Operator Manual

DIGIRAD_uk_user's_manual_W7_v8_12_x_Rev0.0.
docx Page 1 of 124
User Manual
Read the instructions carefully before connecting this device.
Via Caduti Lecchesi a Fossoli, 17 - 23900 LECCO - Italy

Tel. (+39) 0341 364617 - Fax (+39) 0341 285162
23/08/2016
DIGIRAD_uk_user's_manual_W7_v8_12_x_Rev0.0.docx Page 2 of 124
CONTENTS:
1 SYMBOLS............................................................................................... 4
2 IDENTIFICATION. ............................................................................... 4
3 CLASSIFICATION. ............................................................................... 4
4 PRECAUTIONS FOR USE. .................................................................. 6
4.1 DECLARATION OF RESPONSABILITY. ............................................ 6
4.2 CONFORMITY AND REFERRENCE ADDRESS. ............................... 7
4.3 ELECTRIC SAFETY. .............................................................................. 7
4.4 RESIDUAL RISKS. .................................................................................. 8
4.5 TRANSPORT AND STORAGE. ............................................................. 8
4.6 STANDARD EQUIPMENT. .................................................................... 8
5 DESCRIPTION OF THE MACHINE................................................... 9
5.1 ALGORITHMS ........................................................................................ 9
5.2 SOFTWARE STRUCTURE. ................................................................. 10
6 ACCENSION. ....................................................................................... 11
6.1 QUICK COMMANDS. ........................................................................... 12
7 MENU BAR........................................................................................... 13
7.1 FILE MENU. ........................................................................................... 13
7.1.1 New Archive. ....................................................................................................... 14
7.1.2 Open archive. ...................................................................................................... 15
7.2 STUDY MENU. ....................................................................................... 16
7.2.1 New Study. .......................................................................................................... 17
7.2.2 Modify Study....................................................................................................... 18
7.2.3 Copy Study. ......................................................................................................... 19
7.2.4 Copy Study on CD. ............................................................................................. 20
7.2.5 Find, Find Next, Find Previous. ......................................................................... 22
7.3 OPTION MENU ..................................................................................... 23
7.3.1 Study List Font.................................................................................................... 24
7.3.2 Fixed Strings Setup. ............................................................................................ 25
7.3.3 Verify. .................................................................................................................. 26
7.4 HELP MENU. ......................................................................................... 27
8 OPERATING SCREEN. ...................................................................... 28
9 EXAM SETTINGS. .............................................................................. 30
9.1 OPEN THE EXAM FOLDER LIST. ..................................................... 31
9.2 GENERATOR SETTINGS. ................................................................... 32
9.3 ACQUISITION OF AN IMAGE. ........................................................... 33
10 PROCESSING. ..................................................................................... 37
10.1 ADVANCED PROCESSING MENU. ................................................. 38
10.1.1 Harmonization. ................................................................................................... 39
10.1.2 Spatial Filters. ..................................................................................................... 40
10.1.3 Zoom. ................................................................................................................... 41
10.1.4 Overlay. ............................................................................................................... 42
10.2 ROTATE 90 DEGREES ...................................................................... 63
10.3 VERTICAL INVERSION ................................................................... 64
10.4 HORIZONTAL INVERSION ............................................................. 65
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10.5 ELECTRONIC SHUTTERS ............................................................... 66

10.6 OVERVIEW ......................................................................................... 68
10.7 LUT MANAGER.................................................................................. 69
10.8 DETECTOR ZOOM ............................................................................ 72
11 SEARCH. .............................................................................................. 73
12 DICOM. ................................................................................................ 74
12.1 SEND SINGLE IMAGE ...................................................................... 75
12.2 SEND ENTIRE EXAM ........................................................................ 75
12.3 DICOM BURNING. ............................................................................. 75
12.4 FILM EDITOR..................................................................................... 75
12.5 PRINT DICOM. ................................................................................... 75
12.6 DICOM SPOOLER. ............................................................................. 76
13 OPTIONS.............................................................................................. 79
13.1 DUAL DETECTOR. ............................................................................ 80
13.2 ORTHOPEDIC MEASURES .............................................................. 81
13.3 STITCHING ......................................................................................... 89
13.3.1 Construction of a Stitching image ...................................................................... 91
13.4 DICOM BURNING .............................................................................. 98
13.4.1 Edit Readme. ..................................................................................................... 100
13.4.2 Write CD............................................................................................................ 101
13.4.3 Write to disk ...................................................................................................... 104
13.5 FILM EDITOR................................................................................... 107
13.5.1 Film Screen. ....................................................................................................... 108
13.5.2 Print. .................................................................................................................. 108
13.5.3 Print all. ............................................................................................................. 108
13.5.4 Delete images from Film Screen. ...................................................................... 108
13.5.5 Film Editor settings. .......................................................................................... 109
13.6 WORKLIST. ...................................................................................... 111
13.7 QUERY/RETRIEVE SCU. ................................................................ 113
13.8 MPPS. ................................................................................................. 115
13.9 STORAGE COMMITMENT. ........................................................... 118
14 MAINTENANCE. .............................................................................. 120
14.1 ORDINARY MAINTENANCE. ........................................................ 120
14.2 CLEANING AND DISINFECTING. ................................................ 120
15 DISPOSAL OF REFUSE FROM THE ELECTRIC AND
ELECTRONIC EQUIPMENT............................................................... 121
16 APPENDIX. ........................................................................................ 122
16.1 VIEWING WIFI DETECTOR PARAMETERS. ............................. 122
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1 SYMBOLS.
When this symbol is present, always consult and read carefully the warnings in the manual
supplied with the device.
2 IDENTIFICATION.
This device is labeled as follows:
Name and address of the manufacturer: digitec S.r.l.

Via Caduti Lecchesi a Fossoli, 17
23900 Lecco (Italy)
Year of manufacture: 2010
Serial number: SN. 001
Power descriptions: 230V~ 50Hz 80VA

115 V~ 60Hz 80VA
3 CLASSIFICATION.
This instrument is class-I rated with no possibility of connection to the patient pursuant to the
European law EN60601-1. Please, respect the instructions of installation.
Type of protection against electrical contacts: class I

Degree of protection against electrical contacts: type B
Degree of protection against water penetration: common device
Degree of safety in presence of inflammable mixtures: device not suitable for use
Conditions of use: continuous service
This device is designed for applications of radiology image elaboration and applications of
image transferring from generic digital radiology systems to network archives, as equipment for
medical devices in orthopedics and surgery.
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This device MUST BE internally installed in a system which guarantees protection against direct
and/or indirect contact with the active parts.
Additionally, it must have enough space to be installed and connected with the power supply
socket and it must be provided with a covering which protects the cables form damages and
which allows the verification of correct positioning and connection when removed. This space
must guarantee good ventilation that is able to satisfy the environmental limits of the device as
specified in the technical description.
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4 PRECAUTIONS FOR USE.
The digital equipment must exclusively be used according to the safety instructions contained in
this manual and must not be utilized for uses other than those for which it was designed.
It must be used exclusively by personnel with sufficient training in informatics or with training
for the use of this type of devices.
The device must not be used in the presence of electric or mechanical failures. It also must not be
used if there is a malfunction of the warning apparatus or alarm.
Any modifications to the device or to its safety system must be authorized by DIGITEC.
If the apparatus is to be used in combination with other devices, components or modules about
which the compatibility is unknown, it is first necessary to make certain that there is no danger in
doing so. For this purpose, please contact the manufacturer of the machinery or talk with an
expert.
As with any technical equipment, this digital device must be used correctly and must be
periodically checked as specified in this manual in the section "Maintenance".
4.1 DECLARATION OF RESPONSABILITY.
 DIGITEC is responsible for the safety of its products only if the maintenance, repairs and/or
modifications of the same are carried out by DIGITEC or by authorized personnel.
 DIGITEC accepts no responsibilities for malfunction, damages or danger caused by
improper use of the device or caused by non-conformity to the norms for maintenance.
 The owner of the device is responsible for ensuring that the same is used exclusively by
specially trained and skilled personnel.
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4.2 CONFORMITY AND REFERRENCE ADDRESS.
The digital device is produced by:
DIGITEC S.r.l. via Caduti Lecchesi a Fossoli,17

23900 Lecco (LC) Tel. 0341-364617
Fax 0341-285162
The device conforms to EC standards. The applicable harmonized standards are:
EN 60 601-1-6 (ED.3)
EN 60 601-1 (ED.3)
EN 62366 (ED.1)
EN 60 601-1-2:2007
4.3 ELECTRIC SAFETY.
The set-up of the machinery must be carried out by specialized personnel who have been
authorized by the maker. Protection against electrical shocks is carried out through the grounding
of the metallic parts of the device cover.
It is therefore necessary to periodically check the correct functioning of the grounding circuit
(both the internal and external parts of the device).
 The X-Ray apparatus into which the DTU is installed must not be used in environments
where a danger of explosion exists.
 Please, disconnect the device from its power source before carrying out any cleaning,
disinfecting and sterilization operations.
 Cleaning and disinfecting products can form explosive gas mixtures. As a result, use only
products which comply with applicable standards.
 Be careful not to spill liquids that might leak internally compromising safety and the right
functioning of the device.
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4.4 RESIDUAL RISKS.

