Create a hanging protocol

Before reading this section, see Hanging protocols overview. It contains explanations of hanging protocol concepts and terms that are used in these instructions. If you are an administrator, see the hanging protocol section in the Administration Guide.

Quick guide

The following is a set of basic instructions so you can quickly get started with hanging protocols. To learn more about the more advanced fields in the Hanging Protocol editor, see the Advanced guide below.

1. Open a study and arrange the series in the viewports as you'd like them to be seen in the first step of the hanging protocol.
2. On the Hanging Protocol tab, click . eUnity opens the hanging protocol editor. The viewer state is captured as the first Presentation Step in the hanging protocol.
3. In the Name field, add a descriptive name for the hanging protocol.
4. Edit the Display Sets, if needed.
5. To add a new Presentation Step, click in the Presentation Steps section.
6. To edit the Presentation Step, click in the new step. The Presentation Step dialog opens.
7. In the Presentation Step dialog, in the Name field, add a name for the new Presentation Step.
8. Rearrange the series in the viewer and click Get Viewer State. The viewer state is captured as a new Presentation Step.
9. In the Study Slots section of the Presentation Steps dialog, click the individual viewports to edit the Display Sets or set Display Set properties.
10. Click OK.
11. Repeat steps 5-10 for each Presentation Step that you want to add.
12. Click Apply at the bottom of the Hanging Protocol editor to apply the changes to the current view.
13. Click Save to save the changes.

Advanced guide

The number of steps that it takes to create a hanging protocol depends on the quality and quantity of your system's Study Selectors and Series Selectors. After you lay out the study in the viewer, if your selector library is detailed enough, eUnity should be able to precisely identify study types and series types. If your selectors need a little more detail, there may be a few extra steps needed to create a hanging protocol.

The following table represents two possible hanging protocol workflows. Detailed instructions for each step of the workflow are available below.

Selectors identify study and series generally	Selectors identify study and series precisely
Arrange series and capture the viewer state Set hanging protocol matching criteria Refine the Study Selector Refine the selection criteria for the study Add or edit Display Sets Add Presentation Steps, if necessary Define the view for the Presentation Step Add viewer-level properties, if necessary Apply and save changes	Arrange series and capture the viewer state Set hanging protocol matching criteria Add Presentation Steps, if necessary Define the view for the Presentation Step Add viewer-level properties, if necessary Apply and save changes

Hanging Protocol tab overview

The following buttons are available on the Hanging Protocol tab of the toolbar for managing, adding, and editing hanging protocols. For information on navigating through a hanging protocol after it is applied, see Select a hanging protocol and step through it.

	Settings - Hanging Protocols Open the hanging protocol panel (the Hanging Protocol tab in the Settings panel) to add, edit, copy, or delete hanging protocols.
	Add Hanging Protocol Captures the information on screen (Display Sets and layout) and creates a new hanging protocol.
	Edit Hanging Protocol Edit the active hanging protocol. This icon is available only when there is an active hanging protocol. Access non-active hanging protocols in the hanging protocol panel (the Hanging Protocol tab in the Settings panel).

Lay out the study in the viewer and capture the viewer state

Arrange series and capture the viewer state Open a study and arrange the series in the viewports as you'd like them to be seen in the first step of the hanging protocol. On the Hanging Protocol tab, click . Alternately, if the hanging protocol panel is already open, click Add in the upper-left corner of the panel and then and click beside Add Hanging Protocol. eUnity captures the selection criteria for the study and series, and captures the overall layout. This information is displayed in the hanging protocol editor as the Study Selector, Display Sets, and the first Presentation Step. Note that properties such as Window Level, rotation, etc. are not captured; they must be set manually. NOTE: If Shuffle mode is turned on when you capture the viewer state, the screen layout will be captured, but not the study information. To capture the study compare mode, turn off Shuffle mode before you capture the viewer state.

Name the hanging protocol and set matching criteria This part of the hanging protocol defines criteria that the study and viewer must meet for the hanging protocol to be chosen. In the Name field, add a descriptive name for the hanging protocol. In the Priority field, select a priority. When multiple hanging protocols match a study, the hanging protocol with the higher priority will be chosen. If multiple matching hanging protocols have the same priority, a user's own hanging protocol will be chosen over the group or site hanging protocols and a group hanging protocol will be chosen over a site hanging protocol. If there are no user-level or group-level matches, the hanging protocol with the more specific selection criteria is used. Note that the priority will be shown in the priority column in the hanging protocol panel as long as the browser window is large enough to display the column. In the Device field, select the device type that the hanging protocol should be used for. For example, only choose this hanging protocol when the user is on a tablet. In the Screens field, select the number of screens that the hanging protocol should be used for. For example, only choose this hanging protocol when the user has 2 monitors. If necessary, add additional Study Selectors. In the Study Selector field, start typing the name of a Study Selector and select it from the list. The Study Selectors will be separated by "OR". For example, MRI knee with contrast OR MRI knee without contrast OR MRI knee with / without contrast.

Refine the selectors

If the Selectors identify the study and series at a general level, but you would like something more specific, you can further refine the Study Selectors by removing some of their selection criteria or you can add your own selection criteria to the hanging protocol. You can also edit the Display Sets to further refine the Series Selectors.

For example, if the Study Selector used by the hanging protocol has selection criteria that says Modality is equal to MR AND Manufacturer is equal to ACME, but you want to remove the manufacturer criteria, you can clear that criteria in the Study Selector Refinements section. Conversely, if the Study Selector has selection criteria that says Modality is equal to MR, but you want this hanging protocol to apply only to MR studies from a ACME machines, you can add Manufacturer is equal to ACME in the Selection Criteria section.

Or, for example, a Series Selector identifies an AXIAL series, but you were actually interested in that series because it was an AXIAL T2, you can add additional selection criteria to the AXIAL Display Set in the Display Set section. For example, MR repetition time is greater than 2000 AND MR echo time is greater than 80 AND Flip angle is equal to 90.

	Refine the Study Selector Optionally remove selection criteria from the Study Selector. This does not edit the actual Study Selector; it is refined only for the specific hanging protocol. Once you make refinements to the Study Selector in the hanging protocol, the hanging protocol will no longer automatically inherit changes that are made to the Study Selector by an administrator. You will be notified that there are changes available and you can choose to accept them. See Accept Study Selector updates below. Click beside Study Selector Refinements to expand the section. Click a checkbox to clear any of the selection criteria. Click the checkbox beside the operator (AND / OR) to clear all the selection criteria in the expression. When a Study Selector has been refined, three asterisks are displayed beside the label in the hanging protocol editor. The asterisks are also displayed beside the Study Selector in the hanging protocol panel. Accept Study Selector updates If an administrator makes changes to a Study Selector, any hanging protocols that use that Study Selector and have Study Selector refinements will show a message in the hanging protocol editor indicating that "One or more expressions have changed". To view the changes, click to expand the Study Selector Refinements section and click to view a comparison of the old Study Selector and the new Study Selector. A Compare dialog opens. On the left, it shows which Study Selector selection criteria are currently used in the hanging protocol in a read-only view. On the right, it shows the new selection criteria that the hanging protocol will use if you choose to accept the Study Selector update. To update the hanging protocol to use the new Study Selector expression, click Update. To continue to use the old Study Selector expression, click Cancel. Note that if there are multiple new selection criteria and you only want some of them, you can clear any of the checkboxes in the New Selector Expression section before clicking Update.
	Refine the selection criteria for the study In the Selection Criteria section, select AND or OR. If the all selection criteria must be true to match a study, select AND. If any of the expressions can be true to match a study, select OR. Click to add a selection criterion field. For each selection criterion, select the DICOM attribute, the operator, and the value. For example, to use the hanging protocol for a study without priors, add "AND Number of studies is equal to 1". To use the hanging protocol for a study with priors, add "AND Number of studies is greater than or equal to 2". For information on creating more advanced expressions, see the Administration Guide. Note: Selection criteria is appended to the Study Selector (see step ). So, if the Study Selector is MR and you add selection criteria of AND Manufacturer is equal to ACME, then the hanging protocol will apply to studies where Modality is equal to MR AND Manufacturer = ACME.
	Add or edit Display Sets To add a Display Set, click in the Display Set section. To edit a Display Set, click on the Display Set. In the Name field, add or edit the Display Set name. Select AND or OR. If the all selection criteria must be true to match a series, select AND. If any of the expressions can be true to match a series, select OR. Click to add a selection criterion field. For each selection criterion, select the DICOM attribute, the operator, and the value. For example, Series description contains PD. Apply any desired properties to the Display Set. For more information, see Display Set properties. For information on creating more advanced expressions, see the Administration Guide.

Add Presentation Steps and define the Presentation Step view

Presentation Steps are the views that you step through in a hanging protocol. For example, step one of a mammography hanging protocol may be to view the left breasts (LCC, LMLO) and step two is to view the right breasts (RCC, RMLO) and step three may be to view all images with CAD markers turned on. Each of these states is captured as a Presentation Step. You can define a different Study Compare mode and monitor layout for each Presentation Step in the hanging protocol.

