PenTips #183 – PenRad and PenTrac Itemized Upgrade

PENRAD AND PENTRAC VERSION 7.0 UPGRADE

Itemized Release Notes. The following includes additions and requests from our users. *Download this information by clicking on the “Download PenTip” at the bottom of the page. If you would like to learn more about the PenRad/PenTrac Upgrade, contact us today!

ADMINISTRATIVE REPORTS

Added restricted report option allowing staff to review their own data without master or special passwords.
Added additional report grouping by “zones” for multiple locations.
Expanded filtering options for reports by BI-RADS, exam type, gender and breast density.
Added individual help screen for each report, and base help button addressing available reports and common items.
Added report macros “Run Before Audit” and “MQSA Audit”, that will run report sequences for audit preparation.
Expanded grid reports (with letter and export capabilities).
Added three tier sorting capability on grid admin reports by selecting the column names.
Breast density filters added to 1BB, 3V, 4SA, 4SB, 4SC, 4W, 5H, 9C.
Gender filters added to 1CC, 1P, 2A, 2J, 4P, 4R.
Tomographic filters added to 1BB, 4W, 9B, 9C, 9N, 9T.
1Y added display of amended letter for exams and BI-RADS.
2Y expanded for other date ranges, and include B/R/L (bilateral, right, left) in exam description.
3PP and 3T added filter for delayed exam to be excluded, or included, or separately itemized.
3XX added filter for screening (0 and 3s) to diagnostic, without need for biopsy.
4R expanded biopsy type filters.
4T filter added to exclude resolved biopsy exams, aspirations, and cancelled biopsy.
4KK added to assist with ACR audit for stereotactic and US guided biopsy.
5H and 5I added right click support for access to report, breast history and patient risk history.
8L added MQSA EQUIP quality image review tracking & resolution. Supports batch review synchronized with softcopy.
9G added for managing patients on NCBC survey, added direct access via right click capabilities.
9M expanded filters to use malignant pathology, personal breast history, or stage 1-4.
9O expanded itemized by the hour between 6am to 9pm, added 12-6am and 9pm-12.
9T added filtering by risk values and specific risk items
9V added Population serviced reporting.
9Y added Procedures Approved by Day of Week.
9Z added Imaging by Day of Week.
9DD added FDA GUDID Device report to track and search implanted devices and export data to FDA registry.

ADVANCED SPECIALS ADDITIONS

Added custom macro capabilities, like various detail screens, allowing common phrase items stored, edited and recalled.
Added ability to hide non-preferred BI-RADS terminology;
Abnormality classifiers; Density, Lesion.
Distribution modifier; Scattered.
Shape specifier; Lobulated.
Margin specifiers; Lobulated, Smooth.
Added ability to specify clock interval at “:30”.
Added to Location; in the biopsy cavity, in the lumpectomy cavity, in the surgical site.
Added to Surgery Items; Non-calcified fat necrosis, Calcified fat necrosis.
Added to Markers category; Vitamin E tablet (was already available on MRI procedure information screen).
Added distribution modifier “Grouped” for; abnormality, skin abnormality, calcification, cyst, mass, nodes, and other.
Added to Resolved; “Asymmetry” as abnormality type, and “due to tomographic imaging” as resolved by reason.
Added to Abnormality type; “Focal asymmetry”, and “Global asymmetry” (interacts with negative screen).
Added to No correlation “No visible finding” for no imaging findings.
Added “Due to HR patient” as imaging reason recommendation “due to patient’s personal high risk breast cancer value”.

ALTERNATE READER OPTIONS

Removed second read requirement on Mammograms where BI-RADS is BX Marker.

APPROVE SCREEN

Added ability for radiologist to preview the text of the patient letter.
Added ability to reorder reports, other than initial exam, by tapping the Change Order button.
Added option to require overall BI-RADS code for combined imaging exams, versus individual codes by exam.
Added ability to select a teaching reason.
- Expanded teaching reason selector to include custom categories. Tap selector then propose button to assign.
The reason can also be assigned later via the Comparison and Prior exams screen, when pathology is received.
Added option to populate a patient message section in patient exam letter. To access, tap patient message button.
- Can be user defined macros and/or free text for special situations.
Added option to apply restricted recalls based screening, diagnostic and procedure exams.
Added ability to alter clinical text, and access medical and risk screen by tapping in computed risk values window.

