WO2006022656A2

WO2006022656A2 - Radiography image management system

Info

Publication number: WO2006022656A2
Application number: PCT/US2004/024455
Authority: WO
Inventors: Scott H. Siegel; Eric J. Nienhouse
Original assignee: Siegel Scott H; Nienhouse Eric J
Priority date: 2004-07-28
Filing date: 2004-07-28
Publication date: 2006-03-02
Also published as: WO2006022656A3

Abstract

Apparatus and method for managing radiographic images (66) includes a capture device (15), a file server (30), a database server (28), a user workstation (23), and a data storage device (16) with removable media (see figure 3) Digital images (66) are captured b the capture device (15), automatically stored on the file server (30), maintained as the original image and archived to the data storag device (16). The workstation (23) copies and displays digital images (66). The database server (28) includes image records and patient records. The image records include all user manipulations of the digital image (66) as commands, and recalled digital image (66) are displayed as last viewed.

Description

RADIOGRAPHY IMAGE MANAGEMENT SYSTEM

Technical Field

The present invention relates to image management and more particularly to a system and method for acquiring, maintaining and displaying digital medical diagnostic images.

Background Art Medical diagnostic imaging relates to x-ray imaging and other forms of examination and diagnosis employing an energy beam to explore the condition of a patient. A variety of other examination methods are in common use, including ultrasound and magnetic resonance. Digital imaging methods have supplemented or replaced certain prior techniques that recorded a medical diagnostic image on a plate or film. A digital image is recorded electronically and displayed on a monitor screen. It is readily possible to convert the digital image to other media, such as a printed picture of the image. In addition, the digital image can be preserved on many types of standard computer storage media, such as a hard drive, tape drive, or optical disc.

Digital x-ray systems offer many advantages over film-based systems. The x- ray dosage is significantly lower. Results are immediate, without the delay of developing film. The ability to manipulate electronic images and share them over a network or in other forms is well recognized as an advantage of electronic media. Consequently, medical diagnostic digital images can be viewed over a local or wide- area network. Images can be processed and re-processed more readily than with a film- based technology.

As the use of digital imaging becomes wide spread, there is a need to make the advantages of digital technology available at a level that does not require specialized expertise or long schooling. Hospitals and medical clinics often employ specialists in radiology to administer x-ray, CAT scans, MRI scans, and others. However, in many situations, specialists are not often used or not appropriate. For example, in many dental offices, smaller medical offices, and the like, the number of trained medical or dental professionals may be small and the expertise in digital techniques likewise may be limited.

There is a need to create a system that many types of users can operate for improved management and full functionality in manipulating digital images. Such a system should bring the advantages of digital imaging to any level of professional practice, even those employing a single professional. Dental offices stand out as a professional situation in which the patient and a single dentist operate in a one-to-one treatment setting. Although assistants frequently are available, the individual dentist tends to be the cornerstone of the practice and to have the main role in treating and advising the patient. Furthermore, x-rays are a frequent and often necessary part of dental examination and diagnosis. The dentist should have an improved range of tools to more readily and effectively bring the benefits of digital imaging technology to his practice.

It would be desirable to have a medical imaging telemetry device that offers an interactive and intuitive interface. Such a system may offer integrated input/output peripherals. Such a system may be software-based for use with multi-tiered and distributed software networks of minicomputers. Ideally, such a system provides automated storage and retrieval of data in latent real-time. Further, it should offer accessibility to a variety of interactive pointer, annotation, and contrast control devices, including touch-screen. To achieve the foregoing and other objects and in accordance with the purpose of the present invention, as embodied and broadly described herein, the method and apparatus of this invention may comprise the following.

Disclosure of the Invention A radiography image management system includes a file server for storing digital images and a database server for storing metadata; an image spooler, a user workstation, and an archive spooler each connected to the file server and the database server; a digital image capture device connected to the image spooler; and a removable data storage media device connected to the archive spooler. Digital images are captured by the digital image capture device and sent to the image spooler. The image spooler spools digital images to the file server and notifies the database server of each newly captured digital image, and the database server creates an image record for each newly captured digital image. The file server includes all unarchived digital images and the most recently accessed digital images, and sends digital images to the archive spooler, which spools the digital images to the removable data storage media device for storage on removable data storage media. The user workstation includes a display device, an input device, and a graphical user interface. The graphical user interface accesses images records on the database server and copies digital images from the file server for display. The graphical user interface includes user commands for image manipulation, such as enhancement and annotation of the digital images. When a user inputs a command, the result is displayed with the digital image, and the command is recorded in the image record for the digital image. The user commands are tailored for medical diagnosis and to minimize the input steps from the user.

Brief Description of the Drawings

Details of this invention are described in connection with the accompanying drawings that bear similar reference numerals in which:

Figure 1 is a schematic block diagram of a system embodying the features of the present invention.

Figure 2 is a schematic block diagram of the system architecture of the system of Figure 1.

Figure 3 is a schematic diagram of the software components of the system of Figure 1. Figure 4 is a representative view of a screen display of the system of Figure 1 with one image panel.

Figure 5 is a representative view of a screen display of the system of Figure 1 with one image panel.

Figure 6 is a representative view of a screen display of the system of Figure 1 with one image panel.

Figure 7 is a representative view of a screen display of the system of Figure 1 with one image panel. Figure 8 is a representative view of a screen display of the system of Figure 1 with two image panels.

Figure 9 is a representative view of a screen display of the system of Figure 1 with four image panels. Figure 10 is a representative view of a screen display of the system of Figure 1 with four image panels.

Figure 11 is a representative view of a screen display of the system of Figure 1 with twelve image panels.

Figure 12 is a representative view of a screen display of the system of Figure 1 with twelve image panels.

Figure 13 is a representative view of a screen display of the system of Figure 1 with eighteen image panels.

Figure 14 is a representative view of a screen display of the system of Figure 1 with eighteen image panels. Figure 15 is a representative view of a screen display of the system of Figure 1 with twenty-four image panels.

Figure 16 is a representative view of a screen display of the system of Figure 1 with a console window.

Figure 17 is a representative view of a screen display of the system of Figure 1 with a console window.

Figure 18 is a representative view of a screen display of the system of Figure 1 with a console window.

Figure 19 is a representative view of a console window screen display of the system of Figure 1. Figure 20 is a representative view of a console window screen display of the system of Figure 1.

Figure 21 is a representative view of a console window screen display of the system of Figure 1.

Figure 22 is a representative view of a console window screen display of the system of Figure 1.

Figure 23 is a representative view of a screen display of the system of Figure 1 with a text annotation. Figure 24 is a representative view of a screen display of the system of Figure 1 with annotations.

Figure 25 is a representative view of a screen display of the point flag control of the system of Figure 1. Figure 26 is a representative view of a screen display of the measure control of the system of Figure 1.

Figure 27 is a representative view of a screen display of the ink control of the system of Figure 1.

Figure 28 is a representative view of a screen display of the system of Figure 1 with a zoom box.

Figure 29 is a representative view of a screen display of the system of Figure 1 with a resize box.

Figure 30 is a representative view of a screen display of the system of Figure 1 with a shrink box. Figure 31 is a representative view of a screen display of the system of Figure 1 with contrast controls including channel button.

Figure 32 is a representative view of a screen display of the system of Figure 1 with contrast controls including preset buttons.

Figure 33 is a representative view of a modified screen display of the system of Figure 1 showing the user interface in series layout.

Figure 34 is a representative view of a modified screen display of the system of Figure 33 showing the user interface in plan mode.

Figure 35 is a representative view of a screen display of the system of Figure 33 showing the image palette in quadrant layout. Figure 36 is a representative view of a screen display of the system of Figure 33 showing the image palette in focus layout.

