To View Images From Another Computer:

Software must be opened on the Medlink CR computer and the Medlink CR machine must be turned on.
Erasing Cassettes:

Make sure the software is opened on the Medlink CR computer
• Push the BLUE button FIRST then insert cassette
Delete Study (Study Name Will Be Inaccessible But Still Appear On The Worklist):

• Right click on the study you want to erase
• Click “Delete”
• Click “Delete Study”
• Press “Enter”
Permanently Delete Study:

• Site Admin log – Someone at Spectrum will need to log in.
• Highlight patient
• (R) Click
• Delete study
• Top left next to file is study
• Click on study
• Click Purge
• Click remove
Cassette Jam:

Make sure a patient is created beforehand. Shut down the computer and the Medlink CR. Let it sit for 30 seconds then restart the CR Computer then the Medlink CR. It can take up to 5 restarts in order for the CR to release the cassette. (For CR-X, simply hit the eject button)
Show 50 Patients On The List:

• Settings
• Icon -> how many to display on one page
• Set to 50
Another Program Loaded Error:

• Never push the “X” to close the program.
• Always press “Log off” or “Exit”

Can CR-Pro images be transmitted for viewing at other locations?

The CR-Pro DICOM Send capability allows images to be transmitted to any DICOM on the network device that can receive.

Can a remote viewing station operator retrieve or “pull” images from the CR-Pro?

Radlink’s optional Integrated Archive Solution provides the DICOM Image Server capabilities. This allows a viewing station operator to remotely query and retrieve images form the CR-Pro.

Can image processing be performed while the plate is being processed?

Yes, once the plate has been scanned and is in the Erase Cycle, then the user can adjust the image.

Does the CD Burner provide a viewer?

The CR Pro CD Burner automatically embeds a DICOM viewer on each CD burned. The user can optionally load any third party viewer into the system to be burned to the CD.

Is the CR-Pro’s display suitable for primary diagnosis?

This display is intended to provide a reference view for the X-ray technologist to use for Quality Control. The CR-Pro utilizes a 1.3 Mega Pixel display with a 300:1 Contrast Ratio.

How long do the Image Plates last?

Radlink uses the Agfa Image Plate, which Agfa quotes as having a life of at least 100,000 exposures. Since the plate transport in the CR-Pro neither bendsnor touches the plate in anyway, plate life is maximized and the full 100,000 exposures should be realized.

What is the recommended PM schedule?

Traditional CR systems utilize a series of precision tuned optic and mechanical optical components to physically sweep the laser beam across the plate. These optics require regular cleaning and calibration which needs to be performed frequently.
The CR-Pro utilizes a new and proprietary technology that replaces this optic path with a Sealed- Fiber-Optic Laser Distribution System that delivers the Laser light directly to the surface of the Image Plate at specific predetermined points. The fiber-optic light delivery system is inherently fixed in place and requires no cleaning or calibration schedule. The only maintenance required is periodic cleaning of the air filters and checking the mechanical components for alignment and, if necessary, removal of dust or other debris.

Can the images be printed?

The CR-Pro supports both DICOM film printers, such as the Codonics Dry Laser or Sony Film Station, and Post Script printers, i.e. standard office and photo printers.
What about the HIPPA requirement for offsite image storage?

Radlink’s Disaster Recovery Utility provides cost effective removable magnetic archive for off-site storage.

How many images can be stored?

The Pro Image Integrated Archive Solution provides two 250MB disks, this will store 11,000 mirrored (two copies, one on each disk) x-ray images.
The Pro Imaging External Archive System Provides one Terabytes of internal RAID storage and one Terabyte of external RAID storage, this will store 44,000 mirrored x-ray images.

What is the recommended PM schedule?

Traditional CR systems utilize a series of precision tuned optic and mechanical optical components to physically sweep the laser beam across the plate. These optics require regular cleaning and calibration which needs to be performed frequently.
The CR-Pro utilizes a new and proprietary technology that replaces this optic path with a Sealed- Fiber-Optic Laser Distribution System that delivers the Laser light directly to the surface of the Image Plate at specific predetermined points. The fiber-optic light delivery system is inherently fixed in place and requires no cleaning or calibration schedule. The only maintenance required is periodic cleaning of the air filters and checking the mechanical components for alignment and, if necessary, removal of dust or other debris.

Can the images be printed?

The CR-Pro supports both DICOM film printers, such as the Codonics Dry Laser or Sony Film Station, and Post Script printers, i.e. standard office and photo printers.
What about the HIPPA requirement for offsite image storage?

Radlink’s Disaster Recovery Utility provides cost effective removable magnetic archive for off-site storage.

How many images can be stored?

The Pro Image Integrated Archive Solution provides two 250MB disks, this will store 11,000 mirrored (two copies, one on each disk) x-ray images.
The Pro Imaging External Archive System Provides one Terabytes of internal RAID storage and one Terabyte of external RAID storage, this will store 44,000 mirrored x-ray images.