AUTOREADER

Modified AutoApprove to “skip” exams where tracking information is incomplete. Then tap Restart button to complete.
Added for ultrasound, exam modifiers limited and complete.
Added option to disable the AutoApprove function, requiring user intervention to approve each exam.
Expanded display detail to include patient name / DOB / radiologist / technologist.
Added support for consultation, physical breast exam, and skin punch exam.
Added mammography CESM exam modifier.
Added patient search capabilities.
Added radiologist filter.
Incorporated ability to include patient letter message.
Added Terminated for procedure types.

BATCH PRINT SCREENS

Added right click on patient name to provide direct access to patient record.
Added Fax/Email Log button to view faxes, and or emails. As exam/letters are processed, user may view.
Added ability to preview exam.
Expanded the ability to filter exams by birads, exam types, autoreader, amends, for distribution and staff.

BONE DEXA ADDITIONS

Added ability to incorporate reading location.
Expanded DICOM import, and based on the modality vendor and model, historical scan data can be received.
Created report template with DICOM import to automatically filter individual scans and use regions (L1-L4).
Created 8 different formatting templates.
Expanded template logic to insert various findings and impression “trigger” statements based on values.
Added Disease and Medications categories, expanded Risk Factors selection.
Added admin reports 9AA and 9BB for mining dexa data.
Added Patient letter message support for patient exam bone letters.

CLINICAL TEXT ADDITIONS

Added to PreExam, main examination and approve screens; display of clinical text, edit and import capabilities.
Added Risk History Summary button to PreExam, to display summary of medical history/risk in float screen during exam.
Added Insert Risk History button to import medical and risk summary directly into clinical section of report.
Added View Clinical button to allow viewing of prior clinical text.
Did you know that the Import Clinical button displays all historic clinical data for patient, and imports into clinical text?

CLINICAL REPORT GENERATION

Expanded system to allow radiologists to produce comprehensive reports facilitating multiple sequential procedures into common report, versus independent singular reports based on the limitation imposed by RIS/HIS system. Facilitates combinations for example; MG and US, biopsy with post imaging and specimen, multiple biopsies same report, etc.
Added to Approve, Procedure select, and PreExam screens, ability to sort the order of the reports, other than initial exam.
- To change order on approve, tap Change Order button, tap up arrow to move up in report, down arrow to down.
Added option to require overall BI-RADS code for combined imaging exams.

COMPARISON AND PRIOR IMAGING

Added display of dose accumulation calculation for reference and dose by exam.
Added display of teaching reason in report review grid. Right click on exam allows teaching reason selection or edit.
Added ability to print the exam and or letter only, instead of the combination of exam and patient exam letter.
Added access from exam to record and track MQSA EQUIP requirement for image quality review.

COMPARISONS

Added ability to verify availability of exam images in PACS. Status is “D” for digitally available.
- Allows facilities before appointment to check if priors are scanned and create a list requiring scanning.
- Also, those exams “queried” without archived availability will populate admin report 8J (Film Scan request list).
- Requires the specification of each of the PACS parameters to query (up to 10 PACS).
Did you know that there is an option to preselect the comparison studies automatically based on the number of years?

DENSITY PRESELECT

For facilities without prior history of patient breast density to preselect (clone) the option exists to preselect by age.
Age look-up table selects dense < 40, hetero < 50, scattered <60, fatty >=60.

DICOM

Added ability to display density report from Volpara, iCad or Hologic preselecting breast density.
Added ability to import and store mGy dose.

EMAIL AND FAX LOG

Simplified filtering and added preview of document, resend and print capabilities.

EMAIL PATIENT

Added email to patient of narrative report capabilities, in addition to the exam letter.
- Some states require patient receive exam.
Expanded letters sent to include additional detail on emailed correspondences.

GUDID SYSTEM

Added GUDID system to record implanted device serial numbers for FDA. Serial numbers incorporated in narrative.
Administrative report added for searching implanted devices for recalls, and device information upload to FDA.

HELP SYSTEM

Individualized help file for each screen and for each administrative report.

HIDE ITEMS ON SCREENS

Added direct hide capability of items on exam screens to allow customization by radiologist by tapping Set Default button.
- Facilitates default, multiple macros and hide options.

HIDE NON-PREFERRED BI-RADS TERMINOLOGY

To hide by radiologist or globally, tap Hide List box Items on Administration screen, tap the Hide Old BI-RADS button.

HISTORY SHEET

Added ability to exclude breast risk cancer calculations. Tablet version modified to be more user friendly.

HL7 INTERFACE

View and or paste the text of a pathology result message directly into open biopsy or pathology exam.
- Requires facility to send pathology HL7 results.
Added ability to incorporate custom fields in outbound HL7 message (BI-RADS value, next recall date, etc.)
Added ability to Include patient exam letter in outbound HL7 result message.
Added real-time sending of HL7 results to multiple EMRs, versus scheduled distribution.
Expanded ability to facilitate patients with multiple record numbers, prefix modifications, accession numbers, and references in PACs, due to facility mergers. We have a gamut of solutions developed for these situations.
Added flexibility after three attempts with EMR to move to next message.\
Added auto reset for canceled order if new order received with same accession for corrections right/left, scrn/diag.

INSURANCE

Added Effective Date field to patient insurance screen.

MAMMOGRAM

Added on main screen ability to specify abnormality distance from nipple with slider that interacts with detail screen.
Added MQSA EQUIP record and track requirement for quality image review, and inform radiologist of complications.
Ability to hide non-preferred BI-RADS terminology
- Abnormality classifiers; Density, Lesion, Nodule. Margin specifier; Macrolobulated.
- Calcification types; Reniform, Central lucent, Generic, Lucent-centered, Milk of calcium, Spherical.
- Distribution modifiers; Branching, Clustered, Indistinct, Layering, Linear, Scattered.
- To do tap Set Default & Macros button, select hide/unhide listbox items selector, then tap Hide Old BI-RADS button.
With breast density DICOM interface, density selections are preselected (yellow highlighted).
With breast density interface, SR available for review volume, exact percentage.
Modifier “represents change” added to Changes. Generic “core biopsy” added for BI-RADS 3.
Ability to incorporate independent statements into narrative report based on calculated risk values.
Changed breast images to vector technology to allow dynamic scaling for various screen resolutions.
Tomo spot CC, tomo spot MLO, tomo spot ML and tomo spot LM views added for BI-RADS 0.
Added display of Clinical text, ability to edit and import.
Added ability on individual mammogram exams, the breast density at the bottom of the report following BI-RADS code.

MAMMOGRAM CESM

Complete sub system added to capture items associated with CESM (Contrast Enhanced Spectral Mammogram).
- When CESM selected as an exam modifier, the screen is available for the imaging technologist and radiologist.
- The technologist collects imaging and injection information, complications, and blood work.
- CESM screen is available for the radiologist to review and indicate enhancement impression information.
- CESM data is inserted into narrative report in findings paragraph, and comments in impression.

MQSA EQUIP SYSTEM

Records and tracks poor image quality per new requirement. Use proactive or in batch mode. Accessed via imaging button on each exam. Records reason and resolution (custom items can be added via admin screen). Offers flag for ideal MQSA samples. Generates admin report by tech, modality, date range, reason and resolution, and those not resolved.

MAMMOGRAPHY IMAGING

Expanded support for up to 20 separate modalities.
Added ability to manually capture mGy dose.
Added ability to automatically obtain mGy dose from DICOM SR from Hologic, Volpara, and iCad.
Added ability to facilitate MQSA EQUIP requirement for image quality review, and notify radiologist of complications.

MAMMOGRAM NEGATIVE

Added items; “Fat necrosis”, “Focal asymmetry”, “Global asymmetry”, “Calcifications diffused”, “Fibrocystic change”,
- “All findings stable” and “Implant present”.
Option to retire on negative screen independently non-BI-RADS preferred technology:
- Lesion, Lesions, Density, Densities, Nodule, Nodules, Scattered densities, and Scattered calcifications.
- Note: For users auto cloning negatives (preselects last mammogram negative items, benign, tissue density, etc.),
  the previous selected retired items will appear selected allowing selection of preferred items.
With breast density DICOM SR interface enabled, density selection preselected (yellow highlighted).
Added option to include in patient exam correspondence a custom patient message.
Ability to include on individual mammogram exams, the breast density at bottom of report following BI-RADS code.

MEDICAL AND RISK HISTORY

Added ability to specify patient NOT Ashkenazi (eliminating need to ask again). Does not print on history sheet.
Added to Risk Factor; “No other family breast cancer history” to conclude questionnaire. Does not print on history sheet.
Added BRIP 1 Gene Mutation.
Added automatic update from pathology exams, to preselect select risk factors where history of atypical hyperplasia, hyperplasia and or LCIS for breast cancer risk calculators, and if malignant path finding exists, or if stage 1, 2, 3, 4 recorded, automatically sets personal breast cancer history (disables breast cancer risk calculators).
Added to relative tree son, brother, granddaughter, grandson, niece, nephew, maternal grandfather, paternal grandfather, maternal uncle, paternal uncle. Many of new relatives are incorporated into the new Tyrer Cuzick risk engine.
Updated BCRA and Tyrer Cuzick risk assessment engines to a service, removing the need to refresh as items added.
Added ability to collect “average of two or more alcoholic beverages per day”.
For new national mammogram database requirements, expanded risk factors to incorporate:
- Family history of gynecological cancer, Unknown if family history gynecological cancer
- Unknown if personal history of; Breast cancer, Gynecological cancer, Biopsy of atypical hyperplasia,
- Biopsy of hyperplasia, Biopsy of LCIS, Hormonal replacement therapy

MODIFY AND DICTATE

Expanded functionality to insert phrase directly from list located on the Modify and Dictate screen.
- Users can continue to use the independent buttons to select phrases.
- The update shows users categories on upper list and individual phrases are displayed on lower list.
- When phrase is tapped with prefix “f” insert into findings, prefix “i” inserts into impression.
- Hovering over the phrase in lower list exposes complete phrase.

NAVIGATOR

Added “Genetic testing”.

NUCLEAR MEDICINE

Added Change modifier “Represents change”.
Did you know that patient consent and procedure description information, can be included in the report automatically?
- By labeling phrase as “default”, also support for soft bookmarks to include patient name, DOB, times and other info.

MRI ADDITIONS

Added on main screen ability to specify abnormality distance from nipple with slider that interacts with detail screen.
Added Imaging button to record MQSA EQUIP requirement for image quality review, and inform of complications.
Added ability to hide non-preferred BI-RADS terminology, Enhancement modifiers; Central, Dendritic, Reticular.
- To do, tap Set Default & Macros button, select hide/unhide listbox items selector, then tap Hide Old BI-RADS button.
Added “Screening” modifier for MRI studies. Allows separation of statistics diagnostic versus screening MRI.
Added Margin specifier for mass “Circumscribed” and “Not Circumscribed”.
Added “Enhancement clustered ring” and “Periductal stromal enhancement”.
Added generic “core biopsy” for BI-RADS 3.
Added Breast tissue densities selectors;
- Homogeneous fatty, Homogeneous fibroglandular, Homogeneous, and Homogeneous dense.
Added Gadovist and ProHance as contrast types.
Added Clinical text button to main MRI screen and display text, plus on clinical text screen added import clinical button.
Added Change modifier “Represents change”.
Added Preview button on main screen, and clinical text preview and edit.
Added new birads terminology for background enhancement modifiers.
Added macro support for views obtained and sequences, intervals, frames and thickness.
Did you know that patient consent and procedure description information, can be included in the report automatically?
- By labeling phrase as “default”, also support for soft bookmarks to include patient name, DOB, times and other info.