The device has been designed and built according to safety standards.
However, there are still residual risks due to improper use of the device as well as due to possible
malfunctions of the safety features included.
For risks due to improper use, refer to the rules and recommendations given in the previous
points of this section.
Before carrying out any kind of maintenance, disconnect the device from its power supply.
If smoke and/or a burning smell are detected, immediately disconnect the device and contact
authorized servicing personnel.
4.5 TRANSPORT AND STORAGE.
The transport and storage of this product must take place in the manufacturer's packaging and the
following conditions must be respected.
Limit values Suggested values

Temperature from 0 °C to +50 °C from +10 °C to +40 °C
Relative humidity from 20 % to 90 % from 30 % to 80 %
4.6 STANDARD EQUIPMENT.

 N.1 Rack.
 N.1 USB Programs Key.
 N. 1 Software Windows 7 Professional.
 N.1 Acronis True Image license.
 N.1 C disk image.
 N.1 Mouse/Keyboard PS/2 adapter.
 N.1 PS/2 Keyboard.
 N.1 PS/2 Mouse.
 N.1 25-pin cable M/F with ferrite model RKXF-13-A5.
 N.1 Power supply cable.
Optional:
 N.1 External USB DVD-ROM.
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5 DESCRIPTION OF THE MACHINE.

DIGIRAD is a device able to acquire digital images of large size (up to 43 x 43 cm) in GRAFIA
modality from solid-state detector of large dimensions.
The scanned images are saved to the disk drive system, displayed on a high resolution monitor
and possibly sent to a diagnostic workstation (or a general archive) through the DICOM network.
The system allows replacing the standard analog radiographs film in all conventional exams,
with the exception of mammography exams. The system allows setting the parameters for
acquisition, processing and displaying images depending both on the selected anatomical part of
the body and on the patient size. This allows the immediate capture and displaying of the correct
image, without subsequent improvements.
The device also provides post-processing functions that allow both the possibility to elaborate
the images and their management.
5.1 ALGORITHMS
In logical sequence the algorithms applied at the original data of the images are the following:
NOISE REDUCTION: the fluoroscopic images made at low dose are unfortunately characterized
by a high amplitude of the noise that clearly affect in part the visibility and the perception of the
operator. The usual process now used by all manufacturers of vision systems for radiological
application is also called temporal averaging filter (average between successive images) also
proposed by the manufacturers of RX sensors and cameras. It also appears in the scientific
literature for the reduction of noise in all applications with high noise content (radiological,
astronomy, military, etc..)
DIGITAL ROTATION: to allow an easy visualization as a function of position of the implant

relative to the patient table applies the digital electronic rotation followed by a bilinear
interpolation algorithm for elimination of artifacts.
DIGITAL SUBTRACTION: point-to-point operation that performs the arithmetic difference

between the corresponding pixels of two different images; the first, normally defined as "mask",
stored before the introduction of contrast medium, the second image defined as post-introduction
of the contrast medium .
CONTRAST STRETCHING: an operation that improves the appearance of the image improving
the contrast, is the contrast stretching algorithm which allows to use the whole dynamic of the
visualization tool (in our case, the monitor), this algorithm can be applied automatically in real
time, or by allowing the adjustment at the discretion of the operator. The application of a curve
of logarithmic or exponential allows to highlight the contrasts in the parts with higher or lower
density radiographic.
EDGE ENHANCEMENT: algorithm that allows a local place greater emphasis on the details of
the contours of the image by applying a local array with suitably calibrated coefficients applied
to every pixel and its surrounding pixels.
ZOOM: algorithm was applied only in a local post-processing, digital magnifier with bilinear
interpolation to reduce the effect of discretization of individual pixels.
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5.2 SOFTWARE STRUCTURE.

The software installed in the PC, which is compatible with the WINDOWS 7® operating system,
is made of two units:
DigiRad: it provides the acquisition, displaying and processing of the radiological images.
DICOM SPOOLER: it allows getting the images from the HD and transmits them to the remote
DICOM device (set during installation) through the network.
Optional
DUAL DETECTOR
It allows using two detectors to acquire images.
ORTHOPEDIC MEASURES
Graphic measurement functions.
STITCHING
Automatic reconstruction of a composite image from a series of individual images.
DICOM BURNING.
Burning of the images in DICOM CD-ROM.
FILM EDITOR.
Composition of films to print.
WORKLIST.
Management of the daily patient list.
QUERY/RETRIEVE
Query and visualization studies on the Server
MPPS.
Images information that are transferred to the Server.
STORAGE COMMITMENT.
Definitive storing of images to an another device.
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6 ACCENSION.
When starting the device the last used archive will automatically appear on the monitor.
MENU BAR QUICK COMMANDS
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6.1 QUICK COMMANDS.
Open Archive Save Archive
Worklist New Study
Modify Study Query Retrieve
Open Study Emergency Study
About… Shutdown the system
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7 MENU BAR.
7.1 FILE MENU.
The File Menu provides all the operations that can be performed on the archives of the exams.
AVAILABLE COMMANDS FROM THE CLOSED ARCHIVE.

New Archive: to create a new archive.
Open Archive: to open a previously archive created.
Exit: to close the application.
AVAILABLE COMMANDS FROM THE OPEN ARCHIVE.

Close: to close the current archive.
Save: to save the current settings.
CD-Images Manager: to open a list of archives ready to be written on a CD.
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7.1.1 New Archive.

This command allows creating a new archive.
When pushing the button New Archive the following window will appear:
In the Filename field insert the name of the archive then click Save.
The password requested is: MedService.
Once the process ends the Patient List window will open and the name of the archive will appear
at the top of the screen.
See the figure:
The system is now ready to insert new exams.
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7.1.2 Open archive.

This command allows opening an archive previously saved on the hard disk.
When clicking the icon the following window will appear:
OK: It confirms and runs the archive opening.

Cancel: It closes the window and cancels all processes.
Browse: It allows choosing the archive(s) that are not present on the
Archive List Manager.
Remove: It allows deleting the archive(s) from the list.
The Remove command deletes the selected archive(s) only from the Archive List Manager.
The archive is always present on the Hard Disk.
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7.2 STUDY MENU.

The Study Menu provides all the operations that can be performed on the studies.
AVAILABLE COMMANDS WHEN AN ARCHIVE IS NOT SELECTED.

Worklist: to open the Worklist window (see the related paragraph).
Query/Retrieve: to open the Query/Retrieve window (see the Query/Retrieve
Option paragraph).
New Study: to create a new study.
AVAILABLE COMMANDS WHEN AN ARCHIVE IS SELECTED.

Open Study: to open a study previously created.
Emergency Study: to open an emergency study with acquire settings pre-set by the
technician.
Modify Study: to modify the study data.
Copy Study(ies): to copy a study or more studies selected from an archive to
another.
Copy Study(ies) to CD: to copy a study or more studies selected on CD-ROM.
Delete Study(ies): to delete a study or more studies selected.
Find: to search a study or more studies on the archive according to a
parameter set by the user (Name, Date of Birth etc).
Find next: to find a succeeding study to the one shown on screen.
Find previous: to find a previous study to the one shown on screen.
Select all: to select all the studies present on the archive.
Select all empty: to select all the studies without images present on the archive.
Reverse selection: to select all the studies with opposite characteristics to the
already selected ones.
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7.2.1 New Study.

This command allows opening a New Study to insert in the current archive.
PATIENT DATA STUDY DATA
AUTOMATIC PROCEDURE PERFORMED DATA
SCHEDULED DATA
Patient Data: data related to the patient.
Study Data: data related to the created study.
Automatic Procedure : to enable the automatic procedure selections

Scheduled Data and Performed Data.
Insert here the data related to the WORKLIST modality.
Buttons.
Open: to open the created study.
Cancel: to cancel all operations.
OK: to save the created study in the Archive List Manager without opening it.
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7.2.2 Modify Study.

This command allows modifying a study present in the current archive.
The Modify Study window is the same of the New Study window. To modify the data it's
necessary to select the fields wanted to be modified and insert the new data.
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7.2.3 Copy Study.

This command allows copying a study or more studies from the current archive to another
archive on the hard disk.
Please, do this way:
 Select the interested study(ies).
 Click on Copy Study from the Study Menu.
 When pushing the button Copy Study the following window will appear:
Select the file destination and click OK.
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7.2.4 Copy Study on CD.

