans , 16-28 to 16-29
windows Archiving Locations , 16-29 to 16-30
Analysis , 12-22 Arm, Switch/Lamp
AP/Lateral Spine examination DELPHI A and SL , 4-25
confirming scan parameters , 12-6 DELPHI C and W, Left , 4-24
AP/Lateral Spine, Examination , 12-2 to 12-44 DELPHI C and W, Right , 4-24
Archive Menu QDR 4500A and SL , 4-17
Query/Retrieve Scans , 16-22 to 16-24 QDR 4500C and W , 4-16
Archive Scans Button , 3-8 Auto Analysis
Archive Scans, deleting , 6-22 AP Lumbar Spine , 8-14
Archive Scans, Tab , 6-22 Hip , 9-16
Archiving QC Pantom Scans , 5-20, 16-10 Auto Low Density, Enable/Disable , 18-7
Archiving Scans, See Archiving, Locating and Auto QC
Restoring Scans Auto QC, Passed
Archiving, Locating and Restoring Scans Auto QC Plot
Archiving Scans , 16-8 to 16-11 About the QC Plot
Copying Scans , 16-19 to 16-21 Data Points, 5-8
To Copy Scans , 16-19 to 16-21 Mean Value at Calibration, 5-8
Locating Scans , 16-12 to 16-15 Plot Statisics, 5-8
To Locate and Restore Scans , 16-12 to 16-15 CV, 5-8
Index I-3
Mean, 5-8 Changing

Number of Points, 5-8 QC Phantom Details , 19-15
S.D., 5-8 QC Plot Regression , 5-20
QC Limit Value, 5-8 Sort Order , 3-11
Reference Values, 5-8 Changing the Sort Order , 3-12
Scan Dates, 5-7
Check Box , 3-7
Setup, 5-8
Checking the MID/UD Region, Forearm
Auto Whole Body Analysis, Enable/Disable , 18-7 Examination , 10-26
Choosing Alternate Scan Mode
AP Lumbar Spine Examination , 8-27
B AP/Lateral Spine Examination , 12-42
Bars, Scroll , 3-11 Hip Examination , 9-29
Biography Tab, Patient Window Choosing Menu Items , 3-8 to 3-9
Field Descriptions , 6-4 to 6-5 Choosing Scan Mode
Box, Check , 3-7 AP Lumbar Spine Examination , 8-3
Button Descriptions, Select Quality Control Scans, Forearm Examination , 10-4
See Quality Control Scans Hip Examination , 9-3
Buttons Whole Body Examination , 11-3
Command , 3-10 Choosing the Scan Mode
Dragging and Dropping onto a Button , 3-3 AP Lumbar Spine Examination , 8-3
Emergency Stop Forearm Examination , 10-4
DELPHI-A and -SL , 4-26 Hip Examination , 9-3
DELPHI-C and -W , 4-25 Whole Body Examination , 11-3
QDR 4500A and SL , 4-18 Circuit Breaker
QDR 4500C and W , 4-17 DELPHI , 4-23
Flashing QDR 4500 , 4-15
Daily QS , 3-13
Cleaning
System Backup , 3-13
Spills , B-4
Function , 3-5
the QDR System , B-2
Main Window , 3-7
Clicking the Mouse , 3-3
Radio , 3-10
Closing Menus , 3-9
Buttons, Main System
Command Buttons , 3-10
Analyze Scan , 3-7
Compare , 14-2
Archive Scans , 3-8
Analyzing the Follow-up Scan , 14-8 to 14-11
Daily QC , 3-7, 5-2 To Perform the Compare Analysis , 14-8 to
Exit , 3-8 14-11
Locate Scans , 3-7 Evaluating Baseline Scan Analysis , 14-6
Patient Exam , 3-7, 7-5, 7-9 To Reanalyze the Current Scan , 14-6
Patients , 3-8, 6-7 Evaluating the Baseline Scan , 14-4 to 14-6
Report , 3-7 Evaluating Baseline Scan Patient
Scans , 3-8, 6-16 Positioning , 14-4
System Backup , 3-8 Baseline Positioning
Acceptable, 14-5
Scanning Once with Correct Positioning,
C 14-5
Unacceptable, 14-5
Center Table, Switch/Lamp Scanning Once to Duplicate Incorrect
DELPHI-A and -SL , 4-26 Baseline Positioning, 14-5
DELPHI-C and -W , 4-24 Scanning Twice, 14-5
QDR 4500A and SL , 4-18 Reviewing Operator or Physician’s
QDR 4500C and W , 4-16 Comments , 14-4
I-4 Index
Generating a Rate of Change Report , 14-12 to Automatic Analysis of Spine Phantom , 5-5 to 5-
14-13 9
To Generate a Rate of Change Report , 14-12 Button , 5-2
to 14-13 Procedure , 5-2
Introduction , 14-2 Automatic System Test , 5-4
Performing the Follow-up Scan , 14-7 Position the Spine Phantom , 5-3
Performing the Follow-up Scan , 14-7 Start Daily QC , 5-2
Updating the Patient’s Biography Record , 14- System Test, Window , 5-4
7 Daily QC button , 3-7, 5-2
Restoring a Baseline Scan , 14-3 to 14-4 Daily QC, Flashing Button , 3-13
Restoring a Baseline Scan from the Daily System Operation , 4-1 to 4-8
Computer’s Hard Drive , 14-3 Circuit Breaker and Indicator
steps , 14-2 Figure , 4-2, 4-9
Components, Main Window , 3-4 Data Management, QC , 5-11
Computer Power Switch , 4-15 Data Unconsistencies, How the System Handles ,
Configuring 16-7
DICOM , 20-4 Decubitus Lateral Option, Overview , A-4
Confirming Scan Parameters Deleting
AP Lumbar Spine Examination , 8-3 to 8-4 Archive Scans , 6-22
Forearm Examination , 10-4 to 10-5 Reference Curve Records , 19-52
Hip Examination , 9-5 Scan Files , 6-22
Whole Body Examination , 11-4 Scans, Window , 6-21
Confirming scan parameters Unarchived Scans , 6-22
AP/Lateral Spine examination , 12-6 Description
Confirming the Patient Information , 7-6 Analysis Report , 6-2
Context Sensitive Help , 3-14 Patient Record , 6-2
Context Sensitive Help, System Software Help Detail Report, Usage Program , 19-6 to 19-8
Online , 3-14 DICOM , 20-2 to 20-6
Copying Reference Curve Records , 19-49 Closing DICOM , 15-38
Copying Scans , 16-6 Configuring , 20-4
Copying Scans, See Archiving, Locating and Printing the DX Report , 15-37
Restoring Scans Reports , 15-18 to 15-38
Correcting a Failed System Test , 5-5 Choosing the Report Type , 15-19 to 15-22
Creating Creating and Sending , 15-18 to 15-19
A Patient Record , 6-9 to 6-11 Entering the Accession Number and User
New Phantom Record , 5-15 to 5-17 Definable Entries , 15-24 to 15-25
Patient Record , 7-4 Viewing a Scans’s Details , 15-22 to 15-24
Reference Curve Record , 19-44 to 19-47 Troubleshooting , 20-5 to 20-6
Creating/Retrieving A Patient Biography , 7-4 Using , 20-4
AP Lumbar Spine Examination , 8-2 Using DICOM
Forearm Examination , 10-2 Deleting a DICOM Report from the Queue ,
Hip Examination , 9-2 15-34 to 15-35
Entering the Accession Number and User
Whole Body Examination , 11-3
Definable Entries , 15-24 to 15-25
Creating/Retrieving a Patient Record, See QDR
Previewing a DICOM Report , 15-25 to 15-26
Patient Examination, Creating/Retrieving a
Printing a DICOM Report , 15-26 to 15-27
Patient Record
Refreshing DICOM Reports in the Queue , 15-
33 to 15-34
Saving a DICOM Report , 15-27 to 15-29
D Sending a DICOM Report , 15-29 to 15-30
Daily QC Sorting the Scan List , 15-30
Index I-5
Sselecting/Deselecting All Scans , 15-31 to Dual Hip