NOTES

Added option that disables Delete button on notes screen for all users and user types.
Added View Clinical button, to allow view of prior clinical text.

ORDERING PHYSICIANS

Ability to “start” with exam doctors, then alter at the exam level via CC doctor button on Preliminary exam and PreExam.
- This maintains the “base” doctors for patient. Doctors displayed on patient maintenance are “breast” based.
- Facilitates DEXA orders separately from breast ordering physicians.

OTHER LANGUAGES

Expanded terminology for patient exam and recall/reminders for variable items (recall type and interval, etc.).

PATIENT EXAM LETTER OPTIONS

Added ability to facilitate multilevel patient exam letter messaging based on Tyrer Cuzick values.
Added option if patient has more than one letter to be printed, and is same letter, recall type and interval, to do one letter.

PATIENT LIST

Feature to search by accession number patient list – type @ in front of search string and looks for patient.
Added column to display current active password for tablet forms.
Added “Sounds like” selector for patient name search.

PATIENT MAINTENANCE

Added display of last known breast density to automate modality scheduling.
Added Education level and Ethnic selectors, and expanded marital status selections.
Added direct access for form selection and macro form selection for tablet distribution.
Added access to device implant system for addition of implanted and explanted devices for FDA GUDID requirement, interacts with biopsy and localization procedures to record GUDID numbers.

PATHOLOGY ADDITIONS

Added on pathology exam report, Initial and Secondary/Repeat Biopsy Physician, complication and repeat reason.
- Radiologist imported as Initial Biopsy(s) Physician automatically from biopsy exam.
Added Neoadjuvant start/end date/time for reference.
Added ability to specify repeat reason and complications for ACR biopsy audit (administrative report 4KK).
Added “Swap” button to automate initial pathology and secondary pathology, to report as statistical or ancillary.
Added to NCI stage screen: T1mi, N1mi, N2a, N2b, N3a, N3b and N3c to facilitate calculation of stage 1A,1B and 3C.
- Added value recording of Post treatment; ypT, ypN, snN, ypM and Pathological pN.
Added pathology type selectors;
- Cellular fibroadenoma, Focal dense breast tissue, DCIS Clinging non-comedo, DCIS cribiform,
- Invasive ductal carcinoma with lobular differentiation, Invasive ductal carcinoma with lobular features,
- Invasive carcinoma with mixed ductal and lobular, Invasive carcinoma grade 2 with mixed ductal and lobular.
Pathology admin reports 4T and 4X added “Include resolved exam also”, selector to accommodate canceled biopsies. Added ability to paste the text of a pathology result message directly into open pathology exam.
If pathology report interface (HL7) is available, report is available for viewing and can pasted into biopsy or path report.

PATIENT MESSAGE

Added option to include in patient exam correspondence a custom patient message;
Provided on Preliminary exam, PreExam, AutoReader, Tracking only screens, Negative and Detailed approve screens.

PATIENT PORTAL API

Added API for patient portal interface, provides access to obtain patient medical and risk information and update.
- Also provided is a comment field (text) for patient to express concerns.
- This text is written to the indicated problems note and is stored.
- Viewable by technologist and radiologist (automatic pop-up available during exam).

PATIENT PORTAL RESULT LETTER

Added ability to write patient letter to file for presentation in patient portal.

PENTRAC ADDITIONS

Added “CESM” (Contrast Enhanced Spectral Mammogram) as exam modifier for mammograms.
Added “Complete” and “Limited” modifiers for ultrasound studies, and “Screening” for separation of statistics.
Added “Terminated” for biopsy procedures.
Added breast “Density n/a” for mammo and MRI exams.
Added “Sounds like” for patient name search.
Added Skin punch biopsy, Consultation, Physical breast exam tracking.

REGISTRY

Added NMDB 3.0 report.

SPEECH RECOGNITION

Added SpeechAnyWhere and PowerScribe 360 support.

WINDOWS AND LDAP LOGIN

LDAP authentication support. When technologist has shared locations, pop-up presented for location section.