This command allows copying a study or more studies from the current archive to a CD-ROM in
RAW modality.
To execute the command you must select the study or the studies and click the related button.
The following window will appear:
To go on with the operation, click Yes, continue or Cancel to cancel the operation.
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By clicking the Yes, continue button the system creates the CD-ROM structure and at the end of
the process the following window will appear:
Click the Options button to open the CD-R Write Options.

From this window it's possible to set the desired options to create the CD-ROM. See the figure:
Device: select the CD-ROM device to write the CD.

Volume ID: insert here the name of CD-ROM.
On write termination.
Beep: a buzzer is uttered at the end of the writing operation.
Eject: the CD-ROM is ejected at the end of the writing
operation.
CD-R Format.
Multisession: if selected, it creates a multisession disc that
you can reuse later.
Write.
Speed: to choose the CD-ROM speed of writing. Generally
set on MAX.
Folders.
Move to CD Root Folder: to the image directly in the root
of the CD-ROM.
Click OK to set the desired value and close the window.
Click the Start Write button to burn your CD-ROM.
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7.2.5 Find, Find Next, Find Previous.

This command is used to find an exam or more exams present in the current archive according to
specific searching criteria. See the figure:
Type the text you are searching in the Search Text field and select the type of information the
text refers to (patient name, patient ID, exam description, physician).
After entering the text, click the Find Next button. The system searches the studies that meet the
conditions set by the user.
If the listing have multiple studies that meet the desired search criteria, it's possible to further
consult them with the Find Previous and Find Next commands.
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7.3 OPTION MENU

The Option Menu allows configuring the system.
AVAILABLE COMMANDS WHEN AN ARCHIVE IS OPEN.

Study List Font: to change the font size of studies.
Setup: to set the acquisition parameters.
Exam Setup: reserved to the technician.

Procedure Setup: reserved to the technician.
Dicom: management of the DICOM systems.

Setup: reserved to the technician.
Verify: DICOM systems verify.
Stitching Setup: reserved to the technician (if the option is present).
Diagnostic: it allows creating a study called Test used to verify the

proper functioning of the system.
AVAILABLE COMMANDS WHEN AN ARCHIVE IS CLOSED.
Setup: to set the acquisition parameters.
General Setup: reserved to the technician.

Fixed Strings Setup: it allows inserting fixed strings in the list which can be
applied to the image.
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7.3.1 Study List Font.

This command allows changing the display style of the characters used for studies and for
columns that contain the details of the study (e.g. Patient Name, Date / Time Study, etc...)
Select the desired Font and click OK.
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7.3.2 Fixed Strings Setup.

In the Fixed Strings field it's possible to type some text (words or phrases) which can be added
to the image during the post-processing phase.
When the Append button is clicked, a void field appears in the central screen. There you can
type your text.
Click Append to insert the

desired text.
Digit the text in the Void field.
Click Ok to confirm and exit or

click Insert to add other text.
Select the text and click the Edit

button to increase or decrease the
font size.
Choose the font size from the
menu.
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7.3.3 Verify.
This command allows verifying the correct communication with the selected Dicom remote
device.
After selecting the device, click OK.

If the verification is successful, this video will appear on the screen:
Click OK to exit.
If the verification is negative, this video will appear on the screen:
In this case you should contact your network administrator.
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7.4 HELP MENU.

The Help Menu allows getting information about the system, about the key software and helps
consulting the user manual.
Information about DigiRad…: information on the software version and key options.
User's Manual: to open the User's Manual.
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8 OPERATING SCREEN.
The Operating Screen appears when you open an exam.
It is divided into two sections: the Image Area and the Commands Area.
FRAMES AREA COMMANDS AREA
Patient data RX dose
Frame LUT level Study data
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 The Frame Area is made by the images acquired and all the exam data.
 The Commands Area contains all the functions needed to modify the frames. Inside this
area there are various sections:
EXAM SETTINGS – PROCESSING – SEARCH – DICOM.
EXAM SETTINGS
The commands inside this area let you set the acquisition
settings and choose the kind of exam.
PROCESSING
The commands inside this area let you modify the LUT
level, to set the overlay functions, to apply the rotation
commands and to choose the Detector.
SEARCH
The commands inside this area let you consulting the
stored frames.
DICOM
The commands inside this area let you transfer to the
server the acquired frames.
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9 EXAM SETTINGS.
Patient list.
Generator Settings.
Wifi Detector Params

(See the chapter Appendix 1)
Acquire
Scheduled Tech
Open exam folder selection list.
Indication of the body part.
Indication of the projection type.
Patient dimensions
ION chambers
Exposition index for the selected image.
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9.1 OPEN THE EXAM FOLDER LIST.

The first step when opening a new study is to select the Exam Folder based on the type of
anatomical part you want to analyze.
Click the icon and select the anatomical part from the menu.
See the figure:
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9.2 GENERATOR SETTINGS.

Click the icon to open the Exposition Parameters window. In this menu
All the RX Exposition data are summarized.
This function is active after you select the anatomical part.
DETECTOR MANUAL SWITCH

Click with the right button to choose between detector 1 and 2. See Figure.
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9.3 ACQUISITION OF AN IMAGE.

Follow these steps to acquire an image.
 Open an existent study or a new one,
 From operating screen select the exam type,
 Press the trigger button to acquire,
See figure.
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The Waiting X-Ray Emission window will appear, as shown.
The system is ready,
 Perform X-Ray.
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The Expose in Progress window will appear, as shown.
 Waiting…
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Once the Exposition is done, the image is acquired in a few seconds.

The image is automatically saved on the hard disk.
 The obtained image is already elaborated according to the acquisition parameters set for
the type of exam being done. Typically, it has a sufficient quality to be printed or to be
displayed on a high resolution monitor and sent to a diagnostic workstation.
 If needed, the image can be further on elaborated through post-process procedures as

described in the PROCESSING chapter (following).
 If, for any reason, the acquisition process has to be retaken, a new RX Exposition
ordering is needed:
 without selecting a new exam, if the study didn't have a specific procedure;
 In the case of a study with procedure, manually performing the specific procedure;
 All the images of the study are numbered with a progressive number: e.g. 2/3 stands for
the second image of a study made of 3 total images.
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10 PROCESSING.
Advanced Processing menu.
90° anti-clockwise rotation.
Horizontal reverse.
Vertical reverse.
Electronic shutters.
Overview.
LUT Manager.
Detector Zoom.
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10.1 ADVANCED PROCESSING MENU.
Harmonization.
Spatial Filters.
Zoom.
Overlay.
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10.1.1 Harmonization.
The system provides all procedures for the ATH harmonization (Tissue Anatomic
Harmonization), which can be selected from the set examination folder.
When you click the related icon, the following window appears:
Apply: it applies the function of harmonization on

the monitor.
OK: it exits the function, with confirmation of the chosen

parameters.
Cancel: it exits the function turning off the selected set.
LRH Level: filter weight.
Level 0: corresponding to the "no filtering activated".
Level 1: corresponding to the "level of processing activated".
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10.1.2 Spatial Filters.
The system offers the possibility to apply different types of spatial filters to improve
the contrast resolution of the acquired images.
Filter: NONE To select the type of filter

SHARP (NONE voice matches "no
SMOOTH filter applied").
Kernel: 3x3 To select the size of the

5x5 interested Area on which the
7x7 filter processes its action.
9x9
11 x 11
To select the level of
weight: 0 processing.
1
2
3
4
5
Apply: it applies the function of harmonization on the monitor.
OK: it exits the function, with confirmation of the chosen parameters.
Cancel: it exits the function turning off the selected set.
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10.1.3 Zoom.
The Zoom function allows the temporary digital enlargement of a portion of the
image.
Zoom: using the mouse pointer select the interested

portion of the image. Once the mouse key is released, the
image will be shown enlarged.
Lens: using the mouse pointer select the center of the

interested part of the image. Once the mouse key is
released, a portion of the image will be enlarged 100x100
pixels.
Zoom Factor: variable between 1 and 3

1 = no zoom (ratio 1:1)
3 = max zoom
The exit button cancels all operations.
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10.1.4 Overlay.
The system offers the possibility to override texts and to make measurements on the
image.
Text Black area
Angle
Image Statistic
measurement
Calibration Frame
Grid Arrow
Ruler
Gap Cobb's Angle

(See Orthopedic Measures) (See Orthopedic Measures)
Double Cobb's Angle Perpendicular lines

(See Orthopedic Measures) (See Orthopedic Measures)
Lower Limbs Measurement

(See Orthopedic Measures)
Object Delete selected Cancel

selection object calibration
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TEXT
This function allows overriding texts on image.
There are two input methods:

 Selecting the text from the Add Fixed String list;
 Manual insertion;
Selecting from Add Fixed String list:

 Right click the mouse on the desired position of the image.
 Choose an existing string in the list, then select the text left clicking with the mouse.
See the figure:
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MANUAL INSERTION.
There are two input methods:
 Selecting “Insert string” from the menu.