15-32 Choosing the Default Scan Mode , 9-4
Viewing a History of Sent Reports , 15-32 Exiting the Analysis , 9-29
Viewing a History of Sent Storage Positioning The C-Arm , 9-8
Commitment Reports , 15-36 Positioning The Patient , 9-7 to 9-8
Viewing the Queue , 15-32
Repositioning for , 9-12 to 9-13
Discovery System Introduction , 1-1 to 1-12 DXA Results Report , 15-5
QDR for Windows XP Software , 1-9 to 1-10

Main Window Features , 1-9 to 1-10
Daily Function buttons, 1-10 E
File Cabinet buttons, 1-10 Editing a Patient Record , 6-13
Help, 1-10 Emergency motion, Function , 19-40
Main Work Area, 1-9 Emergency Stop Procedure
Menu Bar, 1-9
DELPHI Systems , 4-29
System Function buttons, 1-10
QDR Systems , 4-21
System Message ticker tape, 1-10
Main Window Overview , 1-9 Entering
System Hardware Components , 1-3 to 1-7 Insurance Information , 6-12
C-Arm , 1-5 Patient Information , 6-11
Laser, 1-5 Text , 3-9
X-Ray Source and Detector, 1-5 Entering Forearm Length, Forearm Examination ,
Control Panel , 1-6 10-15
Discovery Control Panels, 1-6 Entering Text , 3-9
Discovery A/SL Control Panel Error Messages
Figure, 1-6 When Running System backup , 17-6 to 17-8
Discovery C/Ci/W/Wi Control Pane Ethnic Groups, Adding New , 19-53 to 19-54
Figure, 1-6 Evaluating a Baseline Scan, See Compare,
Explorer Control Panel Evaluating a Baseline Scan
Figure, 1-6
Evaluating Image
Switches and Indicators, 1-6
Forearm Examination , 10-32 to 10-33
Examination Table , 1-4 to 1-5
Table Pad, 1-4 Hip Examination , 9-30 to 9-32
Operator Console , 1-4 Whole Body Examination , 11-18
Computer Hardware and Peripherals, 1-4 Examinations
Models , 1-2 to 1-3 AP Lumbar Spine , 8-2 to 8-27
Discovery-A , 1-2 Choosing an Alternate Scan Modes , 8-3
Discovery-C , 1-2 Confirming Scan Mode , 8-3 to 8-4
Discovery-Ci , 1-2 Creating/Retrieving Patient Biography , 8-2
Discovery-SL , 1-2 Exiting the Examination , 8-11
Discovery-W , 1-2 Methods of Analysis , 8-12
Discovery-Wi , 1-2 Performing Manual Analysis , 8-16
Explorer , 1-2 Performing the Analysis , 8-11 to 8-27
Disinfecting the Table Pad , B-3 Adjusting the Image Display , 8-16
Display, Usage Choosing the Method of Analysis , 8-11 to
8-13
Detail Report , 19-6 to 19-8
Defining the ROI , 8-16 to 8-19
Summary Report , 19-4 to 19-6
Selecting the Setup , 8-12
Double-clicking the Mouse , 3-3 Steps of the Analysis , 8-16
Dragging and Dropping , 3-3 Performing the Examination , 8-7 to 8-11
Onto the Record Button , 15-39 Positioning the Patient and C-Arm , 8-4 to 8-7
Patient Records , 15-39 Placing the Patient on the Table , 8-5
Scan Records , 15-40 Positioning the C-Arm , 8-6
Drop-down List , 3-10 Positioning the Patient , 8-5
I-6 Index
Preparing the Patient , 8-2 Choosing Dual Hip , 9-4

