Radiologists can use the PHYSICIAN PORTAL module to access studies that have been assigned to them for interpretation. Referring physicians can use this module to obtain study interpretation reports. To search for studies, please use the instruction below:

1. Sign into your account on your EMSOW site.
2. Click PHYSICIAN PORTAL in the upper navigation bar
   
3. In the Options panel on the left sidebar, specify the search parameters as necessary.

Various search options are available. The most common options are the following:

• Date of service (DoS)
• Status: Pending (Reading), Pending (Transcription), Pending (Signing), Ready, or All
• Date of birth (DoB)
• Patient name

There are other filters available such as:

• Studies
• Technologists
• Peer review (available or not)
• Flagged: Yes, No or Any
• Wait addendum: Yes, No or Any
• Service ID
• Accession number
• Reading doctors
• Ordering facilities

Under Study reading stage you can search by the following dates:

• Received date – when the study was received
• Dictated date – when the interpretation report was dictated
• Transcribed date – when the report was transcribed
• Finalized date – when the report was finalized by the doctor

In order to view DICOM images, click the images link in the corresponding study box:

NOTE: Old patient images are automatically archived and are not available for instant viewing. Archived studies have the following icon next to images:

To view the archived images, just single-click the Images link in the same way as to view a regular study. It may take 1–10 minutes to retrieve the complete study from the archive depending on the study size. When it is complete the icon will change to and the images will be available for viewing. In order to obtain a report for a study that has been read by a radiologist, click report in the corresponding study box.

To view patient’s previous studies for the last 1095 days, click the patient has 2 related studies in history link:

As the result, service box unfolds. Previous services and studies appear:

To have access to this function, your user group must have the permission “Doctors cabinet – show patient previous studies with documents” (please ask your system administrator to grant you this permission).

On the upper toolbar such buttons as Create cache, Pack, Change reading stage, Mark as, Select all and Deselect all are available:

Click the Create cache button to make archived images available for viewing (it is done automatically when you click the images link to view the archived images).

For application of the Pack button see the section “How to record images to a CD/DVD or a USB flash drive”.

The Change reading stage button makes it possible to select the required stage as it is shown in the picture below:

Not processed (studies are not processed) Dictated (the report has been dictated) Transcribed (the report has been transcribed)

Click Mark as and select if an addendum report is required for selected studies.

Click Select all or Deselect all to select or deselect all studies shown on the page.

The Viewing preferences button provides an option to open the DICOM viewer in a separate window which can be more convenient for a reading doctor.

To export the list of studies as an Excel, CSV, PDF or HTML document, click the Export button on the right side of the toolbar.

On the bottom toolbar there is the Sort button that permits you to select how the studies are arranged (ASC stands for ascending).

Study boxes have different icons that inform you about the state of studies when you hover the mouse pointer over them.

– contains the information about who and when dictated the report and who and when received it.

– contains the information about who and when received the report and who and when finalized it.

– contains the information only about who and when received the study, means that the study is not finalized.

– shows that the study was checked and who saved it.

– click this icon to flag the study.

1. Images panel
2. Viewer toolbar
3. Main window

The images panel is a large panel on the left sidebar that has thumbnails of the current study. You can jump to any image in the study either by double-clicking a thumbnail or by dragging it to the main window.

The toolbar contains buttons that help you view the images:

– the arrow buttons allow you to jump to the next or the previous image in the study. You can also use the mouse wheel to scroll back or forward, or press the space bar to see the next page.

– the pan tool allows you to move the image in the viewer (useful when the image is zoomed in).

– the reset button resets the view to the original mode, as if it was opened for the first time.

– the window / level tool allows you to change the brightness/contrast of the image. Select this tool, hold the left mouse button on the image, and move the mouse either vertically or horizontally in order to change the brightness/contrast.

– the point tool (Ctrl+~) allows you to measure the number of Hounsfield units in a particular point.

– the distance measurement tool (Ctrl+1) is used to measure the distance between two points.

– the angle measurement tool (Ctrl+2) allows you to draw two lines and measure the angle between them.

– the rectangle / square tool (Ctrl+3) allows you to draw a rectangle or a square and display its area and perimeter. To draw a square, hold the Shift key while using this tool.

– the ellipse / circle tool (Ctrl+4) allows you to draw an ellipse or a circle and display its area and circumference. To draw a circle, hold the Shift key while using this tool.

– the peak velocity / gradient tool (Ctrl+5) is used to read velocity and gradient values from plots.

– the freehand drawing tool (Ctrl+6) allows you to draw figures by placing points on the image. To finish drawing, click the initial point.

– the area / circumference tool (Ctrl+7) allows you to draw arbitrary closed shapes.

– you can use these tools to determine the mean number of Hounsfield units in a particular area. When you select an area using them the system shows the mean value.