Best Mode for Carrying Out the Invention

Referring now to Figure 1, a radiography image management system 11 embodying features of present invention includes at least one computer 14, an image capture device 15 connected to a computer 14, a removable data storage media device 16 connected to a computer 14 and a local area network 17 between a plurality of the computers 14. By way of example, and not as a limitation, the illustrated embodiment is directed towards a system for management of digital dental x-ray images. The image capture device 15 shown has a CCD X-ray sensor 20 connected to a pre-imaging processor 21 that connects to a computer 14 via a universal serial bus (USB) interface. The pre-imaging processor 21 provides power to the sensor 20, digital signal amplification, hardware level control, data transfer, and buffering. The removable data storage media device 16 shown is a tape drive.

As shown in Fig. 2, the computer 14 includes a workstation 23 with an input device 24 and a display device 25. Preferably the computer 14 is a touch-screen computer in which the input device 24 and the display device 25 are combined. Such touch-screen computers are inherently more aseptic and easy to clean than typical office computers, require only one hand to operate, and are compact enough to allow various setups by the dentist. Other input devices 24 and display devices 25 may be used. For example, other input devices 24 include a keyboard and a pointing device. Whether a touch-screen or pointing device such as a computer mouse is used, the act of selecting a feature on the screen, such as an onscreen button, at times will be referred to as "clicking" the feature or button. Similarly, "up-clicking" refers to a conclusion of the clicking process, such as in use of a computer mouse, when a button is released to complete a "click." Thus, although terms "click" and the like are known in reference to the use of a computer mouse, they will refer to the same or similar selection steps and process by any equivalently functioning means, including a touch screen.

Referring to Figures 2 and 3, the radiography image management system 11 includes workstations 23 having graphical user interface 27, a database server 28 in the form of a catalog service 29, a file server 30 made up of a plurality of host services 31 that are combined to form a persistence cloud 32, an image spooler 33, and an archive or backup spooler 34. Workstations 23 and host services 31 communicate over a switched connection 39 using the binary transfer protocol 36. Workstations 23 and the catalog service 29 communicate over a session connection 40 using the message protocol 37. Host services 31 communicate over a routed connection 35 using the workgroup protocol 38. The image capture device 15 automatically captures a digital image when x-ray radiation is detected and sends the digital image to the image spooler 33. The image spooler 33 sends the digital image to the persistence cloud 32 and notifies the catalog service 29 of the newly captured digital image. The cloud 32 stores all unarchived digital images and the most recently accessed digital images, while maintaining free space for newly acquired images. The cloud 32 sends digital images to the backup spooler 34, which sends the digital images to the removable data storage media device 16 for archiving. Removable data storage media with archived digital images can be stored at a centralized data center and accessed therefrom through a data network.

When the image spooler 33 notifies the catalog service 29 of the newly captured digital image, the catalog service creates a new layered image record including a file identifier, and series identifier such as the date and time of creation. The catalog service 29 also includes a patient record for each patient and a user record for each user. In the illustrated embodiment, the digital images are grouped into series, where a series is the set of all of the digital images for a patient for a single session or day.

The graphical user interface 27 accesses an image record on the catalog service 29 to acquire the identifier for a digital image, copies the digital image from the cloud 32, and displays the digital image. The original image data for each digital image in the cloud 32 never changes. User commands to the graphical user interface 27, described hereinafter, are displayed on the display device 25 and automatically saved to the catalog service 29 in the image record, patient record, or user record.

When a user initiates the graphical user interface 27, a login screen is displayed. After the user logs in, the graphical user interface 27 displays on the display device 25, as variously shown in Figures 4 to 6, an application window 41, an image button palette or tray 42, and a tear-off tool palette 43. The application window 41 includes a title bar 45 extending horizontally along the top, a menu bar 46 extending horizontally below the title bar 45, an image palette 47 below the menu bar 46 and a control palette 48 extending horizontally along the bottom below the image palette 47. The title bar 45 has a logo 50 at the left, an application title 51 to the right of the logo 50, and buttons performing the functions of minimize 52, maximize 53, and close 54 at the right.

The menu bar 46 includes, from left to right, file 56, edit 57, view 58, image 59, window 60, help 61, and selected patients 62 menu buttons, each having a drop down menu. A current series display 63 appears at the right of the menu bar, wherein a current patient is displayed in the selected patients menu button 62, and the date of the current series is displayed in the current series display 63. Selection of one of the file 56, edit 57, view 58, image 59, window 60, help 61, and selected patients 62 menu buttons displays a corresponding vertical drop-down menu.

The image palette 47 is the display area and, as exemplified by the illustrated embodiments variously shown in Figs. 6-15, displays a user-determined number of images panels 65 that will each display one digital image 66. Only one image panel 65 is active at any time. The display layouts for one through six image panels 65 often are defined as table layouts or focus layouts, and the display layouts for greater numbers of image panels 65 often are defined as series layouts. Figures 4 to 7 show a display layout with one image panel 65. Figure 8 shows a display layout with two side-by-side image panels 65. The right image panel 65 is active and is indicated by a current image indicator 70, which typically is a colored or highlighted border. Figures 9 and 10 show a display layout with four image panels 65 arranged two across by two down with a current image indicator 70 on the upper right panel of Fig. 9 and on the upper left panel of Fig. 10. Figures 11 and 12 show a display layout with twelve image panels 65 including four vertically spaced, horizontal rectangular image panels 65 along the left side, four vertically spaced, horizontal rectangular image panels 65 along the right side, and four spaced, vertical rectangular image panels 65 in a two by two arrangement in the middle of the image palette 47. Figure 12 is magnified such that not all image panels can be viewed simultaneously, and the system 11 automatically has added scrollbars 64 to enable the user to pan over the full field of images.

Figure 13 shows a display layout with eighteen image panels 65 including six spaced, horizontal rectangular image panels 65 in a three by two arrangement along the left side, six spaced, horizontal rectangular image panels 65 in a three by two arrangement along the right side, and six spaced, vertical rectangular image panels 65 in a two by three arrangement in the middle of the image palette 47. Other display layouts are displayed, depending on the height and width of the image palette 47. Figure 14 shows a display layout with eighteen image panels 65 and onscreen plan control buttons 130. Figure 15 shows a display layout with twenty-four image panels 65.

Referring again to Figures 4 to 6, the control palette 48 includes, from left to right, an array of console control buttons 67, an array of view control buttons 68, and an array of layout control buttons 69. The console control buttons 67 include a console button 71, a notes button 72, a patient information button 73 and a clipboard button 74. The layout control buttons 69 correspond to six available display layouts. The view control buttons 68 control magnifications of the digital images. The number of view control buttons 68 depends upon the display layout. In the series layouts the view control buttons 68 include "Ix" and "2x". For the focus or table layouts, the view control buttons include "100%" and "match."

The image button palette 42 is a scrollable list of thumbnail images of the digital images of a series. Each thumbnail image is a selectable image button 76. Clicking on a selectable image button 76 highlights a border 75, which also is referred to as the selected image button indicator 75. The indicator 75 is distinguished from the focus group indicator 178 that is reflected in the tray, sometimes resulting in both indicators 178 and 75 on the same tray image as shown in Fig. 6. The indicator 178 around a tray image is for reference purposes and is not equivalent to indicator 75 in selecting a tray image.

The default position of the image button palette 42, as shown in Figure 4, is outside the image palette 47 and anchored inside the right edge of the application window 41. Alternative positions of the image button palette 42 are outside and anchored along the left edge of the application window 41, as shown in Figure 5, or outside and anchored along the right edge of the application window 41, as shown in Figure 6. The graphical user interface 27 positions the image button palette 42 based on the size of the application window 41. The user selects image buttons 76 for display of the respective digital images in the images panels 65 of the image palette 47.