Add a Presentation Step To add a new Presentation Step, click in the Presentation Steps section or click to copy an existing Presentation Step. Click in the newly added step. In the Name field, add a name for the new Presentation Step. Select the Monitor Mode, Study Compare Mode, and Monitor layout or click Get Viewer State to automatically capture these fields from the current layout in the viewer. If there are any properties that should be applied to all of the Display Sets in the Presentation Step, set those properties. For more information, see Presentation Step properties.

Edit the Presentation Step view Set which Display Set is shown in which viewport and optionally override some of the properties that are set on the Presentation Step. To do this, you can either change the layout in the viewer and click Get Viewer State to automatically capture the layout and Display Sets (if available), or manually configure the view in the Presentation Step dialog. These instructions explain manual configuration. NOTE: When you click Get Viewer State, properties such as Window Level, rotation, etc. are not captured. Properties must be set manually. The numbers on the screens in the Study Slots section represent studies. The current study is 1, the most recent prior is 2, the next most recent is 3, and so on. A "study slot" is the physical space that a study occupies. For example, if the current study is spread across 2 monitors then study slot one will appear on monitors 1 and 2. This is represented with the number 1s below. In the Study Slots section of the Presentation Steps dialog, click a viewport. In the Series Selection dialog, choose the Display Set that you want to display in the viewport. To add alternate Display Sets, click beside Display Sets. Alternate Display Sets are useful for studies that are missing series. If, for example, your first choice for the view is a Sagittal PD FS, but if that wasn't available, you would prefer to see any Sagittal instead, you add a Sagittal PD FS Display Set first and then Sagittal Display Set after that. If necessary, select property overrides for the view (for example, set strict hanging of Display Sets). For more information, see View properties. Click OK.

Set viewer-level properties

Select any properties that should apply at the viewer / study level. For more information on the available properties, see Viewer properties. Note: Most viewer-level properties can be overridden at the Display Set-level, Presentation Step-level, or the view-level.

Apply and save changes

Click Apply to see your current hanging protocol settings in the current view. Note that Apply does not save changes. Click Save to save the hanging protocol. The hanging protocol will be available only for you. If you edit a hanging protocol and save it, but do not click Apply to apply the changes to the current view, you will continue to see the old hanging protocol in the viewer. To update the viewer to show the changes you made to the hanging protocol, reselect it from the Select Hanging Protocol dropdown on the toolbar . If you changed the name of the hanging protocol, you will see the old hanging protocol name when you hover over . The name will be updated once you select the new hanging protocol in the dropdown.

Hanging protocol properties

Hanging protocols, use properties to control what tools or modes are enabled or disabled, what panels or tools are shown in the viewer, and what kind of effects (such as inversion, rotation, Window Level etc.) are applied to the series. Properties are inherited, so most can be set at the viewer-level and then overridden in the Display Set, Presentation Step, or the individual views in the Presentation Step.

• Viewer properties
• Display Set properties
• Presentation Step properties
• View properties

The labels beside the properties have the following meanings: 

Action: true	Enable the property.
Action: false	Disable the property.
Action: none	Take no action on the property. That is, leave it in its current state. For example, if CAD Markers Action is true in Presentation Step 1, and Action is none is step 2, the CAD markers will remain turned on in step 2.

Viewer properties

With the exception of Breakout modality images and Combine series modalities, any of the properties that are set at the viewer-level can be overridden at another stage of the hanging protocol.

For example, if you want a mammography hanging protocol to have CAD markers turned on only for the first 2 steps of the hanging protocol, you can select CAD markers in the viewer properties and then deselect CAD markers in the third Presentation Step.