Repositioning the Scan , 8-9 to 8-11 Choosing Left or Right Hip , 9-3
Repositioning the Image , 8-9 to 8-11 Choosing the Scan Mode , 9-3
Repositioning the Patient , 8-9 Confirming Scan Parameters , 9-5
Selecting the Scan Type and Mode , 8-2 to 8-4 Creating/Retrieving Patient Biography , 9-2
Starting the AP Lumbar Spine Scan , 8-8 to 8- Dual Hip, Repositioning the Scan , 9-11 to 9-
9 12
AP/Lateral Spine , 12-2 to 12-44 Evaluating the Image , 9-30 to 9-32
confirming scan parameters , 12-6 Exiting the Analysis , 9-29
Forearm Examination , 10-2 to 10-32 All Scans Except Dual Hip , 9-29
About 1/2 Distal Region , 10-21 Dual-Hip Scans , 9-29
About Ulma/Radius Divider , 10-27 Exiting the Examination , 9-13
Choosing Scan Mode , 10-4 Generating Reports , 9-29
Confirming Scan Parameters , 10-4 to 10-5 Methods of Analysis , 9-14 to 9-15
Creating/Retrieving Patient Biography , 10-2 Perform the Analysis , 9-14 to 9-29
Entering Forearm Length , 10-15 Adjusting the Image Display , 9-18
Evaluating the Image , 10-32 to 10-33 Bone Map , 9-21 to 9-24
Exiting the Analysis , 10-32 Adding Bone to the Bone Map, 9-23
Exiting the Examination , 10-11 Deleting Bone from the Bone Map, 9-24
Generating Reports , 10-32 Determining a Starting Point when Deleting
Measuring the Patient’s Forearm , 10-4 Bone, 9-24
Performing the Analysis , 10-12 to 10-31 Editing the Bone Map, 9-22
Adjusting the Display image , 10-15 Evaluating Bone Map, 9-22
Adjusting the MID/UD Regions , 10-25 to Acceptable Bone Map, 9-22
10-28 Unacceptable Bone Map, 9-22
The MID/UD Toolbox, 10-26 to 10-28 Viewing the Bone Map, 9-21
About the Ulma/Radius Divider, 10-27 Choosing the Method of Analysis , 9-14 to
Adjusting the MID/UD Region, 10-27 9-15
Automatically Repositioning the Defining the ROI , 9-18 to 9-21
Ulma.Radius Divider, 10-27 Line Mode, 9-20 to 9-21
Checking the MID/UD Regions, 10-26 Whole Mode, 9-21
Manually Repositioning the Ulma.Radius Hip Structural Analysis , 9-38 to 9-40
Divider, 10-28 HSA Toolbox, 9-39
Bone Map , 10-22 to 10-25 Manually adjusting HSA Regions, 9-39 to
Adding Bone to the Bone Map, 10-24 9-40
Deleting Bone from the Bone Map, 10-25 Viewing Results, 9-41
Editing Bone Map, 10-23 Position the Neck Box , 9-24 to 9-27
Evaluating Bone Map, 10-23 Adjusting the Neck Box, 9-26 to 9-27
Viewing the Bone Map, 10-22 Line Mode
Choosing the Method of Analysis , 10-12 to Move Neck Box away from Femoral
10-13 Head, 9-27
Defining the ROI , 10-16 to 10-22 Move Neck Box away from Ischum, 9-
Generating Results , 10-29 26
Reanalyzing the Current Scan from the Recalculate the Position of All Hip Regions
QDR Main Window , 10-31 via Auto Position, 9-25
Reanalyzing the Current Scan with Differ- Whole Mode, 9-26
ent Settings , 10-31 Viewing Results , 9-27 to 9-29
Steps to Analyze the Forearm Scan , 10-14 Reanalyze the Current Scan from the QDR
Performing the Examination , 10-7 to 10-11 Main Window, 9-29
Hip Examination , 9-2 to 9-29 Reanalyze the Current Scan with Different
Adjusting the Trochanter Region , 9-37 Settings, 9-29
Alternative Scan Modes , 9-29 to 9-30 Perform the Examination , 9-8 to 9-13
Choosing an Altenative Scan Modes , 9-3 Performing Manual Analysis , 9-17
Placing the Patient on the Table , 9-7
Index I-7
Positioning for Dual-Hip Scan , 9-8 Field, Text , 3-7, 3-9

Positioning the C-Arm , 9-8 Filing Report , 15-2
For Dual-Hip , 9-8 Example , 15-13
For Left or Right Hip , 9-8 example , 15-13
Positioning the Patient , 9-7 Finding Records, Alternate Procedure , 6-3
Positioning the Patient and C-Arm , 9-6 to 9-8
Follow-up, See Compare
Preparing the Patient , 9-2
Printing Reports , 9-29
Reposition the Image , 9-10 to 9-12
Reposition the Patient , 9-12 G
Reposition the Scan , 9-10 to 9-12 Generating
Selecting Scan Type and Mode , 9-3 to 9-4 AP Lumbar Spine examination
Starting the Hip Scan , 9-9 to 9-10 reports , 8-27
Verifying Scan Parameters , 9-5
reports , 8-27
Exit Button , 3-8
Generating a Rate of Change Report, See Compare,
Exit the Analysis. Window , 7-27 Generating a Rate of Change Report
Exit the Examination, Window , 7-23 Generating and Printing a Report, See QDR Patient
Exiting , 7-27 Examination, Generating and Printing a
The Analysis , 7-27 Report,
The AP Lumbar Spine Examination , 8-11 Generating reports
The Examination , 7-23 AP Lumbar Spine examination , 8-27
Operator Options , 7-23
The Forearm Examination , 10-11
The Hip Examination , 9-13 H
Exiting Examination, Operator Options , 7-23
Exiting the Analysis , 7-27 Help, See System Software Help
AP Lumbar Spine Analysis , 8-27 Hip examination
Forearm Analysis , 10-32 Analysis
Hip Analysis window , 9-28
For All Scans Except Dual-Hip , 9-29 choosing scan mode , 9-3
For Dual-Hip Scans , 9-29 creating/retrieving patient biography , 9-2
Hip Examination performing the analysis
For All Scans Except Dual-Hip , 9-29 moving neck box away from the femoral
Exiting the Analysis, See QDR Patient head , 9-27
Examination, Exiting the Analysis repositioning the image , 9-10
Exiting the Examination, See QDR Patient repositioning the patient , 9-11
Examination, Exiting the Examination windows
Analysis , 9-28
Hip Structure Analysis , 9-38
F
Failed System Test, Correcting , 5-5
Field Descriptions
I
Add Quality Control Phantom, Window , 5-16 Identifying the Sort Order , 3-11
Patient Window Instant Vertebral Assessment See QM
Biography Tab , 6-4 to 6-5
Insurance Tab , 6-6
Quality Control Plot Parameter, Window , 5-12 K
Quality Control Plot Setup, Window , 5-18
Key Elements of the QDR System , 2-2
Scan property Window, Identification Tab , 6-19 Accuracy and Precision , 2-3
to 6-20
DXA Technology , 2-2
Scan Records , 6-17
I-8 Index
Principles of Operation , 2-3

O
On line help , 3-14
L Operator Maintenance , B-1 to B-4
Cleaning Accidental Spills , B-4
Lateral scan Periodic Cleaning , B-2
Analysis Cleaning the QDR and Computer
window , 12-31 Components , B-2
windows Cleaning the Table Pads , B-2
Analysis , 12-31 Disinfecting the Table Pad , B-3
List items Periodic Visual Inspection , B-3
selecting , 3-12 Checking Cables and Outlets , B-3
multiple , 3-12 Checking for Adequate Clearance , B-3
one , 3-12 Inspecting the Table Pad , B-3
range of , 3-12 Options , A-1 to A-4
Locating Scans, See Archiving, Locating and Body Composition Analysis , A-2
Restoring Scans DAP Meter , A-4
General Region of Interest , A-3
High Power Whole Body , A-3
M Infant Whole Body , A-4
Main window List , A-2
components , 3-7 Low Density Spine , A-4
Managing Network , A-4
patient records , 6-1 Prosthetic Hip , A-3
Measuring the Patient’s Forearm , 10-4 Small Animal , A-3
Menu items Worklist , A-3
choosing , 3-8 Other Manufacture’s System, Adding , 6-24 to 6-
Menus , 3-8 to 3-9 27
Choosing Menu Items , 3-8 Entering data for Hip , 6-27
Closing , 3-9 Entering data for Spine , 6-26 to 6-27
closing , 3-9 Entering data from , 6-24 to 6-26
Using , 3-8 Other Window Components , 3-9 to 3-12
using , 3-8 Changing the Sort Order , 3-12
Using Sub-Menus , 3-9 Check Boxes , 3-11
Models , 1-2 to 1-3 Command Buttons , 3-10
4500A , 1-2 Drop-down Lists , 3-10
4500C , 1-3 Entering Text , 3-9
4500SL , 1-2 Identifying the Sort Order , 3-11
4500W , 1-3 Radio Buttons , 3-10
DELPHI-A , 1-3 Scroll Bars , 3-11
DELPHI-SL , 1-3 Sort List items , 3-11
Discovery-A , 1-2 Tabs , 3-10
Discovery-C , 1-2 Other window components
Discovery-Ci , 1-2 understanding , 3-9
Discovery-SL , 1-2
Discovery-W , 1-2
Discovery-Wi , 1-2 P
Explorer , 1-2 Patient
Mouse, See Understanding the Mouse examination , 7-1
Patient Record, Introduction , 6-2 to 6-3
Index I-9
Accessing the Records , 6-2 to 6-3 AP Lumbar Spine

