LocalEye Viewer, version 10

User Manual
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

Table of Contents
1 ABBREVIATIONS ................................................................................................................................................... 4

2 INDICATIONS FOR USE ....................................................................................................................................... 4

3 INTRODUCTION .................................................................................................................................................... 4

4 MAIN MENU ............................................................................................................................................................ 6

4.1 SAVE/EXPORT...................................................................................................................................................... 6
4.1.1 Exporting to local disk... ............................................................................................................................. 7
4.1.1.1 Export DICOM files to local disk .............................................................................................................................7
4.1.1.2 Export images in JPG format to local disk................................................................................................................9
4.1.1.3 Export series in AVI format to local disk ...............................................................................................................10
4.1.2 Copying images to the system clipboard ................................................................................................... 10
4.2 SETTINGS ........................................................................................................................................................... 11
4.3 VIEW ................................................................................................................................................................. 12
4.3.1 Basic viewing preferences ......................................................................................................................... 12
4.3.2 Viewing preferences for reference lines .................................................................................................... 15
4.4 HELP .................................................................................................................................................................. 16

5 STUDY PANELS .................................................................................................................................................... 17

6 TOOLBAR ACTIONS ........................................................................................................................................... 18

6.1 FINDING PATIENTS / STUDIES ............................................................................................................................. 19

6.2 ASSOCIATION OF TOOLS WITH MOUSE BUTTONS ................................................................................................ 22
6.2.1 Select/Stack image .................................................................................................................................... 25
6.2.2 Zoom area ................................................................................................................................................. 25
6.2.3 Magnifier .................................................................................................................................................. 25
6.2.4 Pan image ................................................................................................................................................. 26
6.2.5 Shutter ....................................................................................................................................................... 26
6.2.6 Window / Level.......................................................................................................................................... 26
6.2.7 Select annotation....................................................................................................................................... 27
6.2.8 Measurement tools .................................................................................................................................... 28
6.2.8.1 Calibrate measurements ..........................................................................................................................................28
6.2.8.2 Measure distance ....................................................................................................................................................29
6.2.8.3 Measure horiz/vert distance ....................................................................................................................................29
6.2.8.4 Measure distances and angles .................................................................................................................................30
6.2.8.5 Measure rect area ....................................................................................................................................................31
6.2.8.6 Measure ellipt area ..................................................................................................................................................32
6.2.8.7 Measure angle (mode 1)..........................................................................................................................................33
6.2.8.8 Measure angle (mode 2)..........................................................................................................................................33
6.2.8.9 Measure density ......................................................................................................................................................34

2
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

6.2.9 Stack image (mouse wheel) ....................................................................................................................... 34

6.2.10 Zoom image (mouse wheel) ...................................................................................................................... 35
6.3 RESETTING OPERATIONS ON IMAGES ................................................................................................................. 35
6.4 SHOWING IMAGE INFORMATION......................................................................................................................... 35
6.5 ZOOMING IMAGES .............................................................................................................................................. 37
6.5.1 Zoom in ..................................................................................................................................................... 38
6.5.2 Zoom out ................................................................................................................................................... 38
6.5.3 Zoom to fit ................................................................................................................................................. 38
6.5.4 Zoom reset ................................................................................................................................................ 38
6.6 MANAGING IMAGE CONTRAST ........................................................................................................................... 38
6.6.1 Invert ......................................................................................................................................................... 39
6.6.2 Auto window ............................................................................................................................................. 39
6.7 ROTATING AND FLIPPING IMAGES ...................................................................................................................... 39
6.7.1 Rotate +90°............................................................................................................................................... 39
6.7.2 Rotate -90° ................................................................................................................................................ 40
6.7.3 Flip horizontally ....................................................................................................................................... 40
6.7.4 Flip vertically ............................................................................................................................................ 40
6.8 MANAGING KEY IMAGES.................................................................................................................................... 40
6.8.13 View 'key' images in current study ............................................................................................................ 40
6.9 VIEWING REPORTS ............................................................................................................................................. 40
6.10 CUSTOMIZING SERIES AND IMAGE LAYOUT ........................................................................................................ 42
6.11 MANAGING SYNCHRONIZED SCROLLING OF SERIES............................................................................................ 44
6.12 SHARING A STUDY WITH A REMOTE RECIPIENT .................................................................................................. 45
6.13 CINE PLAYBACK OF DYNAMIC SEQUENCES ........................................................................................................ 52
6.14 NAVIGATING AMONG AVAILABLE SERIES .......................................................................................................... 53

7 HANGING STEPS AND STUDY VIEW PRESETS ........................................................................................... 54

8 ON-IMAGE POPUP MENU.................................................................................................................................. 55

9 THUMBNAILS PANEL......................................................................................................................................... 56

10 HOW TO REPORT ISSUES ................................................................................................................................. 57

11 ACKNOWLEDGMENTS ...................................................................................................................................... 57

3
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

1 Abbreviations

Abbreviation Description

DICOM Digital Imaging and COmmunications in Medicine

DLL Dynamic Link Library
DPI Dots Per Inch
GUI Graphical User Interface
HTML Hyper Text Markup Language
HTTP Hyper Text Transfer Protocol
JAI Java Advanced Imaging
JRE Java Runtime Environment
JWS Java Web Start
LAN Local Area Network
LUT Look-Up Table
PACS Picture Archiving and Communication System
PC Personal Computer
RAM Random Access Memory
SR Structured Report
TCP Transfer Control Protocol
URL Uniform Resource Locator

2 Indications for use

The LocalEye Viewer software product is intended to be used as a medical image viewer to
visualize and review medical multi-modality image data stored on a portable medium (CD, DVD, USB stick,
etc.) in DICOM format, as well as eventual related reports.
LocalEye Viewer is NOT intended for diagnostic reading and reporting of medical exams.
Typical users of LocalEye Viewer are trained healthcare professionals, including but not limited to
radiologists, physicians, nurses and technicians.

3 Introduction
The following chapters explain the user features available from the LocalEye Viewer's Graphical
User Interface (GUI) and how to exploit the capabilities of this system.

The LocalEye Viewer's GUI is composed of the following main panels and toolbars:

 Main menu bar: this top menu bar allows accessing the main functionalities of the viewer.

 Top, and left and right toolbars: these toolbars contain buttons which correspond with actions
available within the viewer. Example of such actions are: patients/studies search, association of tools

4
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

with mouse buttons, image manipulation functions, display layout configuration functions, reporting
functions, etc.
In LocalEye Viewer’s default configuration, there are no buttons configured for the left toolbar, so the
GUI will appear with just a top toolbar and a right toolbar.

 Study panel(s): each study loaded in LocalEye Viewer is displayed in its own dedicated study panel.
By default, multiple study panels are arranged in a "tabbed" fashion. However, it is possible to
manually drag the tab title of each study panel to arrange and dock the panel according to the user's
preference (e.g., in a side-by-side fashion). A study panel contains one or more series panels,
depending on the “series tiling” (or series layout) currently set on that study panel.

 Series panel(s): each study panel contains one or more series panels, depending on the series tiling
currently set on the study panel. Each series panel contains and shows images belonging to a given
series or sequence. In turn, each series panel contains one or more image panels, depending on the
“image tiling” (or image layout) currently set on that series panel.

 Thumbnails panel: this panel displays thumbnail images. The thumbnails may represent the
available series or all available images, depending on the user’s choice. This thumbnails panel can
be dragged (through the panel’s title bar) to a different position within the viewer’ window, and can
be arranged either vertically or horizontally, according to user’s preference.

 Bottom bar: this thin bar located at the bottom of the viewer’s window contains several context-
specific tools and information. In the left edge, it shows the currently-active mouse tool. Next to the
currently-active tool, it shows the tool options panel related to this currently-active tool, showing the
options and information related to this tool. Hence, the content of this tool options panel changes
according to the currently-active mouse tool. Then, in the right portion of the bottom bar we can find
the hanging steps / hanging views selection and iteration panel. Finally, in the right edge of the
bottom bar we can find the viewer jobs panel, showing the progress of eventual active jobs within the
viewer (e.g., a loading operation).

The following picture shows a screenshot of LocalEye Viewer's GUI, with the main panels clearly shown:

5
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The following sections provide a detailed description of each element of the GUI, as well as of the related
features.

4 Main menu

4.1 Save/Export
Here is a screenshot of the Save/Export menu:

The functions reachable through this menu allow exporting content (typically, images, but also other DICOM
content) outside of the viewer application.

6
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

4.1.1 Exporting to local disk...

The Export files / images to local disk… menu item can be used to export currently-loaded files /
images to the local file system or to save to the local file system modifications and settings made on images.
If you select the Export files / images to local disk… menu item, the Export files and images to local dialog
box will appear, as shown in the following picture:

Through this dialog, user can select which output format to use for the "export to local disk" operation.

4.1.1.1 Export DICOM files to local disk

The Export DICOM files to local disk page can be displayed by selecting the DICOM format item from
the left-hand list:

7
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

This page can be used to export currently-loaded DICOM images to the local file system, or to save to the
local file system modifications and settings made on images, through the Presentation State or Key Object
Selection DICOM objects.
Through this dialog, user can select which series (among the loaded ones) need to be included in the "export
to local" operation.
User can also choose to select all series pressing the Select all series button or to deselect all series
pressing the Deselect all series button.
On the Export DICOM files to local disk page, you can choose to export the original DICOM files of the series
which have been selected in the top list. You can also choose whether to create and export new
Presentation States for the selected series. Presentation State objects are able to save and store all settings
performed by the user on the medical images, including contrast settings, rotation, flipping, annotations, etc.
They don’t contain the image, but only the transformations to be applied to images. They are the preferred
way to save all modifications and annotations performed on the displayed DICOM images. Usually, the
Presentation State files are quite small in size, so the store operation is efficient. In addition, you can choose
whether to export the selections of Key Images for the selected series: this option allows supporting
persistence of the Key Image information, which can be maintained the next time the study will be loaded.
When the Export as DICOM button is pressed, a Save file dialog is shown, through which the user will be
able to select the path to be used to save the appropriate DICOM files.

8
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

4.1.1.2 Export images in JPG format to local disk

The Export images in JPG format to local disk page can be displayed by selecting the JPEG format
item from the left-hand list:

This page can be used to export currently-loaded medical images to the local disk in JPEG format; it allows
selecting which images need to be exported in JPEG format, as well as the quality and resolution of the
JPEG images to be created.
Also, by selecting the Crop images to displayed area option, it is possible to crop images to be exported to
the portion which is visible in the currently displayed area. This option is only available when the export
selection is set to Current image or Current series.
When the Export as JPG button is pressed, a Save file dialog is shown, through which the user will be able
to select the path to be used to save the appropriate JPEG files.

Warning: the supported JPEG export format is a lossy compression format. Even if a “100 %” quality
is specified, the output image is still lossy.

9
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

4.1.1.3 Export series in AVI format to local disk

The Export series in AVI format to local disk page can be displayed by selecting the AVI format item
from the left-hand list:

This page can be used to export currently-loaded series to the local disk in AVI format, as movies; it allows
selecting which series need to be exported in AVI format, as well as quality and frame rate of the AVI movie
to be created.
Also, by selecting the Crop images to displayed area option, it is possible to crop images to be exported to
the portion which is visible in the currently displayed area. This option is only available when the export
selection is set to Current series.
When the Export as AVI button is pressed, a Save file dialog is shown, through which the user will be able to
select the path to be used to save the appropriate AVI files.

4.1.2 Copying images to the system clipboard

LocalEye Viewer supports a set of Copy to clipboard functions, which allow copying medical
images to the system clipboard.

10
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The "Copy screenshot..." set of functions perform a real snapshot of the content of the on-screen display
panels, and copy it to the system clipboard. This implies that in this case the images copied to the system
clipboard have the same pixel size as the related on-screen display panels, hence they are influenced by the
current screen resolution and display mode.
On the other side, the remaining "Copy ... to clipboard" functions copy the medical images to clipboard at
their original pixel size / resolution.
The Ctrl+C keyboard shortcut may be used to copy a screenshot of the current image panel to the system
clipboard.

4.2 Settings
Here is a screenshot of the Settings menu:

This menu allows directly selecting a set of preferences on the scope of the operations which can be
performed on the images.
Zoom operations can be applied to a single image panel, to a series panel or to the study panel; whereas
contrast, geometric and enhancement operations can be applied to a single image, to a series or to the
entire study, depending on the user's preference.

11
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

4.3 View
Here is a screenshot of the View menu:

This menu allows specifying several viewing preferences about what shall be displayed and what shall be
hidden on the image panels of the viewer.

4.3.1 Basic viewing preferences

The Display text overlays menu item allows enabling and disabling the display of textual overlays on
the medical images shown on screen. These text overlays contain fundamental information about each
image, such as Patient ID, Patient name, Patient sex, Patient birth date, Study date, Study description,
Modality used for acquisition, and other acquisition parameters. These acquisition parameters may
sometimes be modality-specific. The specific data fields to include into text overlays related to each kind of
image can be entirely configured in the Text overlays configuration page of the viewer settings.

The Display stack widget menu item controls display on each image of a widget allowing to quickly scroll
across frames of a series, as well as to enable the "thick slab" mode on the original series, as long as the
series represents a volume inside the patient's body (typically, CT or MR series):

12
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

When the "thick slab" mode is disabled, the user will be allowed to scroll the series by dragging the white
cursor labelled with the image number. Moreover, a double click on the cursor will allow the user to manually
set the frame he wants to display:

The "thick slab" mode can be enabled by vertically dragging the horizontal line located next to the white
cursor:

The thickness of the "thick slab" will vary depending on the dragging operation.

13
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

When the "thick slab" mode is enabled, users will be allowed to change the projection algorithm for the slab
by clicking on the box located underneath the widget (MIP, AvgIP or MinIP algorithms are available). Thick
slab mode can be turned off by double-clicking on the central reference line. Finally, a double click on the
horizontal lines which mark the end of the extent of the thick slab on the widget will allow user to manually
set the slab thickness parameters:

The Display annotations menu item allows enabling and disabling the display of measurement and graphical
annotations over all the displayed images.

The Display orientation markers menu item allows enabling and disabling the display of orientation markers,
normally available on CT and MR images, and sometimes on other kinds of images. If the image orientation
information is present inside the related DICOM image file, the orientation markers will be displayed at the
four edges of each DICOM image. The orientation will be indicated as:

 A: Anterior
 P: Posterior
 I: Inferior
 S: Superior
 L: Left
 R: Right

Warning: the orientation markers are information generated by a software algorithm. As such, their
correctness depends on the correctness of several information stored in the original DICOM
datasets, in addition to the correctness of the implemented algorithm. The viewer itself has no mean
to ensure these input data are correct. Hence, orientation markers shall be checked and treated in a
very “critical” way by the user/radiologist, and any conclusion coming from the orientation markers
shall be carefully evaluated.

The Display rulers menu item allows enabling and disabling the display of on-screen rulers showing actual
distances over the displayed images. The rulers show a short tick every 1 cm on the image, and a longer tick

14
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

every 5 cm on the image. Rulers will only be displayed on images having the appropriate calibration
information inside the related DICOM image file.
The Display grid menu item allows enabling and disabling the display of an on-screen reference grid, which
is shown on top of the medical image(s), like this:

The Grid options menu item allows setting the distance between consecutive lines (i.e., the step) of the grid.

4.3.2 Viewing preferences for reference lines

Reference lines show intersections of the currently-selected image plane with all other image planes
shown in the non-selected image panels. Reference lines are only available when the DICOM header
provides enough information on the positioning, orientation and pixel spacing of each medical image in the
3D patient-related coordinates system. Normally, this happens for CT and MR images.
The Display current reference line menu item allows enabling and disabling the display of reference lines
related to the currently selected image on all other displayed and intersecting series. A reference line

15
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

indicates the location of an image slice (the currently selected image) on another image of an intersecting
plane.
The Display first/last reference lines menu item allows enabling and disabling the display of reference lines
related to the first and last image of the currently selected series.
The Display all reference. lines menu item allows enabling and disabling the display of reference lines
related to all images of the currently selected series.
The following picture shows an example of how reference lines look like on a MR study:

Warning: reference lines are generated by a software algorithm. The correctness of their location
and geometry depends on the correctness of several positioning, orientation and spacing data stored
in the original DICOM datasets, in addition to the correctness of the implemented algorithm. The
viewer itself has no mean to ensure these input data are correct. Hence, reference lines displayed on
the images shall be checked and treated in a very “critical” way by the user/radiologist, and any
conclusion coming from reference lines shall be carefully evaluated.

4.4 Help
Here is a screenshot of the Help menu:

16
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The Online help menu item allows accessing the application’s user manual. A suitable PDF reading software
will need to be available on the client machine in order to ensure proper functionality of this feature.
Pressing the About this software menu item, the “About this software” dialog box will appear, showing
information about the current software version in use:

5 Study panels
In LocalEye Viewer, each loaded study is displayed in its own dedicated study panel, which in turn
contains one or more series panels. The number and layout of series panels contained in the study panel
depends on the series tiling setting (i.e., the number of series columns and series rows), which can be set by
acting on the appropriate toolbar button, as detailed in the following chapter.
Once the study is open, and several series are displayed on screen, you can maximize a given series (thus
switching to 1x1 series tiling and 1x1 image tiling) by double-clicking on it when the Select/Stack tool is
associated with the double-clicked mouse button. Then, when you are done with this image, you can double-
click again on it in order to return to the previous display mode, and all previously displayed images will be
restored on screen.

17
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

By default, multiple study panels (corresponding to multiple open studies) are arranged in a "tabbed" fashion.
However, it is possible to manually drag the tab title of each study panel to arrange and dock the panel
according to the user's preference (e.g., in a side-by-side fashion).
In addition, by right-clicking on the tab title related to a study panel, the following drop-down menu will
appear:

As can you see, this menu allows user to arrange study panels on screen in some different ways: study
panels can be grouped together in a tabbed fashion, they can be tiled horizontally or they can be tiled
vertically.

6 Toolbar actions
Toolbars are now entirely configurable in LocalEye Viewer, through the dedicated section of the
Viewer settings. Hence, toolbars can contain virtually any button associated with any action defined and
available within LocalEye Viewer.
Due to this flexibility, your toolbar(s) may differ also substantially from the toolbars shown in the following
sections of this manual. However, the following paragraphs will describe all the main actions which may be
typically assigned with toolbar buttons, obviously including the actions associated with the default toolbar
buttons configuration.
Here is how the top toolbar and the right toolbar appear in a typical default configuration:

18
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The left toolbar is empty, hence hidden, in the default configuration.

6.1 Finding patients / studies

The Patients / Studies toolbar button ( ) can be used to search for available patients or
studies.
If you press the Patients / Studies button, the Find Patients or Studies window will appear, as shown in the
following picture:

19
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

This window shows all available studies, series and images.

Depending on the current user's selection, the tree view may display a “Patient / Study / Series / Image”
hierarchy (Patient-root view) or a “Study / Series / Image” hierarchy (Study-root view).
You can double-click on a patient, study, series or image node (for each operation a massage asks how you
would like to combine the new loaded studies with the existing ones):

 Double-clicking on a patient node (only possible with Patient-root view) will cause loading all studies
belonging to that patient. A confirmation for such operation is asked by LocalEye Viewer;
 Double-clicking on a study node will cause loading all series belonging to that study;
 Double-clicking on a series node will cause loading all images belonging to that series;
 Double-clicking on an image node will cause loading just that image.

A powerful search filter is also provided to facilitate the search of a particular patient, study or series.
The user may specify a value for a given search parameter, then press the Filter button: the “Patient / Study /
Series / Image” hierarchy will be filtered and only those nodes matching the search parameter(s) will be
displayed. In particular, the following search parameters are supported:

 Patient Name

20
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

 Patient ID
 Patient birthdate
 Modality
 Study Description
 Accession Number
 Referring Physician
 Study Date
 Study Status (Read, Dictated, Transcribed, Report present, Report complete, Verified - some study
statuses are only available when a specific type of reporting is enabled)
 Calling AE Title (only available with the “query” integration model)
 Called AE Title (only available with the “query” integration model)

You can apply a previously-saved filter (if any) using the Apply saved search filter drop-down list. Also, you
can delete the currently-selected filter, with the Delete preset filter button.
It is possible to clear/reset all the currently-set search parameters by pressing the Clear Filter button. On the

other side, you can reset each individual search parameter by pressing the small “X” button ( ) located
next to each search field.
With the Save current filter as... button you can save the current set of search parameters, and assign an
identifying name to this preset. The newly-saved search filter will be added to the drop-down list located at
the top of this Find panel.
The Load selected button allows loading the selected studies.
Holding down the Ctrl button of the keyboard, you can select several studies at the same time.
If the checkbox Auto-close window upon load is checked, the Find Patients or Studies window will be
automatically closed after a load operation is triggered on this view.
Clicking on the arrow-shaped drop down button located next to the Patients / Studies toolbar button

( ), a drop down menu containing the other studies (both older and newer) related to the current
patient will appear, allowing to speed up the patient's studies search. See the following picture:

21
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

6.2 Association of tools with mouse buttons

LocalEye Viewer supports a completely flexible association between mouse buttons and image
manipulation tools.
In particular, the following toolbar buttons may be used to associate a tool with the left mouse button, the
mouse wheel and the right mouse button:

When moving the mouse pointer over each one of the above toolbar buttons, a tooltip text will appear,
providing additional information about the function of the button.

The Associate tool with LEFT mouse button toolbar button ( ) can be used to associate an image
manipulation tool with the left mouse button. If you press this toolbar button, the following drop-down menu
will appear:

22
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The Associate tool with RIGHT mouse button toolbar button ( ) can be used to associate an image
manipulation tool with the right mouse button. If you press this toolbar button, the same drop-down menu as
above will appear.
Each available image manipulation tool can be independently associated with the left mouse button and with
the right mouse button. All combinations of left / right mouse button tools are supported.

The Associate tool with mouse WHEEL toolbar button ( ) can be used to associate Stack image or
Zoom image tools with the mouse wheel. If you press this toolbar button, the following drop-down menu will
appear:

This flexible functionality implies that each single image tool is always usable with a single mouse button. For
instance, the Poly line (annotation) tool allows drawing a poly-line with a single mouse button; double-click of
the associated mouse button must be used to conclude the shape.
The icon of the tool currently associated with the left and right mouse buttons will appear in the next to the
left, right and wheel mouse button icons.
In addition to using these toolbar buttons, there are also other ways to associate tools to mouse buttons:

 By CTRL + right-clicking over an image panel, the following contextual menu will appear:

23
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

Using the Associate tool with LEFT mouse button, Associate tool with mouse WHEEL and Associate
tool with RIGHT mouse button menu items, you are able to change the association between mouse
buttons and tools.

 By SHIFT + left-clicking, the viewer directly shows the popup menu to associate a tool with the left
mouse button. By SHIFT + right-clicking, the viewer directly shows the popup menu to associate a
tool with the right mouse button. By SHIFT + wheel-clicking, the viewer directly shows the popup
menu to associate a tool with the mouse wheel.

Each image manipulation tool has its own associated Tool options panel. When the user starts using an
image manipulation tool on a medical image, that tool becomes the active tool, and the Tool options panel
related to that tool will be displayed in the viewer’s bottom bar. Also, the icon of the active tool is displayed in
the bottom left corner of the viewer’s window:

The following paragraphs will describe each image manipulation tool, as well as the options and information
available in the Tool options panel associated with each tool.

24
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

6.2.1 Select/Stack image

The Select/Stack image tool allows selecting an image panel on a screen, by a single click on the
image. To unselect the image you have to click on the image while holding the Ctrl key pressed. Also, it is
possible to scroll through the images of the series by dragging with the associated mouse button over the
image (“stack” operation). It is additionally possible to exploit a ‘Scroll to frame #’ screen action, which can be
associated with a keyboard shortcut.
The Tool options panel associated with this tool, shown in the picture below, in the viewer’s bottom bar,
displays basic information about the currently selected image.

6.2.2 Zoom area

The Zoom area tool allows zooming a specific rectangular portion of the currently selected image.
The rectangular region to be zoomed can be selected by dragging with the associated mouse button over
the medical image (single drag operation to define the boundaries of the rectangular area to zoom). If the
SHIFT key of the keyboard is kept pressed, then the area to zoom will be forced to a square shape.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

The interpolation algorithm used to zoom images can be chosen through the Interpolation quality drop-down
list on the Tool options panel associated with this tool. Three different interpolation types are supported,
providing a speed vs quality trade-off.

6.2.3 Magnifier
The Magnifier tool allows magnifying a moving portion of the image, by dragging with the
associated mouse button over the image.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

25
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The magnification factor used by the magnifier, as well as the size of the magnifier itself, can be modified by
dragging the Zoom factor and the Magnifier size sliders on the Tool options panel associated with this tool.

6.2.4 Pan image

The Pan image tool allows panning over the currently selected image, by dragging with the
associated mouse button over the image.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

6.2.5 Shutter
The Shutter tool allows applying a shutter over the image, i.e., hiding a sub-region of the image,
which is not interesting for medical purposes. The shutter is always applied to the entire series.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

You can select the shape of the shutter to apply on the series by selecting the appropriate Shape option in
this panel. In order to draw a Rectangular or Circular shutter, it is sufficient to select the Shutter tool, to drag
with the associated mouse button over the image, and then to release the mouse button when you are
satisfied with the size of the shutter. On the other side, if you want to draw a Polygonal shutter, then you
need to click the associated mouse button on every point of the polygon contour that you want to define.
When you want to define the last point of the contour, double-click the associated mouse button, and the
polygonal shutter will complete (i.e., close the polygon) automatically.

6.2.6 Window / Level

The Window / Level tool allows modifying the window width and window level values (also known
as "window center") for the gray levels (or colors) of the current image. The Window / Level values are given
in Hounsfield Units if the selected image panel contains a CT image.
You may change the Window,Level values by dragging with the associated mouse button over the image.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

26
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

It is possible to change the sensitivity of mouse dragging movements for contrast changes, by dragging the
Sensitity slider in this panel.
Window width and window level values can also be changed by selecting one of the available contrast
presets (from the Presets drop-down list). Finally, you can manually enter window/level values in the W / W
and W / L text fields, and press Enter on your keyboard to confirm and apply them.

Press the Auto window button ( ) in order to apply an automatic “optimal” windowing for the currently

selected image. The Reset W/L to default button ( ) may be used to restore the original Window / Level
setting suggested in the DICOM data set (if present).

6.2.7 Select annotation

The Select annotation tool allows selecting a measurement or graphical annotation which already
exists on the current medical image. Selection of the annotation shape is done by clicking with the
associated mouse button over the annotation shape itself. Once the annotation is selected, it is possible to
move and modify the shape itself, by dragging with the associated mouse button over specific points of the
selected annotation shape. If dragging is started over one of the displayed selection handles (the small red
squares), then the shape will be modified, by moving the relevant selection handle point. On the other side, if
dragging is started over a generic point of the shape (i.e., not over a selection handle), then the entire
annotation is moved, with no modifications to its geometric shape.
The generic Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom
bar:

Once a measurement or graphical annotation shape is selected, the Tool options panel will reflect the
properties of the specific selected shape, and will offer more options. Also, when an annotation is selected,
you can delete it by pressing the Delete key on the keyboard, or the Delete button in the Tool options panel.
Finally, once an annotation is selected, you can select the previous or next annotation of the current image
by pressing the ‘-’ or ‘+’ keys on the numeric keypad of your keyboard.

27
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

6.2.8 Measurement tools

LocalEye Viewer supports several measurements tools, described in the following sub-paragraphs.