PRE EXAM ADDITIONS

Added new PreExam screen to eliminate clicks. At a glance, all known information is visible.
- The center grid displays previous reports and events chronologically.
- To include comparisons (if not preselected via the autoselect compare option) click selector next to date.
- Above the grid, specialized compare phrase selectors are positioned.
- To access custom compare phrases, tap Comparison & Prior button. Selected items are then displayed within grid.
To preview a report for PeerReview (indicated by PR, N/A not applicable, RE re-edit) tap the button next to report.
To preview a report, tap on the report to view. Note the report appears in a separate float screen.
- Multiple reports can remain open during interpretation, just move to side.
- Float screen size and position reopens where closed last.
- Any open float screens will close automatically when exam is approved or suspended.
The Medical Risk History column displays expanded patient info and risk values, and family breast cancer info.
Tap Persist Risk View button to have clinical risk summary float screen visible during interpretation.
Option is offered to create “red” alter value for set point values for Tyrer Cuzick and BCRA.
Button array is provided for selecting exam, and adds parallel function ability to old PreExam screen.
Added access from Imaging button to record and track MQSA EQUIP requirement for image quality review.
With the AutoNext feature (tapping the AutoNext on exam schedule), if mammo exam, enter key opens negative mammo.
If PenRad integrated with Hughes Risk System, tap the button to review report.

PRELIMINARY EXAM

Added options to automatically display for review/confirmation doctors, medical and risk information, if the technologist has not reviewed prior to transferring the exam to reading schedule.
Added “Pending priors” and “Technical issues” reason for delay.
Includes in report “Reporting delay due to outside images for comparison.”, “Reporting delay due to technical issues”. Allows delayed exams to be excluded turnaround reports.
Added ability to facilitate exam titles greater than 200 characters for various view selections.
Added “Complete”, and “Limited” new modifiers for ultrasound studies.
Added “Screening” modifier for ultrasound and MRI studies. Allows separation of statistics diagnostic versus screening.
Added new exam modifier “CESM” (Contrast Enhanced Spectral Mammogram) for mammography exams.
- When selected, CESM button appears on imaging and detailed mammo screen allowing capture of blood work, injection contrast and reaction information.
- CESM data is inserted into mammography narrative report in findings paragraph, and comments in impression.

PRINTING AND ARCHIVAL

The option was added to remove the dependencies of Microsoft Word; printing, formatting, and PDF generation.
- We are offering a “word less” control. This offers faster printing and reduced operation cost.
- This requires our staff to convert the word templates.
- More importantly this allows PDF to be stored in the database for immediate retrieval, and if desired sent to PACS, and sent via HL7 to EMR, and to patient portal.

RESOURCE VIEW ONLY OPTION

Developed radiologist resource only screen providing preview of previous reports, patient medical and risk items and values, and offers PeerView capabilities. Narrative report generation is other than PenRad. Resource screen is synchronized with softcopy (accession and or MRN). Tracking is provided via the AutoReader or PenTrac.

RECALL DATE

Added option to automatically include the recall date following the recall type and interval statement in narrative report.
- Aids in compliance where regulations require more than “A mammogram in 1 year is recommended”.

PROCEDURES ADDITIONS

Added complete Skin punch biopsy exam.
Added to all procedure screens:
- Custom macro capabilities, like various detail screens, allowing common items stored, edited and recalled.
- Ability to import in to clinical directly, medical and risk information into report.
- Added Preview button on main screens.
- Added on main screen ability to specify abnormality distance from nipple with slider that interacts with detail screen.
- Added MQSA EQUIP record and track requirement for quality image review, and inform radiologist of complications.
Added all biopsy screens:
- Selector “Interpreted on dedicated mammography workstation” to capture post imaging reimbursement.
- Selector to repeat “specimens contain calcifications” in findings, similar to existing impression statement.
- Added GUDID system to record implanted device serial numbers for FDA. Serial numbers incorporated in narrative.
Added to FNA detail screen, imaging methods used selectors:
- Mammo, Digital, Stereotactic, Tomo.
Added to Localization detail screen;
- Methods used, “Tomo mammo”. Adds as to exam header, “Tomographic Guided”. Device type, Savi Scout.
Added GUDID system to record implanted device serial numbers for FDA. Serial numbers incorporated in narrative.
Added ability to AutoRoute pathology results from EMR pathology to;
- Biopsy exams, pathology exam and AutoReader, for review and incorporation.
Added to MRI bx, ability to specify contrast and volume, when biopsy not conducted with original imaging exam.
Did you know that patient consent and procedure description information, can be included in the report automatically by labeling phrase as “default”, and also support for soft bookmarks to include patient name, DOB, times and other info?