 Manual insertion clicking the “abc” icon.
“Insert string” from the menu.

 Right click the mouse on the desired position of the image to set the starting position of
text.
 Select the field “Insert string”, then digit the desired text and press ENTER.
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MANUAL INSERTION CLICKING THE “ABC” ICON FROM THE OVERLAY

MANAGER.
 Click the “abc” icon from the overlay menu.
 Left click the mouse on the desired position of the image to set the starting position of
text.
 Digit the desired text then press ENTER.
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TEXT MANAGEMENT.
Left clicking the mouse on the inserted string it's possible to drag it anywhere on the screen.
 Double-clicking the mouse you can highlight the text or correct it.
 Right clicking the mouse on the inserted string it's possible to modify the text:
Delete: to delete the selected text.
Increase font size: increase the text font size.
Decrease font size: decrease the text font size.
See the figure:
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ANGLE MEASUREMENT.
The Angle command allows the user to draw two half-lines with a common point of
origin and then to measure the obtained angle at the apex. At any time it is possible to
modify the angle by changing the half-lines.
Instructions for drawing:

 Holding the left button of the mouse, draw two segments tracing the angle.
 It is possible to pick up the extreme points of the segments or the apex to correct their
position on the anatomical part desired. The measurement of the angle is automatically
updated.
 It is possible to pick up the field with the angle value and drag it where desired.
 To delete the graphics select the value of the angle with the right button of the mouse
and click Delete.
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CALIBRATION.
The system uses a default “pixel/mm” report to show the measurements made on
images (in mm): the calibration function lets you check that this ratio is right and
allows correcting it if necessary.
Instruction for the calibration of the frame:

 Using the mouse, trace a segment (gauge) above a detail in the image whose
measurement is already known: the measurement automatically appears in mm next to
the segment.
 In the Command area the Calibration Mode Window appears:
 Set the length of the segment (mm) then click OK: all the measures (caliber includes)
on the frame are automatically visualized in millimeters.
Delete Calibration.
OK: close the window and confirm the changes.
Cancel: close the window and discards the changes.
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GRID.
This function lets you add a grid to the image.
 Click on the icon: a grid appears on the image, together with a sample segment
representing the unit of measurement.
 To change the size of the grid, you must change the size of the sample segment by
dragging its ends with the mouse.
 The grid can be dragged by the mouse at its corners.
 To delete the grid right click the mouse on an intersection between two lines and click
Delete from the menu.
See the picture below:
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RULER.
This function lets you measure the image.
 Click on the icon.

 Use the mouse to trace a segment (ruler) above the area you want to measure: the
measurement is automatically displayed in mm. This measure is based on the detector
pixels. If the RUN is calibrated the measure is based on the calibration.
 You can adjust the measurement of the ruler by picking up the ends of the segment and
shifting them with the mouse.
 You can also pick up the field with the value of the ruler and move it at will.
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BLACK AREA.
This function lets you cover parts of the image you wish to hide.
 Click on the icon to enable the rectangle pointer.

 Use the mouse to drag the pointer to that part of the image you want to hide.
 Click to enable the rectangle sizing function and then drag the mouse until you get the
rectangle size you want.
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 Click inside the rectangle to hook it, drag it or make some changes.
Delete: to delete the area.
Reverse: the black area becomes white.
Transparent: to show only the area borders.
Hidden border: to hide the white border of the area.
Round corners: to round up the area corners.
 Click on a corner of the rectangle to drag the corner and so alter the size of the
rectangle.
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IMAGE STATISTIC.
This function comes in handy for technical service during system installation and
maintenance.
It lets you activate the “Image Statistics” menu which detects the position and value of the pixel
in an area selected using the mouse.
The menu fields are:
Selection: to choose the field in which you want to read the

values.
Measurements can be taken on:
 9x9 pixels square central point;
 horizontal segment;
 vertical segment;
 rectangle defined by the operator;
Position on real image:

to identify the position (on the surface of the detector or the
monitor) of the point, segment or rectangle you've selected:
 the 9x9 square is identified by its central point;
 the segment is identified by its ends;
 the rectangle is identified by its opposing vertices;
Statistics: to get statistical measurements for the

unprocessed image (Raw) or the equalized one:
 value in center;
 min value;
 max value;
 mean value;
 standard deviation;
 to select the graphs to be displayed;
 profile;
 moving mean;
 moving standard deviation;
 to select the moving mean and moving standard
deviation reading window;
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The PROFILES, HISTOGRAMS, STATISTICS functions are measuring devices of the image
pixels.
It's possible to take such measurements on Horizontal Segment, Vertical Segment and Rectangle
selections (of this last one is only enabled the HISTOGRAMS function).
In the case of a Horizontal Segment or Vertical Segment selection, do the following:
 Using the mouse, trace a vertical or horizontal segment on the image:
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 Clicking the PROFILES button, the following window appears:
The graphic shows the gray level of the pixels belonging to the traced segment.
The graphics refer to a RAW image, EQL (equalized), HARM (Harmonized) and FILTERED.
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 Clicking the HISTOGRAMS button, the following window appears:
The graphic shows, in a schematic way, how the dark and bright pixels are distributed on the
traced segment.
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 Clicking the STATISTICS button, the following window appears:
The graphic shows the values reported in the Statistics panel, calculated on the RAW image,
MEAN WND 10 image (mean value set around 10 pixels) and STD DEV WND 10 image
(standard deviation set around 10 pixels).
Selecting the Use equalized option, the values of pixels are calculated on the equalized image.
The tolerance (pixels around the traced segment) of the mean value calculation and the tolerance
of the standard deviation may swing between 5 and 60.
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In the case of a Rectangle selection, do the following:
 Using the mouse, trace a rectangle on the section of the image that has to be analysed:
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 Clicking the HISTOGRAMS button, the following window appears:
The graphic shows, in a schematic way, how the dark and bright pixels are distributed on the
traced segment.
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 Clicking the Save to file button, the following window appears:
 In the Save in field, choose the destination folder.

 In the File Name field, type the name of the file, then click Save.
The destination folder will store all images and graphics saved with the RAW file extension and
a word document summing up all data referring to the taken measurements.
The file saving process of Image Statistics is restricted to the installing technician.
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FRAME
This function lets you trace a frame on the image around the area of interest.
 Click on the icon to select the function.

 Drag the pointer into the image at the required point.
 Use the mouse the trace a rectangular frame.
 You can pick up the corners of the frame and drag them to better cover the area of
interest.
 Left click the mouse on the image to confirm the operation.

 Right click the mouse on a corner of the frame, select Delete to delete the frame.
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ARROW
This function lets you draw an arrow on the image.
 Click on the icon to enable the function.

 Drag the pointer into the image at the required point.
 Use the mouse the trace the arrow.
 You can pick up the endings of the arrow and drag them to better cover the area of
interest.
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10.2 ROTATE 90 DEGREES
This function allows rotating the image 90° to the left.
A symbol indicating the current position of the image is displayed in the bottom left corner
of the monitor. See the pictures:
No rotation 90° Rotation
No symbol 90° Rotation symbol
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10.3 VERTICAL INVERSION
This function allows inverting the image vertically.
of the monitor.
See the pictures:
No inversion Vertical Inversion
No symbol Vertical inversion symbol
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10.4 HORIZONTAL INVERSION
This function allows inverting the image horizontally.
of the monitor.
See the pictures:
No inversion Horizontal inversion
No symbol Horizontal inversion symbol
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10.5 ELECTRONIC SHUTTERS
If required, the system displays the position of the shutters in order to reduce the X-
ray exposition of the patient.
Two different types of shutters are available: a rectangular one and a circular one.
Clicking the related icon, the following window will appear:
Images Search Back.
Images Search Forward.
Square Shutter.
Round Shutter.
Max Zoom Shuttered Area.
Delete Zoom and Shutters.
Exit: close the window and save the changes.
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SQUARE SHUTTER:
 Click on the square shutter icon to enable this function.
 Go to the image field and hold the left-hand button on the mouse down to take the
pointer to the top left-hand corner of the section of the image that you want to shutter.
 Hold down the LH button on the mouse and drag the mouse so that the portion of the
image you want is enclosed in a frame.
 Release the left-hand mouse button to shutter the image (now centered on the screen).
CIRCULAR SHUTTER:
 Click on the circular icon to enable this function.
 Go to the image field and hold the left-hand button on the mouse down to take the
pointer to the center section of the image that you want to shutter.
 Hold down the LH button on the mouse and drag the mouse so that the portion of the
image you want is enclosed in a frame.
 Release the left-hand mouse button to shutter the image (now centered on the screen).
With the Max Zoom button the shuttered image is enlarged to the maximum allowed by
the system. The function is marked with a special marker in the image of the operating
framework.
The elimination of the collimation is achieved by clicking with the mouse on the image.
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10.6 OVERVIEW
The Overview command allows displaying the stored images in a mosaic style.
This function also provides some image research commands that allow the visualization of the
previous or following group of images.
See the picture:
The number of images of the mosaic can be set in the following formats: 2x2
3x3
4x4
5+1
7+1
This button allows deleting images from the mosaic and from the study, too.
Select an image or images (hold down the CTRL key) and click the button to delete
it or delete them.
It's possible to send to the server images selected in the Overview.

