Application Note

Radiology Solutions Services

Document ID: 80843773

NX 24.00
Type 4406

Functional Changes in NX 3.0.24.00 / NX 4.0.24.00

► Purpose of this document

This document describes the new customer features that were introduced with software
version NX 24.00.

► Changes compared to previous revision

Initial version

► Referenced documents

Document Reference
NX 24.00 - SB 01 - Release of NX 3.0.24.00 / 4.0.24.00 Document ID 80844814
Application Note “Functional Changes in NX 22.00, NX Document ID 68534240
22.00 SU1”
Application Note “Functional Changes in NX 23.00” Document ID 75753690
NX Service Manual Document ID 74737949
MUSICA Acquisition Workstation (NX) User Manual 4420T Library
Smartbox Service Manual Document ID 80983940
Smartbox - Service Bulletin No. 01 – Introduction of the Document ID 80982773
Smartbox to support AI pathology detection

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Document ID: 80843773 Application Note

► Manufacturer
Agfa NV

Published by
Agfa-Gevaert HealthCare GmbH
Max-Planck-Straße 1
82380 Peißenberg
Germany
Copyright  2023 Agfa NV
All rights reserved.
Technical modifications reserved.
Agfa and the Agfa rhombus are trademarks of Agfa-Gevaert N.V., Belgium or its
affiliates.
All other trademarks mentioned in this document are held by Agfa NV or the respective
owners and are used in an editorial fashion with no intention of infringement.
Nothing contained in this legal notice nor in any text in this document shall be
construed as granting by implication, estoppel or otherwise, any license or right to use
any of the trademarks, service marks, trade names or logos appearing in this document
without the express prior written consent of their respective owner.

WARNING:
Improper operation or service activities may cause damage or injuries.

(1) Read the Generic Safety Directions prior to attempting any operation, repair or
maintenance task on the equipment. Refer to Document ID 11849633.
(2) Strictly observe all safety directions within the Generic Safety Directions and on
the product.

IMPORTANT:
The installation and service of the product(s) described herein is to be performed
by qualified personnel who are employed by Agfa NV or one of its affiliates
or who are otherwise authorized by Agfa NV or one of its affiliates to provide such
services.

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LIST OF CONTENTS

1 OVERVIEW OF NEW FEATURES ...........................................................................................4

1.1 SmartPatientView ..................................................................................................................... 6
1.2 CriticalScan (Chest pathology detection) ................................................................................ 13
1.3 Collimation verification ............................................................................................................ 21
1.4 SmartRotate for all body parts ................................................................................................ 23
1.5 Quicker annotation (RITM2056623) ....................................................................................... 24
1.6 Improved barcode scanner workflow ...................................................................................... 26
1.7 Improved grid line suppression configuration ......................................................................... 29
1.8 Compliance with directive 2013/59/EURATOM [RITM2166148] ............................................ 30
1.9 Updated Dose Structured Report............................................................................................ 30
1.10 CMS improvement .................................................................................................................. 31
1.11 Orthogon “end of service life”.................................................................................................. 33
1.12 ISP hardening ......................................................................................................................... 33
2 EXPLANATION OF NOTES ...................................................................................................35
3 CONVENTIONS .....................................................................................................................35

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1 Overview of new features

Mammo DR Retrofit
CR Systems

DR Retrofit
DX-D 100
DX-D 300
DX-D 400
DX-D 500
DX-D 600

DR 100e
DR 100s
DR 400
DR 600
DR 800
Valory
Feature Reference
SmartPatientView               1.1
CriticalScan (Chest pathology detection)*               1.2
Collimation verification               1.3
SmartRotate for all body parts               1.4
Quicker annotation               1.5
Improved barcode scanner workflow               1.6
Improved grid line suppression               1.7
Compliance with EURATOM directive               1.8
Updated Dose Structured Report               1.9
CMS improvement               1.10
Orthogon “end of service life”               1.11
ISP hardening               1.12
 = feature is not available
 = feature is available

* AI supported chest pathology detection not supported for mobile Retrofit systems (with tablet / notebook) and in
general only in countries where the AI module “LUNIT Insight CXR” is registered.

Note regarding new features of the related XRDI version:

Depending on the DR system, NX 24.00 is released with XRDI 25.0 or XRDI 26.0:
• NX 24.00 / XRDI 25.0 release: DR 100e, DR 100s, DX-D 400, DX-D 500
• NX 24.00 / XRDI 26.0 release: DX-100, DX-D 300, DX-D 600, DR 400, DR 600,
DR 800, DR Retrofit, Mammo DR Retrofit, Valory.

The new features of XRDI 25.0 are explained in the XRDI Service Manual, Document
ID 72453884.
XRDI 26.0 does not have new customer features. For details of all solved software
issues and new features refer to the XRDI Service Manual, Document ID 72453884.

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NOTE:
The NX version depends on the presence of the NX_MULTI_FRAME_IMAGING
license.
• License not present: Version is NX 3.0.24.00
• License present: Version is NX 4.0.24.00
The NX_MULTI_FRAME_IMAGING license enables dynamic imaging, a feature
currently supported by the DR 800 system only.
NX 3.0.24.00 / NX 4.0.24.00 is further abbreviated as “NX 24.00” if both software
versions are meant. The version is displayed in the About NX menu.

Figure 1: About NX

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1.1 SmartPatientView

Status in Software ≤ NX 23.00

SmartPatientView, one sub-function of SmartXR, is not available.

NOTE:
An overview of all SmartXR features is available in the following documents:
• DR 600 – Service Application Manual, Document ID 48556251
• DR 100s – Service Application Manual, Document ID 69476884

For DR 800, SmartPatientView and SmartRotate currently are the only SmartXR
functions.

New in Software NX 24.00

SmartPatientView is introduced for all systems with a camera:
DR 100s, DR 600, DR 800
It requires the NX SMARTXR SMARTVIEW (MBAW4) license, which includes the
following two technical licenses:
• NX_SMART_ID_POSITION (enables patient positioning image)
• NX_SMART_ID_PATIENT (enables patient identification image)

Patient positioning image

Automatically a snapshot of the live view
(as it is displayed on the Tube Head
Display or NX Workstation) is taken at
time of exposure (when the user
presses down the exposure button) and
stored together with the actual image.
Purpose: Possibility to check correct
positioning of the patient in case of
doubts.
The patient positioning image can be re-
called by pressing the camera icon
in the Editing or Acquisition pane.
See also Figure 15 which shows the Figure 2
icon in the Editing pane.

NOTE:
For DR 100s and DR 600 it is possible to adjust the zoom by parameter X-Ray Device
settings > SmartDR Settings > Smart DR Context.

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Patient identification image

The user takes a photo of the patient’s face before the exposure, by pointing the
Tube Head to the face and pressing the camera icon in the Soft Console.
This image is stored together with the patient positioning image and the actual X-ray
image(s).
Purpose: Additional safety step to avoid patient mix-ups.

Figure 3

Once the image is taken, the “patient identification image” icon in the patient
identification pane turns from gray to white.
By clicking on this icon the “patient identification image” can be re-called.
Refer to Figure 4.

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Figure 4

Respecting patient privacy – enabling or disabling global consent

Depending on the configuration, the
consent is either allowed by default (but
still can be set to “Not allowed”), or the
user is forced to take the choice for each
exam.

The “global consent” is configured in the

NX Configuration Tool > General >
Workflow Management.

The appearance of the “Webcam image

consent” dialog depends on the
presence of the NX SMARTXR
SMARTVIEW license in the NX ALF file.
Figure 5

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If global consent is not available,

independent of the workflow*, before the
exam is closed a message appears
which reminds the user to take the
decision.

* for example if the patient is entered by a RIS or

image is a recovery image.

Figure 6

Configuring the patient positioning / patient identification image

The function “patient positioning image” is active, as soon as the ALF file containing
license NX SMARTXR SMARTVIEW is loaded. It has still to be activated for each
single exam. Refer to Figure 8 and Figure 9.
The function “patient identification image” has to be activated in the Patient
Identification Image pane of the NX Configuration Tool > General > Workflow
Management. Refer to the table next page.

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Function Result when activated

Enable Patient ID Image The camera icon in the soft console becomes active.
Enable Forced Patient ID When the patient identification image has not been taken
flow before closing the exam, the following message appears:
“MESS607 - Are you sure you want to archive the
session without Patient ID image? YES/NO”.
Yes: “Close & send” continues. The user can still add a
Patient ID image later on after re-opening the session.
No: User takes image (by pointing the Tube Head to the
patient and clicking the camera icon in the soft console)
and clicks again “close & send”.
Add to primary archive The patient identification image is stored on the archive,
destination together with the X-ray image(s) and the patient
positioning image(s).

Figure 7

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The “Patient Positioning Image” can be activated for each single exam in the
“Processing and Routing” pane of the exam tree.

Figure 8

For Full Leg / Full Spine it is activated in

the partial exposure.
When activated, a Patient Positioning
Image will be taken for each partial
exposure.
For the stitched image only the first
exposure is used.

Figure 9

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It is possible to configure the “Patient Positioning Image” very efficiently via the Exam
Tree Configuration > Find and Replace Exposure Settings.
However, using the “Find and Replace Exposure Settings” function to set the archiving
function per exposure is not available. This has to be set manually, if required.

Figure 10

Configuring SmartPatientView in the Offline Configuration Tool

If you want to configure
SmartPatientView in the Offline
Configuration Tool, it is required to
check the checkboxes “Use Smart
Patient ID” and “Use Smart Positioning”
during start-up.
Reason: SmartPatientView cannot be
disabled via license, because the two
technical licenses (refer to page 6) are
used by XRDI directly from the License
Service. This is valid for all technical Figure 11
licenses starting with “NX_SMART”.

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1.2 CriticalScan (Chest pathology detection)

Status in Software ≤ NX 23.00

The feature to use AI (artificial intelligence) or any other means for automatic pathology
detection is not available.

New in Software NX 24.00

A new feature called “AI pathology
detection”, also known as “CriticalScan”
is available.
Functions:
• Processes all chest x-rays using
LUNIT Insight CXR* to identify
suspicious areas for abnormal
radiologic findings.
• Notifies radiographer automatically if
a critical pathology is detected, after
about 30 secs. (desktop PC) or
about 45 secs (DR 100s)
background processing.
• Chest X-ray images are archived
together with a DICOM secondary Figure 12
capture including burned-in
greyscale overlay and can be
reviewed from PACS or also CMS.

*NOTE:
LUNIT Insight CXR is a deep learning based software that assists radiologists or
clinicians in the interpretation of chest X-ray images. Final responsibility of diagnosis
still lies with radiologists or clinicians. The analysis result contains localization of
suspicious areas in color or outline, abnormality scores reflecting the probability that
the detected lesion is abnormal, and text interpretation for the analysis result by each
finding.

Advantages:
• Radiographer can set a HPM (high priority marker) on patients with critical finding
to reduce the reporting delay, or call clinician according to local protocol to change
patient care pathway.

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Limitations:
• Supports Chest PA and AP exposures.
• Currently for any patient who is 6 years or older.
• Released as an option for DR 100s, DR 400, DR 600, DR 800, DX-D 300,
DX-D 600, desktop PC based DR Retrofit systems and CR systems*. It will not be
released for DX-D 400, DX-D 500, Mammo DR Retrofit, and mobile systems
(except DR 100s).
• Released in countries only, where LUNIT Insight CXR is released. Contact your
local sales representative for information about whether Chest Pathology Detection
can be implemented in your country.
*only CR systems that are released for NX 24.00.
Refer to the NX 24.00 Release SB, Document ID 80844814.