The tear-off tool palette 43 includes twelve tool buttons 77. The position of the tear-off tool palette 43 is user selectable, and can be inside the application window 41 , as shown in Figure 4, or outside the application window 41 as a stand alone window, as shown in Figure 5, or anchored to the edge of the application window 41 similarly to the display of image button palette 42 in Fig. 6. When the tear-off tool palette 43 is inside the application window 41, the tear-off tool palette 43 can be horizontally extending above, as shown in Figure 4, or below the image palette 47, or vertically extending to the right or left of the image palette 47. When the tear-off tool palette 43 is inside or anchored to the application window 41, the graphical user interface 27 displays the tear-off tool palette 43 in one of six configurations depending on the size of the application window 41 and the position selected for the tear-off tool palette 43. The six configurations of the tear-off tool palette 43 include 1x12, 2x6, 3x4, 4x3, 6x2, and 12x1. The tool buttons 77 include point flag 80, move 81, zoom in 82, zoom out 83, erase 84, text 85, ink 86, highlight 87, measure 88, contrast 89, orient 90, and image button palette on/off 91 buttons. In each configuration of the tear-off tool palette 43, tool buttons 77 with similar functions are displayed in adjacent positions, preferably side by side. For example, the zoom in 82 and zoom out 83 buttons are always adjacent, the point flag 80 and move buttons 81 are always adjacent, and the ink 86 and highlight 87 buttons are always adjacent. Actuating one of the console control buttons 67 causes the graphical user interface 27 shown in Fig. 16 to display a console window 94 in the form of a floating window with a phantom or semi-transparent background centered over the center of the application window 41. Console windows 94 are selected from clipboard, notes, find patient and patient information. The desired console is displayed in response to selection of the console button 71, notes button 72, patient information button 73, or clipboard button 74, respectively. Alternatively, the find patient console window is displayed in response to selection of "open" in the file menu or "find" in the edit menu. The application window 41 remains active while a console window is active and displayed. Clicking on a button, tab and other feature displayed on the console window 94 actuates the chosen feature. Similarly, clicking on a selected visible button, tab, or feature of the underlying application window 41 actuates the selected feature, even if the feature is partially obscured by the semi-transparent console window. If a feature of the underlying application window is fully obscured by a feature of the console window, then click-through of the underlying window may be blocked; but the console window can be moved to reveal the underlying feature and allow click-through actuation. This ability to operate one window by click-through of another overlapping window is referred to as non-modal click- through. When a user logs off, the current configuration is recorded in the user record for the user. When the user logs in again, the graphical user interface 27 displays the prior configuration of the application window 41, the image button palette 42 and the tear-off tool palette 43, including the prior patient and series. The user can select another recently accessed patient and series by selecting the selected patients menu button 62 and then selecting the name from the drop down menu, or the user can select another patient and series by activating the find patient console window. Selecting the clipboard button 74 activates the clipboard console, and the graphical user interface 27 displays a console window 94, Fig. 16, for the clipboard. The clipboard includes thumbnail images of all digital images that are not associated with a patient, with each thumbnail image being a clipboard image button 96. The user selects the thumbnail image of an unassociated digital image into the image palette 47. Clicking the paste or insert button 79 associates the digital image with the current patient record, and the graphical user interface 27 records the patient into the image record for the digital image. A trash tab allows the user to dispose of an image from the clipboard. A junk tab automatically receives technically defective images and holds them until they can be reviewed and either discarded or associated with a patient file. Selecting the patient information button 73 activates a console window 94, Fig.

17, for patient information. A find tab on the console window displays the patient directory 97, best shown in Fig. 19-20. The day tab shows a patient log 93, best shown in Fig. 21. From either the find or day tab, the user clicks on a patient name to select the current patient. Selecting the current patient name displays the current patient information in the console window. The patient directory 97 can be viewed alphabetically by clicking on the patient index control 99. Figures 19 and 20 show the console window 94, patient directory 97, patient index control 99, and close button 54. The patient day log 93 of Fig. 21 can be viewed chronologically by clicking forward and back arrows, entering a date, or using the scrollbar in the console window. Figure 21 shows a console window 94 with patient log 93. A user may input or modify patient information 95 by clicking on a line of text in the console window 94 as shown in figures 17 and 18.

Selecting the notes button 72 activates a console window 94 for notes, best shown in Fig. 22, which includes image notes 92. The image notes for the active image panel are shown. The user may input new notes or modify existing notes by clicking on the note number button 78 as shown in figure 22. The graphical user interface 27 provides image manipulation through user commands that include a plurality of tools for enhancing and annotating the display of a digital image. The user commands are saved as recorded manipulations in the layered image record for the digital image. Annotations such as on-screen notes 140, Fig. 23; point flag 141, Fig. 24; or other lines or shapes 142 are displayed and recorded in layers, and the display of each layer may be toggled on or off as shown in figures 23 and 24. The tools can include, by way of example and not as a limitation, as described above for the tear-off tool palette 43: point flag, move, zoom-in, zoom-out, erase, text, ink, highlight, measure, contrast, and orient. Each tool is designed to require the minimum number of user inputs, and user inputs are automatically saved in the image record.

Each annotation includes a jellybean 100, which is a colored dot near the display of the annotation. The color of the jellybean indicated the status of the annotation. When the jellybean is red, the selected annotation tool is active. When the user clicks on the red jellybean, the jellybean turns green and the annotation is stopped. When the user clicks on the green jellybean, the jellybean turns yellow and the annotation is hidden.

The user activates the point flag tool by selecting the point flag button 80, and the graphical user interface 27 displays a pointer shape 141 similar to the icon on button 80. The user clicks on a location of interest in the active image panel 65 to create an annotation 141, Fig. 24. The user clicks on the jellybean to turn the jellybean green. When the user hovers over the green jellybean with the pointing device, a floating shape point flag control 98 is displayed, as shown in Figure 25. The point flag control 98 is a substantially rectangular box with two columns each having five round buttons and, optionally, a single oval button below. The buttons in the first column, from the top, include a jellybean button 100, an increase opacity button 101, a first color preset button 102, a third color preset button 103, and an arrow button 104. The buttons in the second column, from the top, include a delete button 105, a decrease opacity button 106, a second preset color button 107, a fourth preset color button 108, and a star button 109. Optionally, below the columns is the oval density button 110. If the digital image in an image panel 65 is larger than the image panel 65, the user can select the move button 81 and translate the digital image within the image panel 65 to view different portions of the digital image.

Referring to Figure 28, when the user selects the zoom-in button 82, the graphical user interface 27 displays a zoom box 111 centered in the active image panel 65. The zoom box 111 is smaller than the image panel 65, and shows the ratio of the future zoomed image display to the current image display. If the user clicks on the zoom-in button 82 again, the size of the zoom box 111 is further reduced. When the user selects a point within the image panel, the graphical user interface 27 displays a zoomed image display centered about that point. If the user drags the system pointer outside of the image panel, the graphical user interface 27 displays a resize box 112, as shown in Figure 29; and when the user upclicks, the graphical user interface 27 displays a resized image panel 65. When the zoom-out button 83 is selected, the displayed size of the digital image is reduce by 20% or the shrink box 113 is displayed, as shown in figure 30; and the user can drag the system pointer inside the image and upclick to reduce the digital image size. After the upclick on zoom-in or zoom-out, the previous active tool is activated.

The erase tool, selected by clicking the erase button 84, provides selective deletion of previous annotations. Selection of the text 85, ink 86, or highlight 87 button provides for display of annotations 142, Fig. 24, such as lines and shapes drawn in the text, ink or highlight layers, respectively.

Referring to Figure 27, when ink button 86 is selected and the user hovers over the green jellybean with the pointing device, the floating shape ink control 114 is a substantially rectangular box with two columns each having five round buttons and, optionally, a single oval button below. The buttons in the first column, from the top, include a jellybean button 100, an increase opacity button 101, a first color preset button 102, a third color preset button 103, and thicker button 115. The buttons in the second column, from the top, include a delete button 105, a decrease opacity button 106, a second preset color button 107, a fourth preset color button 108, and a thinner button 116. Optionally, below the columns is the oval density button 110. When highlight button 87 is selected and the user hovers over the green jellybean with the pointing device, the graphical user interface 27 displays the floating shape highlight control 118, which is included within the scope of Fig. 27. The floating shape highlight control 118 as a modified version of the floating shape ink control 114. Control 118 is a substantially rectangular box with two columns each having four round buttons and, optionally a single oval button below. The buttons in the first column, from the top, include a jellybean button 100, an increase opacity button 101, a first color preset button 102, and a third color preset button 103. The buttons in the second column, from the top, include a delete button 105, a decrease opacity button 106, a second preset color button 107, and a fourth preset color button 108. Optionally, below the columns is the oval density button 110. Buttons 115 and 116 of Fig. 27 are omitted from the floating shape highlight control 118.

