Hanging Protocols

Customize the display of images in related studies

Hanging Protocols

Overview and the HP Builder | HP Manager

This page is taken from the eFilm Workstation User Guide and all page number references below refer to this guide located here.


Hanging protocols are designed to allow a group of images from related studies to be
displayed in sets that are “hung” according to preconfigured radiologist preferences.
These protocols can also be customized to define preferred methods of presentation and
manipulation for every modality supported by eFilm.

This section shows you how to:

  • understand basic hanging protocol concepts (see “Basic concepts” on page 91)
  • use eFilm after applying a hanging protocol (see “Using eFilm after applying hanging
    protocols” on page 93)
  • create a hanging protocol using the Hanging Protocol Builder (see “Creating hanging
    protocols” on page 95)


Basic Concepts

This section discusses the following basic concepts behind eFilm’s use of hanging

  • Multiple layouts
  • Priors
  • Residual Layouts
  • the Hanging Protocol drop‐down menu
  • associating and disassociating Hanging Protocols
  • the distinction between SINGLE_USER and SITE_DEFAULT protocols


Multiple layouts
eFilm Hanging Protocols allow users to define multiple Layouts. Each Layout is a
complete description of what users should see on the screen and how it should be
displayed. The advantage of multiple Layouts is that they permit different views of the
data set within a single Hanging Protocol; for example, a study with eight series can be
fully displayed in two 1x4 layouts. Moving between Layouts is accomplished using the
and Toolbar Icons.


eFilm Hanging Protocols allow a user to specify that a viewport should be used to display
images from a prior exam. The prior exam can be specified in terms of its relevance to the
Primary Study this is the study that the user clicks on first when choosing which studies
to view via the Study Manager. The Primary Study may not be the same as the Current
Study for a patient, since the Current Study is the most recently performed study and the
Primary Study is simply that which was selected by the user. Therefore it is important to
note that if a Hanging Protocol specifies that the FIRST PRIOR exam is to be displayed, the
exam chosen will be the first prior relative to the Primary Study and not the Current Study
(assuming they are different).


Residual layouts
In eFilm a Hanging Protocol defines where it wants particular images in a study to be
displayed. In many cases, there are additional images in the study that the Hanging
Protocol does not address; for example, a user may not wish to specify that the Scout
should be displayed. Or it may be the case that an additional series was acquired that
would normally not be part of the type of study the Hanging Protocol is displaying. In
order to ensure that the user has easy access to all images in the study, eFilm creates
Residual Layouts and populates them automatically with the residual (or leftover) series.
The number of Residual Layouts depends on the layout format specified by the protocol
and the number of residual images - eFilm will populate one series per residual viewport.
It is possible to define a residual-only- protocol which only defines the layout of the
screen for a particular type of study and does not specify where the images in the study
are to be displayed. The advantage of this type of protocol is that there may be studies that
vary widely in the way images are identified (e.g. there is no standard series description).
In such a case it is still preferable to be able to use a residual‐only protocol to
automatically apply a layout and have the images grouped in layouts, with the associated
user benefits this offers.


Hanging Protocol drop down menu
When a study is loaded, eFilm lists all Hanging Protocols that are considered a match for
the study in the drop-down menu that is invoked by clicking on the down arrow beside
the Hanging Protocol toolbar icon. If the Hanging Protocol that is chosen by eFilm is not
the desired one, a user can click on the Hanging Protocol drop‐down menu and choose
the desired HP. eFilm remembers the HP used last time for a particular type of study and
by default will use that HP again the next time the same type of study is chosen. This
behavior can be affected by settings for the Hanging Protocol such as SITE_DEFAULT vs.
SINGLE_USER and by the choice of Associate vs. Dissociate.


Hanging Protocol associations
Users can choose which Hanging Protocols will be included as candidates for a match for
a particular type of study by ensuring they are Associated with the Hanging Protocol.
Likewise the user can Dissociate themselves from a Hanging Protocol to ensure that the
HP is not included among the candidates for a match. See “Associating and disassociating
hanging protocols” on page 107.


Single-user versus site default protocols
A Hanging Protocol will be defined as either a single user or site default. Protocols with
which the user is associated are considered first when searching for a matching protocol.
If no matching associated protocol (single-user or site default) is found, then all site
default protocols are examined for a match.


Using eFilm after applying hanging protocols
This section describes the functionality of eFilm after a study has been loaded and a
hanging protocol applied. It describes how to:

  • change a hanging protocol (see “Changing hanging protocols” on page 93)
  • use the right‐click context menu (see “Using the right‐click context menu” on page 94)
  • identify related offline studies (see “Identifying related offline studies” on page 94)


Changing hanging protocols
The status bar indicates which hanging protocol has been applied, as well as which layout
the user is currently on. The Apply Hanging Protocol, Next Layout, Previous Layout and
Restore Layout buttons become enabled.

To change a hanging protocol:
1. Choose one of the following options:

  • Click the arrow to the immediate right of and select a hanging protocol from
    the drop-down menu
  • Click the HP Manager button on the Study Manager window to access the HP
    Manager window and select another hanging protocol

Note: The drop-down menu will always contain the hanging protocols returned by
the initial query to the server when the study was first loaded, even if you search for
additional hanging protocols using the HP Manager window. You can select No
Protocol from the drop-down menu to “unapply” the currently applied hanging

2. Switch between layouts by following the procedure detailed in “Switching between
hanging protocol layouts” on page 105.

3. Click Reset Layout to restore the state of the layout to that defined by the hanging
protocol if you have changed the appearance of the images.


Using the right-click context menu
In case the display sets do not include all images in the study, the original series are still
accessible, and can be accessed from the Hanging Protocol right‐click context menu.
To select display sets from the Hanging Protocol right-click context menu:

1. Right-click anywhere in a viewport. The Hanging Protocol right‐click context menu

2. Select a display set from the Hanging Protocol right-click context menu. The selected
display set appears in the current viewport.

Note: To hide the Hanging Protocol right-click context menu, click Close Menu.


Identifying related offline studies
When you are searching for studies with priors, any related studies that appear offline or
nearline will be identified by eFilm. Offline means that the studies are unavailable (e.g.,
they are stored on tape and must be manually retrieved). Nearline means that the studies
are only temporarily unavailable (e.g., they are stored on tape, but can be automatically


A hanging protocol may specify that a particular related study is required. If such a study
is nearline or offline, the Some Related Studies are OFFLINE dialog box will appear.

To identify offline studies:

Choose one of the following options:

  • Click OK to apply the protocol without any related offline or nearline studies (see
    “Applying hanging protocols” on page 104)
    Note: Offline studies can be accessed through the Hanging Protocol right‐click
    context menu (see “Using the right‐click context menu” on page 94).
  • Click Cancel to open the Study Manager window and access the offline or nearline
    studies (see “Using the Study Manager” on page 67)


Creating hanging protocols

This section describes how to create a hanging protocol using the HP Builder.

To create a hanging protocol from scratch:
1. Choose one of the following options:

  • In the HP Manager window, click HP Builder
  • On the Tools menu, click Hanging Protocol Builder
  • Click

The HP Builder window appears, displaying the HP Definition page.

Note: This page allows you to define new hanging protocols.


2. To define a hanging protocol, you must:
a) Select a modality from the Modality drop-down list.
b) Enter a study description in the field provided and click Add.

Note: You can add more protocol definitions to the list by repeating steps a) and b).
You can also select protocols from this list to update or remove them.

3. Click Data matching or click Next to display the Data matching page:

Important: Residual Images is the default layout and cannot be deleted.

4. A hanging protocol consists of one or more layouts for a given modality and study
description. You can create a layout in one of two ways:

  • create a new layout by clicking New Layout (you can then either specify the
    settings manually or capture your existing settings)
  • copy an existing layout and change its settings by clicking Copy Layout


5. Enter a name for the layout.

6. In the Adjust section, specify the number of rows and columns for the viewports (e.g.,
1 row, 2 columns).

7. Define the display set that appears in each viewport:

  1. Select the desired viewport.
  2. In the Viewport Name field, type the name of the viewport (e.g., PA).
    Note: To keep a viewport blank, select the viewport, then select the Blank check box
    in the Study Selection tab.
  3. In the Study Selection tab, select the study you want to display in the selected


8. Select the Series/Image Selection tab.

9. Select an existing setting the protocol uses to filter images; otherwise, edit a setting or
create a new setting:

  1. To edit an existing setting, double‐click the desired setting. To create a new setting,
    double-click within the Series/Image Selection window pane.
  2. In the Description field, type a name for the new setting. If you do not enter
    description, the application automatically creates a description for the new setting
  3. Select the desired series/image attributes to display in the viewport as described


Attribute Description

  • BodyPartExamined -Text description of the part of the body examined.
  • ConvolutionKernel -Label describing the convolution kernel or algorithm used
    to reconstruct the data.
  • EchoNumber -Echo number used in generating the image.
  • ImageLaterality - Laterality of paired body parts examined in the image.
  • ImageNumber Number that uniquely identifies the image within the image
  • ImageType Image identification characteristics.
  • Laterality laterality of paired body parts examined in the series.
  • PresentationIntentType Identification of the intent of the images that are contained
    within the series.
  • ProtocolName User-defined description of the conditions underwhich the
    series was performed.
  • SeriesDescription User-provided description of the series on which the
    hanging protocols will be matched.
  • SeriesNumber Number that identifies the series.
  • StudyDescription User-provided description of the study
  • ViewCodeSequence Sequence that describes the projection of the anatomic
    region of interest on the image receptor (only a single item is permitted in this sequence).
  • ViewPosition Radiographic view associated with Patient Position.

Note: Suggested values that are acquired from the series/image that is currently
displayed will automatically appear in the value column.

d) When you are finished, click OK. If you created a new setting, make sure you
select it before you continue.

10. Select the Image Appearance tab.

11. Select an existing setting for images that will use this protocol; otherwise, edit a
setting or create a new setting:

  1. To edit an existing setting, double-click the desired setting. To create a new setting,
    double-click within the Image Appearance window pane.
  2. In the Description field, type a name for the new setting.
  3. In the VOI LUT section, specify the brightness and/or contrast of the images. You
    can use the modality default, specify a custom window/level setting, or a LUT
    within the DICOM image.Note: If you captured an existing layout, this is set to the Modality Default. To use
    the captured settings, select Custom.
  4. In the Zoom section, you can manually increase or decrease the images’ fields of
    view. You can also select Pixel‐for‐Pixel, which will treat each pixel in the images
    as one pixel on your monitor.
  5. In the Orientation section, you can use the default, or flip the images from left to
    right about the horizontal axis, and rotate them clockwise by the number of
    degrees specified. You can also specify the position of the images using the Right
    Edge and Bottom Edge values.
  6. Select the corresponding check boxes for the following options:
    - Shutter: applies the modality shutter to images that will use this protocol.
    - Overlay Off: hides the study information and scale bar for images that will use
    this protocol.
    - Invert: inverts the color of images that will use this protocol so that they are
    displayed either as black on white or white on black.
  7. When you are finished, click OK.


12. Repeat Steps 7 to 11 for each viewport.

13. Click Saving or click Next to display the Saving & Naming page.

14. Enter a name and description for the hanging protocol in the fields provided.
Important: The Created By field defaults to the profile name of the user that is
currently logged into eFilm (see “Logging in to eFilm” on page 15) and cannot be

15. Select either SINGLE_USER or SITE_DEFAULT from the Level drop‐down list.

16. Choose one of the following methods of saving the new protocol:

  • Do not save the protocol in the database: cancels the creation of the new protocol,
    unless “Save as file” is selected
  • Create a new protocol in the database: saves the new protocol in the database (see
    “Configuring visualization services” on page 64).
  • Update the protocol in the database: updates the current protocol in the database
    (see “Searching for hanging protocols” on page 103).

Note: You can save the new protocol as an XML file by selecting the Save as file check
box (see “Exporting hanging protocols” on page 105)


17. Click Finish to complete the process and close the HP Builde

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