SECTION B

Basic Operations

This section provides basic information about using the DROC to acquire images and send them
to output devices. It also includes procedures for system start up, and shut down.

CONTENTS

SECTION B BASIC OPERATIONS ....................................................................................................... 1

STARTING UP AND LOGGING ON TO THE SYSTEM ..................................................................................... 2

WARMING UP THE X-RAY TUBE ................................................................................................................ 5
CAPTURING IMAGES ................................................................................................................................. 7
POWERING DOWN THE SYSTEM .............................................................................................................. 36

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Starting Up and Logging On to the System

NOTE: Below steps only for reference. Steps maybe changes according to your system configuration.

To start up the system and prepare for acquiring patient images,

Steps

1. Before power up the host system, power up the X-ray generator, detector and all the other
x-ray system components needed.

2. Check that the other X-ray system components are on and working properly.

3. Power up the DROC Host PC.

4. Log in to the PC’s operating system

5. Log in to the DROC application.

The DROC HOST PC should be powered down once a day to ensure a

complete system reset. If this is not done, system performance deteriorates.

The Detector should be powered up at least half an hour before intended

use. If it is used sooner than half an hour after being powered up, image
quality can be affected. For more information about powering up the
Detector, see the next subsection, "Step 1: Starting Up the UPS.”

The following subsections provide instructions for each of these steps:

Step 1: Powering up the X-ray generator, detector, etc

Please refer to the related instructions from their corresponding manufacturers.

Step 3: Checking the System

Once the X-ray generator is powered on, perform the following checks:

z Remove any patient supports or other objects so they do not interfere with the movement of the
X-ray tube's suspension arm.

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Press the light switch on the collimator to ensure that the area exposed to the beam is illuminated.

z Check the releases, if applicable, on the X-ray tube's suspension arm, the bucky, and the table to
ensure that the controls are operating properly.

You can now power up the DROC.

Step 4: Powering Up the DROC Host PC

Power up the DROC HOST PC; if the monitor is not on, press the power button on the monitor.

NOTE: Before you power on the DROC HOST PC, make sure the Detector have completed their startup
sequence (wait at least several minutes after you power on the UPS).

Step 5: Logging In to the PC's Operating System

Log in to the PC's operating system; start up the DROC Application, the Status window will show
the initialization status of the DROC, shown as below:

Figure 1 Initialization window

There are some initialization tasks for DROC functions, the result of each task (successful or
failed) is displayed once it has been performed, after the initialization is completed successfully, the
application Login window is displayed at the upper left corner of the screen. Go to the next
subsection to log on to the DROC application.

NOTE: Consult your System Administrator if you do not know your login or password. Passwords are

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case sensitive, please ensure you enter the correct password, if you enter false password
continually for three times, the application will exit.

Step 6: Logging On to the DROC Application

To sign into the Digital Radiography DROC application, choose your name from the User Name
pop-up menu, enter your password, and click “OK” button.

Figure 2: Login to DROC window

NOTE: There are three types of user who own different administration privilege: tech—common
operator; mgr—administrator; apps—administrator. The default password for these users is
the same with their user name.

The DROC application window for Worklist displays:

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Figure 3: Worklist window

NOTE: Your site’s settings might be different. For example, if you added the Stitching module, there will
appear a “Stitch” menu in the Menu list.

If the X-ray tube has been inactive for a period of time, such as over
3 hours, you must warm it up to prolong the life of the tube, as
explained in the next section. Otherwise, you can create a patient
record and start capturing images.

Warming Up the X-ray Tube

To perform the tube warm-up,

Steps

1. Ensure everyone is out of the X-ray room.

2. Close the Collimator shutter, using the shutter controls.

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3. Cover the Collimator or the Bucky with a lead apron or position the X-ray tube so it will
not expose the Detector to unattenuated dosage.

4. In the DROC main window, with no patient chosen, click the Conventional Mode button.
The Conventional X-ray Mode window displays.

Figure 4: Conventional mode

5. Set the technique settings, as instructed in the Tube Warm-Up panel.

6. Take exposures until the heat unit count reaches 7 to 9%.

7. When you have completed the exposures, click the Close button and remove the lead
apron from the tube.

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Capturing Images

Overview for Capturing Images

The general workflow for using the DROC to acquire and send images to the output devices
involves the following steps.

Steps:

1. Identifying the patient and study;

2. Taking an exposure;

3. Viewing and accepting the image; Optionally, you can reject the image and re-capture one;

4. Closing the patient/study;

5. After all images being captured, the data will be transmitted to the default node.
alternatively, users can send the images to other node or print the images;

6. Signing Out from an Acquisition Session.

The following subsections provide instructions for each of these steps.

Step 1: Identifying the Patient and Study

Before capturing images, you must identify with which patient they are to be associated. Proper
identification ensures that the image data are associated with the correct patient information.

Depending on the system configuration at your site, there are three ways for you to identify the
patient or which you want to acquire images, as described below.

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Worklist page History page Worklist Window

Patient panel

Query panel

Figure 5: Worklist Page

All systems allow you to identify patients manually. Whether you are acquiring images for a new
or existing patient, you can identify a patient manually by:

z Creating a new patient record in the local database.

z Selecting a patient from those previously entered and currently stored in the Worklist database.
For more information about how to manually specify the patient, refer to the topics “Creating a
New Patient Locally”.

If your system supports Modality Worklist queries, you can retrieve patient information from a
Radiology Information System (RIS). Refer to the topic “Query and Refresh”.

If your system supports bar code scanning, you can use the bar code scanner to read in the patient
ID or some other unique identifying number. If the ID is found in the Modality Worklist (if this
feature is available) or in the local DROC patient database, that corresponding patient, and study
is opened. If the ID is not found, you must enter that patient manually.

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The patient/study list in the Worklist page is shown as below:

Figure 6: Worklist Status bar

There are three status related to a slot:

z Scheduled: A new patient/study with no image being captured;

z In Progress: An exiting patient/study not having all the images being captured;
z Completed: An exiting patient/study with all the images being captured.

You can capture images for the patient/study with the status as Scheduled or In Progress even
can supper add images to a completed study as long as it still exiting in the Worklist database.

NOTE: As long as the patient has been accomplished, it will be stored as history data. Meanwhile, the
completed studies will still being stored in Worklist database for a certain period after exposures,
it dependent on the Space Reclamation Strategy and individual configuration .Users can pick up
the patient still in the Worklist table and proceed on capturing images.
A study exiting in the History database could not being superadded images any more.

Creating a New Patient Locally

NOTE: Make sure you enter patient names and IDs correctly. Incorrect entries can cause duplicate
patient records for the same patient, or make it more difficult to find the patient in future search
operations.

To add a new patient when not using a barcode, click the New Patient button in the Patient
panel in the Worklist page.

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Figure 7: Patient panel

The New Patient Entry window displays; a sample is shown below. Note that, for your site, the
fields in this window may be different.

Figure 8: New Patient Information

Complete the fields in the window. Fields whose labels include an asterisk (*) are required fields.
You can switch to different fields by pressing Tab key. After birthday inputted, age is calculated
and showed by the system automatically. The name is stored in the format LAST
^FIRST^MIDDLE. If you don’t want ^ character to appear in name, you can input all content of
name in First Name field or Last Name field.

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When specifying the procedure, you can select multiple procedures. First of all, choose the
checkbox or not to determine whether use the Often Used procedures list.

Figure 9: Procedures Specifying

z If the checkbox is not selected, all procedures display in two drop-down lists. The left one
contains the group of body part. If one group is selected in the left drop-down list, the right
one displays procedures belonging to that group. You can choose one from the right
drop-down list and click “Add” button. You can repeat the selection to achieve multiple
procedures. Looking up procedures in two levels facilitates the user’s operation, avoiding all
procedure items displaying in only one drop-down list and difficult to look up from them.
z If the checkbox is selected, only procedures marked as often used display in drop-down list.
Because such procedure is of relatively less in quantity, they display only in right drop-down
list with left one disabled. You can select one item and click Add to List button. You can
repeat the selection to have multiple procedures chosen.