When the measure button 88 is selected, the user selects a first endpoint and a second endpoint in the active image panel 65, and the graphical user interface 27 displays a first line segment between the first and second endpoints and the distance between the first and second endpoints in true scale in millimeters. Measurements can be chained. When a third end point is chosen, the graphical user interface 27 displays a second line segment between the second and third endpoints, the distance between the second and third endpoints, and the angle between the first and second line segments. Referring to Figure 26, when the user hovers over the green jellybean with the pointing device, the graphical user interface 27 displays the floating shape measure control 119, a substantially rectangular box with two columns each having five round buttons and a single oval button below. The buttons in the first column, from the top, include a jellybean button 100, stretch button 121, a nudge left button 122, a nudge up button 123, and a rotate counter-clockwise button 124. The buttons in the second column, from the top, include a delete button 105, shrink button 126, a nudge right button 127, a nudge down button 128, and a rotate clockwise button 129. Below the columns is the oval move button 120.

The contrast tool enhances the viewability of a digital image by selectively expanding ranges of the grayscale spectrum. Referring to Figure 31 , when the user selects the contrast button 89, the graphical user interface 27 displays semi-transparent contrast controls 131 in the active image panel 65, including two adjacent vertical gradient columns 132 near the left edge, a plurality of vertically spaced, horizontal slider controls 133 near the right edge, and a preset panel 134 below the slider controls 133. One gradient column 132 shows the original grayscale gradient and the other gradient column 132 shows the current grayscale gradient. When the user hovers over a point in the digital image, a grayscale level line 135 is displayed across the gradient columns 132, indicating the grayscale value of the point.

Each slider control 133 adjusts a range of grayscale values. The range of grayscale values corresponding to each slider control 133 is displayed in gradient columns 132 directly to the left of the slider control. When the user hovers over a point of interest in the digital image, the slider control 133 to the right of the grayscale level line 135 corresponds to the grayscale range of the point of interest. The user can drag the selected slider control 133 rightward to increase the range of grayscale value corresponding to the slider control 133, and thereby provide enhanced detail within the selected range. The graphical user interface 27 decreases the range of grayscale values for all other ranges in response to the increase in the selected range.

The preset panel 134 includes two channel buttons 137 and a preset open/close button 138. The graphical user interface 27 alternately displays two different contrast settings in response to selection between the two channel buttons 137. As shown in Figure 32, when the preset open/close button 138 is selected, the graphical user interface 27 displays eight preset buttons 139 in place of one of the channel buttons

137. Each preset button 139 allows a contrast selection to be saved. Referring to Figure 8, two instances of the same digital image with different contrast settings can be viewed side by side in separate image panels 65.

The user selects the orient button 90 on the tool palette to correct orientation of the display of a digital image. For example, in the illustrated embodiment, where the digital image is a dental x-ray, the orientation of display of the digital image can be corrected so that the top teeth are on top. The image button palette on/off button 91 is selected to selectively display the image button palette 42.

Original digital images are stored in the cloud 32, increasing reliability and reducing system resources relative to systems where modified images must continually be saved. AU image manipulations are recorded in the image records in the catalog service 29. The graphical user interface 27 provides a simple, intuitive interface for analysis and presentation to patients of the digital images. Use of touch-screen computers allows one-handed operation and more readily fits into the limited space of a dental operatory. Digital images are easily shared with the system of the present invention. According to a preferred embodiment, the image management apparatus and methods that have been described can be applied to management of dental images. A number of common features and techniques in dental imaging allow the image management system and methods to provide high utility for managing dental images. Aspects of dental imaging favor automatic image acquisition and flexible viewing. This image management system allows dentists to view their images easily and in a preferred manner. Dentists can use a wide range of layouts while viewing images, which are laid out with automated juxtaposition and automatic orientation to preserve anatomical relationships. The following optimizations provide an especially ergonomic and highly accessible management system, providing automation in the organization of images, polymorphic and non-modal controls, and flexible workflow.

The software implementing the image management system provides an intake function for captured, unassigned images from an attached camera or other intake device. A service component of the management system software automatically initializes the camera system regardless of whether the management system software is running. Newly acquired images from capture device 15 or any source or from any time period are collected within a logical depository that previously has been termed a clipboard and accessed through the clipboard button 74, Fig. 4. Each image is associated with a chronological identifier, such as the date and time of acquisition. The clipboard can provide all contained images for display as clipboard image buttons 96. The user is able to select any displayed image 96 from the clipboard and assign the selected image to any patient file. Once assigned to a patient file, an image is no longer displayed in the clipboard view. Images from the clipboard are readily assigned to a patient file by looking up the patient name and attaching the images to the patient file, first actuating the clipboard image button 96 and then using the paste or insert button 79 on the clipboard console of Fig. 16.

A patient record database contains entered records of known patients. A user may use different methods to look up patient records that are gathered for each patient. The software displays the database as the patient directory 97. Access can be according to a database entry, such as for patient name, date of visit according to a patient calendar, or an alphabetical roster listing of all patients in the patient directory 97. The alphabetical roster is reached through patient information console button 73 and the "find" tab 143 in the resulting console window shown at Figs. 19-20. The date of visit also is reached through the patient information console button 73 and the "day" tab 144 shown at Fig. 21. The "search" tab 145 on this console window enables a search according to various selected criteria. A patient located by any of these means can be selected by clicking the patient's entry, which then elevates the patient to "current patient" status and lists the patient at the selected patient menu button 62.

Inbox tab 129 opens a reception area in the console window where a user may receive a list of patient files sent by another user, taken from the common database. One user may send another user a list of patient names for a review of records, with the inbox list serving as a shortcut to speed the selection of names in the database. A logical subset of the patient record database is the recent patients menu. The recent patients menu operates on a first-in-first-out basis to list a selected but conveniently limited number of patients, for example twenty patients. The recent patients menu is reached as a drop-down menu via the selected patients menu button 62. The shortness of the menu allows the files for the selected patients to be shown and updated conveniently.

The composition of the recent patients menu list is dynamically persisted. Software control persists the list of patients from the database in two categories. First, a portion of the recent patients menu lists those who have been the "current patient," listed at the selected patient menu button 62 since the last log-in. Second, the recent patients list includes a sub-menu titled "more." The "more" list contains a numerically limited list of the entries taken from the recent patients menu from prior to the current log-in. Automated software control provides rebinning at login of older patient names into the "more" dropdown submenu at the bottom of the recent patient menu. The software purges these names on a first-in, first-out basis so that the "more" menu is maintained at a convenient defined number, such as twenty. All patient names from the current session are listed in the recent patients menu, allowing easy access, while older names are stored in the "more" dropdown submenu, and removed automatically. Automatic persistence is useful to allow easy access to recently opened files. Such easy access is useful, for example at the end of the day, to aid a user in assigning image records from the clipboard to individual patient records of the day's patients. Console windows such as the find patient console or clipboard console, are persisted on the screen until removed by user.

Selective or manual assembly of the recent patients menu allows the user to enter any patient record from the patient record database. A suggested utilization for manual assembly of the recent patients menu is for prospective purposes. For example, a user might enter the names of patients having appointments during the next business day.