Licensing:
This feature requires the license NX PATHOLOGY DETECTION LUNIT (MBA3H).
This license includes the following technical licenses:
• NX_PATHOLOGY_DETECTION
• NX_PATHOLOGY_DETECTION_LUNIT
• NX_AI_AUTO_ROTATE
• SmartBoxSoftware_SUB_BASE

Smartbox:
The additional computing power which is
required to perform the AI pathology
detection is provided by the Smartbox.
For DR 100s a special kit exists which
integrates the Smartbox into the system.
For more information to the Smartbox
refer to the Smartbox Service Manual,
Document ID 80983940 and the
Smartbox release Service Bulletin, Figure 13
Document ID 80982773.

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Workflow:
When the criteria to allow AI Pathology Detection are fulfilled, the image is sent to the
Smartbox for processing by LUNIT Insight CXR. As a result, a secondary capture
overlay is sent to NX.
With release of NX 24.00 the criteria to allow AI Pathology Detection are as follows
(can change with later NX versions):
• Patient's Age ≥ minimum age
• Body Part Examined within supported Body Parts
• View Position within supported View Positions

Pathology Detection
DR Workflow

Enter patient data

Select thumbnail

Database entry is created

Start exposure

Image arrives on NX

Image reference
gets acknowledged by
NX backend process Image is sent to
LUNIT Insight CXR
Image is processed on Smartbox
incl. SmartRotate

Image is evaluated
Criteria to allow
AI Pathology Detection DICOM Secondary
fulfilled? yes
Capture is sent to NX
no
Image is displayed in NX
Image is displayed in viewer with Secondary
NX viewer Capture Overlay

Figure 14

NOTE:
The VL(Visual Light) and SC (Secondary Capture) images are sent to the selected
archive at the moment of a “Close and Send” action only. A “Send” action will only send
the X-ray image. It is possible to configure where the VL images are sent, but the SC
images are always sent to the primary automation archive. At the moment there is no
way to disable sending of SC images.

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Pathology Detection Viewer:

A new viewer, the pathology detection viewer, has been introduced with NX 24.00.
It is available in the Acquisition and the Editing pane, together with the patient
positioning image viewer.

Figure 15

Additional training material for the CAS:

For more information about the different features of AI Pathology Detection refer to the
NX 24.00 Upgrade training on ALP. All training material for NX 24.00 is listed in the NX
Service Plan, Document ID 75549450.

Configuration
Configuration of AI Pathology Detection comprises two parts:
• Configuration of LUNIT Insight CXR. This is described in the Smartbox Service
Manual, Document ID 80983940.
• Configuration of AI Pathology Detection behavior on NX: This is described in this
section.

To configure the AI device on NX, go to NX Service & Configuration Tool > Device
Configuration > AI Device and click Create.

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Figure 16

Now the New buttons becomes active. Click on New to create a new AI device.

Figure 17

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The Device Settings of the AI Device do not need any change. They fit to the default
settings of LUNIT Insight CXR on the Smartbox.
The Supported Pathologies pane defines the pathologies, which shall generate
operator attention, if this pathology is detected. This should be inline with the
“radiologic findings to analyze”, what is configured on the Smartbox.
Basic rule:
The pathologies which are activated on NX in the “Supported Pathologies” pane,
should also be selected in the “Select radiologic findings to analyze” menu in the
Smartbox Service Interface > DICOM gateway configuration.

Figure 18

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For each exam, where AI Pathology Detection shall be applied, the following settings
are required:
1. Enable Smart Rotate in Exposure Settings. The reliability of the AI Pathology
Detection depends on the correct orientation. This setting is mandatory.
2. Enable module in Processing & Routing settings. This enables the AI
Pathology Detection module. This setting is mandatory.
3. Enable automation in Processing & Routing settings. This enables automatic
image evaluation on the Smartbox. If this is not active, the exposure can only
be sent manually for AI Pathology Detection. This setting is optional.

Figure 19

Figure 20

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When configuring AI Pathology Detection in the NX 24.00 Offline Configuration Tool, it

is mandatory to check the Use Pathology Detection checkbox. Otherwise, the AI
device will not be available for configuration.
The model file “Lunit Lunit INSIGHT CXR 3 (ARM64).xml” which is required to setup
the AI device is part of the NX 24.00 Offline Configuration Tool installer.

Figure 21

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1.3 Collimation verification

Definition of “collimation” on NX in the context of this feature:

The operator uses the collimator mounted below the X-ray tube to reduce the dose for
the patient by exposing the relevant part only.
This relevant part is automatically detected by NX during image processing. The non-
exposed area is covered by a black frame and the image is cropped. This is called
“automatic image collimation” in the NX user manual.

Status in Software ≤ NX 23.00

When the radiologist looks to an image created on NX, it is not clearly visible, whether
the image borders are a result of automatic collimation or whether the image was
cropped manually later on.

New in Software NX 24.00

When a collimation border thickness
≥ 1 mm is configured, a white border is
drawn around the collimation area to
visualize the result of the auto
collimation towards the operator.
The white border thickness is
configurable from 0 up to 20 mm.
0 means: No white border.

Advantage:
• Radiologist sees if the image
borders are the collimation borders
or if it was cropped digitally by the
radiographer. Figure 22

Benefits:
• Safety: QA manager / Radiographer team lead can verify if the X-ray image is
collimated properly for dose reduction purposes.
• Productivity: If a pathology is detected close to the border and deserves a larger
area, the radiologist knows if a retake is necessary or if he can ask for
uncropping to the radiographer.
• Regulatory: required in Germany.

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Configuration on NX:
The white border is configured per exposure in the exam tree. The parameter is called
“Collimation border thickness”.
This border thickness has to be configured manually for each exposure.
By default it is “0” mm”.
It is not possible to use the “Find and Replace Exposure Settings” functions to adapt all
or several exposures at once.

Figure 23

Licensing:
This feature does not require an additional license. It is part of NX 24.00 by default.

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1.4 SmartRotate for all body parts

Status in Software ≤ NX 23.00

When parameter Enable Smart Rotate is configured for a certain examination, an
algorithm evaluates the image and rotates it, if required, to fulfill the optimal patient
orientation specification.
For details refer to Functional Changes in NX 22.00, NX 22.00 SU1, Document ID
68534240.
In NX 22.00 it was only effective for body part "Hand".
In NX 22.00 SU1, body parts Chest, Abdomen, Ankle and Foot were added.

Figure 24

New in Software NX 24.00

Support of SmartRotate for all body parts (new with NX 24.00 in bold): Arm, cervical
spine, elbow, hip, knee, leg, lumbar spine, pelvis, shoulder, skull, abdomen, ankle,
chest, foot, hand.

Licensing:
This feature requires the technical license NX_AI_AUTO_ROTATE which is included in
the license NX SMARTDR AUTO ROTATE (MAE3Q).

For more details refer to document Functional Changes in NX 22.00, NX 22.00 SU1,
Document ID 68534240.

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1.5 Quicker annotation (RITM2056623)

Status in Software ≤ NX 23.00

With NX 8900 the “Text Time Marker”
(TTM) was introduced. It contains by
default the time of image acquisition.
The user may adapt the annotation with
free text.

Figure 25

New in Software NX 24.00

As of NX 24.00 it is possible to combine
the date / time marker with pre-defined
text, for example “Patient swallowed”.
This way it can be avoided that for
typical text annotations the radiographer
needs to type text after the examination.

Figure 26

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The text as well as the time format (Date / Date and Time / Time) is configured in the
NX Service & Configuration Tool > User Interface > General Settings > Custom
Markers.

Figure 27

Licensing:
The custom markers require the technical license NX_Advanced_Tools, which is
included in the NX Precision Tools (ES9BE_3.0) license.

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1.6 Improved barcode scanner workflow

Status in Software ≤ NX 23.00

Using a barcode scanner CS6080 and
CS4070 was possible on DX-D 100 and
DR 100s.
The barcode scanner was just used to
enter patient data in the search pane of
the worklist, this means, it was used as
a kind of keyboard, in “keyboard
emulation mode”.

Figure 28

Example: Instead of entering the Patient

ID “1234” manually in the search pane,
the user could use the scanner to scan a
barcode with Patient ID “1234”. Now
figures “1234” were entered in the
Patient ID search pane. The other work Figure 29
steps, like selecting the type of search
(for example “Patient ID”), clicking
“search” and so on were not automated.

New in Software NX 24.00

In software NX 24.00 it is possible to
use the barcode scanner in “keyboard
emulation mode” or in “COM port
emulation mode”.
The usage is not limited to DX-D 100 or
DR 100s, but the barcode scanner can
be used on any DR system*.
In “keyboard emulation mode” it works
like before, in NX ≤ 23.00.
In “COM port emulation mode”
automatically the scheduled exam
Figure 30
opens, when scanning the patient
barcode. Refer to example of Figure 31.
*refer to section “Limitations” on page 29.

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Licensing:
The following license is required to enable the “COM port emulation mode”:
NX Barcode Reader license (MBGRK).
The hardware is ordered with the following sales order code:
XHV1L (BARCODE READER KIT (BLUETOOTH))

Figure 31

One of the following DICOM attributes can be configured for scanning:

• Accession number
• Admission ID
• Patient Identification

Figure 32

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The Auto Open checkbox defines, how the system behaves in case a
patient is scheduled for more than one exam.
• With Auto open checkbox checked, the scheduled exam opens automatically, if
the configured attribute matches.
• With Auto open checkbox unchecked, the scheduled exams for this patient are
shown in the worklist. The user needs to select the scheduled exam manually.
For details refer to the NX Service Manual, Document ID 74737949, section 4.9.40,
Configuring a barcode scanner CS6080.

Up to three RIS can be configured. For

each configured RIS one of the three
attributes can be assigned.

Figure 33

The usage of the barcode scanner is described in the “Barcode reader User Manual
4422A”.
The setup is described in NX Service Manual, Document ID 74737949, section 4.9.40,
Configuring a barcode scanner CS6080.

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Limitations
The barcode scanner CS6080 is
delivered together with a Bluetooth
cradle using Bluetooth class I which
allows up to 100 m (330 feet) distance
between cradle and scanner.
A free USB Type A slot is required on
the NX.
If the NX is located in the control room,
the shielding of the control might prevent
a satisfying Bluetooth connection. In this
case consider mounting the cradle in the
examination room. Figure 34

The USB cable which is part of delivery has a length of 2 m and can be extended to a
maximum of 5 m (USB 2.0).

1.7 Improved grid line suppression configuration

Status in Software ≤ NX 23.00

With NX 23.00 SU1 and NX 23.00 SU2 improved grid line algorithms were introduced.
In some cases, this new grid line suppression algorithm creates grid lines on 103 lpi
grids that were not present before introduction of NX 23.00 SU1 and NX 23.00 SU2.
To go back to the old grid line suppression, NX 23.00 SU1 and NX 23.00 SU2 had to
be removed.

New in Software NX 24.00

For systems using XD+ Detectors* and
103 lpi grids, it is possible to de-activate
the NX_DR_ADVANCED_GLS license.
This way the “old” grid line suppression
is used, before introduction of NX 23.00
SU1 and NX 23.00 SU2.

Figure 35

* XD+ Detectors = XD+10, XD+14, XD+17. De-activating NX_DR_ADVANCED_GLS is no option for XD 10,
XD 14, XD17.

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1.8 Compliance with directive 2013/59/EURATOM [RITM2166148]

The EURATOM (European Atomic Energy Community) Directive 2013/59/EURATOM

requires, among many other regulations, to estimate the dose to the population taking
into account the distribution by age and sex of the exposed individuals.

