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Understanding image markup behavior

When studies are retrieved from the PACS and saved to the  Server, markups for the study are included. The presence of the PACS markups does not impact your ability to view or create markups on  . In fact, you can use the Select Markup tool to turn off the PACS markups to focus on  markups or, conversely, turn off  markups to focus on PACS markups. Since the studies were originally viewed on a diagnostic quality workstation, there are a few regulations regarding the PACS and  markup behavior that is worth noting.

Note: Markups made on IMPAX workstations will not overwrite markups made on  . Also, markups do not display on thumbnails.

Will the markups I make on  be viewed on IMPAX workstations?

No. You can view markups from IMPAX workstations but any markups you make and save on a non-diagnostic quality workstation are not viewable on IMPAX. Unlike IMPAX,  workstations are not intended for diagnostics;  users cannot change, overwrite, or save markups to images or studies.

Are all IMPAX markups supported?

IMPAX has an extensive markup tool set and not all markups will display in  . There are a set of commonly supported markup tools that include the following:

When a study is opened with unsupported markups, a message displays at the bottom of the screen, in yellow: There are unrecognized markups.

There is a slight difference between how IMPAX and  read and interpret measurements. Since IMPAX is meant for diagnostic purposes, the measurement is exact;  is not intended for diagnostic purposes, measurements from the PACS are rounded off. For example, 10.52 mm on IMPAX is displayed as 10.5 mm on  .

* Vertical text annotation is not supported on  . Vertical text annotations made on IMPAX will display horizontally on  .

** The IMPAX ellipse displays on  as a Region of Interest Ellipse, including the following measurements: number of pixels, perimeter, area, average grays (Houndsfield units for CT), and deviation.

How can I tell the difference between  and PACS markups?

 markups are white, PACS are red.

Note: Markups on images that were retrieved from PACS previously to display as white.

Why do some old IMPAX markups displays as duplicates or not at all?

Sites that have migrated from  4.1 to 5.1 may have some residual markup restrictions. In 4.1 eight markup types are supported for display (caliper, ellipse, angle, freeform, arrow, line arrow, rectangle, and text) but only four types can be saved (caliper, ellipse, angle, and freeform). When IMPAX markups are displayed in 4.1, and new markups are added and saved, only the four supported markup types are retained with the study. If sites have Data Currency installed (a synchronization of study information between IMPAX and  ), and a study is updated, the markups will update as well; the original IMPAX markup may duplicate and display in red on top of the saved 4.1 white markup. These markup restrictions should, on the whole, work themselves out after a short period of time using 5.1.

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Can I make changes to the PACS markups?

 users cannot modify PACS markups. PACS markups are made on diagnostic-quality monitors with uncompressed images and cannot be changed by  because it is not intended for diagnostic interpretation.

Can I erase PACS markups?

You cannot remove PACS markups from studies, only  markups can be erased. If only PACS markups are displayed, the Erase tool is disabled.

How do I turn on the markups? What if I only want to see PACS markups?

The Select Markup tool provides the ability to view -only markups,  -only markups, both IMPAX and  markups, or no markups at all. Select your preference from the drop-down list next to the Select Markup tool button. Your selection is remembered only for the duration of your session. The next time you log in, you will have to make your selection again. The Select Markup tool also acts as a toggle; once you select your preference, the button is depressed or on. You can clear your selection by clicking on the button again and turning the markups off.

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In split screen mode, can I view  markups in one screen and PACS in the other?

Yes. The markups displayed on the left side of the split screen maintain focus when exiting split screen mode.

Can I view PACS markups in conference mode?

PACS markups are not viewable in conference mode.

What about Window/Levels from the IMPAX workstation?

If an IMPAX user adjusts and saves the Window/Level for an image, that Window/Level is displayed in . You can adjust the Window/Level when viewing the image on . The commonly supported Window/Levels are: Invert, Window/Level, Window/Level Reset, Window/Level Preset.

Is Rotate and Flip supported?

Flip Horizontal, Flip Vertical, Rotate 90° Right, Rotate 90° Left, and Rotate 180° are supported.  will display any Rotate and Flip changes made to the image or study on an IMPAX workstation; however,  does not support smooth rotation and instead displays rotations rounded to the nearest increment supported: 90° Right, 90° Left, or 180°. When a study is opened with unsupported rotation, a dialog displays with the following message: Rotation is not accurate.

Are IMPAX arrows supported?

 displays the Markup arrow (outline) and Markup thin arrow. Markup thick arrow will display as a Markup line arrow.

Can I view markups on MPEGs?

Markups on MPEGs are not supported. If you view the study as wavelets in Cine mode and stop the Cine player, the markups will display.

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See Also

Data Currency: key concepts