Within a patient record, images 66 are grouped by acquisition date. A group of images 66 acquired on a single date often is referred to as a series and is named by its acquisition date, or "Today", if applicable. In use, the user selects a patient record, which will be referred to as the current patient appearing at menu button 62. The user also selects an image series from the record, which will be referred to as the current series identified at menu button 63. Software control persists the current series and the current patient. Once the current patient has been selected, button 63 provides a drop¬ down menu from which the current series can be selected. This selection information is displayed at preselected positions on the display, such as at the top right side of the application window 41 , at buttons 62 and 63.

The images 66 in the currently selected, dated series are displayed as thumbnail images in an area of the display referred to as the image button palette 42 or "tray," if the on/off setting of button 91 allows the tray to be displayed. The tray 42 may be displayed at the right edge of the display as shown in Fig. 4 or elsewhere as previously described. Each dated series of a specific patient automatically will contain all assigned images 66 of a single date. Therefore, when a user assigns images from the clipboard to a patient, the images 66 of the same date are automatically logically assembled under software control into a series of that date, and the series of a single date can be displayed in the tray. Images 66 can be arranged and viewed within the image palette 47 in a layout.

A layout is a collection of image panels 65 arranged in selected positions within the image palette 47. Thus, a layout can be considered to be a template for the relative placement of images. A layout can be either a standard template or a user-established template. Each image panel 65 is positioned at a predetermined location within a layout, into which an acquired image 66 can be entered for display, if desired. A visible border encloses and defines the area within an image panel. The user can select any image panel 65 to be filled with an image 66, and any image panel within a layout may or may not contain an assigned image.

An embodiment of the application window 41 suited for dental image management, best shown in Fig. 33, displays a tray 42 containing a date series of images 66. The control palette 48 is located below the image palette 47 and includes the previously described console control buttons 61 to the left, a modified version of the layout control buttons 69 in the center, and drop, add, and step buttons on the right. The previously described view control buttons are consolidated into a single dynamic sizing button 150. A supplemental set of onscreen layout control buttons is located at the middle top of the image palette. The tear-off tool palette 43 is located at the top of the image palette 47 and contains the array of tool buttons 77 previously described. The highlighted or colored selected image button indicator 75 frames one or more of the tray images 76, showing that image 76 is a selected image.

The application window of Fig. 33 shows an onscreen add button 146, drop button 147, and step button 148. These buttons are useful for assigning images from the tray 42 to an established layout that can be displayed in the image palette 47. The array of image panels 65 in the image palette 47 of Fig. 33 is an example of such an established layout.

Each image panel 65 of the array carries a unique step indicia, shown in Fig. 34 as one of a sequential series of numerals 1-18, corresponding in number to the eighteen image panels of the layout. These panels are arranged in a preselected order, either as pre-established in the software of the image management system or as arranged by a user. The numerical indicia 1-18 are convenient indicators of the steps or sequence of the preselected order.

A variable one of the eighteen image panels 65, in this case image panel containing numeral 4 in Fig. 33, contains a designation or special feature referred to as the next-position-indicator or NPI 149. The NPI is a logical pointer set on this image panel to receive the next pasted image from the tray or from the clipboard. The NPI 149 is shown in Fig. 33 as a display of the numeral indicia, such as the presentation of the illustrated numeral "4," while the remaining image panels contain no numeral indicia. The NPI initially points to the lowest numbered vacant image panel, according to the stepping order of numerals 1-18 shown in Fig. 34. Thus, the image panels are filled in order as the NPI steps from one panel to another in ascending numerical order. When images are being assigned to the image panels, only one image panel displays the NPI 149 at one time.

The add button 146 will automatically assign the chronologically first acquired, unassigned image from the tray to the image panel marked by the NPI 149, also automatically stepping the NPI 149 to the next vacant panel in ascending numerical sequence of the contained numerals 1-18. Repeated use of the add button 146 will assign the tray images in chronological sequence to vacant image panels in the numerical sequence. Selecting or clicking a series of selectable image buttons 76 in the tray 42, thus actuating the indicator 75 bordering each of them, can accelerate this streamlined process. The add button need be clicked only once, which will assign all of the selected images seriatim to a series of vacant image panels. These automated assignment functions are particularly useful if the images in the tray were acquired according to an ordered protocol corresponding to the numbered arrangement of the image panels in an array or layout. The drop button 147 of Fig. 33 un-assigns an image from a current image panel and advances the selected image button indicator 75 to the next tray image 76 in chronological order. Sequentially clicking the drop and add buttons will cycle through the series of images in the tray.

In the view of Fig. 34, the current image indicator 70 is associated with one of the image panels, in this instance the image panel containing numeral "8." The current image indicator 70 typically is a colored, heavier box, which distinguishes the current image from all non-current images in the layout. Clicking the image panel for the current image selects this panel and its contained image, if any, as the key panel or key image for formulating the display of other templates such as focus or quadrant views. The current image indicator 70 and the NPI 149 may point to the same image panel, or they may point to different image panels. In Fig. 33, the current image indicator 70 is pointed to a different image panel. Images from the tray of Fig. 33 can be assigned in any order to image panels. Any image in the tray, not already assigned to an image panel in the layout, can be selected as the image button 76. Next, any image panel within the layout can be selected as the current image to receive the selected image from the tray. Clicking the selected image panel 65 places the current image indicator 70 and the NPI on the selected image panel and assigns the selected image from the tray. If an image previously was displayed in the selected image panel, the previous image is un- assigned from the image panel when the new image is assigned. The previous image is saved as an alternate image, discussed below. The step button 148 of Fig. 33 advances the NPI 149 to a next vacant image panel in numerical order. An image is allowed to be present only in one image panel at one time in a selected series layout. Thus, although an assigned image continues to be displayed in the tray 42 as well as in the assigned image panel of one series layout, it cannot be simultaneously displayed in another image panel of the same series layout. This logical rule can prevent certain errors in assignments and conveniently allow cycling through the tray to find unassigned images.

The layout of image panels as shown in Fig. 34 is persistent, such that the content is sustained even when the content of the tray 42 is variable. For example, from a first series of images 66 in the tray of Fig. 33, a first image 66 may be selected and assigned to an image panel 65 in the image panel layout of Fig. 33. At any time, toggling button 91 closes the open tray, although unassigned images in the first dated series will persist as saved images in the first dated series. Alternatively, a second dated series can be selected to replace the current first dated series in the tray. An image from the second series, when opened in tray 42 of Fig. 33, may be selected for insertion into another image panel of the first layout in Fig. 33. During assignment of both images, the layout is continuously displayed on the image palette 47 of Fig. 33, despite the change of the dated series in the tray 42. This feature is referred to as persistence. The persistent layout then will contain two images 66, each from a different dated series. A layout is a created group of images that are associated with a date and a patient record. Dental imaging lends itself to the use of layouts that are coordinated with the arrangement of teeth in the mouth. One type of layout, which is referred to as a series layout, is illustrated in Figs. 33 and 34. Often, although not necessarily, the series layout contains a collection of images 66 representing the entire mouth and typically acquired on a single date. The series layout is the basic organizational arrangement for acquired images. Image panels in the series layout are divided into subgroups based on anatomy, such as left and right posterior subgroups, anterior subgroup, and bitewing subgroup.

Another type of layout is a quadrant layout, Fig. 35, which is a layout showing a group of images of a selected dental quadrant of the mouth. A quadrant layout can be derived from a series layout in which certain preselected image panels are designated to contain images of a dental quadrant. The images appearing in a quadrant view are selected based upon the current image or key image in the series layout, as well as the choice of anatomical subgroup where the key image appears in the series layout. The key image or image panel will appear, together with at least one other image panel from the same anatomical subgroup. Thus, both series and quadrant layouts are coordinated to the anatomy of teeth in a mouth, although subject to modification according to user preferences. The software selects the image panels to accompany the key image panel based upon pre-established mapping or an algorithm, coordinated with the content of the subgroup where the key image panel is located.