RECALL/REMINDER LETTERS

Added Right click support on patient name on batch print screen to provide;
Direct access to various functions, including preview of correspondence on batch print screen.
Expanded system to produce “immediate” follow up recall letters (x) number of days after exam, if exam is not resolved,
or if the patient has no appointment or order within (x) days, or currently does not have an exam on worklist.
Expanded “smarts” not to create recall/reminder letter if patient has an order within (x) days of recall date or appointment, and to create letter if scheduled order or appointment was not fulfilled.
Did you know the AutoSelect (recall/reminder letters system) automatically sequentially selects letters to patients?

RESOLVE

Added Custom resolve reasons system to draw from a common list;
- Reasons can be added via the Exam Resolution Reasons button on the Administrative screen.
- Administrative report 5I uses reasons for filters, along with exam type and BI-RADS code.
- Automatically an administrative note is created when exam resolved, referencing exam, date resolved and by whom.
Added option to AutoResolve screening mammogram BI-RADS 0 exam;
- When followed by another mammo or US exam within 10 days.
Added option to allow exam resolving to other than master user and/or radiologist.
Added option to notify radiologist during interpretation automatically of prior exams in unresolved status;
- Option to prompt at PreExam and or during approve process.
- Resolving during interpretation allows facilities to be pro-active for audit preparation.

RISK ENGINES

Converted BCRA and Tyrer Cuzick risk assessment engines to a service, removing the need to refresh as items added.
Added display of BCRA and TC values on PenTrac screen. Incorporated v7.2 and v8 of Tyrer Cuzick.

RIS LIST

Default option to limit load on RIS LIST to 500 orders, improving performance.
Added RIS filters and assign status:
- Exam location, orders by location, apply filters and memorize by workstation for locations.
- Assign status and filtering for workflow staging, dressing room, ready to image, etc, by right click.
- To create status list, tap the RIS Order Status Type Config button on Administrative screen, add status name/color.
Added procedures and modifiers;
- Skin punch procedure. CESM (Contrast Enhanced Spectral Mammogram) as exam modifiers.
- Ultrasound modifiers; limited, complete and screening.
Option to show last known patient breast density, to help select modality.
Added right click support to select tablet forms for patient and display of tablet passcode on grid.
Added Hover over patient name to show complete grid row contents including patient tablet passcode.
Added reset button to reset order status when “orphaned”. Occurs during preliminary exam when network disconnected.
Added reset button to reset order status when “canceled” then when re-ordered it was ignored. (screening to diagnostic).

SAVE LAST USED LOCATIONS

Ability added when opening preview screens for help, exams, clinical summary, and application window size and monitor location by logged in user, and by the workstation, to remember location. If monitors change (go from three to two), it may be necessary to reset “saved” locations. Access admin screen, tap Clear Current User’s Form Positions button.

SCHEDULE

Added Hover over patient name to show complete contents of grid including tablet passcode.
Added status change to allow “complete” to be toggled to “complete held” and back.
- Saves as a “hold” to show surgeon. Will not be printed or removed from schedule, until toggled back to complete.
Added Density column displaying last known breast density.
- If have DICOM SR density interface, if calculated, density number followed with C for computed.
- Also on the mammo detail screen, if SR available for review (volume, exact percentage, etc.)
Right click on patient name for assignment of; memo/color, radiologist, and direct access to patient record.
- Also added is ability to create new exam for patient short-cut, and select exam information to view individual exams incorporated into the study, and referring physician contact information (cell, office, pager).
Did you known by filtering exam list (screening for example), sorting by density, selecting imaged only, tapping AutoNext button first, as an exam is approved, the next exams appears automatically, synchronized the viewing workstation.