Status in Software ≤ NX 23.00

The patient gender and date of birth is not included in the exported XML file when
exporting acquired dose values.

New in Software NX 24.00

When exporting acquired dose values, gender and date of birth are appended to the
generated XML file. Gender and date of birth are still optional fields, this means, in
case of an emergency exam, the radiographer doesn't need to fill out these fields.
These new fields are added as the last columns in the XML file to ensure that other
customers will experience as little impact as possible in case they already have scripts
to analyze the XML file.

1.9 Updated Dose Structured Report

Status in Software ≤ NX 23.00

IHE (Integrating the HealthCare Enterprise) Dose Reporting was implemented with
NX 8600 and got many updates with new NX versions.
However, some data were missing in the IHE Dose Structured Report to be fully
compliant with IEC 61910-1:2014.

New in Software NX 24.00

The Dose Structured Report has got some minor changes to comply with the current
DICOM standard (IEC 61910-1:2014).
Example: Concept Name “Column Angulation” is added to the Irradiation Event - X-ray
Mechanical Data.

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1.10 CMS improvement

Status in Software NX 23.00

With NX 23.00 the CMS for collection of hospital wide quality metrics was introduced.
This was achieved by distinguishing between:
• Rooms for Image Review
• Rooms for Dose and Repeat/Reject analysis
For details refer to Application Note “Functional Changes in NX 23.00”, Document ID
75753690.
Disadvantage: The database for Dose and Repeat/Reject analysis is limited to 10 GB.
In the worst case this can lead to OutOfMemory exception causing CMS connectivity
issues [PRB2000837].

New in Software NX 24.00

In NX 24.00 the database for Dose and Repeat/Reject analysis is still limited to 10 GB,
but to prevent OutOfMemory exceptions, the number of dose records as well as the
number of reject reports is limited to 850.000 records each, as a total for all connected
in-room workstations. If more records are submitted than the maximum allowed, the
oldest records in the database are deleted.
The table next page summarizes the CMS functionality.

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Overview of CMS functionality

NOTE:
How to read this table:
There are two general application types for a CMS:
CMS is either used for review of images (left column) or for review of quality metrics
(right column).
Depending on the application type, there are different requirements and technical
specifications for the CMS and in-room NX.
Example: If the CMS is used for review of quality metrics, the NX version of the CMS
must be ≥ NX 23.00. All in-room NX must be of version ≥ NX 21.00. All NX must be
configured the same dose type (lgm or EI). And so on ….

CMS for review of images CMS for review of quality

metrics
NX version on CMS NX ≥ 21.00 NX ≥ 23.00

NX version in-room NX ≥ 21.00 NX ≥ 21.00

Condition • NX main version on CMS and in- • All NX must be configured for
room must be identical same dose type (lgm or EI)
• All in-room must be on the same
subnet as CMS
• All NX must be configured for
same dose type (lgm or EI)
Limitation • Max. 5 NX in-room can be • max. 850.000 dose records*
connected to the CMS • max. 850.000 reject reports*
Comment • CMS does not display the patient • NX / CMS can be on different
positioning image provided by subnets
SmartPatientView (option as of • No limitation on number of in-
NX 24.00 for DR 100s, DR 600 rooms
and DR 800) • When limit of dose records is
• CMS can be used for both, reached, the oldest records will
review of images and review of get replaced by newer ones
quality metrics • For NX < NX 23.00 on CMS,
statistics are deleted on the In-
Room NX after retrieval
• CMS can be used for both,
review of images and review of
quality metrics
*limit introduced as of NX 24.00

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1.11 Orthogon “end of service life”

Status in Software ≤ NX 23.00

As of NX 3.0.9000 an application for
advanced measurements called
“Orthogon” is integrated. It is based on
pre-defined measurement schemes,
which can be selected for different
human and vet body parts.
Orthogon is already part of RADMedia
(Impax) and the SE Suite. The Orthogon
software is identical to the one released
for SE Suite (version 1.0.1029).