Warning: measurements taken through the LocalEye Viewer software are based on pixel-to-
millimetres calibration information which is read from the DICOM dataset. This calibration information
is stored by the modality which originally acquired the medical images. LocalEye Viewer has no
mean to guarantee that the calibration information is correct and accurate, hence it has no mean to
guarantee that the final measurements taken by the software are actually accurate. It is
recommended that the user of LocalEye Viewer critically checks the result of each measurement.

6.2.8.1 Calibrate measurements

The Calibrate measurements tool allows calibrating distances, that is, assigning an actual known
distance value (in mm, cm or inches) to a given distance measured on-screen, over the image. In order to
perform calibration, select the Calibrate measurements tool and drag with the associated mouse button over
the image, on the distance that you want to calibrate / set. As soon as the drag operation has finished, the
Calibrate measurements dialog will appear:

User needs to enter the Actual distance corresponding to the measured Pixel distance. User also has the
option of specifying that the following calibration must be applied to the whole series, that is, to all images
belonging to the current series. If this option is not checked, then the calibration will only be applied to the
DICOM file containing the current image.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

This panel basically allows you to modify the measurement unit used for calibration.

28
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

6.2.8.2 Measure distance

The Measure distance tool allows measuring linear distances on the selected medical image. The
measurement is performed by dragging with the associated mouse button over the image, and releasing the
mouse button once you traced the distance that you want to measure.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

The user may choose to create an annotation of each measurement, thus leaving a persistent graphic object
over the image, by enabling the Create annotation checkbox. In addition, the user may choose to add the
drawn measurement annotations to all images of the current series, by pressing the Apply to series toggle
button. If the Create annotation option is disabled, the graphic object representing the current measurement
over the image will immediately disappear when the measurement is complete (i.e., the mouse button is
released).
The user may also choose whether to display an on-screen label of each performed measurement, by
checking or unchecking the Show on-screen meas. option.
The measurement unit used for measurements may be chosen by selecting the corresponding option (mm,
cm, or in) in the Unit drop-down list of this Tool options panel.
Finally, it is possible to delete the currently selected annotation by pressing the Delete button, or to delete all
measurement annotations by pressing the Delete all meas.

6.2.8.3 Measure horiz/vert distance

The Measure horiz / vert distance tool allows measuring linear horizontal or vertical distances on the
selected medical image. The measurement is performed by dragging with the associated mouse button over
the image, starting the dragging operation on the start point and releasing the mouse button on the end point
of the vertical or horizontal distance that you want to measure.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

29
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The user may choose whether he wants to compute the horizontal offset (i.e., horizontal distance) or the
vertical offset (i.e., vertical distance) between the start and end point which have been identified through the
mouse drag operation, by acting on the Type drop-down box.

Computation of the Cardio-Thoracic Ratio (CTR)

The Measure horiz / vert distance tool allows computing the value of the Cardio-Thoracic Ratio. Once the
appropriate chest xray image is selected, just select Horizontal offset in the Type drop-down of the Tool
options panel. Take a first horizontal distance measurement corresponding with the cardiac size, then a
second horizontal distance measurement corresponding with the maximum width of the thoracic cavity.
Finally, press the Measure CTR button, and you will get the value of CTR. According to literature, a value of
CTR above 50% is considered abnormal.

Warning: in order to guarantee maximum accuracy, it is recommended that the Measure CTR tool is
only used on a PA (Posterior - Anterior) chest xray image.

6.2.8.4 Measure distances and angles

The Measure distances and angles tool allows measuring angles among an arbitrary number of
segments, which may be intersecting or not. Also, the distances represented by each segment are computed
and displayed. The measurement is performed by dragging with the associated mouse button over the
image, in order to trace each segment. A double-click with the associated mouse button will terminate the
sequence of segments. Once the sequence is terminated, all distances and angles will be computed and
shown.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

The user may choose whether he wants only angles among intersecting segments are computed and shown,
by checking the Show inters. angles only option. Also, it is possible to set the number of segments in a
sequence to a fixed value, by acting on the Num of segments drop-down box: this will eliminate the need for
a double-click to terminate the sequence, as the sequence will be automatically terminated once the just-set
number of segments will be traced.
Each sequence of segments is independent from other sequences, even on a single image. Once a
sequence is terminated, it can still be modified both in terms of position of each single segment and in terms
of number of segments: this last aspect can be managed by acting on the Add segment(s) and Remove last
segment buttons (a sequence must be selected first).

30
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

6.2.8.5 Measure rect area

The Measure rect area tool allows measuring rectangular areas on the selected medical image.
Information about the surface, the perimeter, the minimum/maximum/mean density, and the standard
deviation of the densities within the rectangular area is provided. The measurement is performed by
dragging with the associated mouse button over the image, and releasing the mouse button once you traced
the rectangular area that you want to measure. Keeping the Shift key of the keyboard pressed will force the
area to be exactly square.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

Please refer to the paragraph about the Measure distance tool for an explanation of the options available in
this panel.
In addition, as shown in the following screenshots, on PET images containing the appropriate data elements
in their DICOM dataset, LocalEye Viewer is able to provide the minimum/maximum/mean SUV, and the
standard deviation of the SUV within the selected rectangular area.

SUV (Standardized Uptake Values) is commonly used in PET image analysis. It measures the concentration
of a radiotracer in a defined region of interest (ROI), which provides interesting diagnostic information. In
particular, LocalEye Viewer computes SUV according to the "SUV Body Weight" algorithm which is based on
the following formula:

suvValue[body weight] = (activityConcentration / (radionuclTotalDoseBq * decayFactor)) * patientWeightG

where:

 activityConcentration: the pixel value in the image, after processing of Modality LUT.
 radionuclTotalDoseBq: the radionuclide total dose, expressed in Bequerels.

31
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

 decayFactor: the decay factor.

 patientWeightG: the patient's weight, expressed in grams.

Warning 1: computation of SUV in LocalEye Viewer is based on generally accepted methods and
equations, and in particular on the Body Weight equation reported above. However, some institutions
may use methods and/or equations that differ from those used by LocalEye Viewer and described in
this user manual. Prior to use in a clinical environment, it is important that all equations be confirmed
and an independent evaluation be conducted of the SUV values reported by LocalEye Viewer with
studies from all PET acquisition devices present at your facility, under typical acquisition conditions.

Warning 2: LocalEye Viewer computes SUV only based on the information stored in the image's
DICOM dataset. It is the modality technician's responsibility to ensure that all information is correct
and accurate. LocalEye Viewer won't compute SUV if some of the data elements which are used to
compute SUV are not present or empty in the DICOM dataset.

Warning 3: LocalEye Viewer does not compute SUV on images that have not been decay-corrected
by the acquisition device, because the computed SUV value would not be reliable in that case.

6.2.8.6 Measure ellipt area

The Measure ellipt area tool allows measuring elliptical areas on the selected medical image.
Information about the surface, the perimeter, the minimum/maximum/mean density, and the standard
deviation of the densities within the elliptical area is provided. The measurement is performed by dragging
with the associated mouse button over the image, and releasing the mouse button once you traced the
elliptical area that you want to measure. Keeping the Shift key of the keyboard pressed will force the area to
be exactly circular.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

Please refer to the paragraph of the Measure distance tool for an explanation of the options available in this
panel.
In addition, as shown in the following screenshots, on PET images containing the appropriate data elements
in their DICOM dataset, LocalEye Viewer is able to provide the minimum/maximum/mean SUV, and the
standard deviation of the SUV within the selected elliptical area.