Patient Record, Updating a Patient Record , 6-12 to editing a bone map , 8-20
6-14 evaluating a bone map , 8-20
Patient Record, Working with , 6-4 to 6-15 viewing a bone map , 8-19
Creating a Patient Record , 6-9 to 6-10, 7-4 to 7- Hip examination
7 moving neck box away from the femoral
Creating a New Patient Record , 6-10 head , 9-27
Entering Insurance Information , 6-12 Performing the Analysis, See QDR Patient
Entering Patient Biographical Information , Examination, Performing the Analysis
6-11 Performing the Examination, See QDR Patient
Overview , 6-4 to 6-6 Examination, Performing the Examination
Biography Tab , 6-4 to 6-5 Performing the Follow-up Scan, See Compare,
Window , 6-4 Performing the Follow-up Scan
Body Mass Index, 6-5 Phantom
DOB, 6-5 Spine , 5-3
Ethnicity, 6-5 positioning the , 5-3
First Name, 6-4 Positioning
Height/Weight, 6-5 the Phantom Spine , 5-3
Identifier 2, 6-5
Positioning the Patient and C-Arm, See QDR
Last Name, 6-4
Patient Examination, Positioning the Patient
Menopause Age, 6-5
and C-Arm,
MI (Middle Initial), 6-4
Power failure
Patient Comment, 6-5
operator action during
Patient ID, 6-5
QDR 4500 , 4-20
Referring Physician, 6-5
Sex, 6-5 Printing
Insurance Tab , 6-6 AP Lumbar Spine examination
Window , 6-6 reports , 8-27
Address, 6-6 reports , 8-27
Address 2, 6-6 Printing reports
City, 6-6 AP Lumbar Spine examination , 8-27
Group, 6-6
Insurance, 6-6
Name, 6-6
Patient ID, 6-6
Q
Plan, 6-6 QC Data Management , 5-11 to 5-19
Postal Code, 6-6 QC Plot , 5-7 to 5-9
State, 6-6 selecting scans to include , 5-13
Retrieving a Patient Record , 6-7 to 6-9 QC Plot Progression , 5-20
Go to the Patient Drawer , 6-7 QC Spine Phantom , 5-10
Searching the Patient Drawer , 6-7 to 6-9 QDR 4500
Using the Scroll Bar , 6-8 main window , 6-22
using the Search Text Field , 6-9 QDR Patient Examination , 7-2 to 7-33
Updating a Patient Record Creating/Retrieving a Patient Biography , 7-4 to
Editing a Patient Record , 6-13 7-7
Performing , 14-7 Confirming the Patient Information , 7-6
Performing analysis Creating a Patient Biography , 7-4
Forearm examination Retrieving a Patient Biography , 7-4
steps to , 10-14 Retrieving a Patient File , 7-4
the AP Lumbar Spine examination Searching for a Patient’s Name , 7-5
selecting the setup , 8-12 Exiting the Analysis , 7-27
steps to , 8-16 Exit Analysis Window , 7-27
Performing the analysis Analyze Another Scan button , 7-27
I-10 Index
Exit button , 7-27 Specifications , 13-2

New Scan button , 7-27 IVA Image Viewer , 13-55 to 13-60
Report Button , 7-27 DE Scan , 13-59 to 13-60
Exiting the Examination , 7-23 to 7-24 The IVA Viewer , 13-55 to 13-59
Adding Scan Comments , 7-24 The Image , 13-55 to 13-56
Exit Exam Window , 7-23 Mouse Pointer Control, 13-58
Add Scan Comments , 7-23 The Control Bar, 13-56 to ??, 13-56 to 13-
Analyze Scans , 7-23 58
New Scan , 7-23 Cancel button, 13-58
Generating and Printing Reports , 7-32 to 7-33 Close button, 13-58
Configuration the Report , 7-32 DE Scan button, 13-56
Editing Physician’s Comments , 7-33 Invert button, 13-57
Generating a Report , 7-32 Markers button, 13-56
Performing the Analysis , 7-24 to 7-26 Print Report button, 13-57
Contrast and Brightness , 7-25 to 7-26 Revert button, 13-57
Adjusting Contrast and Brightness , 7-26 W-L Control, 13-57
Performing the Examination , 7-22 Zoom Control button, 13-57
Positioning the Patient and C-Arm , 7-21 to 7-22 The Control Print Image button, 13-57
Placing the Patient on the Table , 7-21 The Patient Data, 13-56
Positioning for the Specific Examination , 7- IVA Imaging on an A or SL System , 13-4 to 13-
22 20
Preparing the Patient , 7-2 to 7-4 Creating/Retrieving a Patient Biography , 13-
Interview , 7-2 5
Patient Questions , 7-2 Preparing the Patient , 13-5
Preparation , 7-3 Selecting the Scan Type and Mode , 13-6 to
13-9
Selecting the Scan Type and Mode , 7-21
To select IVA Imaging scan modes , 13-7 to
QDR User Interface , 3-4 to 3-7
13-9
Dialog Windows , 3-6 Starting the Examination , 13-5 to 13-6
Main Window , 3-4 The AP IVA Scan
Tab Windows , 3-5 Conforming Scan Parameters for AP IVA
QM , 13-2 to 13-76 Scan , 13-10
Generating and Printing Images and Reports , To Verify Scan Parameters, 13-10
13-69 to 13-73 Performing the AP IVA Scan , 13-11 to 13-
Printing IVA Images from the Reports 12
Button , 13-69 to 13-71 Positioning the Patient for the AP IVA
Sample Printouts , 13-72 to 13-73 Scan , 13-10
Sample Image , 13-72 Repositioning the Scan , 13-12 to 13-14
Sample Report , 13-73 The Lateral IVA Scan , 13-15 to 13-20
Imaging on an A or SL System Confirming Scan Patameters for Lateral
Selecting the Scan Type and Mode IVA Scan , 13-15 to 13-16
To run the IVA Imaging examination using To Verify Scan Parameters, 13-16
defaults , 13-7 Performing the Lateral IVA Scan , 13-16 to
The AP IVA Scan , 13-9 to 13-15 13-17
Interpreting the IVA Image , 13-74 to 13-76 Repositioning the Scan , 13-17 to 13-19
Introduction , 13-2 to ?? Returning the C-Arm to the AP Position ,
Disclaimer on IVA Scan , 13-4 13-20
Patient Position and Scanning , 13-2 to 13-3 Using the IVA Viewer for Lateral IVA
Patient Position on an A or SL System , 13- Scan , 13-19
2 IVA Imaging on an C or W System , 13-21 to 13-
Patient Position on an C or W System , 13-3 37
Positioning Aids for the C and W System Creating/Retrieving a Patient Biography , 13-
Head Rest , 13-4 21
Index I-11
Preparing the Patient , 13-21 Exiting the AP BMD Analysis , 13-47 to

