Pacs Training

1 Reminder..............................................................................................................
2 PACS ..................................................................................................................... 2
3 Logging On........................................................................................................... 3
3.1 User name and Password ................................................................................... 4
3.2 Changing Your Password ................................................................................... 4
3.3 The Worklist ......................................................................................................... 6
4 Searching ............................................................................................................ 7
4.1 Display Options ................................................................................................... 7
All Studies .............................................................................................................................. 7
All Patients ............................................................................................................................. 8
My Patients ............................................................................................................................ 8
4.2 Searching Using the Worklist Screen ................................................................ 8
4.3 Searching Using The „Perform New Query‟ button .......................................... 9
5 Search Results ................................................................................................. 10

5.1 Pictorial Index .................................................................................................... 11
5.2 External Notes and Reports.............................................................................. 12
Patient Info .......................................................................................................................... 12
Exam Info ............................................................................................................................ 13
Report .................................................................................................................................. 13
e-Learning ........................................................................................................................... 13
6 Viewing Exams .................................................................................................. 15

6.1 The Pictorial Index ............................................................................................. 16
6.2 The Viewport ...................................................................................................... 16
The left mouse button .......................................................................................................... 16
The middle mouse button (or scroll wheel) ........................................................................... 16
The right mouse button ........................................................................................................ 16
Double Click ........................................................................................................................ 17
6.3 The Toolbar ........................................................................................................ 17
7 Logging Off...................................................................................................... 27
8 Tips .................................................................................................................... 28
9 Appendix ............................................................................................................ 31
1. 1
A shared service hosted by; Health Informatics Service
South Staffordshire Healthcare NHS Trust
1 Reminder
Once you are logged into PACS, everything that you do will be
recorded.
You should only access patient information if there is a legitimate
relationship between you and the patient.
Any access to patient information that is without a legitimate
relationship is likely to be challenged by the Radiology PACS team as
this contravenes the Data Protection Act. The staff member involved
would be required to provide evidence of the legitimate relationship to
avoid disciplinary action.
2 PACS
Picture Archiving and Communications System, more commonly known
as PACS, enables images such as x-rays and scans to be stored
electronically and viewed on screens, so that doctors and other health
professionals can access the information and compare it with previous
images at the touch of a button.
For the past 100 years, film has been almost the exclusive medium for
capturing, storing, and displaying radiographic images. Film is a fixed
medium with usually only one set of images available.
PACS technology allows for a near filmless process, with all of the
flexibility of digital systems. It also removes all the costs associated with
hard film and releases valuable space currently used for storage. Most
importantly, however, PACS has the potential to transform patients'
experience of the care they receive across the NHS.
Education, Training and Development

PACS User Guide 2
3 Logging On
On your Windows desktop there will be two icons that will launch PACS:
Should you require access to both versions of PACS you will need two
separate passwords.
Double click on the icon for you organisation.
This may bring up the following message:
If this appears just click on Yes and this will take you to the password
screen.

PACS User Guide 3
3.1 User name and Password
Type in your username and password making sure that you enter it in
the correct case (i.e using capitals or not in the same way it was done
when it was set) and click Login.
Your username will be SS followed by the first three

letters of your surname and the first three letters of
your forename. For example, if your name was John
Smith your username will be:
SSSMIJOH
Once you have completed a Password Request form

(see Apendix), you will be sent your password on the
completed form.
This could be any combination of a minimum of eight
letters and numbers.
3.2 Changing Your Password
Click on the Change Password button and you will get the following
screen:

PACS User Guide 4
Type in your username, current password and then type the new
password twice in the appropriate boxes and click Login. This will take
you into the PACS System.
N.B You can change your password again in the future by following
the same procedure.
The password can by any combination of letters or numbers but

must be at least eight characters long.
If you have any problems with either your user name or your
password then you should contact either Rosie Briggs at Samuel
Johnson Hospital or Sue Archer at Sir Robert Peel Hospital.

PACS User Guide 5
3.3 The Worklist

When you have successfully logged into PACS you will be taken to the
‘Worklist’. This is the section of PACS that enables you to search for
patients’ examinations.
As soon as you reach this screen you should click the button on
the right hand side of the screen. This will make the PACS web browser
full screen and you will no longer see the Microsoft Internet Explorer
options.