What is the System Speed of FCR?

FCR should be considered a multi-speed system. The imaging plate employs a linear capture of exposure exceeding the capabilities of film/screen systems. FCR is not density or contrast limited but is noise limited.

Can I use the same techniques as before?

For some exams the exposure factors will be the same. This is highly dependent on the currently deployed film/screen system speed.

Can I continue to use phototiming with FCR?

Yes. A requirement for the use of phototiming with FCR is that calibration must be completed before using CR Cassettes and Imaging Plates. When a phototimer is used, the resulting mAs can change depending upon the type of cassette and detector (due to the absorption and backscatter characteristics of the cassette/detector). As the density of the image is controlled by the FCR processing, this calibration must be completed as described in the “Fuji CR Users Guide”

Can I acquire multiple images on the same Cassette/IP?

Yes*. Collimated borders are detected as part of the Exposure Data Recognizer (EDR) processing. For best results, the collimated borders should be sharp and well defined. This ensures that unnecessary information, such as scatter; outside the collimated edges will be eliminated from the analysis. This process is often referred to as PRIEF (Pattern Recognizer for Irradiated Exposure fields). See the “CR Users Guide” for guidelines in exposure patterns. Note* when delivering images to PACS, multiple images obtained on a single cassette will limit the individual control of image enhancements and must be taken into consideration. For that reason, many facilities that have employed PACS prefer that only one image is acquired per cassette/IP.

When should multiple views not be done on the same cassette?

When the thickness of the anatomy varies such as an AP and Lateral. The CR Reader Unit will average both images and poor quality will result.

What is the significance of the green stripe on my CR cassettes?

The green stripe is used as a reference for image orientation and should be placed at the cephalic/top of the image in the portrait orientation. For landscape orientation (crosswise) the green stripe should be toward the patient’s right side. Incorrect image orientation should be corrected prior to sending images to PACS or the Laser Printer.

What is the significance of the “S” Value?

The Sensitivity number, so-called “S” Value is an indicator of the Photostimulable Luminescence (PSL) given off by the imaging plate (IP) while being scanned by the laser. The values are inversely proportional to the amount of radiation that strikes the IP.

What is the significance of the “L” value?

The Latitude value, so called “L” value is as important as the “S” Value when critiquing a CR image. For most clinical imaging, “L” values typically range between 1.6 and 2.3. When “L” values are outside this range, the result can also be an abnormal “S” Value.

Is radiation exposure the only factor that affects the “S” Value?

No. The following factors can affect the “S” Value:
• Scatter
• Positioning and centering.
• Distance – SID and OFD
• Proper use of Grids
• Collimation
• Improper Exam selection at the IIP
• Failure to erase IP if it has not been used for 48 hours or longer
• Delay in processing from time of exposure

If my “S” number is out of the recommended range, should I change it to be within the recommended range?

In most cases it is NOT recommended. The “S” Value should not be altered unless the image data is compromised due to an over correction of the Exposure Data Recognizer (EDR). For example, this can occur when the “S” Value goes below 25 and “L” Value is greater than 2.0. These images typically appear completely whitened out after the EDR is applied; however, the image details were present during the initial plate reading.
What are the differences between the NETWORK list, TODAY list, ALL list, DELIVERED list, and the LOCAL WL?

Network list contains the patients to be done. This will link to the procedure ordered at the RIS/HIS system. Today list shows patients completed today. All list shows all the patients completed, including today and prior to today. Delivered list shows all the patients completed with the study delivered to any destination such as a printer and/or PACS. Local list shows patients that have been registered at the IIP with menus picked and suspended or reserved waiting for the exam to be performed.



What is the crossover procedure?