Figure 36

New in Software NX 24.00

Orthogon’s CE mark expired in June 2023. Therefore, NX 24.00 no longer supports
Orthogon licenses.
Consequently, a customer using Orthogon will no longer be able to use the software
after upgrade to NX 24.00.

1.12 ISP hardening

Definition of hardening
The purpose of system hardening is to eliminate as many ISP (Information Security
and Privacy) security risks as possible. This is typically done by removing all non-
essential software programs and utilities from the computer.

Status in Software ≤ NX 23.00

Various hardening measures are performed on the NX application software and also
during the installation of NX.
Excerpt of hardening measures of NX 23.00:
• Microsoft IIS is intentionally disabled.
• All software is scanned for malware prior to release.
• All software components are versioned and are built using .NET strong name
signing.

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New in Software NX 24.00

Hardening measures are based on the guidelines defined by the US Defense
Information System Agency.
In their STIG (Security Technical Implementation Guide) they have defined a set of
security rules to harden the Windows 10 operating system, with the goal to make it
more difficult to misuse the system. The measures are mostly policies and registry
settings. The measures are categorized by STG severity: HIGH (CAT I) / MEDIUM
(CAT II) / LOW (CAT III).

Hardening is performed by a separate

installer on NX, the
NX_Hardening_Installer_1.1.0000.exe*.
It is executed in the background during
NX activation.
Based on the available hardening
license, the hardening is performed:
• NX hardening level 1: only CAT I
fixes are executed
• NX hardening level 2: CAT I + CAT II
fixes are executed
The NX hardening level 1 license is
Figure 37
default for all systems.
NX hardening level 2 requires license
NX ISP LEVEL 2 HARDENING
LICENSE (MBD3U).
* Version of the hardening installer is subject to change.

The NX_Hardening installer is available on

C:\Agfa\Healthcare\NX\Installers\Hardening.
Executed fixes are recorded in
C:\Agfa\Healthcare\NX\Configuration\Hardening\StigFixes.xml. The StigFixes.xml is
also included in NX System Snapshot.
Fixes can be undone by uninstalling NX_Hardening from Programs & Features.
NX_Hardening is automatically uninstalled when NX is uninstalled for example as part
of an upgrade installation.

NOTE:
Difference between hardening and installing Windows hotfixes:
Hardening a Windows 10 computer means configuring the security settings. This
reduces opportunities for a virus, hacker, ransomware, or another kind of cyberattack.
By installing hotfixes, system files are installed to correct a functional or security issue.

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2 Explanation of notes
Safety-relevant notes
Icon Signal word Situation
CAUTION: Hazardous situation which, if not avoided, can lead to a minor
injury to a user, engineer, patient or any other person.

WARNING: Hazardous situation which, if not avoided, can lead to a potential

serious injury to a user, engineer, patient or any other person.

DANGER: Direct, immediate danger: If not avoided, it can lead to a serious

injury to a user, engineer, patient or any other person

- Instruction to avoid damage to equipment and/or environmental

pollution.

- Prohibition to avoid damage to equipment and/or environmental

pollution.

Non-safety-relevant notes
Icon Name Type of information
IMPORTANT: Highlights very important actions which have to be carried out to
prevent malfunction.

NOTE: • Indicates advice to facilitate the following step or action

without having a direct influence on the step or action.
• Highlights unusual points.
• Indicates background information.
• Can be used to explain or highlight displays of the
graphical user interface.

3 Conventions
Style Use case Example
(1) Step 1 Step by step task description (1) Connect the cables.
(2) Step 2 (2) Mount the cover.
Bold Menu topics, keyboard keys, device Press F9 or double-click the Refresh
buttons, commands, and so on button.
Italic Emphasizing a word or indicating Do not insert the USB flash drive yet.
references in continuous text. Refer to section 10, Release
information.
Courier System messages When the success message
bold appears, close the window.

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