NOTE: You need to re-assign an Accession Number whenever you adding a new procedure.

To save the patient information, click the Accept button. The Creating/Editing Patient
information window closes and the patient is loaded on the Exam window for technicians to
capture images.

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NOTE: Your site’s settings might be different from those described above.

Figure 10: the Exam window opens after accepting the new patient

To clear the patient information and input again, click the Clear button.

To cancel entry of the patient information, click the Cancel button.

Emergency Patient Registration (Optional)

To add a patient for emergency, you need to register the patient rapidly, and need not fill in the
detailed information. By clicking the Emergency button, the system will register next patient
automatically with the name composed of prefix, current date and sequence number, and sequence
number increases in 1 step by each patient. Then DROC loads the Exam window directly for
technicians to expose the patient.

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Figure 11: Emergency patient register button

Figure 12: Exam window for the emergency patient

The default procedure is set according to configuration. Settings of prefix and default procedure
and other factors can be completed in Setting window, please refer to section C.

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Editing Patient Demographic Information Before Exposure (Optional)

You can edit an emergency patient or locally registered patient demographic information before
exposure.

Figure 13: Edit button

1. From the Worklist page in the Worklist window, select the patient/study with whose
demographic information you want to correct;

Figure 14: Patient selecting

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1. Click Edit button, patient demographic information editing page displays with the original
information:

Figure 15: Edit Patient dialog

2. Input the corrected information;

Figure 16: Demographic information correction

3. Click Accept button to save the correction, the updated information will shown in the Worklist

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page as:

Figure 17: After demographic information correction

NOTE: As to a fresh completed study, the images will be transmitted to a default PACS node.
In case you edited an item with images being captured, the new information, for example, the new
name will be written into the DICOM info. Whenever you re-open the patient in DROC, it will
appear the new name. If the item also exists in the History list, you can find the related item shows
the new name, too.
This Editing operation is only effective for local database data. It DOES NOT make any
changesfor the images already transmitted to the PACS node. We extremely recommend you to
resend the Study you just edited to your desired destination.

Query and Refresh (Optional)

To search an exact patient

From the Query Panel in the Worklist page, you can query a patient/study by various searching
criteria such as Patient ID, Patient Name, Accession Number and date. The Query panel is shown
as below:

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Figure 18: Query and Refresh panel

Input the key information associated to the desired patient/study, then click Query button, the
DROC application will search both the local database and from the Radiology Information System
(RIS), the result list displays in the Worklist page.

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Figure 19: searching result list

If multiple patients/studies match the criteria, they will be listed in the Worklist page, you can
choose the exact study or patient to perform the exposures;

If only one result matches, the study or patient will be loaded into the Exam interface
automatically to perform the exposures.

To manually refresh the Worklist from Radiology Information System (RIS)

If your site is connecting with RIS, the DROC can retrieve the worklist in background and
automatically refresh the Worklist page. Users also can override this operation manually by
clicking the Refresh button.

Deleting an item from the Worklist page (Optional)

To delete a Worklist item, choose the item from the worklist;

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Figure 20: Choosing the item

Then by clicking Delete button, the wordlist item will be prepared to delete.

Figure 21: Delete button

To delete the item, click OK.

Figure 22: Confirm information

NOTE: Only the local cache of the worklist item has been removed by this Deleting operation. If the item
can be still retrieved from RIS, it may appear again.
To remove the completed item from the Worklist will not inflect the corresponding item’s existing
in History page.

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Step 2: Exposing Patients

This X-ray unit may be dangerous to the patient and operator unless safe
exposure factors and operating instructions are observed.