32
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

Please refer to the previous paragraph "Measure rect area" for details and recommendations about SUV
(Standardized Uptake Values).

6.2.8.7 Measure angle (mode 1)

The Measure angle (mode 1) tool allows measuring angles on the selected medical image. The
measurement is performed by clicking three times with the associated mouse button over the image; each
click identifies one of the three points defining the angle to be measured.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

Please refer to the paragraph of the Measure distance tool for an explanation of the options available in this
panel.

6.2.8.8 Measure angle (mode 2)

The Measure angle (mode 2) tool allows measuring angles on the selected medical image. The
measurement is performed by drawing two segments over the image; each segment can be drawn by
dragging with the associated mouse button over the image, and releasing it when each segment has the
desired properties.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

33
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

Please refer to the paragraph of the Measure distance tool for an explanation of the options available in this
panel.

6.2.8.9 Measure density

The Measure density tool allows measuring densities on the selected medical image.
The measurement is performed by dragging with the associated mouse button over the image. Once the
mouse button is released, the density measurement is eliminated.
The Tool options panel associated with this tool is shown in the picture below, in the viewer’s bottom bar:

Moreover, on PET images containing the appropriate data elements in their DICOM dataset, LocalEye
Viewer is able to provide the SUV for each point which is selected on the image. The value provided in
square brackets is the actual detected pixel value, after modality LUT transformation.

Please refer to the paragraph "Measure rect area" for details and recommendations about SUV
(Standardized Uptake Values).

6.2.9 Stack image (mouse wheel)

If the Stack Image tool is associated with the mouse wheel, scrolling the mouse wheel will cause
scrolling the images of the current series (equivalent to Previous frame and Next frame buttons optionally
available in the Series toolbar, depending on the viewer configuration). If the Alt key on the keyboard is kept
pressed while scrolling the mouse wheel, a scrolling of the current scene (i.e., page of images) will happen
(equivalent to Previous scene and Next scene buttons optionally available in the Series toolbar, depending
on the viewer configuration).

34
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

6.2.10 Zoom image (mouse wheel)

If the Zoom Image tool is associated with the mouse wheel, scrolling the mouse wheel will cause a
zoom in or zoom out operation (depending on the direction of wheel rotation) on the current image.

6.3 Resetting operations on images

The following toolbar button may be used to reset all changes done on the current image, on all
images of the current series, or on all images of the current study:

More specifically, the "reset" toolbar button above may correspond with the Reset selected image, or with the
Reset selected series, or with the Reset selected study action, depending on which item is selected in the
related drop-down menu, which can be shown by pressing the down arrow next to the "reset" toolbar button,
as visible in the screenshot above.
Here is a short description of each Reset operation available:

 Reset selected image: all changes and operations performed on the currently selected image will be
reset.
 Reset selected series: all changes and operations performed on the current series will be reset.
 Reset selected study: all changes and operations performed on the current study will be reset.

6.4 Showing image information

The Show image information toolbar button ( ) allows viewing information about the currently
selected image. If you press this toolbar button, the Current Image Info dialog box will appear:

35
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

This dialog box is composed of several tabs:

 Patient tab
 Study tab
 Series tab
 Equipment tab
 Image tab
 Clinical Trial tab (if enabled)
 Meta-Info tab
 DICOM dump tab

These tabs display information extracted from the current DICOM file, i.e., the DICOM file related to the
currently selected image.

36
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

In particular, the DICOM dump tab allows performing the DICOM dump of the selected image or of a file not
open in LocalEye Viewer, dragging it in the "dump area". In this second instance, the DICOM dump could be
a useful diagnostic tool, when, for some reason, is impossible opening the file.
The DICOM dump, indeed, shows all the DICOM data elements related to the selected file/image.

A search box is also supported, allowing to easily find information in the DICOM dataset dump.

6.5 Zooming images

Several zoom-related operations are available as toolbar buttons, as shown in the screenshot
below:

37
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

When moving the mouse pointer over each single zoom button, a tooltip text will appear, providing additional
information about the function of the underlying button.
The following paragraphs will describe each zoom operation tool.

6.5.1 Zoom in

Pressing the Zoom in toolbar button ( ) the image displayed in the current panel will be zoomed
in.

6.5.2 Zoom out

Pressing the Zoom out toolbar button ( ) the image displayed in the current panel will be
zoomed out.

6.5.3 Zoom to fit

Pressing the Zoom to fit toolbar button ( ) the image displayed in the current panel will be
zoomed to fit the size of the panel itself.

6.5.4 Zoom reset

Pressing the Zoom reset toolbar button ( ) the image displayed in the current panel will be set
at zoom 100%, i.e., at its original pixel size.

6.6 Managing image contrast

Several contrast management operations are available as toolbar buttons, as shown in the
screenshot below:

38
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

When moving the mouse pointer over each single contrast management button, a tooltip text will appear,
providing additional information about the function of the underlying button.
The following paragraphs will describe each contrast management operation, corresponding with each
button.

6.6.1 Invert

Pressing the Invert toolbar button ( ) all images of the current series will be contrast-inverted.
In other words, the images are transformed into their “negative” images.

6.6.2 Auto window

Pressing the Auto window toolbar button ( ) all images of the current series will be auto-
windowed. In other words, an automatic “optimal” contrast windowing will be applied to images.

6.7 Rotating and flipping images

Several geometric transformation operations (i.e., rotation and flipping) are available as toolbar
buttons, as shown in the screenshot below:

When moving the mouse pointer over each single geometric transformation button, a tooltip text will appear,
providing additional information about the function of the underlying button.
The following paragraphs will describe each geometric transformation operation, corresponding with each
button.

6.7.1 Rotate +90°

Pressing the Rotate +90° toolbar button ( ) all images of the current series will be rotated
clockwise of 90 degrees.

39
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

6.7.2 Rotate -90°

Pressing the Rotate -90° toolbar button ( ) all images of the current series will be rotated
counter-clockwise of 90 degrees.

6.7.3 Flip horizontally

Pressing the Flip horizontally toolbar button ( ) all images of the current series will be flipped
horizontally.

6.7.4 Flip vertically

Pressing the Flip vertically toolbar button ( ) all images of the current series will be flipped
vertically.

6.8 Managing key images

LocalEye Viewer supports functionalities to display all images marked as key images within the
current study. All these functions are available as toolbar buttons, as shown in the screenshot below:

6.8.13 View 'key' images in current study

Pressing the View 'key' images in current study toolbar button ( ) all images previously marked
as “Key Images” will be displayed in the current study panel, each key image in a dedicated image panel.

6.9 Viewing reports

LocalEye Viewer allows viewing reports associated with the displayed studies. The View report…
toolbar button is shown in the following picture:

40
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

When this button is pressed, the report dialog-box will be show and it will be possible to view the existing
report for the current study (i.e., the study of the currently-selected image).