Toolbar mask	Hide unused tools from the toolbar. All tools are available to hide.
Navigate mode*	Change the series navigate mode to one of the following options:  Navigate through images– scroll only the selected series Navigate through series– scroll to the next series in the study when you reach the end of the series (i.e. scroll across series stacks). Once you reach the end of the study, eUnity will not loop back to the first series unless the configuration property EnableNavigateWrapAround is set to true. Navigate through studies (shuffle mode only)– Scroll to the next series in the study, and when the end of the last series is reached, continue to the first series of the next loaded study. Note that this option will skip over any series that are already on screen. This navigation option works only in Shuffle Mode. Navigate related series (mammo only) - In mammography studies, stack images that are the same view type together (for example, stack all CC views together). The view types that are stacked together are configured by the administrator. When images are stacked, an indicator (such as 1 / 2) shows in the viewport to indicate that multiple images are stacked. Note that key images are not included in related series.
Mammography view	Select of the following display modes for mammography images:  Same size – Displays images from the same patient acquired on different detectors at the same size. Quadrant – Breaks the images in 4 quadrants and allows the user to step through each quadrant. Maintains "same size" on each viewport. Fit to window – Zooms in on the breast bounding box to fit the viewport and maintains "same size" on each viewport.
Modalities to break out to separate series	Set which modalities should separate each image into a separate series. For example, if this property is set to DX, each image in a DX series will be broken out into its own series. Separate multiple values with a comma.
Modalities to combine to a single series	Set which modalities should combine all series into a single series. For example, if this property is set to CR, all series in CR studies will be combined into a single series. Separate multiple values with a comma.
Display demographics	Show or hide demographics.
Display reference lines*	Show reference lines on initial display.
Display CAD markers	Show the CAD markers for mammography studies by default. Note that if you have CAD markers on in the first presentation step, they will be on as you scroll through the presentation steps unless CAD markers are explicitly turned off in the step or the CAD markers are off on the viewer properties.
Auto shuffle mode	Automatically switch to shuffle mode if a series is dragged to a restricted location (for example, series from study 1 dragged to study 2 viewport).
Spine label	Toggle spine labels on or off.
Show report	Show the report panel on initial display.
Show study list	Show the study list on initial display.
Play cine	Start playing cine / video on initial display.
Series linking	Series linking for studies: Link series from the same plane across all studies Series linking for active studies: Link series from the same plane only within the active studyThe study that the currently selected series belongs to. No Series Linking: Do not link any series
Allow skipping	Skip over presentation steps when the study does not have the required display sets. Note that this applies only when the Strict property is selected.
Apply newest presentation state*	Applies the newest presentation state on initial display.
Presentation steps wrap around	Cycle back to the first presentation step in the hanging protocol once the final presentation step has been reached. This property will also cycle from the first to the last step when reversing through presentation steps.
Ignore saved zoom	Any zoom factor that was saved as part of a presentation state is ignored when you view the presentation state. If you are viewing a presentation state when this property is enabled, and you save a new presentation state or key image, the zoom factor from the original presentation state will not be saved in the new presentation state or key image. Note that the presentation state indicator is still shown in the viewport even when zoom is being ignored.

*These properties apply to prior studies as well. All other properties are for the current study only.

Display Set properties

The Display Set properties apply to any matching series even if it is not hung in the Presentation Step view. The Display Set view properties are mainly used to set the desired default presentation of the series. For example, if a study contains a scanned document which is usually white and very bright, it is nice to invert the series with the associated Display Set even if it is not hung in one of the Presentation Steps. It will be inverted when it is dragged into view from the available series.

These properties can be overridden in the view properties.

Rotation	Apply a rotation to the images in the series: No rotation Rotate 90° Rotate 180° Rotate 270° Flip horizontal Flip horizontal + rotate 90° Flip vertical Flip horizontal + rotate 270° WARNING Since this option will change the orientation of the image it is critical that the images have pre-existing orientation markers either burned into the pixel data or the annotation indicator in the demographic overlay. In the absence of these indicators, the system administrator should configure the annotation overlay to include the image rotation indicator.
Window Level Preset	Select a Window Level preset to apply to the series.
Sharpening	Apply a sharpening preset of High, Medium, or Low to the series.

Presentation Step properties

The Presentation Step view properties would be configured to step through different views of the series. For example: first show a series with a BONE Window Level then a SOFT TISSUE Window Level. If the Window Level of the series was just wrong, it would be best to correct it in the Display Set view properties.

Note that Presentation Step view properties are only applied if a specific Display Set matches the viewport. For example, if the view is not strict and the next available series is placed in the viewport, the Presentation Step view properties for the viewport will not be applied to the series. The Presentation Step view properties are usually specific to the series, so it normally would not make sense to apply them.

The Presentation Step properties are the same as the Viewer properties except for Breakout modality images and Combine series modalities.

View properties

Set properties that will apply at the view-level (that is, the individual Display Sets in the viewport). In the view properties, you can override the image rotation, Window Level presets, or sharpening properties. You can also set two additional properties: 

Strict Selection	If a study does not contain the Display Set that is defined for the view, the viewport will be left blank, when this option is selected. If this option is not selected, the next available series will be shown in the viewport. For example, in a mammography study, if there is no LCC, you may want to select "Strict" to leave the viewport blank rather than show the next available series.
Invert image	Select to invert the image.