The transfer of these images is similar to the transfer of a single image.
Click the right-hand mouse button to open the Dicom Menu and select Store Selected.
Exit: exit the function. The monitor will present the last selected image.
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10.7 LUT MANAGER
This function lets you change the look of the saved images (brightness and contrast)
varying the L (Level) and W (Window) parameters.
This can be done in one of two ways:
Using the central key on the mouse: use the central key on the
mouse to click on the image and then drag it horizontally to correct increase L
the W, vertically to correct the L (see drawing on right).

You can also rotate the central key on the mouse to correct the L decrease W increase W
parameter while keeping the W parameter unchanged.
Double click on the central key of the mouse to return to the
acquisition mode.
decrese L
Using the cursors in the “LOOKUP MANAGER” menu: in the “Processing” strip:
The level and window controls affect each other.
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LOOKUP MANAGER
Selection of the Gamma correction curve.
Level correction.
Window correction.
Variation of scale for L and W adjustement:

 0: max scale
 C: acquisition scale
 +: to increase scale
 - : to decrease scale
Enable automatic correction.
Enable full detector dynamics.

(L=0 e W=65535)
Reverse polarity.
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REPLACING / CHANGING THE CORRECTION CURVE.

From the “LOOKUP MANAGER” menu, select the curve selection icon.
The default curve for the acquired image is shown.
The system generally offers 3 types of curves:
Linear Cubic Natural Spline: Cubic Deriv0 Spline:

Linear curve. The system To create a correction curve To create a correction curve
keeps the original acquisition where the construction points where the construction points
contrast ratio. are joined by are joined by
No other type of curve is “Cubic Natural Spline”. “Cubic Deriv0 Spline”.
possible if you select this
option.
If you want to apply a different correction curve, right click

(with the cursor on the curve) to open the curve list and
then select the one you want.
You can also change a curve by dragging the intermediate

points in the curve. These points can also be moved (after
selection) by entering the relevant X and Y values and then
clicking on Set.
Changed curves cannot be saved.
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10.8 DETECTOR ZOOM
This function changes the visualization of the images acquired by the Detector.
The Detector always acquires full size images (3001x3001pixels).

During the installation it's possible to set the visualization, on full monitor, of a portion of image
of 1000x1000 pixels.
It's also possible to set this kind of visualization from the Zoom Detector menu.
See the picture:
Size: 1000 x 1000
Size: 3001 x 3001
Scale factor: from 1.0 to 3.3
This function is available also on shuttered images.

The indication of Scale Factor appears at the center bottom of the monitor.
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11 SEARCH.
This area shows a preview of the images saved during the examination process.
Images preview
Search Back
Search Forward
The Search Back and Search Forward commands allow scrolling the images in the Preview Area.
To show the selected image in full size mode you must left click the mouse on it.
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12 DICOM.
Send Single Image.
Send Entire Exam.
DICOM Burning.
Film Editor.
Print DICOM.
The Dicom option, except the Burning process, is also available in the Image Area, by right
clicking the mouse on the image.
See the picture:
The Print command is the same that sends Single Images, the only difference is the Remote
DICOM Device, which is not a Server but a Printer.
The Show Spooler command allows opening the DICOM Spooler window.
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12.1 SEND SINGLE IMAGE

Clicking this icon, the system sends a single image to the Server.
The Remote DICOM Device of destination is set by the technician.
12.2 SEND ENTIRE EXAM

Clicking this icon, the system sends the entire exam to the Server.
The Remote DICOM Device of destination is set by the technician.
12.3 DICOM BURNING.

For more details see the paragraph: DICOM Burning Option.
12.4 FILM EDITOR.

For more details see the paragraph: Film Editor Option.
12.5 PRINT DICOM.

The Print command is the same used for the Send Single Image function. The only difference is
that the Remote DICOM Device is not a Server but a Printer.
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12.6 DICOM SPOOLER.

The DICOM Spooler contains the images that the system has sent to the Server or to another
Remote DICOM Device.
If the list is empty it means that the Network setups are right and all images have been sent on
the net.
In case of problems with the network, the images reside in the Spooler waiting to be sent back or
to be deleted.
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To send back or delete the images you must click the related button:
After clicking the Disable Queue or the Disable Spooler buttons, other two functions will be
activated:
Reschedule: it allows sending back images that were not sent automatically.
In order to do so, select the desired items and click Reschedule.
As soon as possible: to send the images right after

the function was left and the Disable Queue
rebooted.
On: to send the images the set day and hour.
Retry count: to set the number of attempts at

sending the rescheduled images.
It might happen that the images cannot be sent to the server even if rescheduled. In that
case problems with the network might be probable.
Contacting the technician may result necessary.
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Delete: to remove from the Spooler the images not able to reach the server.
Select the desired items and click Delete.
Click YES to confirm or NO to exit the function.
After performing the Reschedule or Delete options it's necessary to click the Enable Queue and
Enable Spooler buttons. This way all images will be sent automatically to the Server.
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13 OPTIONS.
Here listed all the available options:
Optional
 DUAL DETECTOR
It allows using two detectors to acquire images.
 ORTHOPEDIC MEASURES
Graphic measurement functions.
 STITCHING
Automatic reconstruction of a composite image from a series of individual images.
 DICOM BURNING
It allows burning on CD/DVD-ROM the exams stored on the archive.
 FILM EDITOR
Composition of the Print Film.
 WORKLIST
Management of the daily list of patients.
 QUERY/RETRIEVE
Query and visualization studies on the Server.
 MPPS
Mechanism to pass information about images which are transferred to the server.
 STORAGE COMMITMENT
It allows a final storage of the images on a different device.
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13.1 DUAL DETECTOR.

The system allows the acquisition of images by two detectors.
The detectors are identified with a number:

 FP 1
 FP 2
The choice between one detector and the other is performed by the operator from the table
control.
The number corresponding to the used detector is shown on the right top of the acquired image:
FP1 indicates the detector 1 (FP = Flat Panel)
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13.2 ORTHOPEDIC MEASURES

This option provides some graphic measurement functions, enabled on all images but
particularly remarkable when applied to the vertebral column or to the inferior arts images,
obtained with the stitching function.
All functions are listed in the following figure:
Gap
Cobb's Angle
Double Cobb's Angle
Perpendicular lines
Lower Limbs Measurement
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GAP
This function allows measuring the gap between two points of the image.
 Select the function.

 Move the mouse pointer to the required position of the image, then left click in order to
define the first point of reference (A).
 Following the same procedure, define the second point of reference (B): the gap
between the points is visualized in millimetres.
 By left clicking on any point of the image, the function is closed.
 Afterwards, using the left button of the mouse, it's always possible to catch the single
points of reference in order to change their position.
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COBB'S ANGLE.
 This function allows measuring the curving of the vertebras by

using the Cobb Method.
 In order to use this method, the operator has to firstly identify the
“final vertebras” of the curve.
 The final vertebras are those placed on the inferior and superior
limit of the curve sloping the most towards the concave side of the
curve.
 Identified these vertebras, trace a segment (at least as long as the
diameter of the vertebra) all along the superior side of the higher
vertebra and all along the inferior side of the lower vertebra, as
shown in the image.

 Using the mouse, by holding the left button, draw the first segment.
 Following the same procedure, draw the second segment: the curving angle of the
vertebras is visualized.
 By left clicking on any point of the image, the function is closed.
 Afterwards, using the left button of the mouse, it's always possible to catch the single
segments in order to change their position and length.
 By using the mouse it's even possible to change position to the angle displayer.
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DOUBLE COBB'S ANGLE.
In the case of scoliosis with a double curved spine, this function

allows measuring the two angles of curvature of the vertebrae.
The measuring is taken defining 3 segments, as shown in the
figure aside:
 2 segments placed on the vertebrae of the upper and

lower limits of the curvature.
 1 central segment placed in correspondence with the
vertebra from which the bending of the curvature
changes.

 Holding the left button of the mouse, draw the first segment.
 The same way, draw the central and then the third segment.
 The 2 angles of curvature are visualized.
 By left clicking any point in the image, the function is closed.
 Using the left button of the mouse, it's always possible to select the single segments
changing their position and length.
 The same way, it's possible to change position also to the display of the angle
measurements.
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PERPENDICULAR LINES.
This function allows measuring the distance between a point and a traced vertical line.