Depending on the viewer's configuration, one or more Report templates may be available. Selecting a given
report template will affect the way the DICOM structured report is presented to screen and printed to an
output sheet (which information is included in the report, how the text will look like, how each data is laid out
to screen / sheet, etc.).
In case multiple DICOM structured reports are available, a selection window will appear, allowing to choose
the desired SR. The displayed DICOM structured report may also be printed, through the Print… button.

41
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

By pressing the Print preferences... button, the SR print preferences dialog box (in case of DICOM structured
report) will be shown, allowing to define a custom header and footer for the printed structured report,
including both images and texts:

6.10 Customizing series and image layout

Pressing the Set display mode... toolbar button ( ) is pressed, the following drop-down menu
will appear:

42
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

This section allows defining exactly how series and images are presented within this study panel.
Series Tiling allows specifying the series tiling for the current study. The series tiling determines how many
series will be concurrently visible, and their layout on screen.
If Auto view all series item is chosen, then all series are automatically shown and an auto-selected layout will
be applied.
Image tiling allows specifying the image tiling for the series panel. The image tiling determines how many
images of each series will be concurrently visible, and the layout of images inside the series panel.

43
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

If the View study in full-screen mode toolbar button ( ) is pressed, the selected study is viewed in full
screen. You can the exit from the full-screen mode by pressing the ESC button on the keyboard: normal-
screen mode will then be restored.

6.11 Managing synchronized scrolling of series

The Toggle automatic series synchronization... toolbar button ( ) allows synchronizing different CT or
MR series whose images (slices) were acquired moving in the same direction (acquisition planes with the
same orientation). The synchronization causes a scrolling through the images of these series, in such a way
all panels show images related to the same patient coordinates (where available). The reference coordinates,
at which all other panels are synchronized, are the ones of the currently selected image panel / series. In
order to support synchronization of all series, the image tiling of all series panels is automatically set to 1x1.
Once the Toggle automatic series synchronization... function is enabled, all scrolling operations will be
synchronized across the displayed series. In order to disable the Toggle automatic series synchronization...
function and the related locked scrolling among series, it is sufficient to click once again on the same toolbar
button.

The Toggle manual series synchronization... toolbar button ( ) allows manually synchronizing
different CT or MR series whose images (slices) were acquired moving in the same direction (acquisition
planes with the same orientation). This manual function is useful when it is necessary to manually set the
initial "aligned" state among several different series, and/or to synchronize scrolling among series belonging
to different studies, even acquired by different modalities: under these conditions, the Toggle automatic
series synchronization... function won't work. In order to use the manual series synchronization, the user
must scroll all relevant series in such a way they all show images related to the same patient coordinates.
When synchronized scrolling among several studies is necessary, the user shall select a given study, then
click on the arrow-shaped drop down button, placed next to the Toggle manual series synchronization...

toolbar button ( ). A drop-down menu will appear, allowing user to choose the other studies (in
addition to the current one) to synchronize with.

44
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

In case of cross-study manual synchronized scrolling, before activating the synchronization, the user must
scroll all relevant series of each study, in such a way they all show images related to the same patient
coordinates.
Once all relevant series have been scrolled in such a way to represent an initial "aligned" situation, it is
possible to press the Toggle manual series synchronization... button in order to lock scrolling of all those
series in a synchronized way. The scrolling position of each series in the moment when the Toggle manual
series synchronization... button is pressed is considered to be the initial reference point. In order to disable
the Toggle manual series synchronization... function and the related locked scrolling among series, it is
sufficient to click once again on the same toolbar button.

Warning: synchronized scrolling functionalities are based on a software algorithm. As such, the
proper functioning of sync scrolling depends on the correctness of several orientation and spacing
data stored in the original DICOM datasets, in addition to the correctness of the implemented
scrolling algorithm. The viewer itself has no mean to ensure these input data are correct. Hence, the
proper synchronization of the series shall be checked in a very “critical” way by the user/radiologist,
and any conclusion coming from these functionalities shall be carefully evaluated.

6.12 Sharing a study with a remote recipient

The Share study through Dropbox ( ) toolbar button allows sharing the current DICOM study with
a remote recipient (e.g., for a consultation, second opinion, etc.) by exploiting the sending user's Dropbox
and a NeoLogica-powered cloud viewing infrastructure. This cloud-based viewing infrastructure has been
called "Exams Sharing Portal (ESP)".
Clicking on this button, a step-by-step Share through Dropbox wizard is started, as shown in the following
picture:

45
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The first step of this wizard allows user to authenticate on the Exams Sharing Portal by entering email and
password related to his ESP account. If the user does not have a user account on the ESP yet, he can
create a new one selecting the appropriate option, as shown in the following screenshot:

Once user has successfully logged in to the ESP, LocalEye Viewer stores his login data, so that he will be
able to auto-login upon later usages of the Share through Dropbox functionality.

Clicking on the Next button, the page related to the second step of the wizard will appear:

46
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

Once user has authenticated on ESP, an attempt will be made to authenticate on Dropbox. If automatic
authentication succeeds, user can choose to proceed with that Dropbox account, as shown in the image
above. Otherwise, if automatic authentication on the user's Dropbox is impossible or fails, or user just wants
to associate a different Dropbox account, an authentication and authorization step takes place on Dropbox,
as you can see in the images below:

47
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

Once user has logged in to the ESP, and access to user's Dropbox is granted, LocalEye Viewer is ready to
upload current study's DICOM files to Dropbox.

48
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

In this step, user is prompted to choose a password needed to encrypt all DICOM files which will be
uploaded to his Dropbox. This password must be at least 8 characters long, and user will need to
communicate it to the recipient of the shared study. Through this password, indeed, the recipient will be able
to decrypt and view the medical images.
In addition, selecting the option Anonymize DICOM files before uploading to Dropbox, a further layer of
privacy will be added to the data that user is going to share.

Important note: please consider that only the attributes inside the DICOM header will be
anonymized, according to the anonymization preferences. Eventual personal identifying information
burnt into the image pixels will be left unchanged. Also, please notice that in this case anonymous
information will be published to the Exams Sharing Portal (ESP), hence the recipient will see
anonymous data.

At this point, LocalEye Viewer is ready to encrypt and upload all DICOM files related to the current study to
user's Dropbox. During the upload of DICOM files to Dropbox, a progress bar shows the current progress of
the whole upload procedure, which may be very lengthy. User can choose to abort and stop the upload
operation.

Once the upload to Dropbox of all DICOM files of the study has successfully completed, the "Publish to
Exam Sharing Portal" step takes place:

49
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

Here, it is necessary to enter the email address of the recipient, which will be used to send him a notification
email, informing him about the availability of a shared study for him on the ESP. This email will provide the
recipient with an appropriate link, as well as login information, which will enable him to access the exam's
images. Also, this email address will be used to create the recipient's user account on ESP, if not already
existing. It is possible to send the exam password to the recipient directly by email, by selecting the Transmit
exam password to recipient by email option.

Warning: transmitting the exam password to the recipient by email may be insecure. If you want to
ensure maximum security, please leave this option unselected, and transmit the password to the
recipient through a different mean (e.g., phone call).