Another available type of layout is a focus layout, Fig. 36, in which an image panel 65 is sized to the constraints of the application window 41, and aspect is a function of application window proportions. The focus layout is a product of individual image selection of the key image or key image panel, but the focus layout also is keyed to the subgroupings of the series layout arrangement. The focus layout automatically includes logically associated neighboring images. Thus, for example, an anterior image panel chosen for a focus layout will associate additional anterior image panels, and a left posterior image panel in focus layout will associate additional posterior image panels.

Various means enable the user to enlarge or shrink an image within any image panel. Dynamic sizing button 150 and layout control buttons 69 select and operate the three described layouts. On-screen control enabled through the dynamic sizing button

150 enables a user to cycle through sizing settings for an image panel. In series and quadrant layouts, the magnifications available through button 150 are Ix or 2x, and aspect is fixed. In a focus layout, an image panel can be magnified to fit the available window, such as by a "100%" button. Another focus layout selection, previously discussed as the "match" button, matches the size or magnification of a selected image panel among all image panels of the layout. Figs. 33 and 34 each show a different selection of buttons positioned at the lower right corner of the application window 41. However, both show the dynamic sizing button 150, but with opposite toggled labels "Ix" and "2x." The dynamic sizing button 150 simultaneously causes all image panels in a series layout or quadrant layout to assume either Ix or 2x magnification with fixed aspect. If the number of image panels or the magnification of the image panels should expand to beyond the viewable area of the display, horizontal or vertical scroll bars 151 as shown in Fig. 4 are automatically added to enable the view to be moved so that all image panels can be viewed.

The three main types of layouts in which to display images are series, quadrant, and focus. Within each type of layout, variations are available in numbers and positions of image panels 65. Using the modified selection of layout control buttons 69 shown in Figs. 33 and 34, the user may navigate through set combinations in a given type of layout. Left and right double arrow buttons 152 allow the user to cycle among a series layout, a quadrant layout, and a focus layout. The oppositely pointing buttons 152 provide two directions of access, so that each layout is a single click from each other layout; or if only one directional key 152 is used, any layout can be reached within two clicks in a single direction. Clicking the left and right single arrow buttons 153 advances through pre-established extensions of layouts, such as bitewing, various quadrants, and other variations in template arrangements. Onscreen bitewing button 155, anterior button 156, and posterior button 157 navigate through a sequence of pre- established extensions for series layouts.

Image panels 65 are keyed in subgroups to an anatomical arrangement of teeth and to the traditional types of image views used in the dental profession. Image panels can be classified in three main groups, as bitewing images, anterior images, and posterior images, reflecting the images 66 to be displayed in each. Within a series layout, all three main groups of image panels may be viewed. Supplemental layout control buttons 154 are located near the top edge of the image palette 47 in Figs. 33 and 34. These buttons are suited to show a selected extension of image panels in the current series layout for bitewing images and posterior images and to toggle anterior images between on and off. The plan button 158 is another supplemental layout control button. The plan button enables the plan mode shown in Fig 34.

A user enters the plan mode to modify an existing layout or to select one of three other plans to be the current plan. The current plan is persisted. Additional onscreen buttons 160, 161 allow the user to modify the current series layout to show a changed number of anterior image panels, as needed. These functions provide easily accessible layouts, customizable according to user needs and the patient's dental anatomy.

In a series layout such as the one shown in Fig. 34, image panel locations are based on anatomy. For example, an image of upper left teeth is viewed on the upper right of the layout, and neighboring images showing neighboring teeth. These views closely approximate the arrangements dentists have used historically with film x-rays. Using the plan mode, the user orders and assigns the sequential onscreen numerals, such as 1-18 shown in Fig. 34, to coordinate with the user's practice of acquiring sequential images of selected mouth areas. Thus, on the left side of the layout in Fig. 34, horizontal image panels 5 and 6 are upper right posterior images, horizontal panels 7 and 8 are lower right posteriors, and horizontal panels 1 and 2 are right bite wings. The arrangement on the right side of Fig. 34 provides corresponding posterior and bitewing panels for the left side of a patent's mouth, hi the center area, vertical panels with on-screen numerals 13-15 are top anterior panels; and vertical panels 16-18 are bottom anterior panels.

Layout control buttons 154 in series layouts include a bitewing button 155, an anterior button 156, and a posterior button 157. Clicking one or more of these buttons changes the series layout view within image palette 47 to show only the selected image panels within an extended or limited series layout. For example, when button 157 is repeatedly actuated, the screen will cycle through corresponding series of different displays of posterior image panels, showing selected variations in the numbers of such panels. Because a dentist may acquire only selected images, such as only bitewings during a single visit, such a limited or extended series display is desirable and convenient.

Plan button 158 adds the contained numerals to the image panels shown in a presently viewed layout, as chosen by buttons 155-157. With these numerals shown in the plan mode image panels, the user can alter the order of the steps for the displayed image panels. Actuating plan button 158 together with all of buttons 155-157 produces the application window 41 shown in Fig. 34.

Anterior images often are acquired according to variable schemes. These schemes can vary according to the anatomy of the patient, such as the narrowness of the patient's jaw. The number of images typically varies among two, three, four, five, six, eight, ten, fourteen, sixteen, eighteen, and twenty. Fig. 34 shows a mid range of six image panels. An onscreen anterior layout dropdown menu 160, located above the anterior image panels, provides alternate choices in the number of image panels in the anterior group. An available menu choice of "midline" provides three anterior image panels. A menu choice of "narrow" provides two image panels. Other menu choices including "offset upper" and "offset lower" can further vary the number and scheme of image panels. "Offset upper" provides an even number of upper row anterior panels and an odd number of lower row panels, wherein the odd number is one greater than the even number. "Offset lower" provides an odd number of upper row anterior panels and an even number of lower row panels, wherein the odd number is greater than the even number.

Onscreen panel number buttons 161 allow a quick change in the number of anterior image panels. The buttons present choices to either increase or decrease the number of such image panels. When either choice is selected, the respective button increments or decrements to offer a further increase or decrease in the chosen number of panels. Choices include image panels displayed in either one or two rows, which typically correspond to top and bottom anterior teeth.

The layout control buttons 69 below image palette 47 of Fig. 33 include a central button 163 that toggles between wide and tall settings for a focus layout of image panels. A wide focus layout is wider than it is tall, such as three columns wide and two rows tall. A tall focus layout is taller than it is wide, such as two columns wide and three rows tall. This selection provides a useful choice in certain focus layouts and varies in the resulting configuration according to the number of available image panels to be included in the focus layout.

Actuating the plan button 158 displays view control button "A" 165, "B" 166, and "C" 167. These buttons are exclusive to the plan mode, where they replace the add, drop, and step buttons of Fig. 33. Each of burtons "A," "B," and "C" selects a saved and persisted, pre-established arrangement of the onscreen numerals, allowing a user to select among up to three pre-established plans.

Each image panel can be associated with a preset orientation correction, which can be established in the plan mode. For example in Fig. 34, the current image panel containing numeral "8" displays a preset orientation button 168, linked exclusively to this image panel. The user can set this button to re-orient any image 66 placed in the image panel, according to the user's pre-established choice. A utility of this button is to accommodate the user's unique method in acquiring the type of image that would be placed in the specific image panel. For example, if a user prefers to rotate the image sensor 20 by one hundred eighty degrees from customary position when acquiring the image to be placed in a predetermined image panel, the preset orientation button 168 allows the user to establish the automatic re-orientation of any image in panel "8" by one hundred eighty degrees, so that it is presented in accurate orientation within the layouts. While the plan button 158 is actuated, a user can rearrange the step order of the image panels 65 in Fig. 34 by switching the numbered panels in pairs. For example, the current image panel numeral "8," marked by the current image indicator 70, can be switched with the numeral in another panel by clicking the other panel, such as image panel numeral "6." The numerals will switch between the two panels. This new arrangement will be persisted or saved automatically as the current plan A, B, or C, whichever is the currently actuated plan button. Other selections and changes in the layout are similarly persisted and saved in the currently selected plan.