Perform a crossover procedure when a new box of QC film is opened to adjust the originally established parameters for speed, contrast, and base plus fog on the processor QC chart for the characteristics of the new emulsion. An adjustment is required because film used in medical imaging is produced in batches and there may be slight differences in the sensitometric characteristics from batch to batch. The conditions under which the film is stored (i.e., temperature, relative humidity, exposure to fumes from chemicals or to ionizing radiation, etc.) and the age of the film can also affect the sensitometric characteristics of film.
Performing a crossover procedure is necessary to maintain a controlled processing environment. Note the following important points:
1. The crossover should be performed on the same day rather than over five consecutive days as when the processor QC program was initially established.
2. Expose and process all of the films required for the crossover:
At the same time of day that processor QC is normally performed because slight sensitometric changes due to fluctuations in film feeding patterns throughout the day are common. All at the same time, without interruptions. With the same delay (e.g., a few seconds) between exposure and processing that is normally used. Alternating the films from the existing QC box and from the new box. Expose and process the first film from the existing box, followed by the first film from the new box, the second film from the existing box, the second film from the new box, etc. This distributes any sensitometric changes due to seasoning equally among the 10 films. The films from the existing box and new box can easily be distinguished from each other before processing by marking one set of films with a lead pencil or by cutting a corner of one set of films, etc.The computations and adjustments to the control chart may be delayed until a more
3. The chemicals in the processor should be seasoned when a crossover is performed on a single day. Generally, for this purpose, it is important to avoid performing a crossover immediately after a preventive maintenance procedure (PM). Monitor both the number of films remaining in the QC box and when the next processor PM will be performed so that the crossover can be performed before the PM occurs and with fully seasoned chemicals in the developer tank. A good rule of thumb is that a minimum of 10 to 15 films should remain in the existing box of QC film when beginning a crossover procedure. A piece of cardboard from the film box inserted between the last 15 films and the balance of the box makes a good divider and serves as a reminder that a crossover must be performed.
4. The processor should be in control (within the ± 0.10 control limits for speed and contrast) for crossovers performed all on a single day. It is extremely unlikely, however, that the speed and contrast of the processor will be at the operating level originally established. It will be necessary, therefore, to adjust the new operating levels (taken from the characteristics of the new film) by the difference between the originally established aims and the current box of film.
5. The developer in the processor must have reached its operating temperature before doing a crossover procedure.
6. The crossover procedure should be fully outlined in the policy and procedures manual, and all QC personnel should be trained.
What is an emulsion number log, and how is it used for troubleshooting a suspected image quality problem?
Film manufacturers designate each box of x-ray film with a multiple digit emulsion number. This number provides important information such as which particular emulsion batch was used as well as which roll it came from, the specific part (slit) of the roll, and which variation of emulsion was used (variation code). Keeping track of the emulsion number of the film used for processor quality control is generally done in every processor quality control program. It is also extremely advantageous to keep track of the complete emulsion numbers of all film used clinically, especially for mammography. Doing so allows film manufacturers to make comparisons in speed, contrast, D-max, etc., between current clinical images and images taken one or more years previously. Such comparisons may assist in troubleshooting image quality concerns. The easiest way to retain this information is to start an emulsion number log. The log should contain the following information:

Type of film.
Date film box was opened.
Film size.

Complete emulsion number, including variation code.
Any other comments, such as which emulsions were used for processor QC or phantom images. Refer to the example of a emulsion number log below. Every time a box of film with a different emulsion number is opened, a new entry should be made in the log.
When is it appropriate to restart the processor and processor quality control program?
After a processor QC program has been initially established, it may be possible to proceed for a long period of time (i.e., a year or more) using the original operating aims if the processing environment is well controlled and all personnel operate in a consistent manner.
Most facilities, however, will benefit from a periodic reevaluation and reestablishment of the processor QC program. This might be done on, at least, an annual basis. Some facilities are hesitant to re-establish a processor quality control program. If you do reestablish your program, be sure to make a notation in the “remarks” section of the processor QC chart that the program was re-established and the reason why (e.g., annual reestablishment, etc.)
There are also a number of other events that dictate the reestablishment of the processor QC program. These include:

A change of film type in a dedicated processor.
A change of film mix in a non-dedicated processor.
When a film manufacturer makes a change to a film currently in use (e.g., increases the D-max) and recommends that the processor QC program be reestablished.
A change in film volume.
A change of brand(s) of chemicals used.
A change of chemical form used (e.g., switching from premixed solutions to concentrates used in an automixer).
A change in replenishment rates.
A change in the settings on a specific gravity automixer.
A change in the average optical density of the films being processed (e.g., the level of exposure on mammographic images is increased).

Using a different sensitometer and/or densitometer.

Running out of film or having less than five sheets of film in the QC box, thus preventing a crossover from being done correctly.
A change in the way the crossover procedure is done. Note that it is particularly important to first re-establish the processor QC program (over five consecutive days), and then, upon opening the next new box of QC film, implement a new way of doing the crossover.
In addition, over time, the values for speed and contrast on particular steps may no longer be consistent with the guidelines for establishing processor QC (the speed step closest to 1.20, and the two steps used to calculate the density difference closest to 2.20 and closest to, but not less than 0.45) due primarily to adjustments from the crossover procedure. If the step chosen to monitor speed, in particular, is now lower than 1.0 (down in the toe, not on the straight-line portion of the characteristic curve), the control chart will be relatively insensitive to processing changes that could affect clinical films. If the step chosen to monitor speed is now higher than 1.50, the control chart will be hypersensitive to processing changes and it may be difficult to maintain a controlled environment.
The reestablishment of the processor QC program, including changing the step numbers used, if appropriate, is recommended.
How important are environmental temperature and relative humidity to image quality?

Storage of Unprocessed/Unexposed Film

Most medical x-ray films come in a sealed, moisture-proof inner wrap, which is packed in an outer cardboard box. Sealed packages of film are affected by heat; open packages are affected by both heat and humidity.
All packages of film should be stored away from heat sources: store in a cool, dry place at a temperature between 50° and 70° F (10° to 21° C). The National Council on Radiation Protection and Measurements (NCRP) Report No. 99 recommends that photographic material be stored at temperatures less than 75° F (24° C).
Keep open packages of film at a relative humidity between 30 and 50 percent. An inexpensive instrument called a sling psychrometer can be used to measure relative humidity. This instrument is commonly available through precision instrument supply houses. Hygrometers may also be used to measure relative humidity. Check the accuracy of the instrument under consideration before purchasing it.
Consult your film manufacturer(s) for temperature and relative humidity recommendations for the specific type(s) of film used in your facility.
Also keep in mind that temperature and relative humidity values frequently fluctuate throughout medical facilities from season to season. Year-round tight control of temperature and relative humidity should be the goal to achieve and maintain high quality and stable radiographic images.
It is also important to avoid storing film near chemical fumes, which can fog film. Film may also be damaged by exposure to radiation from x-ray machines or radioactive materials.
In addition, packages of sheet film should be stored on edge (like the books in a library). This allows for easy rotation of inventory. Always use older films first. The film’s expiration date is generally printed on both the box’s front and side panels, so the date is visible when the boxes are stored on edge.
Boxes of film should never be stacked horizontally because film at the bottom may show pressure artifacts by being weighed down by other boxes or cases of film.

Storage of Processed Film

Proper storage and handling of processed film is imperative for stability of the radiographic image. It is especially important to treat single-emulsion mammography film with great care, the same care you would give to your most treasured family photographs.
Film must be thoroughly washed during processing to remove residual fixer, which can cause staining and fading. Tests for fixer retention should be done at least every three months.
Since all films contain gelatin as one of the principal ingredients of their emulsion, it is important to maintain a constant temperature at about 70° F (21° C) and 40 to 60 percent relative humidity.
Subjecting radiographs to humidity below 30 percent and/or high temperatures can occasionally lead to emulsion cracking, an artifact that appears as a series of parallel lines in a D-max area of the film. This artifact can be avoided by storing film at constant temperatures and humidity, not overexposing film to “hot-lighting,” and using only the recommended bulb wattage for hot lights.
Should single-emulsion mammography film be processed emulsion side up or down?
Each processor used for mammography film (manually fed) should be evaluated before establishing the processor quality control (QC) program to determine whether single-emulsion mammography film should be processed emulsion side up or emulsion side down. The decision should be based on which orientation provides the best uniformity and the fewest processor-induced artifacts. There are no regulations that require a specific film orientation. Room-light processing systems are excluded from this evaluation because film orientation during processing is fixed.
Initially, it is necessary to assess whether any artifacts are being caused by the x-ray equipment, especially the grid(s). Both the 18 x 24 and 24 x 30 cm grids should be evaluated. This procedure (Artifact Evaluation) is discussed in the 1999 American College of Radiology’s Mammography Quality Control: Medical Physicist’s Manual.
Then follow this procedure:

1. Select a 24 x 30 cm mammography cassette that is known to have good screen-film contact.
2. In the dark, load a sheet of film into the cassette so that the film notch is positioned at the lower right corner or the upper left corner. The emulsion is upward facing if the notch or notches are located as described.
3. Place the cassette in the non-grid cassette holder or on top of the grid. A uniform sheet of acrylic (1-inch [2.54 cm]) thick may be placed on top of the cassette.
4. Select an exposure technique that will provide an optical density of 1.10 to 1.50 on the processed film.
5. In the darkroom under safelight illumination, remove the exposed film from the cassette. Lay the film on the film feed tray so that:
-The widest dimension of the film is the leading edge.
-The emulsion side is up.
-The film edge is along the guide on the right side of the film feed tray.Using a pencil, mark ” ­ UR” on a corner of the film nearest the film guide immediately before processing. The leading or trailing film edge corner may be used, as desired, as long as consistency is employed. The ” ­ ” indicates the direction of film travel, “U” indicates that the emulsion side is up, and “R” indicates that the right hand side of the processor was used.
6. Repeat the above steps for three additional films, all processed with the widest dimension of the film as the leading edge, and as follows:
Process film #2 emulsion side up on the lefmt side of the film feed tray; mark the film ” ­ UL.”
Process film #3 emulsion side down on them right side of the film feed tray; mark the film ” ­ DR.”
Process film #4 emulsion side down on them left side of the film feed tray; mark the film ” ­ DL.”
7. Place the four films on a view box and evaluate. Careful analysis will indicate whether emulsion up or down gives the best overall processing results. All clinical and QC films should then be processed in the same orientation.
It may also be possible to determine if one side of the processor is significantly different than the other in terms of artifacts. If so, it may signal a need to have one or more rollers replaced. It is important to check whether any film feeding practices (e.g., all single films habitually fed on the right side) may be accelerating roller wear on one side of the processor versus the other. Clinical films should be processed on both sides of the processor to prolong roller life. All QC films, however, should be processed consistently on only one side.
Note that while the above evaluation should take place in all processors used for mammography film, many processor manufacturers do recommend a particular orientation. Information on specific processors may be obtained by consulting the processor manufacturer.
It is also generally considered that processing mammography films with the emulsion side up will provide the best overall results. Notable exceptions include the recommendation that KODAK MIN-R EV, KODAK MIN-R 2000 and MIN-R L Films should be processed emulsion-side down in KODAK MIN-R Mammography or KODAK M35 or M35A-M X-OMAT Processors. It may be necessary to install smooth guide shoes to minimize guide shoe marks.

What is the crossover procedure?

Perform a crossover procedure when a new box of QC film is opened to adjust the originally established parameters for speed, contrast, and base plus fog on the processor QC chart for the characteristics of the new emulsion. An adjustment is required because film used in medical imaging is produced in batches and there may be slight differences in the sensitometric characteristics from batch to batch. The conditions under which the film is stored (i.e., temperature, relative humidity, exposure to fumes from chemicals or to ionizing radiation, etc.) and the age of the film can also affect the sensitometric characteristics of film.
Performing a crossover procedure is necessary to maintain a controlled processing environment. Note the following important points:
1. The crossover should be performed on the same day rather than over five consecutive days as when the processor QC program was initially established.
2. Expose and process all of the films required for the crossover:
At the same time of day that processor QC is normally performed because slight sensitometric changes due to fluctuations in film feeding patterns throughout the day are common. All at the same time, without interruptions. With the same delay (e.g., a few seconds) between exposure and processing that is normally used. Alternating the films from the existing QC box and from the new box. Expose and process the first film from the existing box, followed by the first film from the new box, the second film from the existing box, the second film from the new box, etc. This distributes any sensitometric changes due to seasoning equally among the 10 films. The films from the existing box and new box can easily be distinguished from each other before processing by marking one set of films with a lead pencil or by cutting a corner of one set of films, etc.The computations and adjustments to the control chart may be delayed until a more
3. The chemicals in the processor should be seasoned when a crossover is performed on a single day. Generally, for this purpose, it is important to avoid performing a crossover immediately after a preventive maintenance procedure (PM). Monitor both the number of films remaining in the QC box and when the next processor PM will be performed so that the crossover can be performed before the PM occurs and with fully seasoned chemicals in the developer tank. A good rule of thumb is that a minimum of 10 to 15 films should remain in the existing box of QC film when beginning a crossover procedure. A piece of cardboard from the film box inserted between the last 15 films and the balance of the box makes a good divider and serves as a reminder that a crossover must be performed.
4. The processor should be in control (within the ± 0.10 control limits for speed and contrast) for crossovers performed all on a single day. It is extremely unlikely, however, that the speed and contrast of the processor will be at the operating level originally established. It will be necessary, therefore, to adjust the new operating levels (taken from the characteristics of the new film) by the difference between the originally established aims and the current box of film.
5. The developer in the processor must have reached its operating temperature before doing a crossover procedure.
6. The crossover procedure should be fully outlined in the policy and procedures manual, and all QC personnel should be trained.
What is an emulsion number log, and how is it used for troubleshooting a suspected image quality problem?
Film manufacturers designate each box of x-ray film with a multiple digit emulsion number. This number provides important information such as which particular emulsion batch was used as well as which roll it came from, the specific part (slit) of the roll, and which variation of emulsion was used (variation code). Keeping track of the emulsion number of the film used for processor quality control is generally done in every processor quality control program. It is also extremely advantageous to keep track of the complete emulsion numbers of all film used clinically, especially for mammography. Doing so allows film manufacturers to make comparisons in speed, contrast, D-max, etc., between current clinical images and images taken one or more years previously. Such comparisons may assist in troubleshooting image quality concerns. The easiest way to retain this information is to start an emulsion number log. The log should contain the following information:

Type of film.
Date film box was opened.
Film size.

Complete emulsion number, including variation code.
Any other comments, such as which emulsions were used for processor QC or phantom images. Refer to the example of a emulsion number log below. Every time a box of film with a different emulsion number is opened, a new entry should be made in the log.
When is it appropriate to restart the processor and processor quality control program?
After a processor QC program has been initially established, it may be possible to proceed for a long period of time (i.e., a year or more) using the original operating aims if the processing environment is well controlled and all personnel operate in a consistent manner.
Most facilities, however, will benefit from a periodic reevaluation and reestablishment of the processor QC program. This might be done on, at least, an annual basis. Some facilities are hesitant to re-establish a processor quality control program. If you do reestablish your program, be sure to make a notation in the “remarks” section of the processor QC chart that the program was re-established and the reason why (e.g., annual reestablishment, etc.)
There are also a number of other events that dictate the reestablishment of the processor QC program. These include:

A change of film type in a dedicated processor.
A change of film mix in a non-dedicated processor.
When a film manufacturer makes a change to a film currently in use (e.g., increases the D-max) and recommends that the processor QC program be reestablished.
A change in film volume.
A change of brand(s) of chemicals used.
A change of chemical form used (e.g., switching from premixed solutions to concentrates used in an automixer).
A change in replenishment rates.
A change in the settings on a specific gravity automixer.
A change in the average optical density of the films being processed (e.g., the level of exposure on mammographic images is increased).

Using a different sensitometer and/or densitometer.

Running out of film or having less than five sheets of film in the QC box, thus preventing a crossover from being done correctly.
A change in the way the crossover procedure is done. Note that it is particularly important to first re-establish the processor QC program (over five consecutive days), and then, upon opening the next new box of QC film, implement a new way of doing the crossover.
In addition, over time, the values for speed and contrast on particular steps may no longer be consistent with the guidelines for establishing processor QC (the speed step closest to 1.20, and the two steps used to calculate the density difference closest to 2.20 and closest to, but not less than 0.45) due primarily to adjustments from the crossover procedure. If the step chosen to monitor speed, in particular, is now lower than 1.0 (down in the toe, not on the straight-line portion of the characteristic curve), the control chart will be relatively insensitive to processing changes that could affect clinical films. If the step chosen to monitor speed is now higher than 1.50, the control chart will be hypersensitive to processing changes and it may be difficult to maintain a controlled environment.
The reestablishment of the processor QC program, including changing the step numbers used, if appropriate, is recommended.
How important are environmental temperature and relative humidity to image quality?

Storage of Unprocessed/Unexposed Film

Most medical x-ray films come in a sealed, moisture-proof inner wrap, which is packed in an outer cardboard box. Sealed packages of film are affected by heat; open packages are affected by both heat and humidity.
All packages of film should be stored away from heat sources: store in a cool, dry place at a temperature between 50° and 70° F (10° to 21° C). The National Council on Radiation Protection and Measurements (NCRP) Report No. 99 recommends that photographic material be stored at temperatures less than 75° F (24° C).
Keep open packages of film at a relative humidity between 30 and 50 percent. An inexpensive instrument called a sling psychrometer can be used to measure relative humidity. This instrument is commonly available through precision instrument supply houses. Hygrometers may also be used to measure relative humidity. Check the accuracy of the instrument under consideration before purchasing it.
Consult your film manufacturer(s) for temperature and relative humidity recommendations for the specific type(s) of film used in your facility.
Also keep in mind that temperature and relative humidity values frequently fluctuate throughout medical facilities from season to season. Year-round tight control of temperature and relative humidity should be the goal to achieve and maintain high quality and stable radiographic images.
It is also important to avoid storing film near chemical fumes, which can fog film. Film may also be damaged by exposure to radiation from x-ray machines or radioactive materials.
In addition, packages of sheet film should be stored on edge (like the books in a library). This allows for easy rotation of inventory. Always use older films first. The film’s expiration date is generally printed on both the box’s front and side panels, so the date is visible when the boxes are stored on edge.
Boxes of film should never be stacked horizontally because film at the bottom may show pressure artifacts by being weighed down by other boxes or cases of film.

Storage of Processed Film

Proper storage and handling of processed film is imperative for stability of the radiographic image. It is especially important to treat single-emulsion mammography film with great care, the same care you would give to your most treasured family photographs.
Film must be thoroughly washed during processing to remove residual fixer, which can cause staining and fading. Tests for fixer retention should be done at least every three months.
Since all films contain gelatin as one of the principal ingredients of their emulsion, it is important to maintain a constant temperature at about 70° F (21° C) and 40 to 60 percent relative humidity.
Subjecting radiographs to humidity below 30 percent and/or high temperatures can occasionally lead to emulsion cracking, an artifact that appears as a series of parallel lines in a D-max area of the film. This artifact can be avoided by storing film at constant temperatures and humidity, not overexposing film to “hot-lighting,” and using only the recommended bulb wattage for hot lights.
Should single-emulsion mammography film be processed emulsion side up or down?
Each processor used for mammography film (manually fed) should be evaluated before establishing the processor quality control (QC) program to determine whether single-emulsion mammography film should be processed emulsion side up or emulsion side down. The decision should be based on which orientation provides the best uniformity and the fewest processor-induced artifacts. There are no regulations that require a specific film orientation. Room-light processing systems are excluded from this evaluation because film orientation during processing is fixed.
Initially, it is necessary to assess whether any artifacts are being caused by the x-ray equipment, especially the grid(s). Both the 18 x 24 and 24 x 30 cm grids should be evaluated. This procedure (Artifact Evaluation) is discussed in the 1999 American College of Radiology’s Mammography Quality Control: Medical Physicist’s Manual.
Then follow this procedure:

1. Select a 24 x 30 cm mammography cassette that is known to have good screen-film contact.
2. In the dark, load a sheet of film into the cassette so that the film notch is positioned at the lower right corner or the upper left corner. The emulsion is upward facing if the notch or notches are located as described.
3. Place the cassette in the non-grid cassette holder or on top of the grid. A uniform sheet of acrylic (1-inch [2.54 cm]) thick may be placed on top of the cassette.
4. Select an exposure technique that will provide an optical density of 1.10 to 1.50 on the processed film.
5. In the darkroom under safelight illumination, remove the exposed film from the cassette. Lay the film on the film feed tray so that:
-The widest dimension of the film is the leading edge.
-The emulsion side is up.
-The film edge is along the guide on the right side of the film feed tray.Using a pencil, mark ” ­ UR” on a corner of the film nearest the film guide immediately before processing. The leading or trailing film edge corner may be used, as desired, as long as consistency is employed. The ” ­ ” indicates the direction of film travel, “U” indicates that the emulsion side is up, and “R” indicates that the right hand side of the processor was used.
6. Repeat the above steps for three additional films, all processed with the widest dimension of the film as the leading edge, and as follows:
Process film #2 emulsion side up on the lefmt side of the film feed tray; mark the film ” ­ UL.”
Process film #3 emulsion side down on them right side of the film feed tray; mark the film ” ­ DR.”
Process film #4 emulsion side down on them left side of the film feed tray; mark the film ” ­ DL.”
7. Place the four films on a view box and evaluate. Careful analysis will indicate whether emulsion up or down gives the best overall processing results. All clinical and QC films should then be processed in the same orientation.
It may also be possible to determine if one side of the processor is significantly different than the other in terms of artifacts. If so, it may signal a need to have one or more rollers replaced. It is important to check whether any film feeding practices (e.g., all single films habitually fed on the right side) may be accelerating roller wear on one side of the processor versus the other. Clinical films should be processed on both sides of the processor to prolong roller life. All QC films, however, should be processed consistently on only one side.
Note that while the above evaluation should take place in all processors used for mammography film, many processor manufacturers do recommend a particular orientation. Information on specific processors may be obtained by consulting the processor manufacturer.
It is also generally considered that processing mammography films with the emulsion side up will provide the best overall results. Notable exceptions include the recommendation that KODAK MIN-R EV, KODAK MIN-R 2000 and MIN-R L Films should be processed emulsion-side down in KODAK MIN-R Mammography or KODAK M35 or M35A-M X-OMAT Processors. It may be necessary to install smooth guide shoes to minimize guide shoe marks.

Why is my prep ready light on a GX/MP/AP/ATC/MPX/APX generator not illuminating after the prep delay?

In addition to the possibility of a door or collimator interlock connection; check that the X-Ray tube stator is wired to the generator correctly. Incorrect main and phase currents will cause the absence of the Rotor OK signal. The wire colors for main, phase and common can vary. It is best to measure the main to common and phase to common resistance to determine connections. The main resistance is about half the phase resistance with a typical R stator. Q stators would be a similar ratio, but measuring lower resistance values.

Why does my GX/MP generator’s time display flash when I attempt an exposure?

The flashing time display indicates a KV fault. (Refer to user manuals section)

What is meant by the phrase KV Fault?

The fault is an error that means the anode and /or cathode KV feedback is either less than 13 or greater than 72.5 KV. (Refer to user manuals section)

Why do I have a 4 digit KV or other strange symbols displayed on my AP/ATC series generator display when manual mode is selected?

This problem is usually a corrupted NVRAM chip on the Microprocessor board inside the control console. A tube arc or electrical surge may have caused this to happen. Another symptom of this problem is that you can’t change focal spot in calibration. Proceed as described below to reprogram the default values for manual techniques.
Turn console on
Press “Prev Screen” to display “SYSTEM MENU”
Select “Utilities”
Enter Password – SR48
From “Utilities Menu”, select “System Install”
Press “SELECT” 10 times, or until the “Default Values” screen is displayed
Press arrow key above Mas display to highlight value
On right side of console, press “Arrow Up”, then “Arrow Down”
Press arrow key above Kvp display 2 times to highlight value
On right side of console, press “Arrow Up”, then “Arrow Down”
Press 3rd key on top row (Filament Select) 3 times to toggle focal spot
Press “Select” and answer NO to Password Modification question
After “Checking for and Saving Changes…”, select Manual Mode on console and verify proper system operation.

I can’t change focal spot in calibration. What shall I do?

Refer to last answer.

Why does a mA fault occur when pressing prep or exposure on AP/ATC /MPX/APX generators?

The mA fault calibration needs to be performed. The actual filament reference voltage cannot exceed the limit set in the calibration. The filament reference voltage may be a higher than normal value due to a component failure on the mA/Rotor board. (See service manual for details)
Need to switch incoming power to a GX/MP/AP/ATC/MPX/APX generator from single phase to 3 phase power.

Are modifications necessary?
No modifications are necessary on generators produced after the 1994 production run. These generators can accept single or 3 phase power with the proper line matching transformer requirements. Generators produced earlier than that time need to be checked to confirm that a 3 pole line contactor in the power module is present. Please consult tech support if a 3 pole contactor upgrade kit is needed or a need for a line matching transformer part number to step the voltage up or down. Nominal 240-280 is required depending on the generator.

What are the power requirements for the GX/MP/AP/ATC/MPX/APX generators?