Loading the desired patient/study to the Exam window

To load SINGLE study:

1. Double-click the exact item in the Worklist page,

Figure 23: Double-click the desired study

2. The study is loaded in the Exam Window.

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Figure 24: Study loaded

To load MULTIPLE studies:

1. From the Worklist page, select a study belong to the desired patient ,

Figure 25: Select a study related to the desired patient

2. Click the Select button in the Patient panel,

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Figure 26: Select button

3. Studies associated with the assigned patient are loaded in the Exam Window:

Study control area

Message display area

Figure 27: studies loaded

NOTE: The UI in your site may not show the some buttons after its installation due to the customizatio .
Please refer to your support engineer for more details.

You can switch the studies by choose the related item shown in the Study Control Area:

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Figure 28: The Study Control Area in the Exam window

Exposure Settings and Exposure Sequence adjusting (Optional)

At the time the system is installed, default exposure settings and imaging sequences are
configured according to every specific view. You can use manual techniques or phototiming
techniques to adjust the default exposure settings.

Figure 29: Exposure Control panel

Typically, you will simply use the default settings. You would only change them for special

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circumstances, such as a very small person or a missing lung.

If you want to adjust the exposure settings or capture sequence, refer to Section C for detailed
instructions.

When you have finished adjusting exposure and sequence settings, you are ready to position the
patient and acquire images.

Checking the Grid

Figure 30: Gird indication

Please check whether you are using a correct grid, otherwise, error message will appear in the
Message display area.

Adding an Additional Procedure (Optional)

For a given patient, you may want to open additional procedures, to include their images in the
same study. For more information, refer to "Working with Multiple Open Procedures" in section
C.

Adding a View to a Procedure (Optional)

If the current procedure does not include all the views you want to capture, you can add views to
it.

Figure 31 : Procedure editing

For more information, refer to "Adding a View to a Procedure" in Section C.

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Taking an Exposure

While behind the leaded wall when taking an exposure, you must maintain
verbal communication with the patient and keep the patient within your
sight at all times.

If the X-ray tube heat units exceed the maximum allowable limit, the X-ray
tube and generator will be disabled until the heat units drop to a safe level.
If this condition occurs, a message will be displayed and an audible beep
will sound.

Steps:

1. There is a detector state indicator at the bottom of this panel Menu Bar, it uses three colors to
show the detector state: green indicates “ready to exposure”, yellow indicates “be busy doing
preparation for exposure”, red indicates “on exposure”; if the indicator turn into yellow, please
wait several seconds for green background.

Figure 32: Detector Status—Ready to exposure

Figure 33: Detector Status—Be busy doing preparation for exposure

Figure 34: Detector Status—On exposure

2. Optionally, give the patient breathing and/or pre-exposure instructions.

3. Press the Prep/Expose button all the way (to the second position) and hold till the generator is
ready. Approximately a half to several seconds (the time interval is decided by the
characteristic of the detector) after pressing the exposure button, the exposure occurs. When
the exposure occurs, a tone sounds.

4. After the tone stops, release the button

5. Give the patient the appropriate breathing instructions.

When the exposure is complete, the View window opens and displays the image.

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For more details of the other buttons on the EXAM window, please refer to “SectionC_Addtional
Operations”

NOTES:
Releasing the Prep/Expose button on the hand-switch before exposure will cancel the exposure
without any error occurs.
If the is any error occurs during the exposure, the message field below the “Reset” button will
display the warning or error.
If it is just a warning, it disappears automatically after several seconds, you needn’t interfere it;
If it is not a auto recoverable error, the message will remain, click the “reset” button before
performing subsequent exposure.

Figure 35: Reset button & Warning Area

NOTE: The UI in your site may not show the “Reset” button after its installation. Please refer to your
support engineer on how to show the button.

Taking an Exposure on dual-detector system

NOTE: If you are not using dual detector system, the UI may not show the selection of WS. It is depends on
different UI version.

Firstly, please select the proper detector you want to capture image with.

1. Select correct WS to use the proper Bucky to capture image. This step is needed in using dual
detector system. Usually the DROC will choose the correct WS according to procedure
setting and you do not need to change it. When the WS change, system needs preparation.
This usually takes several seconds.