 Holding the left button of the mouse, draw the horizontal segment.
 The system automatically generates the perpendicular line to the given segment.
 Always using the mouse, it's possible to draw distance segments between the vertical
line and any point in the image.
 Once traced, these segments can be modified either in length or position all along the
vertical line.
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LOWER LIMBS MEASUREMENT.
This function allows measuring the length and the angles of relevant bony landmarks of the
lower limbs.
Relevant landmarks:
A: Femoral head center
B: Femoral neck center
C: Knee center
D: Ankle center
Tan1: Femoral tangent
Tan2: Tibial tangent
Length measurements:
A – B: Femoral neck axis
B – C: Anatomical femoral axis
C – D: Anatomical tibial axis
A – C: Mechanical femoral axis
A – D: Mechanical femoral/tibial axis
Angle measurements:
Alfa 1 Angle between: A-B and B-C
Alfa 2 Angle between: B-C and Tan1
Alfa 3 Angle between: A-C and Tan1
Alfa 4 Angle between: B-C and C-D
Alfa 5 Angle between: A-C and C-D
Alfa 6 Angle between: A-C and Tan2

 By clicking the left button of the mouse, choose the relevant landmarks of the image:
A, B, C and D.
 Holding the left button of the mouse, draw the segment Tan1, starting from point C and
tangent to the lower part of the femur.
 Holding the left button of the mouse, draw the segment Tan2, tangent to the upper part
of the tibia.
 At this point, the system visualizes the 5 lengths and the 6 angles calculated.
 Always using the left button of the mouse, it's possible to select all the measurements
displayed, changing their positions in the image as liked.
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 Right clicking the mouse on any measure it's possible to select

the Show Report option which shows a summarizing table of all
lengths and angles calculated.
Left clicking the mouse on all 4 angles of the summarizing table, it's possible to move the table
any place in the image or drag it on the Film Editor panel (See the paragraph about the editing of
print films).
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13.3 STITCHING
There are different methods to scan the images that make up the Stitching. In the most used one,
the detector moves along the patient, and the X-ray tube rotates, keeping the focus position
unchanged. See pictures below:
LOWER-LIMBS STITCHING
The picture shows the acquisition procedure of three images making up the Stitching.
The first image making up the Stitching is acquired with the Detector in position 1 (STEP 1), the
second Stitching image is acquired with the Detector in position 2 (STEP 2), and the third
Stitching image is acquired with the Detector in position 3 (STEP 3).
Overlap Region 1 and Overlap Region 2 are the two overlap regions in which calculations will
be made in order to reconstruct the whole image. The size of these two regions usually vary from
3 to 5 cm.
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RACHIS STITCHING
The picture shows the acquisition procedure of two images making up the Stitching.
The first image making up the Stitching is acquired with the Detector in position 1 (STEP 1), and
the second one is acquired with the Detector in position 2 (STEP 2).
In the Overlap Region calculations will be made in order to reconstruct the whole image.
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13.3.1 Construction of a Stitching image

A Stitching image is constructed automatically; the configuration settings are made by the
installation technician; the operator need only acquire the individual images.
Proceed as follows:
 Open the DigiRad application, wait for it to plug into the detector and open a New
Patient.
 Select anatomic technique 41 STITCHING → 47 SPINE AP 90cm.
 Acquire the first element of the Stitching.
 Follow the instructions in the status bar to acquire the other two elements, too. See
pictures below:
First element Second element
Third element
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 Once the three individual acquisitions have been completed, the system will reconstruct
the Stitching image. See picture below
In most cases the system reconstructs the image correctly: small triangles are then displayed on
the sides of the image at the junctions.
If instead of triangles there are small rectangles, the reconstruction has not been perfectly
successful and some modifications may be made to improve precision.
Proceed as follows:
 Position the mouse on the image at the centre of the monitor and right click. The
following window displays:
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 Select Manual Stitching Correction. The following screen will appear:
JUNCTION CHOICE LUT LEVELS
OVERLAP REGIONS
This window shows the tools for manual modification of junction points for overlapping areas.
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JUNCTION CHOICE
In this section it is possible to select the junction to work on: Overlap Region 1, i.e. between first
and second component image, or Overlap Region 2, i.e. between second and third component
image.
LUT LEVELS
Once the junction to work on has been chosen, it is possible to edit the LUT levels of the
component images so as to help the operator consult them.
Automatic values: it automatically sets the

LUT values of the component images (in our
case 1 and 2), which are displayed in the
Junction Choice section (in our case 1).
Automatic overlap: It automatically sets the

LUT values of the two overlap regions, which
are displayed in the Overlap regions section.
Enable correspondence: homogenizes the

contrast in the junction regions.
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OVERLAP REGIONS
This section displays the junction between the two component images in the Junction-choice
section. It also allows to position the two overlap regions correctly in order to blend the two
images correctly.
Fit Magnification: it fits the size of the junction to the window.
Magnification: it manually edits the Zoom value from a minimum of 1:11

to a maximum of 11:1.
Display chessboard: it enables/disables the display of the chessboard.
Chessboard size: it edits the length of the sides of the chessboard squares.
Values range from a minimum of 5 to a maximum of
100 pixels.
: it allows horizontal and vertical displacement with the mouse.
Enable Blending: it enables or disables the blending of the two overlap regions.
Values range from 10 to 90.
The value 10 mainly highlights the overlap
region belonging to image 1, the value 90
mainly highlights image 2's overlap region.
Vertical: it vertically displaces the overlap region of image 2
Horizontal: it horizontally displaces the overlap region of image 2
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Markers: it allows to put two points in the junction and overlap them in order to
reconstruct the Stitching image correctly.
Click with the right mouse button on the picture upper and select Insert marker to enter the first
point of junction. See the figure below:
Insert marker: create the joint point.

Remove marker: remove the marker joint point.
Center marker: places the point at the center of the square.
Move marker here: moves the point in a position chosen by the operator.
Move markers togheter: moves the two points at the same time
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The system automatically generates the second junction point on the lower picture. See the figure
below:
The square delineating the point defines the area in which it is possible to overlap the two
images.
It is possible to modify the position of both points and surrounding squares.
To move the points left-click the mouse and hold.
Moving the point of the upper image shifts the square delineating the lower image.
Moving the point of the lower image shifts the square delineating the upper image.
Zoom to fit: fits the junction size to the window.
Link frames positions: when selected users can simultaneously view

the two images by scrolling horizontally.
Show map: shows thumbnails of the images in the top left

of the frame.
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13.4 DICOM BURNING

 The system allows burning a CD/DVD-ROM on which selected studies can be stored in
DICOM format.
 During the burning process, a program called DG VIEWER is also included so that it is
possible to view the images of the exam from another PC which is not part of the system.
From the commands area, click on the related icon to open the procedure
which converts the images stored on HD to DICOM format (CD Images):
The following window will appear
Click OK to Proceed or Cancel to abort the operation.
Click the OK button to start burning.
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At the end of the conversion the system opens the CD-Image Manager window containing the
list of converted exam to DICOM format. The exams are now available for the burning process.
Edit README: to show and modify the study data.

Write CD: to open the CD-Writer window to start the burning on
CD/DVD-ROM.
Delete: to remove the selected item from the list.
Exit: to close the window.
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13.4.1 Edit Readme.

The Readme file contains all information about the exams to burn.
By clicking the related button it is possible to open or modify this file.
The file will be burned on CD/DVD-ROM with the images.
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13.4.2 Write CD.

The Write CD command opens the CD-Writer window containing the study to be burned.
In the center section you'll find the study or studies to be burned on the CD/DVD-ROM; in the
example above, the study is called John doe.
These three commands in the top right-hand corner of the burning window are respectively for
Deleting, Moving Up and Moving Down any file selected in the directory of the CD/DVD-
ROM.
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Before creating a CD/DVD-ROM it is possible to modify the burning settings using the Option
key.
Device: burning device.
Volume ID: it is possible to label the CD/DVD-ROM here.
On Write Termination: Beep: at the end of the burning process the RTP makes an audio
signal.
Eject: at the end of burning process the disk created is
automatically ejected.
CD Format: Multisession: if selected, the CD/DVD-ROM is created in

Multisession mode which allows the operator to add other studies
to the CD later on. This option is not available for DVD.
Write: Speed: set the CD/DVD burning speed.
Additional Contents: checking this field it is possible to burn the Dg Viewer program
on the CD/DVD necessary to visualize the studies.
Folders: Move to CD Root Folder: to write directly the images in the

root of CD-ROM
Click OK to confirm the settings and return to the burning window.
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After setting all parameters it is possible to start burning the CD/DVD-ROM by

clicking on the WRITE key.
The study/ies burning process can be interrupted any time by clicking on TERMINATE.
Note: the Multisession mode is not available for burning DVD-ROMs. If the
Multisession option is not on, the CD/DVD-ROM is usable only once.
After the burning process, eject the CD/DVD-ROM and click on EXIT.
The system returns to the window containing the complete list of studies from which other
operations can be carried out.
The disk created can be read from any PC.
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13.4.3 Write to disk

The system allows users to create a directory where exams are stored in DICOM format.
The operation is similar to writing a CD/DVD-ROM but the image is stored on a removable
device, such as a USB device, or a hard drive D:.
 In the CD-Image Manager window, click Write Disk.
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 The following window displays:
Destination Folder: select the path to the folder in which to save the exams converted
in DICOM format.
Additional Contents: enable the option of adding other components to the folder
containing the DICOM images.
Additional folder: select a component to add to the folder containing the
DICOM images. The file DgViewer.exe is generally added as it
enables viewing of the DICOM images on any PC even if not
configured for the system.
 Click Browse to select the destination folder for the exam or exams converted in DICOM
format. In this case it is the drive USB_KEY:.
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 Click OK to start the process of writing the images.