PACS User Guide 6
Your screen will now appear as below:
4 Searching
4.1 Display Options
There are two different ways of searching for patients but before you
start to search you must first decide how you want the information
displayed and choose one of the following three options:
All Studies
If you were to search for your patients using the ‘All Studies’ tab the
results would be displayed as one result for each individual study.
For example, if John Smith has had five exams then John Smith would
be listed five times using the ‘All Studies’ tab.

PACS User Guide 7
All Patients
If you were to search for your patients using the ‘All Patients’ tab the
results would displayed as just one result per patient that when clicked
will show all of the studies.
For example, if John Smith has had five exams then John Smith would
be listed just once. However, if you were to click on his name then all
five exams would be listed beneath.
My Patients
The radiographer or radiologist who performs the exam will be able to
search for patients in this section. Anybody else, however, will not be
able to.
4.2 Searching Using the Worklist Screen
You can search for your patients by typing the required criteria into the
white boxes underneath each of the headings on the worklist. You can
either search just using one criterion or a number of criteria.

PACS User Guide 8
Once you have filled in the required boxes press the „Enter‟ key on
your keyboard and the search results will be displayed:
4.3 Searching Using The ‘Perform New Query’ button
On your toolbar at the top of your screen you will see a button.
Click this button once and the following screen will appear:

PACS User Guide 9
Type the required criteria into as many boxes as you need to and click
the „OK‟ button. This will return your results in the same way as before.
5 Search Results
Once you have searched for your patient or exams there are a number
of options you have available to you before looking at the x-ray.
The screen is split up into three main sections:
Worklist
Pictorial Index
External Notes
and Reports

PACS User Guide 10
5.1 Pictorial Index

If your search has been successful and you have found the patient or
exam you want to view, clicking on the patient’s name once will
highlight it in blue:
As soon as you do that you will see small versions of all of the images
in this exam (thumbnails) in the pictorial index section of the screen:
Exam Information
This area tells you the name of
the exam (typically it will tell Patient Information
you which part of the body the Name and ID number is taken
exam relates to and what type from the RIS system.
of exam it was e.g. XR Ankle

LT for an x-ray of the left
Series Information
ankle), what date and time the
This area tells you a little
exam was taken and how
information about this series of
many series there are in this
images, for example, how
exam (a series is a set of
many images there are in this
images)
series.
Thumbnails

PACS User Guide 11
The pictorial index will stay open throughout your usage of PACS and
will always display the same information for the exam you are viewing.
If you wish to hide the pictorial index (i.e. change your screen so that
the pictorial index is not shown), you will need to click the button
located in the top right hand corner of the pictorial index.
N.B. Once it is hidden you need to click the same button to unhide
the pictorial index.
5.2 External Notes and Reports

In this section of the screen you are presented with four options:
Patient Info
On this screen you are able to see some information regarding the
patient e.g. name, address, allergies etc.:

PACS User Guide 12
Exam Info
This is the area that you can view information regarding the exam itself
such as where the exam was taken and who the referring physician
was:
Report
Using the ‘Report’ tab you will be able to view and print off any reports
that are attached to this exam.
e-Learning
e-Learning is an online course all about PACS. When you click on the
tab you may or may not be presented with a security message:

PACS User Guide 13
If you do see this message, simply click ‘Yes’ and you will be taken to
the e-Learning section of PACS.
As the External Notes and Reports section of the screen is very small it
will be necessary to expand this before viewing the e-Learning. To do
this you must hover your mouse over the blue bar that separates the
External Notes and Reports section with the Worklist section. When you
do this your mouse pointer will become a double headed arrow:
Click and hold the left mouse button and drag your mouse upwards to
expand the screen. You will now see the e-Learning software at a
viewable size:
There are three

levels to this course.
Level one lasts 30
minutes, level two
lasts one hour and
level three which
lasts two hours.
If you choose level
three you will not
need to complete
the other two as all
of the information is
included.