Finally, user can type a note for the recipient of the shared exam through the appropriate box.

At this point, clicking on the Next button LocalEye Viewer will publish the current study to the Exams Sharing
Portal (ESP).

Once the study has been successfully published to ESP, user can choose whether to use one of his existing
credits (if available) to unlock viewing of the study, or to purchase new credits to unlock the study on behalf
of the recipient, or rather to leave the recipient the task of unlocking the study at a later stage.

50
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

Once a user has unlocked a shared exam, that exam will be online and viewable (by both the sender and the
recipient) as long as the sender will keep it in his own Dropbox, for an unlimited number of times.

Once the unlock step has been done or skipped, the exam sharing operation is complete, and LocalEye
Viewer provides a final summary:

51
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

6.13 Cine playback of dynamic sequences

Cine movie toolbar buttons allow obtaining a dynamic playback of the cine sequences belonging to
the current study.

The Play/Stop cine movie toolbar button (toggling between and ) allows you to start or stop the
cine-playback of cine-sequences currently displayed within the current study panel.

Pressing the Playback preferences… toolbar button ( ), the following options panel will appear:

52
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The Apply cine commands and settings to all series in the study option let you decide whether the play and
stop commands will have effect just on the currently-selected cine sequence, or rather to all series within the
study.
It's possible to modify the speed of the playback (in terms of frames per second, or FPS) by dragging the

dedicated slider. The Apply default FPS (movie speed) button ( ) allows setting the predefined
playback speed for a given cine-sequence (according to the information coming from the DICOM dataset, if
available).
The buttons on the bottom of this cine preferences panel allow controlling the loop mode of the playback,
which can be Play once, Looping (default) or Sweeping (i.e., back and forth).

Pressing the Play once button ( ) the frames 1 to N (where N is the total number of frames in the current
series) are displayed in rapid sequence, then the playback is stopped.

Pressing the Looping button ( ) the frames 1 to N are displayed in rapid sequence, then the playback
begins again from frame 1 and so on (frame sequence: 1,2,…,N,1,2,…,N,1,2,…).

Pressing the Sweeping button ( ) the playback sequence is as follows: 1,2,…,N,N-1,N-2,…,2,1,2,…,N…

(forward and backward).

6.14 Navigating among available series

The following toolbar buttons allow you to navigate among the available series:

53
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

The Previous series toolbar button ( ) and Next series toolbar button ( ) are used switch the
currently-selected series panel to the next or previous series (if multiple series are available in the current
study).

7 Hanging steps and study view presets

The picture below shows the "Hanging steps / Hanging views" dropdown box, which is located at the
bottom-right corner of the viewer’s window(s):

In case "hanging steps" are defined within a hanging protocol, it will be possible for the user to easily iterate
through all "hanging steps" which are present within the hanging protocol, also in a next/previous fashion,

through the arrow buttons available next to this dropdown box ( ). Switching to a different hanging
step is a viewer-wide operation, which may have an effect on what is hung on all available monitors. It is
possible to open several studies, belonging to different modalities or even different patients, and to hang
them all together according to their hanging steps.
Each individual hanging view defined in the matching hanging protocol(s) can be directly applied to the
single study panel through the same dropdown box.

54
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

For some particular kinds of studies, special hanging functions are

available in the view presets drop-down menu. For instance, in case of
ultrasound "echo stress" studies, user will be able to select hanging of
series "by view" or "by stage". When selecting a given "view" from the
drop-down menu, LocalEye Viewer will display all series related to that
view, and will arrange the series tiling automatically in order to contain
all series related to that view. In the same way, selecting a given
"stage" from the drop-down menu, LocalEye Viewer will display all
series related to that stage, and will arrange the series tiling
automatically in order to contain all series related to that stage.

8 On-image popup menu

LocalEye Viewer features a pop-up menu on images, which allows a fast selection of common
tools, functionalities and options.
In order to show the pop-up menu it is necessary to right-click on a non-empty image panel while keeping
the Ctrl key of the keyboard pressed. Since LocalEye Viewer allows a flexible association of image tools to
both left and right mouse buttons, pressing Ctrl on the keyboard is necessary, in addition to right-clicking, to
display this pop-up menu.

LocalEye Viewer also supports a faster association of the tools with the left, right and wheel mouse buttons.
In order to change the tool associated with the left mouse button, press the left mouse button while keeping
the Shift key pressed on the keyboard. In order to change the tool associated with the right mouse button,

55
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

press the right mouse button while keeping the Shift key pressed on the keyboard. Finally, in order to change
the tool associated with the wheel mouse button, press the wheel mouse button while keeping the Shift key
pressed on the keyboard.
The pop-up menus are particularly useful when operating in full-screen mode, since most functions may be
accessed without the need for the main toolbars.

9 Thumbnails panel
The Thumbnails panel displays thumbnail images:

If the Series option button is selected on the Thumbnails panel, then each thumbnail image will represent a
series currently loaded in LocalEye Viewer, and the number of displayed thumbnail images for each study
will be equal to the number of series currently loaded in LocalEye Viewer for that specific study. The
thumbnails are grouped by study.
On the other hand, if the Images option button is selected on the Thumbnails panel, then each thumbnail
image will represent a single image currently loaded in LocalEye Viewer, and the number of displayed

56
 LocalEye Viewer v10: User Manual [LE-V-UM-EN-10 – Rev A]

thumbnail images for each study will be equal to the total number of images currently loaded in LocalEye
Viewer for that specific study. Also in this case the thumbnails will be grouped by study and series.
Drag&drop of images or series from the Thumbnails panel to the study panel(s) is supported. You can also
select multiple thumbnails in the Thumbnails panel, by the Windows-usual Shift-click or Ctrl-click, and then
dragging & dropping all selected images or series (depending on the active mode) to the Study panel.
Double-clicking on a thumbnail will load the double-clicked series or image into the currently selected image
panel. Double-clicking on a series thumbnail while pressing the Alt key on the keyboard will load the study
panel with the scene starting at the double-clicked series. Double-clicking on the tab related to a particular
study, will hang the study, following the rules of the first matching hanging protocol.
When the proper option is enabled in the Settings section (under Display preferences) , the thumbnails will

be marked by symbols to identify the series or images displayed on the main study panel(s): while the

symbols identify the series or images currently displayed (i.e., hung on screen) in LocalEye Viewer, the
symbol indicates the currently-selected series.
The thumbnail panel may be hidden or shown by clicking on the pin icon appearing at the top right of the
panel itself.

10 How to report issues

In case you encounter issues or you detect a malfunctioning while using the LocalEye Viewer
software, please report the problem to the NeoLogica Support Staff.
NeoLogica uses a ticket-based online support system. In order to report a problem, please browse to the
following web address:

https://www.neologica.it/Support

You will then be able to open a new "support ticket", and specify the details of the issue you have detected.
The NeoLogica Support Staff will analyze the reported issue and will reply promptly, then making every effort
to solve the issue in the shortest possible time.

11 Acknowledgments
LocalEye Viewer relies on the CharLS library in order to decode JPEG-LS-compressed images.

57