Figure 36: Stand bucky and Table Bucky for dual buckies

2. Please refer to the above steps to capture an image.

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Step 3: Image Viewing

After the exposure, the image is shown in the View window. From the Image View window, you
can:

z Verify the exposure information.

z Select ESA or IT(if available).
z Verify the appropriate ESA information.
z Crop the image.
z Enter a comment that accompanies the image if sent to a DICOM workstation or printer.
z Add markers.
z Rotate or flip image, if required.
z View the image in full size.
z Accept the image as it is.

OR

z Reject the image.

Dose Message Area

Image working panel

Image Optimization Panel

Figure 37: View window

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The following topics explain how to perform these tasks. A sample of the View window is shown
on the following page.

Figure 38: Accepting or Rejecting an Image

Changing the ESA Setting (Optional)

Figure 39: Image optimization panel—ESA and IT

From the ESA/IT panel, you can change the current ESA setting by:

z Clicking on the drop down list in the ESA panel and choosing a different setting.
z Pressing and holding the right mouse button, and moving the mouse on image preview area,
change the LUT. Vertical movement changes window width of LUT, horizontal movement
changes window level of LUT.
z Adjusting the image’s LUT settings by placing the cursor on the three rectangle handles of
the curve, pressing and holding the left mouse button, and dragging the handle.
z ESA setting changes or LUT adjustments are not typically needed. For more information
about making LUT adjustments, refer to the topic “Changing the ESA Setting or Adjusting
the LUT” in Section C.

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Cropping an Image (Optional)

You can crop an image in order to cut the background and only save the area with useful
information. The cropping applies only to the image when it is sent to a DICOM print or storage
device. In DROC Configure page, the default crop size is set for each procedure. When preview
image, the initial crop rectangular is positioned according to the size. If DROC is capable of
controlling the collimator’s movement, the collimator receives the position parameters from
DROC and sets its field to the specified size before image taken. Furthermore, if DROC could be
notified the new position of collimator when collimator is adjusted manually, when preview image,
the crop rectangle’s size will be changed according to the new collimator field.

For more information, refer to "Cropping an Image" in section C.

Adding Comments to an Image (Optional)

You can add text comments to an image at the time of acquisition; the comment is sent to any
DICOM devices chosen as an output destination for the image.

For more information, refer to the topic “Adding Comments to an Image” under the topic
“Working with Acquired Images” in Section C.

Selecting ESA or IT (Optional)

For more information, refer to the topic “Selecting ESA or IT” under the topic “Working with
Acquired Images” in Section C.

Adding Markers to the Image (Optional)

You can add markers to an image that allow you to give further information about the image (for
example, supine, upright, and so on), and the markers are sent to any DICOM devices chosen as
an output destination for the image. In DROC Configure page, you can configure the default
maker added to preview image and its position on the image for each view. For more information,
refer to the topic “Adding Markers to an Image” under the topic “Working with Acquired Images”

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in Section C.

Rotating or Mirroring the Image (Optional)

You may wish to rotate or mirror the image. For more information, refer to the topic “Rotating or
Mirroring the Image” under the topic “Working with Acquired Images” in section C.

View the Image in Full Size (Optional)

You can view the image in full size. For more information, refer to the topic “View the Image in
Full Size” under the topic “Working with Acquired Images” in Section C.

Accepting the Image

To accept the image, click the Accept button. The View window closes and a thumbnail
(minimized view) of the image is displayed in the Image Panel of the DROC application's main
screen, as shown below. The exposure settings used to acquire the image are displayed next to its
thumbnail.

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Figure 40: Image accepted

Once accepted, that image is stored in the DROC and is queued to be sent to the selected output
devices. You are now ready to acquire the next image in the procedure.

By default, the next view to be exposed is selected in the image panel. If needed, you can select a
different view and adjust the exposure settings before acquiring the next image. For more
information about these procedures, refer to Section C.

Rejecting the Image (Optional)

You may want to reject an image (for example, if the patient moved during the exposure).

To reject the image

Steps:

1. In the View window, click the “Reject” button.

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The Image Rejection Information window displays, as shown below. In this window, you
enter a reason for the rejection.