Selecting the Scan Type and Mode , 13-22 to 13-48
13-24 Performing the AP BMD Scan , 13-47
To run the IVA Imaging examination using The AP IVA Scan , 13-43 to 13-46
Defaults , 13-23 Confirming the Scan Parameters for AP
To select IVA Imaging scan modes , 13-23 IVA Scan , 13-44
to 13-24 Performing the AP IVA Scan , 13-44 to 13-
Starting the Examination , 13-21 to 13-22 46
The AP IVA Scan , 13-24 to 13-30 Repositioning, 13-46
Confirming Scan Parameters for AP IVA Using the IVA Image Viewer for the AP
Scan , 13-25 IVA Scan , 13-46
Position the Patient for the AP IVA Scan, 13- The Lateral BMD Scan , 13-48 to 13-50
25 Confirming Scan Parameters for Lateral
Exiting the IVA Image Viewer , 13-29 BMD Scan , 13-48
Performing the AP IVA Scan , 13-26 to 13- Exiting the Lateral BMD Scan , 13-50
29 Performing the Lateral BMD Scan , 13-49
Repositioning the Scan, 13-27 to 13-29 to 13-50
To Start the AP IVA Scan, 13-26 The Lateral IVA Scan , 13-51 to 13-54
Using the IVA Image Viewer for AP IVA Confirming Scan Parameters for Lateral
Scan , 13-29 IVA Scan , 13-51
The Lateral IVA Scan , 13-30 to 13-37 Performing the Lateral IVA Scan , 13-52 to
13-53
Performing the Lateral IVA Scan, 13-33 to Returning the C-Arm to the AP Position, 13-
13-36 54
To start the Lateral IVA Scan, 13-33 to Using the IVA Image Viewer for the Lateral
13-34 IVA Scan, 13-53
Repositioning the Scan, 13-34 to 13- The IVA Examination , 13-4 to 13-54
36 IVA Image Exam , 13-4
Placing the Patient on the Table, 13-31 to IVA with BMD Exam , 13-4
13-33 Using Markers , 13-61 to 13-68
Positioning the Patient, 13-31 to 13-32 QM Result Block , 13-66
To position the C-Arm, 13-32 QM QM Results Block for AP IVA Scans ,
To position the patient, 13-32 13-68
To use the positioning aids properly, The Object of QM MaRKERS , 13-61
13-32 Using QM Markers , 13-61 to 13-68
Positioning the Patient for the Lateral IVA Adding QM Markers , 13-63
Scan, 13-31 Deleting Marker Sets , 13-66
Confirming Scan Parameters for Latera Editing Markers , 13-64
IVA Scan , 13-30 to 13-31 Flipping the Image , 13-62
Using the IVA Image Viewer for Lateral IVA Labeling Marker Sets , 13-65
Scan , 13-36 Moving Markers , 13-64
IVA With BMD , 13-38 to 13-54 Selecting Markers , 13-64
Creating/Retrieving a Patient Biography , 13- QM
38 to 13-39 Using Markers
Preparing the Patient , 13-38 QM Result Block
Selecting the Scan Type and Mode , 13-40 to QM Results Block for Lateral IVA Scans ,
13-43 13-67
To Run the IVA with BMD examination us- Quality Control Plot Parameters
ing defaults , 13-40
window , 5-12
To select IVA Imaging scan modes , 13-41
Quantitative Morphometry See QM
to 13-43
Query/Retrieve Scans , 16-22 to 16-24
The AP BMD Scan , 13-46 to 13-48
Confirming Scan Parameters for AP BMD Query Parameters , 16-23 to 16-24
Scan , 13-47
I-12 Index
Printing a Report Using the Report Button ,

R 15-6 to 15-9
Radio Buttons , 3-10 Editing the Physician’s Comments , 15-8 to
Rate of Change Report 15-9
example , 15-15 To Print a Report Using the Report Button ,
Reference Database , 2-8 15-7
Reminders Repositioning the image
system software , 3-13 Forearm examination , 10-9
flashing buttons , 3-13 Hip examination , 9-10
Reports , 15-2 to 15-40 Repositioning the patient
Alternate Navigation , 15-39 to 15-40 Forearm examination , 10-10
Drag and Drop Records , 15-39 to 15-40 Hip examination , 9-11
Patient Records , 15-39 Restoring a Baseline Scan, See Compare,
Scan Records , 15-40 Restoring a Baseline Scan
DICOM , 15-18 to 15-38 Restoring Scans, See Archiving, Locating and
Creating and Sending , 15-18 to 15-19 Restoring Scans
Examples , 15-13 to 15-16 Retrieving
Filing Report , 15-13 scan records , 6-22
Interpreting Report , 15-14
Rate of Change Report , 15-15
Referring Report , 15-15
Introduction , 15-2 to 15-5
S
Report Information Blocks , 15-3 to 15-5 Scan Record, Introduction , 6-16
Report Blocks, Window , 15-4 Scan Drawer , 6-16
DXA Results, 15-5 Scan Record, Working with , 6-17 to 6-23
Rate of Change Graph, 15-5 Retrieving Scan Records , 6-22 to 6-23
Reference Graph, 15-5 Performing an Analysis , 6-23
Header, 15-4 To go to the Scan Drawer , 6-22
Image, 15-5 To View a Scan , 6-23
Patient Information, 15-4 Scan Deleting Scan Files , 6-21 to 6-22
Physician’s Comments, 15-5 Archive Scans Tab , 6-22
Scan information, 15-4 Unarchive Scans Tab , 6-22
Report Types , 15-2 to 15-3 Scan Details , 6-17 to 6-20
Filing Report , 15-2 Details Tab , 6-18 to ??
Interpreting Reports , 15-2 Accession Number , 6-18
Rate of Change Report , 15-3 Height , 6-18
Reference Report , 15-2 HL7 Field 1 , 6-18
Preview Reports , 15-11 to 15-12 HL7 Field 2 , 6-18
Report Preview, Window , 15-11 HL7 Field 3 , 6-18
Close button , 15-12 Operator , 6-18
Next Page button , 15-11 Patient Name , 6-18
Prev Page button , 15-11 Scan Comments , 6-18
Print button , 15-11 Weight , 6-18
Two Pages button , 15-11 Identification Tab , 6-19 to 6-20
Zoom In button , 15-12 Analysis Date , 6-20
Zoom Out button , 15-12 Archive 1 Date , 6-20
Printing Reports , 15-6 to 15-10 Archive 2 Date , 6-20
Editing the Physician’s Comments , 15-8 Machine Type , 6-19
Print Dialog Box , 15-10 Patient ID , 6-19
To Select the Print Dialog Setting , 15-10 Patient Name , 6-19
Printing a Report After Analysis , 15-6 Scan Date , 6-19
Printing a Report Print Dialog Box , 15-10 Scan ID , 6-19
Scan Mode , 6-19
Index I-13
Scan Type , 6-19 Running the System Backup , 17-5 to 17-6