Please refer to the X-Ray Generator Power Requirements document here. Be sure to match the KW rating of the generator to the specific chart from the document.

Why do the buckys oscillate without command after the generator is powered on?

The H.V. auxiliary board has a snubber network for each bucky drive circuit. This is to prevent damage to the generator from some older style bucky’s. The snubber networks are not needed for the buckys we use. Leakage current through the snubbers is enough to drive the buckys on an intermittent basis. To disable the snubber networks, clip one side of resistors R2 and R15 on the HV auxiliary board.

Why do I keep experiencing Inverter #1 errors when an exposure is attempted at higher KV settings?

Inverter # 1 errors indicate that the inverter has exceeded the current limitations. High currents occur when arcing in the secondary of the high voltage chain. A tube seasoning procedure in the Maintenance section of the service manual may need to be performed to heat soak the tube housing and eliminate this arcing, in some cases.

The generator does not turn on via the console, what might cause this problem?

There’s a possibility of a broken communication wire in the network communication cable between the console and power unit. Swap the cable with a standard network cable as a test. This problem is known to occur during new installations especially if the comm. cable was pulled through conduit.

The generator does not prep via the console, what might cause this problem?

See answer to last question.

The generator does not expose via the console, what might cause this problem?

See answer from 2nd to last question.

When programming technique changes for small, medium and large patients, why aren’t all the entered mAs values saved to memory?

Only the KV value can be programmed for each patient size. You can not do this with mAs. The last entered mAs value will be the mAs value for all three patient sizes small, medium, and large. If this is unacceptable, you have to configure the console for CM thickness. Here the user will have control over kV, mAs and time for a selected anatomy and CM thickness.

When utilizing CMP or Indico GenWare software, what type of cable do I use to connect to the console?
This cable must be a 9 pin NULL MODEM cable with female connectors at both ends. If your laptop does not have a serial port, you will need to purchase a USB to serial adapter with the driver.
Do I really need to use the CPI GenWare?

For CMP and Indico generators, GenWare is not required for every installation, however; you will need to utilize the GenWare program if the tube data information is not in the console tube library or if you are making major changes to the APR data base. It is also a wise idea to back up all of the APR and generator data when installation is complete.

Why do I get “CAL-MIN MA ERROR” when calibrating a CMP generator for the first time?

Since tubes have different emission levels, some tubes conduct (produce mA) easier than others. This error is displayed when the tube conducts as a result of filament current in stand-by. The mA produced under this condition is so small that it triggers the Low mA trip point and displays the error. Simply lower the stand-by filament current by 2 clicks, and re-try the auto cal.

Can I view images from a home or remote computer?

Yes, you can view both uncompressed and compressed DICOM studies from home or other remote locations. In fact, every function of our software, including templating, can be accessed from any computer with the Browser installed and Internet access to your Server.

How many users can sign in to Echoes simultaneously?

There is no limit to the number of simultaneous user sessions; however, each actual person accessing Echoes must have their own individual Echoes user account. Sharing Echoes user accounts is not allowed as it obfuscates log entries used to determine the actual person who accessed the patient health information.

Is there a limit to the number of DICOM modality connections to the server?

Medstrat does not restrict the number of DICOM modalities that may use the server for storage. Please contact us if you wish to add another modality connection to your PACS.

Will this software integrate with our EMR (Electronic Medical Record) System?

Medstrat has strategic partnerships with a number of EMR system vendors and integrates with new ones each month. If we have never worked with your EMR vendor before, we will do our best to facilitate the integration with this software. The EMR vendor simply needs to follow the EMR Interface Specifications. Please contact us for a list of current EMR vendors that have been integrated already.

Is the modality worklist feature an out-of-box solution, or does it require custom software for integration?

We provide an out-of-the-box solution to HL7 that is IHE compliant. This means your EMR, if it is IHE compliant, can send Scheduling Information (SIU) HL7 messages to our PACS. Those scheduling entries will be stored on the PACS until they are requested on the Study Date by the Modality during a DICOM Modality Worklist request. Unfortunately, some EMRs are not IHE compliant solutions for integrating with a PACS because they use their own brand of “HL7 messaging”. As such, there can be a need for collaboration between all three parties to help alleviate non-compliance issues.

Can I put studies on removable media (CDs, USB keys, portable hard drives)?

The Echoes Browser provides powerful tools to easily burn CDs for distribution to patients. It also provides a tool to synchronize studies and a viewer onto many types of removable media. On read-write removable media (such as USB keys) the viewer has full functionality including all tools, templates, and the study’s images. Please note that if you plan to use USB keys with the Echoes To Go solution, we recommend you use IronKey to protect your patient health information from breaches in cases of lost or stolen removable media.
I cannot access my PACS from the operating room, nor can I install software on any operating room computer, due to hospital policies and procedures.

How can I get my studies into the OR while still conforming to these rules?
The Echoes To Go solution is tailor made for just such a situation.