Figure 40: Reject Image Information

2. Choose one or more reasons from the displayed list of default comments, and/or type in a
reason.

3. To save the rejection reason and reject the image, click the “Reject” button.

NOTE: Rejected images can be manually deleted by the system administrator; the system will delete
rejected images when it reclaims disk space.

The Rejection Reason and View window close and you can then recapture the image.

To dismiss the window and return to the View window without rejecting the image, click
the “Return” button.

Rejected images are stored in a designated reject bin storage area in the DROC, and can be
discarded or resent to an output device by users with administrative operating privileges.

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Step 4: Outputting Images manually (optional)

After the images being captured, they will be output to default destinations and printers
automatically. But users can still send the images to different destinations or resend images from
Output window.

User can send image for storage or printing, there are two types of output destinations: archive
server and printer. These two destinations which can contain zero or multiple nodes can be
configured for all images belong to the same procedure. Further more, the film orientation, size
and format can be configured for each different procedure. When an exam is opened, these
configurations are loaded automatically. You can also change them manually for current study.

For detailed information, please refer to Section D: Working with Worklist Studies.

Step 5: Closing the Study/Patient

You can quit the View window by closing the current study to perform other operations, no matter
whether all the images being captured or not.

z If the images in the current study has being acquired, the status of this study will become
Completed;
z Otherwise, the status will become In Progress.

You can pick up the incomplete study from the Worklist page to proceed on the exposures
whenever you like.

To close a completed study, from the bottom of the operation panel located in the View window,
click the Close button.

Figure 41: Close button

The Study Close window display,

z Suspend, to change the status into “IN PROGRESS” and return to Worklist interface;
z Finish, to change the status into “COMPLETED” and return to Worklist interface;

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Figure 42: Close button

For multiple studies belonging to the same patient, you can switch to other studies and close the
patient by closing any one of those in spite of the progress status.

NOTES:
The fact that a study is incomplete does not prevent the patient record and associated images
from being deleted as part of the system's storage space reclamation process. For more
information about the reclamation, and how to protect a patient record and associated images
from being deleted, refer to Section E.
When the study is closed and no new patient selected, the detector will perform offset
calibration; if no study is opened for a period of time, the detector enters “sleep” mode to
save energy. To ensure detector can enter “sleep “mode when system is idle; don’t leave a
study opened for a long time without taking exposure.

Step 6: Signing Out from an Acquisition Session

NOTE: You can not sign out from an acquisition session with a study open. The procedure must be
closed or paused before signing out.
If you click the Exit button in Login window, you must restart the DROC. This takes several
minutes.

To sign out from the current DROC acquisition session, from the Menu Bar click the Exit
button. The DROC Exit dialog displays.

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Figure 43: DROC Exit dialog

Three options are available:

z Close the DROC

z Logoff DROC
z Close Computer

Users can switch to another account by choosing the “Logoff DROC” option, shown as below.

Figure 44: User Logon

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Powering Down the System

Typically, you should leave the system components on. The DROC HOST PC, monitor, and
Detector enter an energy-saving "sleep" mode1 when they are not used for a period of time.

If you have to power down the system, perform the steps outlined in the following sections.

Recommended Power Down Procedure Overview

To power down the system, it is recommended that you perform the power down tasks in the
following sequence,

Steps:

1. Power down the DROC HOST PC.

2. Power down the X-ray generator. This also typically powers down the other X-ray system
components.

Refer to the following topics for instructions on how to perform each of these steps.

The DROC HOST PC should be powered down once a day to ensure a

complete system reset. If this is not done, system performance deteriorates.

Step 1: Powering Down the DROC HOST PC

To power down the DROC HOST PC,

Steps:

1. Close all the applications running in the PC;

2. From the Start, choose power off the PC.

1
The “Sleep” mode is available for Trixell Detector.

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Step 2: Powering Down the X-ray Generator

Powering down the X-ray generator also typically does power down the other X-ray system
components, such as X-ray tube, tube suspension arm, collimator, bucky, and table (if applicable).

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