dysect FAQ CT Technologist FAQs

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1 401 Washington Avenue Suite 1010 Towson, Maryland Tel +1 (410) Fax +1 (410) dysect FAQ CT Technologist FAQs What will be different with the DICOM modality worklist I view at the CT scanner? Single procedure orders will not appear differently in the worklist. However, multiple procedure orders will be replaced with a single group order. For example, before you might see head, chest, abdomen, and pelvis orders for a single patient. With the dysect, these multiple orders will be replaced by a single grouped order designated head, chest, ab, pelvis. Do I send all studies to dysect or just the multiple procedure studies? You should send all studies to dysect. dysect will transmit the single procedure studies unchanged to the PACS. How do I send the studies to dysect? You can either send the studies manually to dysect once each study is complete or you can use the scanner s auto-send feature. You should make sure that the order information in the worklist is correct before sending the study to dysect. How does dysect know where to separate the study? dysect reads the DICOM header of each image to garner series information, but also inspects the pixel values of each image using a series of histogram and bone moment algorithms to determine the specific anatomical region and the boundary between anatomical regions. dysect then applies the configured overlap above and below the anatomical region to assign images to a specific procedure. Do the scout or localizer images get copied into each of the separated studies? No, dysect intelligently copies the scout or localizer images to the appropriate procedure. For example, if you perform an AP and lateral head scout and an AP body scout for a head, chest, ab, pelvis study, then dysect attaches the AP and lateral head scout to the head study and copies the AP body scout to the chest, abdomen and pelvis studies. What happens to any processed images I may create later? If you add the processed images to the original study, dysect will attach the processed images to the appropriate anatomical region. For example, if you performed a head, chest, ab, pelvis study and only created processed images for the head, then dysect will attach the processed images to the head study. However, if you create the processed images as a separate study, then dysect will transmit the processed images unchanged to the PACS. If you send the processed images to dysect soon after the original study no later that the study complete time-out configured on the dysect then dysect will add the appropriate scouts. DEJARNETTE Research Systems, Inc.

2 How can I tell whether or not all the orders are complete? Check the DICOM modality worklist. You should be able to tell if an order is missing. For example, if the grouped order in the worklist is head, chest, but you scan the neck under the direction of the radiologist, then the neck order is missing. Enter the neck order before sending the study to dysect. You can tell that the neck order has arrived at dysect when the grouped order in the worklist changes to head, neck, chest. How do I handle an emergency trauma case with no orders? This will depend on your department s processes. If you send the study to dysect without the orders, dysect will not split the study and will transmit it unchanged to the PACS. But, you could send the study directly to an ED workstation, then, once the orders are placed, send the study to dysect which will split the study and send it on to the PACS. Are there any special scanning concerns I should be aware of? Yes. When scanning a heavy patient, make sure you center the patient in the scan field. Any part of the body extending outside the scan field causes artifact that can disrupt the algorithms used to identify the individual anatomical regions. PACS Administrator FAQs If my radiologists prefer not to separate abdomen pelvis studies, how do I accomplish this? There are a couple of methods to accomplish this. Some PACS allow you to link abdomen and pelvis into a single order. If your PACS does not support this feature and auto grouping is ON, set the overlap between abdomen and pelvis so large that all the pelvis images will be grouped with the abdomen images. In this case, two studies will be sent to the PACS: an abdomen study containing all the abdomen and pelvis images and a pelvis study containing the pelvis images. If auto grouping is OFF, you can remove pelvis procedures from the defined procedure groups and any pelvis images will be placed with the abdomen images. In this case, the pelvis order will remain orphaned. When should I not use auto grouping? Auto grouping is a very powerful tool, but it groups all multiple procedure orders and breaks up each study into its constituent anatomical pieces. Turn auto grouping OFF if you need to customize the specific procedures to be grouped and eventually separated. What should I do if my radiologists complain of missing images? One of two problems can lead to claims of missing images, so you need to discuss the problem with your radiologists. a) The overlap between adjacent body parts is too small. For example, chest radiologists prefer to read chest CT down to the adrenal glands, but if the overlap is too small, then the last few abdomen images down to the adrenal glands will not be included with the chest study and the radiologist will complain that images are missing. In this case, increase the overlap below the chest. b) The CT technologist rescans an area. For example, if a chest, ab, pelvis study is rescanned through the abdomen, then the radiologist will have two sections of abdomen images separated in 2 of 5