PACS User Guide 14
Once you have completed the course it will be necessary to return the
screen to it’s normal proportions by using the same drag and drop
technique as earlier.
As soon as you have finished with the External Notes and Reports
section click the button on the top right hand side of this section to
hide it.
N.B. You can print the information from the Patient Info, Exam
Info and Report tabs at any time by clicking the button on the
top right hand corner of this section.
6 Viewing Exams
When you have located the correct patient and exam double click on
the exam on the worklist screen to be taken to the viewing screen:
Pictorial Index
Toolbar
Viewport

PACS User Guide 15
6.1 The Pictorial Index
When in the viewing section of PACS you can click on any thumbnail
once to display the large image in the viewport.
6.2 The Viewport
The viewport is the name given to the area of the screen where the
image is displayed. There are a number of options available to you in
the viewport simply by using your mouse.
The left mouse button

Move your mouse onto the image and click and hold down your left
mouse button. As you move your mouse the image on the screen will
start to move with it.
The middle mouse button (or scroll wheel)

Move your mouse onto the image and click and hold down the middle
mouse button (or scroll wheel). As you move your mouse away from
you in a forwards motion the image will zoom out and become smaller;
as you move your mouse towards you in a backwards motion the image
will zoom in and become larger.
The right mouse button

Move your mouse onto the image and click and hold down the right
mouse button. As you move your mouse in all directions you are
changing the ‘window’ levels i.e. the contrast and the brightness of the
image on the screen.

PACS User Guide 16
Double Click
Double clicking your mouse on the image will make the image almost
full screen. To return it to normal, double click on the image again.
6.3 The Toolbar

The toolbar contains a number of buttons each that performs a different
function.
Worklist
This button returns you to the worklist where you may

choose another exam to view or search again.
Previous Worklist Item
This button will take you to the previous item on the worklist. If
there are no previous worklist items this button will be ‘greyed out’ and
you will not be able to use it.
Next Worklist Item
This button will take you to the next item on the worklist. If there are
no further worklist items this button will be ‘greyed out’ and you will not
be able to use it.
View Previous Images
This will show the previous image in the series in the viewport.

PACS User Guide 17
View Next Images
This will show the next image in the series in the viewport.
Historical Exams
You should use this button to compare your current study with a
study created in the past. When you click on the button you will be
presented with a list of the patient’s previous exams on the PACS
system. When you have chosen your historical exam to compare the
current study with they will be displayed side by side in the viewport:
The historical study also appears in the pictorial index.

PACS User Guide 18
Single Series Area
This will return your viewport to a single series view. When you are
comparing two exams your viewport is in a double series view; to return
to single series click once on the series you want to keep (it will then
have a yellow border around it), then click this button.
Two Vertical Series Area
When viewing two series this button will display them side by side.
Two Horizontal Series Area
When viewing two series this button will display both images with
the divider running from left to right across the middle of the screen.
Window Level Preset
For different images there are different window levels that will
display the image in the best possible way for viewing. PACS has some
preset window levels for different parts of the body. To choose from the
presets click on the black arrow to the right of this image and choose
your preset from the menu:
Choose the relevant option from the menu to

apply it to your viewport.

PACS User Guide 19
ROI (Region of Interest) Window Tool.
Clicking on this button will display a green box on the image:
This is the region of interest window tool. By clicking and holding down
your mouse within the box you can move it around your image; as you
do PACS will automatically detect the best window setting for that part
of the image and adjust the whole image so that it matches that setting.
You can also make the ROI window tool larger or small by positioning
your mouse on the green line on any side of the box so that your pointer
becomes a double headed arrow, click and drag your mouse in either
direction to shrink or expand the box.
Once you have finished with the ROI window tool you can move it off
the right hand side of the window or press the button which will
revert the image to it’s original state.

PACS User Guide 20
Zoom
This is a magnifying tool. To choose from the different magnifying

options you need to click the black triangle to the right of this button:
 Zoom to fit - makes the image as large as it can be within the

limitations of the screen.
 Zoom Relative 2x – this will make the image double it’s original size.
 Original Resolution – as the image is of such high quality it‘s actual
size is much too large to view on a regular PC screen. However some
monitors are large enough and this option would display the image in
it’s actual size.
 Zoom Absolute 2:1 – this displays the image at twice it’s actual size.