– the calibration tool (Ctrl+8) is used to calibrate the distance measurements by entering a correction value.

– the annotation tool (Ctrl+9) allows you to add text labels to the image.

– zoom in (Ctrl +), zoom out (Ctrl -) and custom zoom tools. Alternatively you can hold the Shift key and use the mouse wheel to zoom in or out.

– the multiframe video tools allow you to pause a video clip (e.g. a moving image sequence typical in echocardiology studies) and view it frame-by-frame.

– the Layout and Options buttons are in the right upper corner.

– the Layout button allows you to view multiple images side by side.

– the Options button is used to specify how the data will look when it is viewed.

Loop video: check the loop video box and the video will be repeated continuously. When the box is unchecked you need to click Play / Pause Video button to play the video again.

1. Display region calibration.
2. Display measurements: this check box controls whether measurements are displayed or not.
3. Display OSD: this check box controls whether image information is displayed or not.
4. Viewports Behavior (Linked / Separated) is helpful when using different layout views to customize how the images are displayed.
5. Linked – images are displayed in the particular order as they are on the left sidebar.
6. Separated – allows you to choose what image to be displayed in each section.

These three options allow you to add a report in one of the three following ways:

• By using EMSOW’s built-in report templates
• By uploading a report in the PDF or DOCX format
• By using EMSOW’s built-in document scanning capabilities

2. Then click the add report link in the study box:

Using EMSOW’s built-in report editor

If Template has been selected as the report upload mode, a report editor tab will open where you can select an appropriate template (such as “Echo” for echocardiology studies):

Structured reporting (SR) in templates

Most templates have tables with measurements that are prepopulated from equipment if the equipment supports structured reporting. The measurements that come over from the equipment are highlighted in green color and the ones that are modified by the user are highlighted in blue. If there are no measurements in the table, the SR data was not received from the equipment.

How to fill out findings and conclusions

Depending on the template, it may have some prepopulated findings/conclusions according to the measurements. Some templates are fully manual; then the findings have to be entered manually.

• Some reports may have two rows of checkboxes indicated by two icons: If the checkbox in the “eye” column is selected, this part of the text will go to the findings section. If the checkbox under the “report” icon is selected, this part of the text will go to the conclusion. If both of the checkboxes are selected, the text will go in both the findings and the conclusion sections.
• Some templates don’t have a prepopulated finding/conclusion section, instead there is the gear button: This button allows you to select findings from the list of findings.
• To add a free text, please use the plus button at the end of each section.

Report finalization

After the report is filled out and ready to be finalized, click I confirm this report in the bottom left corner of the screen and then click Finalize and send in the bottom right corner of the screen. The report will be attached to the patient’s record.

Other buttons available in the report editor perform the following actions:

1. Clear – reverts all changes to the original values as if the template was opened for the first time.
2. Reset – resets all changes to the draft version or to the original values as if the report was opened for the first time.
3. Preview – creates a preview of the final report in the PDF format.
4. Save as draft – saves the report with all the changes and selections as a draft version.

Uploading report files

If you have prepared a report using third-party software (e.g. Microsoft Word), you can use the upload feature instead of EMSOW’s reporting capabilities. To upload your report, select Upload on the Report upload mode pane:

Then click the Add report link in a study box:

If a study was read, it is possible to add an addendum report which can be signed by another doctor. The “addendum” option is available for every study including those with finalized reports (using this option on those studies will result in moving the existing reports to the archive).

Drag and drop your report file onto the window or browse for it. The supported formats are DOCX and PDF. Then click Upload.

1. First, measure Aortic Valve Area. Find an image with appropriate part of the heart. Click AVA on DICOM viewer toolbar:
   
2. Select “Distance” tool on DICOM viewer toolbar:
   
3. Click at one side of the area you would like to measure and drag the cursor to another side. The system will measure distance and will show it on the “Measurement” panel:
   
4. Select the image where you would like to measure LVOT VTI. Select “VTI” tool on DICOM viewer toolbar:
   
5. Drag the cursor around the area you would like to measure. The system will automatically calculate LVOT VTI and will show it on the “Measurement” panel:
   
6. Select the image where you would like to measure AV VTI. Select “VTI” tool on DICOM viewer toolbar again and drag the cursor around the area you would like to measure. The system will automatically calculate AV VTI and AVA (VTI) and will show it on the “Measurement” panel:
   
7. To measure MV PHT and MVA (PHT) find an image with appropriate part of the heart and click MVA on DICOM viewer toolbar:
   
8. Select “PHT” tool on DICOM viewer toolbar:
   
9. Click at one side of the area you would like to measure and drag the cursor to another side. The system will automatically calculate MV PHT and MVA (PHT) and will show it on the “Measurement” panel: