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Image Viewing Solution

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Lock Icon - DS Logon Required Apps for Health Care Professionals that display a lock icon require VistA account credentials because they connect to the VA Electronic Health Record (EHR). 

The Image Viewing Solution (IVS) App allows VA clinicians and other relevant staff to search for and view patients’ x-rays, radiology images, and other stored images in Veterans Health Information Systems and Technology Architecture (VistA) Imaging. The app aggregates images from all VA medical facilities, offering easily accessible diagnostic-grade images, capabilities to work with images (e.g., zooming, rotating, changing viewpoints, measuring) and a tool to collaborate with other clinical staff.

The IVS App protects Personally Identifiable Information (PII) and Protected Health Information (PHI) as well as the fidelity of the image, ensuring IVS usage is HIPPA compliant and that images cannot be manipulated.

Features:

  • Find patient’s by searching specific archives or all of VA’s databases
  • View and work with images in the IVS Study Browser
  • Collaborate with other health care professionals
  • View images from different perspectives (e.g., 2D, MIP/MPR, 3D)
  • Work with images in a variety of ways, such as zooming, flipping, highlighting and measuring on an image
  • Diagnostic Quality Images

    With the Image Viewing Solution (IVS) VA clinicians can view Veteran patients’ clinical images. The IVS aggregates images from VA enterprise medical facilities, offering easily accessible diagnostic-grade images.

  • Many Ways to Work with Images

    Work with images in a variety of ways, such as zooming, mirroring, measuring and making notes on an image.

  • MIP/MPR View

    The maximum-intensity projection/multiplanar reconstruction (MIP/MPR) view allows you to see and interact with cross sections of 2D images.

  • View and Work with 3D Images

    The 3D view allows you to see and interact with images as they would seem in real life.

  • Magnify Part of a 3D Image

    The lens feature allows you to magnify a section of a 3D image while keeping the entire volume in the main view.

  • Collaborate

    Collaboration allows multiple physicians to view a patient’s images simultaneously and offer feedback.

The Image Viewing Solution (IVS) mobile application (app) allows U.S. Department of Veterans Affairs (VA) clinicians and other medical professionals to search for and view patients’ clinical images. The IVS aggregates images from VA enterprise medical facilities, offering easily accessible diagnostic-grade images, capabilities to work with images (e.g., scrolling, panning, zooming, adjusting window/level) and a tool to collaborate with other VA clinical staff.
To use the IVS, you must be a VA health care professional with credentials for the Veterans Health Information Systems and Technology Architecture (VistA).
With the IVS you can view and manipulate images in three different ways: 2D, MIP/MPR and in 3D.
When you log into the IVS, the search will default to Search options. Fill out one or more of the following fields: patient name, modality, date range or a specific repository. Click Search to open up the Search Results, directly below the Study Search options, showing all patient entries that match your search. You can also click Reset to clear all the forms. NOTE: Patient ID and Accession Number should not be used in the IVS.
After you have searched for a patient using the Search options, a list of patients whose information matches your search criteria will appear on Search Result , directly below the Study Search options. Select the image search results you would like to view and work with, and click Add to Study List. The image(s) will appear in the Study List (right side of the screen). Double click the image under the Study List you would like to view in the Image Viewer, or from the Image Viewer, click and drag the image (when the study list is visible after clicking the “Expand Study List” icon) you would like to view to the Image Viewer (or to the desired location if in a multiple image layout).
You can navigate images in the Image Viewer with the navigation tools. In the top left corner of the image under Navigate, click one of the following, and your cursor will change to that icon and you can manipulate the image:
  • Scroll (several lines with an up and down arrows icon) – When selected, click and drag up and down to scroll through the images in a series. This view is available for 2D and MIP/MPR view modes only.
  • Pan (two multidirectional arrows in a cross icon) – When selected, click and drag in any direction to Pan (move an image one direction or another) the image.
  • Zoom (magnifying glass with a + icon) – When selected, click and drag up and down to zoom in and out of the image.
  • Window/Level (half shaded sun icon) – When selected, click and drag left and right or up and down to adjust window level.
After you have loaded images into the Image Viewer, the patient’s data can be divided into two vertical, two horizontal or four separate panes. By clicking on the buttons on the bottom left of the screen, you can change the way the images are presented:
  • Link Views (chain icon) – In 2D mode, you can scroll through images by moving the wheel of your mouse, and you may view up to four images at one time. If you are viewing two or more images at one time, you can link your views together so that when you scroll through one image, the other images scroll simultaneously. Or you can unlink your views so that if you scroll through one image, the others remain fixed.
  • 1x1 Layout (box icon) – One image.
  • 1x2 Layout (vertical rectangles icon) – Two images side by side.
  • 2x1 Layout (horizontal rectangles icon) – Two images stacked top and bottom.
  • 2x2 Layout (four squares icon) – Four images in a square.
To begin a linear measurement, click the ruler icon under Measure. Your cursor will change to a +, and click on the image where you would like to start drawing a line. Hold down and drag your cursor to where you would like to end your line. Release your mouse, and the distance between the two points will be calculated both next to the line and in the measurement box. You can adjust the line by clicking on an end point and dragging it to a new location.
To begin a region of interest measurement, click the ellipse-plus icon under Measure. Your cursor will change to a +, and click on the image near the region you would like to measure. Hold down and drag your cursor, and a box with an oval inside will appear. Release your cursor when the box and circle has covered the region you would like to measure. The measurements for Mean, Std Dev (standard deviation) and Area will be calculated both next to your drawn box and in the measurement box. You can adjust the box by clicking on the corners and dragging it to a new location.
To begin a point measurement, click the cross with open circle in center icon under Measure. Your cursor will change to a +, and click on the image at the point you would like to measure. The X axis, Y axis and Value (in Hounsfield Units) will calculate both next to the point and in the measurement box. You can move the point by clicking on it and dragging it to a new location.
To begin an angle measurement, click the angle with a degree symbol in the center. Your cursor will change to a +, and click on the image where you would like to measure the angle. Click on the points at the vertex and the arms of the angle, and drag until the angle faces and covers the region you would like to measure. The degrees will be calculated both next to the angle’s vertex and in the measurement box.
While the MIP/MPR view is generally used to show images at right angles to each other, you can create a Curved MPR (CMPR), which is a series of 2D images that follow the curvature of a specified part of anatomy. When viewed together, they present a continuous (elongated) depiction of the entire anatomical structure in a single plan. You must first enable CMPR by right clicking to display the radial menu and clicking Manual CMPR. Use your cursor to draw and define a centerline. Points will appear on the line as you draw, and the line will be reflected in the other three images.
There are a few ways you can work with 2D images:
  • Scrolling through slices – Either use the wheel on your mouse or use the Scroll icon.
  • Zooming in – Either (1) press the = key, (2) hold the Alt key, and scroll up with your mouse wheel or (3) hold Ctrl-Shift while clicking and holding down the left side of your mouse, then drag your cursor up. (On a Mac, hold Cmd instead of Ctrl).
  • Zooming out – Either (1) press the – key, (2) hold the Alt key, and scroll down with your mouse wheel or (3) hold Ctrl-Shift while clicking and holding down the left side of your mouse, then drag your cursor up. (On a Mac, hold Cmd instead of Ctrl).
To manipulate the image, including rotating, mirroring and using preset views, click the three line icon at the bottom left of the image, and the Tools menu will appear. Under Manipulate, click one of the following:
  • Mirror Vertical – The image will flip vertically.
  • Mirror Horizontal – The image will flip horizontally.
  • Rotate CW (clockwise) – The image will rotate 90 degrees to the right.
  • Rotate CCW (counter clockwise) – The image will rotate 90 decrees to the left.
  • Invert – The intensity of the image will invert.
  • Lens – A magnifying glass tool will appear. Click and drag to move the magnifying glass across the image.
  • Reset – Only the image you are accessing the Tools menu from will reset.
  • Window/Level Presets – Several preset views will appear. These presets are to view certain elements or materials within an image, such as soft tissue or blood. For 2D images, click the preset you would like to use, and the width and level will adjust accordingly.
The MIP/MPR (maximum-intensity projection/multiplanar reconstruction) view allows you to see and interact with cross sections of 2D images. When you load images into the Image Viewer, the view will default to 2D. To change the view, click on the three line icon at the bottom of the image. The Tool menu will appear, and click MIP/MPR. The MIP/MPR screen is divided into four images: three small images in a vertical strip on the left, and one large image on the right. The small images on the left show three perspectives and are color coded:
  • Green - Slices taken from left to right (sagittal).
  • Blue - Slices taken from front to back (coronal).
  • Red - Slices taken from top to bottom (axial).
The larger image will be a close-up of one of the smaller images. Double-clicking on a small image will change the image in the big window for viewing. To emphasise from which perspective the larger image is being viewed, the larger image outline will match the color (green, blue or red) of the small image it duplicates. Any changes or mark-ups made to one image will be reflected in the other images of the series being viewed.
In each of the small images on the left, there are two perpendicular positional lines that represent the cross sections or slices you are viewing. You can move lines to view the image from different perspectives. To change the view, you can:
  • Move a plane perpendicularly or in parallel orthogonally – Click on any solid part of the perpendicular positional lines over the image. Hold down and drag up, down, right or left to reposition.
  • Freely move positional lines – Click on the center of the cross hair at the bottom left of the large image and drag.
  • Re-center the positional lines – Click on the intersection of the perpendicular positional lines. Hold down and drag to reposition.
  • Triangulate a point – Hold down the Ctrl (or Cmd on a Mac), and click anywhere on any of the three smaller images in the strip view. The point will be reflected in the other two smaller images, and the large image on the right will adjust accordingly.
While the MIP/MPR view is generally used to show images at right angles to each other, you can create a curved MPR (CMPR), which is a series of 2D images that follow the curvature of a specified part of anatomy. When viewed together, they present a continuous (elongated) depiction of the entire anatomical structure in a single plane. To enable CMPR click on the three line icon at the bottom left of the image, and the Tools menu will display. Under Manipulate click CMPR (curved line icon). By default, the bottom left pane becomes the curved MPR. Then you can:
  • Draw to define a centerline – Left click your mouse and hold down, and draw a line on any of the images to designate your centerline. Points will appear on the line you have drawn, and the line will be reflected in the other three images.
  • Adjust the centerline – Click any of the points on the centerline you have drawn, and hold down and drag to reposition.
  • When you load images into the Image Viewer, the view will default to 2D. To change the view, click on the three line icon in the bottom left of the image to display Tools, and click 3D.
    The lens feature allows you to magnify a section of a 3D image while keeping the entire volume in the main view. Press the O key and click on the area you would like to magnify. The magnified area will appear in a circular lens. You can then:
  • Move the lens over the volume – Left click on the magnified area in the lens and hold down. Drag the lens to reposition.
  • Move the lens through volume – Click on the magnified part of the lens, and scroll the wheel of your mouse up or down to push the lens deeper into the volume and back out.
  • Adjust the level of the lens’s magnification – Click on the magnified part of the image in the circular lens. Scroll the wheel of your mouse up to increase magnification, or scroll the wheel of your mouse down to decrease magnification.
  • You can use either Clipping Planes or the Scalpel Tool to view only a section of the 3D image.
  • Clipping Planes - If you would like to view certain areas of an image but other parts of the image are in your way, you can remove the material that is obscuring your view. Click the three line icon in the bottom left of your screen, and the Tools menu will appear. Under Manipulate click Clipping Planes (box icon). A box will appear around the image with floating dots or “handles” in the middle of the box. Click on either an edge or a corner of the box, and drag to readjust the size. Click on one of the floating dots or “handles” in the middle of the box, and drag to slice away or remove planes of material. To rotate the image, click outside the box, and drag. To reset the clipping planes and image orientation, press G.
  • Scalpel Tool - The scalpel tool manually cuts away obscuring anatomy, allowing for a greater degree of precision than clipping planes. Press the X key, then left click, hold and drag the scalpel around the part of the image you would like to cut away. Release your mouse, and hover your mouse over the outlined area so that it is highlighted. Press the Delete key, and the shaded section will disappear. To undo the cuts, press Z while the scalpel tool is enabled.
  • Collaboration allows multiple physicians to view a patient’s images simultaneously and offer feedback. NOTE: When collaborating, only the host’s images will be of diagnostic quality.
    To host a collaboration session, click the Collaboration Panel button (the person with a + icon in the bottom right corner). A pop-up Collaboration box will appear, and click Start Session. As a host, you can send invites, allow participants to interact with the images, show or hide confidential personal information and end the session. NOTE: Each session has its own link, so once you end a session, you cannot use the same link again to host or enter a collaboration session. You must send a new invite by email or by copying the session link and pasting it into a tool like Skype to begin every session.
    In order to join a session, you must have received an emailed invite for the session and be actively connected to the VA network or the link has been sent to you by another method e.g. “Copy Link” and instance message. Open the emailed invite, and click the link to the session provided in the email. A pop-up Participant Info box will appear. Type your name and email address, and click Join. You will enter the meeting and be able to see the host’s screen.
    Additional information about other available VA Apps can be found on mobile.va.gov/appstore as well as mobile.va.gov.
    IVS offers a built-in User Guide. To access the built in User Guide click the Image Viewer icon (person with x-ray) in the top left corner to go to the Image Viewer screen > Click the book icon in the top right of your screen, and a User Guide will open in another window. In addition to the User Guide built into the app, more resources, such as a Quick Start Guide, Slideshow and FAQs, can be found on mobile.va.gov/appstore, and search for the app to access the resources. If you need assistance with the Imaging Viewing Solution, dial 1-844-482-6624 to speak with a VA representative. The Help Desk is open weekdays from 7 a.m. to 7 p.m. CT. For TTY assistance, dial 711.


    Help Desk
    VA Care Teams: (844) 482-6624
    Veterans: (877) 470-5947
    Weekdays 7 a.m.-7 p.m. (CT)

    Correspondence Address
    VA Mobile Health
    VHA Office of Connected Care (10P8), 375AA
    U.S. Department of Veterans Affairs
    810 Vermont Avenue, NW
    Washington, DC 20420