 The final result is as follows:
Exam folder and file dicom.dir
Add-ons
Selected store device
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13.5 FILM EDITOR.

The Film Editor option can be used to edit print films.
The option can only be used in a study.
When the Film Editor button is clicked, the following dialogue window appears in the
commands area:
Film Screen
→
Print →
Image Preview 1:1 ↑ ↑
Settings Exit
Film Screen: composition of the film.
Print: to print the film.
Image Preview 1:1: it displays a true size dimension box on the image.
The image will be printed in the real format related to the
projection of the detector.
Settings: Film Editor settings.
Exit: to close the window.
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13.5.1 Film Screen.

To create the film to print you must click on the image to be printed with the left
button of the mouse and keep the button clicked. Then drag it to the film Screen.
When finished, click on Print to send the completed film to the printer.
See the figure:
Film Screen
→
Print →
Print all
Delete images from Film Screen Exit
Settings
13.5.2 Print.
Use this command to send the manually edited film (the film created by dragging
frames to the film screen) to the printer.
The final result is a single plate.
13.5.3 Print all.
This command sends the complete memorized series to the printer. The editing of
the film screen is done automatically by the system.
The final result is a series of plates containing all the frames belonging to the series.
E.g. a series of 14 frames sent with the Film Screen option in 2 x 2 modes (2 lines and 2
columns) will produce 4 plates of which 3 will be full with 4 frames each and one plate will
contain 2 frames.
13.5.4 Delete images from Film Screen.
This command deletes all frames.
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13.5.5 Film Editor settings.

This function allows modifying printer and film format settings.
Printer Settings
Advanced Parameters
Film Format Settings
Default Values
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Advanced Parameters:
Film Destination.
Film Format Settings.
Exit from Settings Menu.
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13.6 WORKLIST.
The Worklist function allows the system to receive from the Hospital Net the Daily Patient List.
In this case the operator must not enter manually the patient data, but he has to simply load the
received list in the archive.
There are two ways to open the Worklist window:
From the Study Menu From the Worklist button in the Patient List
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Worklist window:
 From and To: search by interval date.

 Patient Name: search by patient name.
 Accession Number: search by accession number of the study.
 Patient ID: search by Patient ID of the study.
 Requested procedure ID: search by Request Procedure ID of the study.
 Open the list by the command Get List.

 Select the DICOM Device from wich to import the list.
 Select the patient and open the related study by the command Create Study.
If necessary, you can modify the list using the following commands:
 Toggle Check: to uncheck a study.

 Remove: to remove an exam from a list.
 Erase List: to delete the entire list.
 Edit List: to modify the list.
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13.7 QUERY/RETRIEVE SCU.

A query of the Server regarding stored studies can be performed with the system. The user can
upload and consult them in a temporary directory.
An operative dialogue of the Query/Retrieve service is opened when you click on the command.
The window is divided in two parts:
 Query List: here you find the studies stored on the server having the query parameters
specified by the operator.
 Retrieve List: here you find the studies uploaded from the server ready to be consulted.
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 AE Title of Server: selection of remote server for Q/R operation.

 Patient Name /Patient ID: parameters used to carry out the query of the selected
server. Once the selected server receives the request, it will check its database looking for
the presence of studies that satisfy it.
The query can be accomplished in one of two ways:

- Single Definition: exact correspondence to the entire definition entered.
- Multiple Definition: it is possible to enter the special characters “*” and “?” in
the query field. When “*” is used, any definition in the position is considered as
valid. When “?” is used, any character in the same position is considered as valid.
If you only use the “*”character as a query definition, all the studies on the Server
will result from the query.
 Ask: it carries out the query towards the selected server. It is functional only if at least
one of the query fields contains a definition.
 Study Info: information regarding the studies selected from the list.
 Retrieve Study: it retrieves the study selected from the Query list. If the study has
already been downloaded a confirm message appears to continue the operation.
 Delete Studies: it deletes the selected studies in the retrieve list.
 Visualize Study: it opens the application to visualize the frames from the study selected
in the Retrieve list.
 Operation Status: information about the operations carried out.
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13.8 MPPS.
Modality Performed Procedure Step, more commonly known as MPPS, is a device which
enables the transfer of information about the images sent to the Server.
An MPPS object contains all the data concerning the study, the procedures carried out and the
series/images created during the execution of a procedure.
MPPS management can be activated or deactivated for every study. Activation depends on the
configuration of the machine (see MPPS Setup restricted to the installing technician) and on the
presence of the software option in the key.
MPPS State.
Every MPPS has a DICOM state which is interpreted by the server when reading messages sent
to the system.
This DICOM state can be:
“IN PROGRESS”, ”COMPLETED” or “DISCONTINUED”:
 N CREATE message, setting of the "IN PROGRESS" status. This is sent at the
beginning of the procedure.
 N-SET message, the "COMPLETED" or “DISCONTINUED” status. This is sent at the

end of the procedure.
The complete MPPS message also includes a list of all the instances of the image created during
the passing of the procedure, allowing the Server to notify the complete receipt of the data
package.
Active MPPS.
An active MPPS can be modified as long as an N-Set message with a “COMPLETED” or
“DISCONTINUED” state has not been sent to the server yet; such a message definitively closes
the MPPS.
At any given time a study has only one active MPPS, on which all modifications are made. If
there is no active MPPS and a modification must be made, a new MPPS is created and remains
active.
Image Acquisition.
If an active MPPS does not exist, one is created. The series and the images just acquired are
connected to it.
If an active MPPS already exists, the series and the images are connected to the list of
series/images.
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Store Dicom of an image.

The “Store Dicom” function stands for the successful execution of a Dicom service that has as
final result the transfer of an image to the Server.
By default, it's considered as a transfer the execution of the service “Store Dicom” (which is
successful when the image passes to the spooler), but it is also possible to set the system (see
MPPS Setup) so that “Print Dicom” (direct or through the Film Editor, and completed when the
images pass to the spooler) and “Dicom Media Write”(in this case, transfer is complete when a
CD image is created on the hard disk) are also considered as a transfer.
Once the transfer is ended, the image is marked as “Dicom transferred”.
The presence of the “Dicom transferred” notification is visible to the operator.
Modification of an Image.
The modification of an image is a variation of the parameters of elaboration and/or of
visualization of an image made to alter its look, either on monitor or when printed.
Since two different images cannot have the same UID, the modifications have no influence if the
image is still stored within the system database.
If the image has already been labeled as “Dicom transferred”, the modifications cause the
creation of a new UID and the (new) image is reconnected to the active MPPS. If there is not an
active MPPS, a new one is generated.
Management of the Exposure Data in the MPPS.

During the image acquisition in the C Exam (study) object, exposure data are memorized for
each image acquired: KV, mA, mAs, msec, dose, type of radiation (continued, pulse). Some of
these parameters may be missing, depending on the communication received by the controller of
the ray generator. Besides this data, the total number of exposures carried out and the total dose
are also memorized.
None of this data is changeable after acquisition; moreover, no data can be modified when
images are cancelled.
When a MPPS Dicom message is sent to the server (both N-CREATE and N-SET), the current
overall situation of the study exposure (therefore of the Performed Procedure Step) is included in
the message itself, no matter if a similar or identical situation was already been sent with a
previous message regarding the same or another MPPS. Therefore the server doesn't need to sum
up the doses received in the individual messages, but it can consider as overall situation the one
received in the last message.
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Dicom Communications to the MPPS Server.

The Dicom communications take place through the N-CREATE and N-SET commands of the
MPPS service. The system has always the role of SCU.
MPPS N-CREATE.
The time of creation of the MPPS on the server is determined by the settings (see MPPS). In the
message connected to the N-CREATE command, references to the series and the images are
never included, even if the MPPS on the system is connected to some of those.
This allows possible deleting of images before the final closing of the MPPS.
MPPS N-SET.
The closing time of the MPPS on the server is determined by the settings (see MPPS Setup). In
the message related to the N-SET command, references to the series and images contained at the
moment in the active MPPS are always included. For each MPPS just one N-SET command is
sent; therefore, partial updates are not made. The Dicom state of the MPPS will generally be
“COMPLETED”, except when the MPPS contains no reference to series and images (because
they are all deleted); in this case the Dicom state will be “DISCONTINUED”.
Selection of the MPPS Server.

The selection of the AE title of the server is made by the spooler through the “Network”
dialogue. In the “Local” page the edit box associated with “Default MPPS Server” is used.
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13.9 STORAGE COMMITMENT.

The Dicom service of Storage Commitment (from here on referred to as SC) allows a Dicom
device that has transferred images to another device (normally a workstation or an archive), to
make the second device responsible for the storage of the images. Once the notification of
acceptance has been received, the first device is free to use all images as it wants, including
deleting them.
SC takes place between two devices that have roles of SCU and SCP.
SCU is the device which sends the images and requests storage commitment.
SCU starts the process.
SCP is the server of SC and receives the images for which it accepts the commitment.
Transferring of Images.
The transfer of images must take place before beginning SC using one or more of the DICOM
services. In particular, network services (Storage, Query/Retrieve) or the generation on a Dicom
Media user and successive loading on the server can be used.
General Enabling of Storage Commitment.

To maintain reverse compatibility, when the SC is created, it is also enabled at the exam level. In
the exam data, the SC is activated.
When this flag is absent, the DigiRad works exactly like the version without SC.
For the flag to be set, the following conditions must be valid at the time the exam is created:
 H/W key with SC option enabled

 Enabling of the service in the SC setup.
Deleting Images.
The deletion of images is directly linked to the SC state of the images.
If the SC is not enabled for the study, deletion is always permitted.
If the SC is enabled, deletion is secondary to the SC and to the storing states of the images.
For images that are not stored, the system can be set to always allow the deleting of an image, to
never allow it or to allow it after the request of confirmation.
For stored images with SC-null or SC-pending states, the system can be set to never allow the
deleting or to allow it after confirmation.
For images stored with a SC-failed state the system can be set to never allow the deleting or to
allow it after confirmation. In any case, the operator is always advised by a video message to
repeat the storage of the image.
For images stored with a SC-success state deletion is always permitted.
Error Management.
The operator is informed of error situations that lead to an SC-failed state for images by a marker
on the video of the image.
The main corrective action to be taken is to repeat the storage of the image and thus the SC.
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SC Marker
SC State Image Marker

Pending
Store OK
Store FAIL
Auto commit OK
Store OK + Commit OK
Store OK + Commit FAIL
The image markers described above appear on the left of the screen.
The error markers are only displayed if the option Storage Commitment is enabled.
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14 MAINTENANCE.
This manual refers only to ordinary maintenance.
At the request of specialized personnel and after evaluation by DIGITEC S.r.l., the constructor
commits itself to supplying information, boards and setting procedures for the solution of
technical problems.
For special maintenance, (updates, malfunctions or substitution of parts) it is necessary to
request the intervention of a technical service approved by the constructor.
14.1 ORDINARY MAINTENANCE.
The ordinary maintenance regards the operations included in the system test.
It must be made every six months according to the local requirements.
The results must be recorded and stored (see INSTALLATION) together with all repairs done.
If you have any problems, please contact the technical service.
14.2 CLEANING AND DISINFECTING.

Do not use cleaning products that have a high alcohol content. Do not use corrosive detergents,
abrasive products or solvents.
Before carrying out cleaning or disinfecting follow the following precautions scrupulously:
 Turn off the device and disconnect the power cable.
 Be sure that no liquid enters the machinery, thus preventing short-circuiting or
corrosion of electric or electromechanical components.
 The device is not suitable for use in the presence of anesthetics and/or flammable
cleaning products.
 If products that form mixtures of explosive gases are used, be sure that the gas is
dispersed before turning the machinery on again.
 For the cleaning of the device use only mild solutions dampening a soft cloth, not use
agents or abrasive or solvent sponges like alcohol or gasoline.
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15 DISPOSAL OF REFUSE FROM THE ELECTRIC AND

ELECTRONIC EQUIPMENT.
At the end of its lifespan, the product must be disposed of properly, following the applicable
norms dealing with differentiated waste disposal and cannot be treated as simple urban waste.
The product has to be brought to the appropriate waste disposal center or must be returned to the
manufacturer in the case that it is to be substituted with a new equivalent product.
The symbol:
Indicates that the product complies with the new guidelines regarding environmental protection
(2002/95/EC, 2002/96/EC, 2003/108/EC) and that it must be disposed of properly at the end of
its life cycle.
Ask the local authorities for information regarding the areas for waste disposal.
Those who don't comply with the indications given in this paragraph regarding the correct
disposal of waste will be held responsible by law.
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16 APPENDIX.
16.1 VIEWING WIFI DETECTOR PARAMETERS.
Where a Wifi detector is connected to the system, it is possible to view the operational
parameters by clicking the icon provided.
The icon is found in the patient list pane, beside the menu, or alternatively, on the toolbar on an
open study. See the figures below:
CARESTREAM DRX-1 DETECTOR
Patient list Commands toolbar
When the button is clicked the following window displays:
Connection status and Wifi signal

power
Battery charge level
Temperature of the detector
Operational status of the detector
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THALES PIXIUM 3543EZ DETECTOR

power
Temperature of the detector
23/08/2016
TOSHIBA 3543/4343RPW DETECTOR

power
TRANSLATED FROM ORIGINAL DOCUMENT: MANUALE UTENTE

FILE: DIGIRAD_it_manuale_utente_W7_v8_12_x_Rev0.0.docx
DEL 05/08/16
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DIGIRAD_uk_user's_manual_W7_v8_12_x_Rev0.0.

docx Page 1 of 124

Read the instructions carefully before connecting this device.

Via Caduti Lecchesi a Fossoli, 17 - 23900 LECCO - Italy

10.5 ELECTRONIC SHUTTERS ............................................................... 66

Name and address of the manufacturer: digitec S.r.l.

Year of manufacture: 2010

Serial number: SN. 001

Power descriptions: 230V~ 50Hz 80VA

Type of protection against electrical contacts: class I

4 PRECAUTIONS FOR USE.

4.1 DECLARATION OF RESPONSABILITY.

4.2 CONFORMITY AND REFERRENCE ADDRESS.

The digital device is produced by:

DIGITEC S.r.l. via Caduti Lecchesi a Fossoli,17

The device conforms to EC standards. The applicable harmonized standards are:

4.3 ELECTRIC SAFETY.

4.4 RESIDUAL RISKS.

Limit values Suggested values

4.6 STANDARD EQUIPMENT.

5 DESCRIPTION OF THE MACHINE.

DIGITAL ROTATION: to allow an easy visualization as a function of position of the implant

DIGITAL SUBTRACTION: point-to-point operation that performs the arithmetic difference

5.2 SOFTWARE STRUCTURE.

MENU BAR QUICK COMMANDS

6.1 QUICK COMMANDS.

Open Archive Save Archive

Worklist New Study

Modify Study Query Retrieve

Open Study Emergency Study

About… Shutdown the system

AVAILABLE COMMANDS FROM THE CLOSED ARCHIVE.

AVAILABLE COMMANDS FROM THE OPEN ARCHIVE.

7.1.1 New Archive.

The system is now ready to insert new exams.

7.1.2 Open archive.

OK: It confirms and runs the archive opening.

7.2 STUDY MENU.

AVAILABLE COMMANDS WHEN AN ARCHIVE IS NOT SELECTED.

AVAILABLE COMMANDS WHEN AN ARCHIVE IS SELECTED.

7.2.1 New Study.

PATIENT DATA STUDY DATA

AUTOMATIC PROCEDURE PERFORMED DATA

Automatic Procedure : to enable the automatic procedure selections

7.2.2 Modify Study.

7.2.3 Copy Study.

Select the file destination and click OK.

7.2.4 Copy Study on CD.

Click the Options button to open the CD-R Write Options.

Device: select the CD-ROM device to write the CD.

Click OK to set the desired value and close the window.

Click the Start Write button to burn your CD-ROM.

7.2.5 Find, Find Next, Find Previous.

7.3 OPTION MENU

AVAILABLE COMMANDS WHEN AN ARCHIVE IS OPEN.

Setup: to set the acquisition parameters.

Exam Setup: reserved to the technician.

Dicom: management of the DICOM systems.

Stitching Setup: reserved to the technician (if the option is present).