SCREEN SCALING

Expanded the scaling of application screen area to facilitate custom size and monitors and tablets of higher resolution.
Added option to disable minimization of screen for clients without window tray to restore application once minimized.
Added ability to adjust the size and the view area of administrative reports.

SEND TO PACS

Added option to automatically send history sheet or custom form to patient notes (history sheet) and to PACS without scanning. Also provides facilities where PenRad is used for tracking only, the radiologists to view during interpretation, and archives a copy in PACS.

SOFTCOPY SYNCHRONIZATION AND AUTOMATION

Options to format synchronization messages (pad, strip, accession and mrn) for dissimilar systems.
Options to send messages to PACS, as exam is approved (PACS work list can indicate study read). And as exam is committed with screening or follow-up recall, images can be purged, leaving images for returning patients on viewer.

TABLET FORMS

Added help screen support and various worksheet forms for biopsies, ultrasound, and assessments.
Added Form Marco Sets system that automatically assess forms to be distributed to patient to refresh or populate. Interested in adding patient forms for surveys, release and consent forms with or without signatures?

TEACHING REASON

Ability to specify custom categories when flagging exam as teaching. Teaching reason selector available on Approve screen, Comparison and Priors Exams screen (by right click on exam). To add or retire teaching reasons, tap Teaching Purposes List button on Administrative screen, and edit using form. Teaching reason can be applied at approve during interpretation or to existing exams, for building libraries. Admin report 7A offers various search capabilities.

ULTRASOUND ADDITIONS

Added on main screen ability to specify abnormality distance from nipple with slider that interacts with detail screen.
Added ability to specify regions scanned (breast, axilla, supervicular), various quadrants and individual clock regions.
- If collected by technologist it is automatically transferred to the ultrasound exam for radiologist.
Added breast densities selectors;
- Homogeneous fatty, Homogeneous fibroglandular, Homogeneous, Homogeneous dense.
Added display of clinical text, edit and import, and Preview button without proceeding detailed approve screen.
Added ability to hide non-preferred BI-RADS terminology;
- Abnormality classifiers; Area, Lesion, Nodule, Region.
- Echo modifiers; Homogeneous, Septated, Sonolucent.
- Margin modifiers; Irregular, Lobulated, Smooth.
- To do, tap Set Default & Macros button, select hide/unhide listbox items selector, then tap Hide Old BI-RADS button.
Added exam modifiers:
- Complete, Limited, Screening (allows separation of statistics diagnostic versus screening).
- Added 3D insertion statement to reflect “exam was performed with computer guidance to assure complete coverage
  of the breast tissue and to provide a uniform data set. Images were transferred to a viewing station for 3D rendering.”
Added detail item specifier selectors:
- Index or Satellite (If satellite abnormality, distance from index can be referenced).
- Nodes as Axillary, Infraclavicular, Intramammary, and Supraclavicular.
- Axillary lymph nodes as level I, II and III.
- Extranodal extension, No extranodal extension.
- Thickening modifiers; Eccentric, Focal and Uniform cortical.
- Margin modifiers; Homogenous, Heterogenous, Not circumscribed.
- Change modifier; Represents change.
- Heterogenous modifier in internal echo pattern window.
- Generic “core biopsy” for BI-RADS 3.
- Automatically insert “of mixed echogenicty” when multiple acoustic posterior modifiers are selected.
Changed breast images to vector technology to allow dynamic scaling for various screen resolutions.

ULTRASOUND IMAGING

Expanded support for up to 20 separate modalities.
Expanded the ability to specify scanning method, regions, and or individual clocks scanned.
- Automatically transferred to the ultrasound exam for radiologist.
Added MQSA EQUIP record and track requirement for quality image review, and inform radiologist of complications.
Added Macros for imaging, to allow selection of techniques.

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PenTips #183 – PenRad and PenTrac Itemized Upgrade

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