The image management system is conveniently able to serve a plurality of users at a single workstation 23 by recording and recalling selected information associated with each user. A user log-in allows the system to pre-load a user record, such that the application window is initially configured as the user last used it. This is termed session persistence. One of the recalled data items is the preferred series layout. Others include, current series, current patient, selected image panel, and current series layout.

The view of Fig. 35 illustrates a representative quadrant layout and displays a history of all of a patient's arranged images, constrained by quadrant of the mouth and sorted by date. For example, all of a patient's lower right posterior and lower anterior images can be shown, organized by date displayed on a dateline 169. Layout control buttons, shown at the top of the image palette 47 in Fig. 35, provide six quadrant choices: posterior upper left, posterior upper right, posterior lower left, posterior lower right, bitewings, and vertical bitewings. Choices and combinations of a bitewing layout choice button 170, an anterior on/off toggle button 171 , an upper/ lower toggle button 172, and a left/right toggle button 173 select among the quadrant layouts. The anterior button 171 provides an option for the user to view anterior images when viewing a posterior quadrant. The anterior button 171 is inactive when the selected quadrant is bitewing or vertical bitewing layout. Focus layouts provide a larger workspace for magnification, viewing, and comparison of a set of up to six juxtaposed images, as shown in Fig. 36. A focus layout may be selected from either a series layout screen or a quadrant layout screen. A focus layout displays a focus group of images 175, which consists of the currently selected image panel 176 plus selected associated image panels 177. When a user changes to a focus layout from a series or quadrant layout, the currently selected image 176 and up to five neighboring images 177 will remain in view. This feature allows the user to continue viewing neighboring images, such as from the same anatomical region of the mouth, when changing to a focus layout for more study.

In a series layout or quadrant layout, the current image provides a basis for forming a focus layout group 175. The tray indicates any displayed images that would be a part of the prospective focus layout group 175 by displaying a colored border 178 around each of them. The different borders 178 display different colors indicative of the relative position the image would occupy in the prospective focus group 175. Figs. 4-6 shows focus group indicator 178 on one image in the image button palette 42. The focus layout allows two images to be placed in overlapping proximity in a single image panel 176, 177, rather than juxtaposed. For example, a selectable image button 76 from the tray 42 can be clicked and added over a focus image in a panel 176 or 177. The added image does not displace the underlying focus group image 175 but becomes an alternate image that can be viewed in selected layouts. The alternate image may be a duplicate of any image in the focus group, if desired.

Images are classified as primary images and alternate images. Images inserted into a series layout are defined as primary images. Series layouts only display primary images. Images chosen by the user to be shown in a series layout define the primary images for that date and patient. An alternate image is a second or subsequent image to a primary image and can be viewed only in quadrant or focus layouts.

The user may view alternates of an image in a focus layout, allowing comparisons without changing primary arrangement. When a focus layout is linked to a series layout, the user may assign primary images to empty image panels; and thereafter the newly assigned primary images also will be visible in the associated series layout. When focus layout is linked to a quadrant layout, the user may only assign alternate images. As previously described, the user may use the drop button 147 to un-assign an image from the current image panel. If the image is a primary image, the image will be removed from the layout. If image is an alternate, the image will be removed from the alternate arrangement.

As illustrated in Fig. 35 for a quadrant layout, each pair of primary posterior image panels 180 is bracketed by two additional image panels 181, which can only show alternate images. The additional image panels 181 are only shown in focus and quadrant layouts. Alternate arrangements allow the user to arrange images differently from the primary arrangement and allow images to be shown multiple times. Primary arrangements are unchanged by alternate arrangements. Primary arrangements are common to all users of the system, while alternate images are specific to each user. A history of a user's alternate images plus all other users' alternates is available for each image panel.

Primary arranging or alternate arranging is determined by context. When viewing a series layout, only primary arranging is allowed. When viewing a quadrant layout, only alternate arranging is allowed. When viewing a focus layout linked to a series layout, both primary and alternate arranging is possible. If an image is being arranged in a position that has no primary image and the image being arranged is not otherwise in the primary arrangement, then the arranging is primary. Otherwise, alternate arranging is used.

Scrollbars 151 are shown in series and quadrant layouts when some image panels in the layout are not in view, hi focus layouts, scrollbars are shown only in image panels where the image has been magnified such that it is not entirely visible.

Although the present invention has been described with a certain degree of particularity, it is understood that the present disclosure has been made by way of example and that changes in details of structure may be made without departing from the spirit thereof.

Claims

1. A system for managing medical diagnostic digital images, comprising: a file server operable to store said digital images and an image directory for said digital images; a database server operable to store an image record for each of the digital images; and a user workstation having an input device and a display device and operable with a graphical user interface, said user interface being coupled to said file server and to said database server, the user interface being operable to create an image copy of a user selected digital image from the file server, to display said image copy on said display device, to receive user selected image manipulations of said selected digital image from said input device, to display said image manipulations with the image copy on the display device, and to automatically add the image manipulations to said image record for the selected digital image as recorded manipulations.

2. The system as set forth in Claim 1 , wherein: said user interface is operable to access said image record of said user selected digital image and to display said recorded manipulations from the image record with said image copy.

3. The system as set forth in Claim 2, wherein: said image manipulations are added as commands and said recorded manipulations from said image record are displayed by executing said commands.

4. The system as set forth in Claim 1, wherein: said image manipulations are selected from the group consisting of move, zoom-in, zoom-out, rotate, and contrast.

5. The system as set forth in Claim 4, wherein: said user interface is operable to display a zoom-in box centered in said image copy in response to user selection of said zoom-in image manipulation and to display a zoomed in image of the image copy, centered around a point in response to user selection of said point after said zoom-in box is displayed.

6. The system as set forth in Claim 4, wherein: said user interface is operable to display a plurality of contrast controls with said image copy in response to user selection of said contrast manipulation, said contrast controls including a plurality of slider controls, each representative of a grayscale range.

7. The system as set forth in Claim 1, wherein said image manipulations further comprise annotation.

8. The system as set forth in Claim 7, wherein: said annotation manipulation is selected from the group consisting of erase, text, pencil, highlight, point flag, and measure.

9. The system as set forth in Claim 1 , wherein: said user interface is operable to display on said display device an application window, an image button palette, and a tool bar, said image copy being displayed in said application window.

10. The system as set forth in Claim 9, wherein: said tool bar is a tear-off tool bar displayed at a user selectable location relative to said application window.

11. The system as set forth in Claim 10, wherein: said tear-off tool bar includes twelve tool buttons with each said tool button corresponding to a said image manipulation.

12. The system as set forth in Claim 11, wherein: said tool buttons include point flag, move, zoom in, zoom out, erase, text, ink, highlight, measure, contrast, orient, and image button palette on/off buttons.

13. The system as set forth in Claim 11, wherein: said user interface is operable to display said tool buttons in any rectangular arrangement with rows and columns where the number of rows multiplied by the number of columns equals twelve.

14. The system as set forth in Claim 13, wherein: said user interface is operable to display said tool buttons with similar functions in adjacent positions in each said arrangement.

15. The system as set forth in Claim 9, wherein: said user interface is operable to display thumbnail images of all said digital images in a series, wherein said series includes all digital images of a patient from a single date.

16. The system as set forth in Claim 9, wherein: said user interface is operable to display a plurality of image layouts of said image copies of said digital images.

17. The system as set forth in Claim 1, wherein: said user interface is operable to associate, in response to user input from said input device, a patient name with said user selected digital image and to add said patient name to said image record for the user selected digital image.

18. The system as set forth in Claim 1, further comprising: a removable data storage media device in communication with said file server and operable to receive said digital images from the file server and archive the digital images on removable data storage media.

19. The system as set forth in Claim 18, wherein: said file server is operable to store all unarchived digital images and said digital images that were most recently accessed by said user interface, while reserving free file space for digital images, and to clear archived unused digital images.