3 image numbers. The radiologist may complain of missing images, but the images are not really missing they are in the pelvis study. A multiple procedure study was sent through dysect, but it was not separated into its constituent orders. Why not? Version 2.0 dysect separates multiple procedure studies that contain any of the following body part related procedures: head craniofacial bones maxillofacial bones orbits petrous bones neck cervical spine chest abdomen pelvis However, dysect does not separate multiple procedure studies that contain extremities, thoracic spine or lumbar spine. So, check the orders if there is an order for an extremity for example, then dysect will not separate the study, but will instead send the study to the PACS as is. If the orders do not include unsupported anatomical regions, then two other factors can cause dysect to not separate the studies: a) The orders are not complete, i.e., one or more orders are missing from the worklist. Make sure the orders are entered into the RIS before performing the study and sending it to dysect. b) The algorithm failed to correctly identify a body part. The version 2.0 algorithm is not perfect it fails about 13 times for every 1,000 multiple procedure studies sent to dysect. Please call DeJarnette when this occurs so that our engineering staff can investigate the root cause and further improve the algorithm. Radiologist FAQs I m a neuro-radiologist and I don t read body CT. How will dysect affect my workflow? images will show up in your worklist as a head study. But, what do you do with all those body images? Do you read them anyway or do you trust that these images will find their way to the radiologist reading body CT? If your PACS links multiple orders, you should be able to find your prior images without the benefit of dysect, but not before reviewing a number of irrelevant images costing you precious reading time. For example, if you are reading a cervical spine CT, the prior cervical spine images may be part of a multiple procedure study containing head, cervical spine, chest, abdomen and pelvis images, forcing you to scan through the head images before arriving at the cervical spine images. If your PACS does not link the cervical spine, chest, abdomen and pelvis orders to the head order, you may not find the relevant priors within the PACS. For example, depending on your pre-fetch rules, the head study may be determined to 3 of 5

4 be irrelevant. If you query your PACS for your prior studies, you may decide that the head study was not a relevant prior and miss the prior cervical spine images. I read body CT and I don t read neuro studies. How will dysect affect my workflow? images will show up in your worklist as a head study. This is not a desirable outcome, but with dysect, your worklist will show chest, abdomen and pelvis studies. You would read the chest study followed by the abdomen study and then the pelvis study. There are ways to configure dysect so that you can read the abdomen and pelvis images together under the abdomen study. In this case, you would dictate your report for abdomen pelvis and ignore the pelvis study in your worklist. If your PACS links multiple orders, you should be able to find your prior chest images without the benefit of dysect, but not before reviewing a number of irrelevant images costing you precious reading time. For example, if you are reading an abdomen CT, the prior abdomen images may be part of a multiple procedure study containing head, chest, abdomen and pelvis images, forcing you to scan through the head and chest images before you arrive at the abdomen images. If your PACS does not link the chest, abdomen and pelvis orders to the head order, you may not find the relevant priors within the PACS. For example, depending on your pre-fetch rules, the head study may be determined to be irrelevant. If you query your PACS for your prior studies, you may decide that the head study was not a relevant prior and miss the prior abdomen images. I m a general radiologist and read every CT performed at my institution. How will dysect affect my workflow? images will show up in your worklist as a head study and you read the entire study. But with dysect, your worklist will show head, chest, abdomen and pelvis studies. You would read the head study, followed by the chest study, followed by the abdomen study and then the pelvis study. There are ways to configure dysect so that you can read the abdomen and pelvis images together under the abdomen study. In this case, you would dictate your report for abdomen pelvis and ignore the pelvis study in your worklist. If your PACS links multiple orders, you should be able to find your prior images without the benefit of dysect, but not before reviewing a number of irrelevant images costing you precious reading time. For example, if you are reading an abdomen CT, the prior abdomen images may be part of a multiple 4 of 5

5 procedure study containing head, chest, abdomen and pelvis images, forcing you to scan through the head and chest images before you arrive at the abdomen images. If your PACS does not link the chest, abdomen and pelvis orders to the head order, you may not find the relevant priors within the PACS. For example, depending on your pre-fetch rules, the head study may be determined to be irrelevant. If you query your PACS for your prior studies, you may decide that the head study was not a relevant prior and miss the prior abdomen images. 5 of 5