Serial Number , 6-19 System Recovery , 17-8
Window , 6-20 System Backup, Flashing Button , 3-13
Scan Sites , 2-4 to 2-7 System Backup, See System Backup and Recovery
Forearm , 2-6 System Configuration , 18-2 to 18-81
Lumbar Spine , 2-4 Analyze Tab , 18-5 to 18-7
Proximal femur , 2-5 Analysis Options
Whole Body , 2-7 , 18-7
Scoliotic Spine Scan, AP Lumbar Spine Default , 18-5
Examination , 8-30 to 8-34 Changing a Configuration Selection on a
Adjusting the ROI Box , 8-30 to 8-32 Default Setting , 18-5
Defining ROI using Line Mode , 8-31 General Options , 18-6
Defining ROI using Point Mode , 8-32 Display Region of Interest Coordinates ,
Marking Interventebral Lines , 8-33 to 8-34 18-6
Marking Interventebral Spaces , 8-33 Enable Body Composition Analysis , 18-6
Image Display Options , 18-6
Pivoting Interventebral Lines , 8-33 to 8-34
Display Hip Axis Length , 18-6
Pivoting Intervertebral Line , 8-33 to 8-34
Display Pseudo Color Image , 18-6
Scroll Bars , 3-11 Image Pro , 18-6
Selecting Items Initially Display Unanalyzed Hip Image as
Selecting a Range of Items , 3-12 Single Energy , 18-6
Selecting Multiple Items , 3-12 Initially Display Unanalyzed Lateral Image
Selecting One Item from a List , 3-12 as Single Energy , 18-6
Selecting scan type and mode Image Style
Whole Body examination , 11-3 , 18-7
Selecting the Scan Type and Mode, See QDR Lateral Options , 18-7
Patient Examination, Selecting the Scan Type Display MID Regions , 18-7
and Mode Prevent Vertical Motion of ROI , 18-7
Sort List Items , 3-11 Archive Tab , 18-31 to 18-33
Study
Configuring. See System Configuration, Study Adding a New Location , 18-31 to 18-32
Tab Adding a New Location to the Archive List,
Using See Using a Study 18-31
Changing the Default location, 18-32
System Backup and Recovery , 17-2 to 17-8
Deleting a Location from the Archive List,
Errors and Exceptions , 17-6 to 17-8
18-32
Backup File with the Same Name , 17-6
Including Raw Data Files, 18-33
Drive Not Accessible , 17-7
CAD BMD Tab , 18-8 to 18-9
Drive Does Not have Enough Space , 17-7
Configuration Settings , 18-8
3.5 inch diskette, 17-7
Typical CAD BMD Dialog , 18-9
Network Drive, 17-7
DICOM Tab , 18-44 to 18-66
Read/Write CD, 17-7
Host Machine , 18-66
SuperDisk, 17-7
Modality Worklist , 18-44 to 18-52
Drive not Accessible , 17-8
Auto Query Interval , 18-47
Overview , 17-2 to 17-5
Configure Worklist Provider , 18-49 to 18-
Files Saved , 17-2
52
Media Formatting , 17-3
Input From File , 18-48
Management of Media , 17-3
Map Worklist Fields , 18-49, 18-51 to 18-52
Floppy Diskette , 17-3
Performed Procedure Step , 18-49 to 18-50
Network Drive , 17-3
Provider, 18-49 to 18-50
Read/Write CD , 17-3
Purge Interval , 18-48
SuperDisk , 17-3
Query Parameters , 18-46
Naming the Backup File , 17-4
Query Retry Parameters , 18-47 to 18-48
When to Run System Backup , 17-3
I-14 Index
Use Performed Procedure Step , 18-49 Reference Block Lateral Configuration, 18-
Worklist Provider , 18-49 29
Query/Retrieve Destinations , 18-63 to 18-65 Configuring the Ancillary Report , 18-30
Add / Edit DICOM Query/Retrieve Desti- Scan Conversion , 18-39 to 18-40
nation Dialog , 18-65 Adding Additional Manufacturers , 18-40
Send Destinations , 18-53 to 18-58 Study Tab , 18-68 to 18-81
Add / Edit DICOM Send Destination Adding a Study , 18-68 to 18-71
Dialog , 18-55 to 18-57 Deleting a Study , 18-77 to 18-78
Add / Edit Storage Commitment Destina- Editing an Existing Study , 18-72 to 18-74
tion Dialog , 18-61 Adding Items , 18-72 to 18-74
Configure DICOM Send Dialog , 18-57 to Deleting Items , 18-74 to 18-77
18-58 Locating a Study from a Long List , 18-81
Storage Commitment Destinations , 18-59 to Renaming a Study , 18-78 to 18-80
18-62 System Tab , 18-3 to 18-4
Configure Storage Commitment Dialog , System Tab Window
18-62 Autopositioning for Hip Scans , 18-3
HL7 Tab , 18-34 to 18-38 Customer , 18-3, 18-4
Changing HL7 Fields , 18-36 to 18-37 Data Directory , 18-4
Entering HL7 Fields , 18-34 to 18-35 Date Format , 18-3
Removing HL7 Fields , 18-37 to 18-38 Default Ethnicity , 18-4
Overview Language , 18-4
Entering System Configuration , 18-2 Last Service Date , 18-4
Privacy Tools , 18-67 Last System Backup Date , 18-4
QDR Modality Worklist , 7-8 to 7-20 Model , 18-4
Modality Worklist Operations , 7-16 to 7-20 Patient Biography , 18-3
Adding a Patient , 7-17 to 7-18 Report Dose Area Product , 18-3
Adding a Study , 7-18 S/N , 18-4
Matching an Existing Patient , 7-18 to 7-20 Software , 18-4
Using Modality Worklist , 7-8 to 7-13 System ID , 18-4
Using Modality Worklist with a Study , 7-13 System Hardware Components
to 7-16 AC Power isolation Module , 1-4
Report Tab , 18-10 to 18-30 DELPHI Systems , 4-23 to 4-30
Configuring Reports , 18-14 to 18-30 AC Power Isolation Module , 4-23
Report Blocks Window , 18-10 Circuit Breaker , 4-23
Report Configuring Reports Indicator , 4-23
Configure the Optional Reports Control Panels , 4-23 to 4-26
Configuring the Common Block, 18-19 to DELPHI-A and -SL , 4-25 to 4-26
18-20 Arm, 4-25
Configuring the Header Block, 18-21 Center Table, 4-26
Configuring the Optional Reports of a Emergency Stop button, 4-26
Report Type, 18-19 Emergency Table Lift, 4-26
Configuring the Physician’s Comments, Enable Lateral, 4-26
18-22 Laser, 4-26
Configuring the Reference Block, 18-20 Patient On/Off, 4-26
Details of the Patient Block, 18-23 to 18-24 Power Switch, 4-26
Details of the Reference Block for Configure Table, 4-26
Common Block Option, 18-26 to 18- X-ray on Lamp, 4-26
27 DELPHI-C and -W , 4-23 to 4-25
Details of the Results Block, 18-25 to 18-26 Arm Left, 4-24
Details of the Scan Block, 18-24 to 18-25 Arm Right, 4-24
Reference Block Forearm Configuration, 18- Center Table, 4-24
28 Emergency Stop button, 4-25
Reference Block Hip Configuration, 18-27 Instrument On/Off, 4-25
Index I-15
Laser, 4-24 Operator Action During a Power Failure ,

Laser On/Motion Enabled (green indicator), 4-20 to 4-21
4-25 After Power is Restored, 4-21
Patient On/Off, 4-24 Shutting down, 4-20
Table In, 4-24 Power Module , 4-14 to 4-15
Table Out, 4-24 Rear Panel , 4-15
X-ray On (amber indicator), 4-24 Side Panel , 4-14
Emergency Procedures , 4-28 to 4-30 Circuit Breakers, 4-15
If Equipment Fails while Operating , 4-29 Computer Power Switch, 4-15
Emergency Stop Procedure., 4-29 Instrument Power Switch, 4-15
If Power has been Turned Off , 4-30 X-ray Emissions Ind., 4-15
Applying Power to System, 4-30 X-ray Enable Key, 4-15
Operator Action During a Power Failure , X-ray Enable Lamp, 4-15
4-28 to 4-29 QDR 4500C and W
After Power is Restored, 4-29 Control Panel
Shutting Down, 4-29 Arm, 4-16
Turning Power On and Off , 4-26 to 4-28 Turning Power On and Off , 4-18 to 4-20
Beginning of the Workday , 4-27 Beginning of the Workday , 4-18
End of the Workday , 4-27 End of the Workday , 4-19
Examination Table System Recovery
Control panel function , 17-1
DELPHI , 1-7 System Recovery, See System Backup and
Indicators , 1-8 Recovery
QDR 4500 , 1-7 System Software Help , 3-14 to 3-15
Switches , 1-8 Online
Operator Console Ticker Tape , 3-15
Power Module , 1-4 Online Context Sensitive Help , 3-14
QDR 4500 Systems , 4-14 to 4-22 Tool Tips , 3-14
Control Panel , 4-15 to 4-18 System Software Reminders , 3-13
Laser , 4-16
Flashing Buttons , 3-13
QDR 4500A and SL , 4-17
Daily QC , 3-13
Arm, 4-17
System Backup , 3-13
Center Table, 4-18
Emergency Stop button, 4-18
Emergency Table, 4-18
Enable Lateral, 4-18 T
Laser, 4-17 Tabs , 3-10
Patient On/Off, 4-18 Tool Tips, System Software Help , 3-14
Table, 4-17
T-Score , 2-8
X-ray on Lamp, 4-18
QDR 4500C and W , 4-16
Center Table, 4-16
Emergency Stop button, 4-17 U
Patient On/Off, 4-16 Understanding
Table, 4-16 main window components , 3-7
X-ray on Lamp, 4-16
other window components , 3-9
Emergency Procedures , 4-20 to 4-22
Understanding Scan Results , 2-8
Equipment Fails While Equipment is
Operating , 4-21 Reference Database , 2-8
Emergency Stop Procedure, 4-21 T-Score , 2-8
Equipment has been Turned Off , 4-21 Z-Score , 2-8
Applying Power to the System, 4-22 Understanding the Mouse
Holding the Mouse , 3-2
I-16 Index
Mouse Tasks , 3-2 Height, 19-13

Clicking the Mouse , 3-3 Help button, 19-14
Double-Clicking the Mouse , 3-3 Identifier 2, 19-13
Dragging and Dropping , 3-3 Last Name, 19-13
Enter Text in a Field , 3-2 Menopause Age, 19-13
Move an Object on the Desktop , 3-2 Middle Initial, 19-13
Perform an Action , 3-2 OK button, 19-13
Pointing with the Mouse , 3-3 Patient Comments, 19-13
Using Patient ID, 19-13
menus , 3-8 Referring Physician, 19-13
sub-menus , 3-9 Weight, 19-13
Using a Study , 7-28 to 7-31 Erasing Scans, 19-23 to 19-25
Insurance, 19-14 to 19-15
Utilities , 19-2 to 19-57
Window, 19-14
AP Reposition , 19-40 to 19-41
Address1, 19-15
Database Tools , 19-9 to 19-32
Address2, 19-15
Auto Baseline Utility , 19-36
Cancel button, 19-15
Export , 19-27 to 19-29
City, 19-15
Export/Import , 19-25 to 19-26
Group, 19-15
Help button, 19-15
Types of Data
Insurance, 19-15
Patient Data, 19-26
Name, 19-14
QC Scan Data, 19-26
OK button, 19-15
Referring Data, 19-26
Patient ID, 19-14
Scan Data, 19-26
Plan, 19-15
Types of Transfers, 19-26
Postal Code, 19-15
Types of Data , 19-26
Managing Patient Baseline Scans, 19-17
Export/Import Function , 19-25 to 19-26
Managing Scans, 19-18 to 19-25
Import , 19-29 to 19-31
Window, 19-19
Patient Callback , 19-33 to 19-35
Analysis Date (button), 19-20
Patient Management , 19-9 to 19-25
Back button, 19-20
Managing Patients , 19-10 to 19-11
Window, 19-10
Deselect All button, 19-20
Birth Date, 19-10
Erase Scan button, 19-21
Close button, 19-11
Move >> button, 19-20
Edit, 19-11
Patient ID, 19-20
Erase Patient button, 19-11
Patient Name, 19-19
Ethnicity, 19-10
Scan Date (button), 19-19
Patient ID, 19-10
Scan Details button, 19-20
Patient Name Text Box, 19-10
Scan ID (button), 19-20
Patient Selection, 19-11
Scan Location, 19-20
Referring Physician, 19-10
Scan Type (button), 19-19
Sex, 19-10
Select All button, 19-20
Managing Patients Information , 19-12 to Moving Scans, 19-21 to 19-23
19-15
QC Phantom Details, 19-15
Biography, 19-12 to 19-14
Window, 19-15
Window, 19-12
Biography Tab, 19-12
OK button, 19-16
Phantom Name, 19-15
DOB Day, 19-13
Phantom Number, 19-16
DOB Month, 19-13
Phantom Type, 19-16
DOB Year, 19-13
Removing a Patient from the System, 19-18
Ethnicity, 19-13
Starting , 19-9
First Name, 19-13
Reconcile , 19-31 to 19-32
Index I-17
Emergency Motion , 19-40 Displaying the Summary Report, 19-4 to

Import , 19-29 to 19-31 19-5
Install Options , 19-57 Technically Unacceptable Studies, 19-6
Rebuild Archive Indexr , 19-55 to 19-56 Usage Claims for Technically Unacceptable
Reference Curve , 19-42 to 19-54 Studies, 19-8
Adding New Ethic Groups , 19-53 to 19-54 Usage Detail Report, 19-6 to 19-8
Starting Reference Curve Editor , 19-43 Displaying the Detail Report, 19-6 to 19-
7
Reference Curve Editor
Copying a Reference Curve Record , 19-49 to Utilities not covered , 19-1
19-50
Creating New Reference Curve Records , 19-
44 to 19-49 V
Creating a New Reference Curve Record ,
Visualization of abdominal aortic calcification ,
19-44 to 19-47
13-1
Table
Reference Curve Description Fields, 19-47
to 19-49
Age Peak BMD, 19-49 W
Author of Curve, 19-48 Whole Body auto low density, Enable/Disable , 18-
Comment, 19-48 7
Date Last Modification, 19-48
Whole Body examination
Ethnicity, 19-47
Analysis
Is this curve current?, 19-48
window , 11-9, 11-16
Method, 19-48
Scan Site, 19-48 selecting scan type and mode , 11-3
Select X, Y Labels Button, 19-48 windows
Sex, 19-47 Analysis , 11-9, 11-16
Source, 19-48 Windows
X-Axis Display from - to, 19-48 Add Quality Control Phantom , 5-16
X-Axis Label, 19-48 Analysis
Y-Axis Display from - to, 19-48 AP scan , 12-22
Y-Axis Label, 19-48 Forearm examination , 10-14, 10-29
Deleting Reference Curve Records , 19-52 Hip examination , 9-28
Editing Reference Curve Records , 19-51 to Lateral scan , 12-31
19-52 Whole Body examination , 11-9, 11-16
Restoring Reference Curve Databases , 19-54 Analysis Setup
Viewing Reference Curve Data , 19-44 AP Lumbar Spine examination , 8-12
Scan File Look , 19-36 to 19-38 main
Scan File Plot , 19-39 components , 3-7
Starting a Utility , 19-2 QDR 4500
Accessing the Utilities Menu , 19-2 main , 6-22
System Configuration , 19-2 Quality Control Plot Parameters , 5-12
Usage , 19-3 to 19-8 Select a Patient for this Exam , 6-13
Starting Usage , 19-3 to 19-4
Usage Program Menu , 19-4
Show Detail, 19-4
Show Summary, 19-4
Z
Usage Summary Report , 19-4 to 19-8 Z-Score , 2-8
I-18 Index

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QDR

Caution: Federal (U.S.A.) law restricts this device to sale by or on the

Document No. MAN-00732 Revision 002

Whole Body ................................................................................................................... 2-7

Flashing Buttons .......................................................................................................... 3-13

End of the Workday ............................................................................................... 4-19

Set up the QC Plot ....................................................................................................... 5-17

Table of Contents vii

Retrieving a Patient Biography ................................................................................ 7-4

viii Table of Contents

One-Time™ Auto Analysis ................................................................................... 8-14

One-Time™ Auto Analysis ................................................................................... 9-16

Methods of Analysis ....................................................................................... 10-13

Preparing the Patient .................................................................................................... 12-2

xii Table of Contents

Viewing Results .............................................................................................. 12-39

Table of Contents xiii

Repositioning the Scan ................................................................................... 13-27

xiv Table of Contents

The Object of QM Markers ....................................................................................... 13-61

xvi Table of Contents

Deleting a DICOM Report from the Queue ............................................................... 15-34

Table of Contents xvii

Problems Accessing an Archive Location ................................................................. 16-28

xviii Table of Contents

General Options ........................................................................................................... 18-6

Table of Contents xix

Changing HL7 Fields ................................................................................................. 18-36

Database Tools ................................................................................................................... 19-9

Table of Contents xxi

Using DICOM .................................................................................................................... 20-4

xxii Table of Contents

Introducing the QDR Series Models

1-2 Introducing the QDR Series System

Introducing the System Hardware Components

Operator’s Console Examination Table

Introducing the QDR Series System 1-3

Computer Hardware and Peripherals

4500 Power Module

Delphi AC Power Isolation Module

1-4 Introducing the QDR Series System

Table 1-1. Item Description Function

X-Ray Source and Detectors

Introducing the QDR Series System 1-5

Control Panel for QDR Systems

The Discovery and Explorer Control Panels

Discovery/Explorer Control Panel Switches and Indicators

1-6 Introducing the QDR Series System

• Center Table switch (also centers the C-arm)

The QDR 4500 and Delphi Control Panels

The QDR 4500 Control Panels

Figure 1-7 Table

The Delphi Control Panels

Introducing the QDR Series System 1-7

indicator lights inform the operator these activities are in

QDR 4500/Delphi Control Panel Switches and Indicators

1-8 Introducing the QDR Series System

Introducing the APEX Software

Main Window Overview

Main Window Features

Introducing the QDR Series System 1-9

3 - Filing Cabinet buttons

Introducing the Quality Control Spine Phantom

Continuous, self-calibration is a feature of the QDR series. The