20. The system as set forth in Claim 1 , including a digital image capture device in communication with said file server and said database server, said capture device being operable to capture a digital image, transmit the digital image to the file server and to notify the database server of the digital image; wherein the file server is operable to automatically store the digital image, and the database server is operable to create a said image record for the digital image in response to said notification.

21. The system as set forth in Claim 1, wherein: said input device and said display device are combined into a touch-screen with user input selections being displayed as buttons on said display device.

22. The system as set forth in Claim 1, wherein: said database server is operable to store a first image display template including a group of image display panels, each of said panels being capable of displaying at least one said image copy, wherein said group of image display panels is arranged in subgroups of image display panels, each of said subgroups being selected from differing locations of anatomy and including at least two image display panels; said graphical user interface is operable to display said first image display template and to display the image copy in a user-selected one of said image display panels within a user-selected one of said subgroups of said group of image display panels; said input device is operable to designate one of the image display panels of the user-selected subgroup as a key image display panel; and further comprising: means for establishing a second image display template including both said key image display panel and at least one additional image display panel of said at least two image display panels in said user-selected subgroup; and means for changing the display of the graphical user interface from said first image display template to said second image display template; whereby the graphical user interface displays at least two image display panels associated as a single subgroup of a single location of anatomy.

23. The system as set forth in Claim 22, wherein: said file server maintains a chronological record of said digital images; said user interface is operable simultaneously to display on said display device, in said second image display template, a chronological sequence of image copies of said subgroup containing said key image display panel.

24. A system for managing medical diagnostic digital images, comprising: a digital image capture device operable to capture digital images; a file server operable to store said digital images and to store an image directory for said digital images, said file server being in communication with said capture device and operable to receive and automatically store the digital images from the capture device; a database server operable to store an image record for each digital image, wherein said database server is in communication with said capture device and is configured to receive notification of the digital images from the capture device and to create a said image record for each digital image in response to said notification; a user workstation having a touch-screen input and display device, and operable with a graphical user interface, wherein said user interface is coupled to said file server and to said database server, said user interface is operable to create an image copy of a user selected digital image from said file server, to display said image copy on said input and display device, to receive user selected image manipulations of said selected digital image from said input and display device, to display said image manipulations with said image copy on said input and display device, to automatically add said image manipulations to said image record for said selected digital image as recorded manipulations, to access said image record of said selected digital image, and to display said image copy with said user selected said recorded manipulations from said image record; wherein available said manipulations include move, zoom, rotate, contrast, and annotations; available said annotations include erase, text, pencil, highlight, point flag, and measure; said user interface is configured to associate, in response to user input from said input device, a patient name with said selected digital image and to add said patient name to said image record for said selected digital image; and a removable data storage media device in communication with said file server and operable to receive digital images from said file server and archive said digital images on removable data storage media, wherein said file server is operable to store all unarchived said digital images and said digital images that were most recently accessed by said user interface while reserving free file space for said digital images and to clear archived unused said digital images.

25. A method for managing medical diagnostic digital images, comprising the steps of: providing a file server; storing a plurality of said digital images in said file server; providing a database server; storing an image record in said database server for each of said digital images; providing a user workstation having an input device and a display device; receiving a selected digital image from said input device; displaying said selected digital image on said display device; receiving a user command for an image manipulation of the selected digital image from said input device; displaying said image manipulation with the selected digital image on the display device; and adding the image manipulation to said image record for the selected digital image as a recorded manipulation.

26. The method as set forth in Claim 25, including the step of displaying said recorded manipulation with said selected digital image on said display device.

27. The method as set forth in Claim 26, wherein: said image manipulation is added to said image record as said user command, and said recorded manipulation is displayed by executing the user command.

28. The method as set forth in Claim 25, wherein: said image manipulation is selected from move, zoom, rotate, contrast, and annotation.

29. The method as set forth in Claim 28, wherein: said annotation is selected from erase, text, pencil, highlight, point flag, and measure.

30. The method as set forth in Claim 25, including the steps of: receiving a patient name from said input device; and adding said patient name to said image record for said selected image.

31. The method as set forth in Claim 25, including the steps of: providing a digital image capture device; capturing a digital image with said capture device; storing the digital image on said file server; and creating an image record for the digital image on said database server.

32. The method as set forth in Claim 25, including the step of archiving said digital images to removable data storage media.

33. The method as set forth in Claim 32, including the steps of: maintaining all unarchived said digital images and said digital images that were most recently accessed on said file server, while reserving free file space on said file server for new said digital images; and clearing archived, unused said digital images from said file server.

34. The method as set forth in Claim 25, wherein said step of displaying said selected digital image on said display device comprises: establishing a first template for display of a group of digital images in image panels arranged in a plurality of subgroups, each of said subgroups being selected from differing locations of anatomy and including at least two image display panels; receiving a user command designating one of said image display panels in one of said subgroups to receive and display the selected digital image; and displaying the selected digital image on the display device in the designated image display panel.

35. The method as set forth in Claim 34, further comprising: receiving a user command designating one of the image display panels as a key image display panel; establishing a second image display template including both said key image display panel and at least one additional image display panel of said at least two image display panels in said subgroup containing the key image display panel; and changing the display of the graphical user interface from said first image display template to said second image display template; whereby the graphical user interface displays at least two image display panels associated as a single subgroup of a single location of anatomy.

36 . The method as set forth in Claim 34, further comprising: receiving a user command designating one of the image display panels as a key image display panel; establishing a second image display template including both said key image display panel and at least one supplemental image display panel not appearing in said first template; changing the display of the graphical user interface from said first image display template to said second image display template; receiving an alternate selected digital image from said input device; displaying said alternate selected digital image in said supplemental image display panel on said display device; and adding a record of said alternate selected digital image to said image record.

37. A method for managing medical diagnostic digital images, comprising the steps of: providing a digital image capture device; providing a file server; providing a database server; providing a user workstation having an input device and a display device; capturing digital images with said capture device; storing said digital images on said file server in response to said step of capturing; creating an image record for each said digital image on said database server in response to said step of capturing; receiving a selected digital image from said input device; displaying said selected digital image on said display device; receiving a patient name from said input device; adding said patient name to said image record for said selected digital image; receiving a user command for an image manipulation of said selected digital image from said input device, wherein said image manipulation is selected from a plurality of available input manipulations including move, zoom, rotate, contrast, and annotation; and said annotation is selected from erase, text, pencil, highlight, point flag, and measure; displaying said image manipulation with said selected digital image on said display device; adding said user commend to said image record for said selected digital image as a recorded manipulation; executing said user command to display said recorded manipulation with said selected digital image on said display device; archiving said digital images to removable data storage media; maintaining all unarchived said digital images and said digital images that were most recently accessed on said file server while reserving free file space on said file server for new said digital images; and clearing archived, unused said digital images from said file server.

38. Software stored on computer storage media for managing medical diagnostic digital images, comprising: a set of computer instructions for receiving a selected digital image from an input device, displaying said selected digital image on a display device, receiving image manipulations of said selected digital image from said input device, displaying said image manipulations with said selected digital image on said display device, and adding said image manipulations to an image record for said selected digital image on a database server as recorded manipulations.

39. The software as set forth in Claim 38 wherein said image manipulations are selected from move, zoom, rotate, contrast, and annotation.

40. The software as set forth in Claim 39, wherein: said annotations is selected from erase, text, pencil, highlight, point flag, and measure.

41. The software as set forth in Claim 38 wherein said set of instructions includes instructions for displaying said recorded manipulations with said selected digital image on said display device.

42. The software as set forth in Claim 38 wherein said set of instructions includes instructions for receiving a patient name from said input device and adding said patient name to said image record for said selected image.

43. The software as set forth in Claim 38 wherein said set of instructions includes instructions for displaying said recorded manipulations with said selected digital image on said display device.

44. The software as set forth in Claim 38 wherein said set of instructions includes instructions for adding said image manipulations as commands and for executing said commands to display said recorded manipulations with said selected digital image on said display device.