PACS User Guide 21
 Display magnifying glass – this enables the magnifying glass tool:
You can move the magnifying glass around the screen by clicking and
holding your mouse down on it and moving your mouse. This will
display a real time magnification of any area you hold the magnifying
glass over.
Along the bottom of the magnifying glass is a sliding scale; move this
slider from left to right to zoom in further.
Once you have finished with the magnifying glass, click on the red cross
at the top right hand corner of the tool and it will disappear.
N.B. Whichever option you last chose from the Zoom menu will now
be the function of the button until you log out. For example if you
used the magnifying glass last the button will now look like this:
and clicking it would reopen the magnifying glass. For the

other options you will need to click the black arrow again.

PACS User Guide 22
Flip
Clicking on this button will flip the image horizontally. However

there are numerous options for flipping the image and these can be
accessed by clicking the black arrow next to the button:
 Flip horizontally – see above.

 Flip vertically – flips the image vertically.
 Rotate left / Rotate right – this option rotates the image at 90° a time.
N.B. As with the zoom button the most previous option you choose
will now be the function of that button until you log out.
Distance
When you click on this button a ruler will display on the image:
You can move either of the two green crosses by clicking and dragging
them to anywhere on the image. As you do the measurement in
millimeters will automatically update.
Once you have finished with the distance tool you can move it off the
right hand side of the window or press the button which will
PACS User Guide 23
Angle
When you click on this button the angle tool will be displayed on the
image:
You can move any of the green crosses to anywhere on the screen by
clicking and dragging them; PACS will automatically calculate the angle
between the two extreme crosses.
Once you have finished with the angle tool you can move it off the right
hand side of the window or press the button which will revert
the image to it’s original state.
Cobb Angle
Clicking on this will display the cobb angle tool on the image:
You can click and drag either of the two green circles and either of the
two green crosses to anywhere on the screen and PACS will
automatically calculate the angle between the two lines.

PACS User Guide 24
Once you have finished with the cobb angle tool you can move it off the
right hand side of the window or press the button which will
Reset
This button resets the image to how it was originally therefore

cancelling any changes you have made or annotations you have added.
Select quality
This button changes the quality of the image.
N.B. There are only two settings to this button and it is very
unlikely that you will notice any difference on a low resolution (i.e. a
regular PC) monitor.
Scope
You can use this tool to link (scope) images together so that any
changes you make to one will happen to all of the scoped images. You
have four different options available by clicking the black arrow:
 Scope Image - Only the currently selected image will be affected.

 Scope Series - All the images in the same series will be affected by
any changes you make.
 Scope Study - All the images in all the series in the study will be
affected.
PACS User Guide 25
 Scope All - All the studies currently open will be affected in the same
way.
N.B. As with the zoom button the most previous option you choose
will now be the function of that button until you log out.
Include study link in e-mail
Clicking on this button will open Microsoft Outlook (or Outlook

Express if Outlook is not available) and start a new e-mail that includes
a hyperlink to this current study.
When you send that e-mail to a current PACS user they will be able to
click your link and be taken directly to that study.
N.B. The person you send the e-mail to must be a PACS user as they
will be prompted for their username and password before being
able to view the study.
Staff who use Healthcare to access their Windows desktop and e-

mail will not be able to use this function as normal. Upon clicking
this button Outlook Express will open and you must then copy and
paste the link into your own e-mail program before sending it.

PACS User Guide 26
7 Logging Off
When you are ready to log off and close click the button in the top
right hand corner of the screen.
When you click the log off button you will see the following:
Click OK to exit PACS and close the browser or Cancel to continue

using it.
N.B. If you did not click the button at any point and you are not
running in full screen mode you will not see the Log Off button. Go
to full screen and then click Log Off.

PACS User Guide 27
8 Tips
There is no way to save your actions on PACS – it is for viewing only.
As soon as you choose to log off all of the changes you have made will
be reset and the images will stay as normal. This means that it is not
possible for the user to cause any damage to PACS – so feel free to
explore. Here are some tips you may find useful.
 In the search query box you can type the words ‘TODAY’ or
‘YESTERDAY’ in the Study Date search box as opposed to the actual
date:
N.B. You should combine the TODAY or YESTERDAY search with

another criteria such as referrer code or you will return so many
results that it would be unmanageable.
 You can refresh your query at anytime in worklist view by clicking the
button in the top left hand corner of the screen. This will run your
search again with exactly the same criteria.

PACS User Guide 28
Help! To access the PACS online help you can click the button in
the top right hand corner of the screen:
Follow the on screen

instructions to use Help.

It is also possible to
access e-Learning from
Help.
This will open e-Learning
as a full screen browser.

PACS User Guide 29
There are more options available to more advanced PACS users and
you can access these by adding more toolbar buttons. To do this click
on the button in the top right hand corner of the screen. You will
be presented with three options:
Basic – You only have the most basic buttons to use PACS such as
Worklist and Log Off.
Modality Dependent – This is the default setting and all of the buttons
will be set out as in this manual.
All – You will now have every option available to you:
To find out how to use these extra options please refer to Help.
N.B. When displaying ‘All’ of the buttons some options will be

disabled therefore will not work and some options may not have a
function while viewing x-rays.

PACS User Guide 30
9 Appendix
PASSWORD REQUESTS FOR SSPCT PACS ACCESS
Clinician Requiring Access
Hospital Site PACS requested for:
Full Name:
Role/Job Title:
Professional Registration number (e.g.GMC,PH,RA,N number):
Employing Organisation:
Email Address:
Telephone Number:
Clinical justification for access:

[Provide clinical use case(s) of why user access is justified]
I can confirm the user has undertaken appropriate PACS training to ensure patient safety
and confidentiality.
Training:
PACS Web Training completed: [Date]……………………………..
Managers Name……………………………Signature……………………….
Designation………………………………….
Please ensure that you keep a record of your chosen PASSWORD on

this document in your files.
For Official Use only.
USER NAME ISSUED:
PASSWORD ISSUED:
When the password is entered the message “password expired” mayl

appear. Use the change password routine to enter a password of your
own choice
N.B. Both user name and password must be in UPPER case and a minimum
of 8 characters is required for the password..
If you have any problems with the system please contact the Radiology
departments at Sir Robert Peel or Samuel Johnson Hospitals. If you require
any PACS training please contact the training department who have a
designated PACS trainer.
1. 31

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1 Reminder..............................................................................................................

5 Search Results ................................................................................................. 10

6 Viewing Exams .................................................................................................. 15

Education, Training and Development

Double click on the icon for you organisation.

This may bring up the following message:

Education, Training and Development

3.1 User name and Password

Your username will be SS followed by the first three

Once you have completed a Password Request form

3.2 Changing Your Password

Education, Training and Development

The password can by any combination of letters or numbers but

Education, Training and Development

3.3 The Worklist

Education, Training and Development

Your screen will now appear as below:

Education, Training and Development

4.2 Searching Using the Worklist Screen

Education, Training and Development

4.3 Searching Using The ‘Perform New Query’ button

Education, Training and Development

Education, Training and Development

5.1 Pictorial Index

exam relates to and what type from the RIS system.

of exam it was e.g. XR Ankle

Education, Training and Development

5.2 External Notes and Reports

Education, Training and Development

Education, Training and Development

There are three

Education, Training and Development

Education, Training and Development

6.1 The Pictorial Index

6.2 The Viewport

The left mouse button

The middle mouse button (or scroll wheel)

The right mouse button

Education, Training and Development

6.3 The Toolbar

This button returns you to the worklist where you may

Previous Worklist Item

Next Worklist Item

View Previous Images

Education, Training and Development

View Next Images

The historical study also appears in the pictorial index.

Education, Training and Development

Single Series Area

Two Vertical Series Area

Two Horizontal Series Area

Window Level Preset

Choose the relevant option from the menu to

Education, Training and Development

ROI (Region of Interest) Window Tool.

Clicking on this button will display a green box on the image:

Education, Training and Development

This is a magnifying tool. To choose from the different magnifying

 Zoom to fit - makes the image as large as it can be within the

Education, Training and Development

 Display magnifying glass – this enables the magnifying glass tool:

and clicking it would reopen the magnifying glass. For the

Education, Training and Development