User’s Manual

for
SYNERGY- CCD
Version(1.3.4.3)
 Table of Contents
Sr. No Topic Page No.

1. Preface 3
2. About This Manual 4-8
2.1 Audience and Scope
2.2 Indication for Use
2.3 Prerequisites
2.4 Conventions Used in This Manual
2.5 Symbols
2.6 Safety Summary
2.7 List of Abbreviations Used
3. Section A: Introduction 9-19
3.1 Introduction
3.2 Operations Performed
4. Section B: System Management 20-27
4.1 System User Interface (Configuration Settings)
5. Section C: Worklist Management 28-37
5.1 Identifying the Patient and Study
5.2 Query
5.3 Create New Patient
5.4 To Register an Emergency Patient
5.5 Query from HIS
6. Section D Exam Management 38-54
6.1 Real Time Image Viewing
6.2 Additional operations
7. Section E: View Management 55-64
7.1 View Tab
7.2 Image Processing Tools
8. Section F: Exit Management 65
8.1 Exit Tab Working

2 
 
 1. Preface

The information contained in this manual is confidential and proprietary to Allengers Medical
Systems Limited. This information is provided only to authorize representatives of Allengers
Medical System's customers and dealers solely for the purpose of facilitating the use of
Allengers Medical System's products. No information contained herein may be disclosed to any
unauthorized person for any purpose whatsoever without the prior written consent of Allengers
Medical Systems Limited.

The information in this document is subject to change without notice.

3 
 
2. About This Manual
2.1 Audience and Scope

This manual is intended for partners, to help them get a general idea on how to install,
configure the SYNERGY CCD & Allengers Service program, and operate the
application.

The expected audience should be the product specialists or supporting engineers, but not
the end-users in the clinical enterprise.

2.2 Indication for Use

Allengers Service concerns to protect database related query & PACs connectivity
information.

The SYNERGY CCD major concerns the operator application.

The SYNERGY CCD application involves fluoroscopy and cinegraphy images; the
transmission of these images and related text are required from digital technology to
hardcopy, softcopy, or archive.
Follow all safety labels on the equipment.

2.3 Prerequisites

The procedures in this manual assume that the end-users know how to do the following
operations related to the system's graphical user interface:

Perform mouse and trackball operations, such as click, drag and select from menus
Click buttons
Enter information in text fields Select options
Select entries from pop-up or drop-down lists Use scroll bars

4 
 
2.4 Conventions Used in This Manual

This manual uses three types of special messages to emphasize information or point out
potential risks to personnel or equipment.

NOTE: Notes provide additional information, such as expanded explanations, hints, or

reminders.

Cautions point out procedures that you must follow

precisely to avoid damage to equipment, loss of data,
or corruption of files in software applications.

Warnings point out procedures that you must follow

precisely to avoid injury to yourself or others.

2.5 Symbols

NOTE: Following symbols are just some examples for common use, RF modality
suppliers should take care of their specific symbols.

Caution: Consult accompanying documents

Authorized Representative in the European Community

Date of manufacture.

Manufacturer

This symbol indicates protective EARTH (ground).

This symbol indicates the equipment is suitable for alternating current.

Do not dispose this product as unsorted municipal waste. Collection of such

waste separately for special treatment is necessary.

5 
 
2.6 Safety Summary

The operator must read this manual in its entirety and receive training, from the
authorized key operator as designated by the RF modality supplier, in system operation
and application prior to operating the system.

Please do not execute the Synergy CCD application before you get
the necessary training from the manufacturer.

The Synergy CCD system must be operated in such a manner that

no patient contact with any part of the system is possible.

The Synergy CCD is interfaced to medically approved x-ray

generating equipment! Be certain to follow the x-ray generator
instructions and specification for wearing proper lead shielding
when in the presence of x-ray generating equipment.

All personnel must wear Dosimeters during all phases of

installation, operation and maintenance of the Synergy CCD and the
equipment to which it is interfaced.

Do not attempt to alter any system software. Doing so could disrupt

the functioning of the instrument and result in loss of images.

Do not attempt any maintenance of this unit, including

troubleshooting, in the presence of any patients or non-authorized
staff.
Do not attempt any repairs if the equipment fails to operate
correctly. Only the specified engineer authorized by the
manufacturer has the rights to do this.

Please do not attempt to move equipment, or connect or disconnect

any commutation cables. Only the specified engineer authorized by
the manufacturer has the rights to do this.

6 
 
Route cables properly to eliminate tripping hazards.

Do not spray the cleaning solution directly onto the equipment.

Moisten a cloth with the solution and wipe the equipment.
The Synergy CCD may only be operated in an area that is located
beyond the 20 Gauss limit.

The Box of Synergy CCD is made by metal, which can prove

Electromagnetic interference shielding.

No directly electrical connection to patient or operator is allowed to

connect to any cables of the Synergy CCD.

When the product should be connect to other equipment for intended

use or other purpose, all the Signal input part and Signal output part
of the product should be connected to the inside of other
equipment’s.

There is no patient circuit is provided in the equipment. All of the

outputs are not allowed to be accessible to the patient. And the
outputs are only allowed to be accessed by the operator in the normal
use when the operator can not touch the patient and outputs
simultaneously.

The integration of the equipment should be carried out according to

the operator manual.

Please read the Usage manuals and diagrams of the Generator ,

Detector, Tube, Table, Collimator and all the devices which may be
connected to Synergy CCD carefully before connect the cable of
Synergy CCD.

Please turn off the power of the Synergy CCD before connecting the
cable of Synergy CCD.

7 
 
2.7 List of Abbreviations Used

LUT stands for Look Up table.

LIH stands for Last Image Hold.

GUI stands for Graphic user Interface.

L/R stands for Live to reference.

DRC stands for Dynamic range compression.

WW/WL stands for window width and window level.

IP stands for Internet Protocol.

MAC stands for media access control.

AE stands for Application Entity

MAG stands for Magnification.

PACS stands for Picture archive and communication system.

8 
 
 Section A
3. Introduction
This section provides an overview of the SYNERGY CCD system, the characteristics of the
SYNERGY CCD application, a description and illustration of the system components which
might be concerned, as well as a brief description of possible usage.

3.1 Introduction

The SYNERGY CCD system is entirely developed by Allengers Medical Systems Ltd., focuses
on the Graphic User Interface application of the digital RF equipment. It is the interface that
faces to the operator directly for executing the digital images’ acquisition in the mode of
radiography, fluoroscopy, Digital Subtraction Angiography (DSA) and some other advanced
models, concerning Retrieving Work-list from HIS/RIS or creating a new patient locally,
exposing the patient along with the real-time processing, image optimization, and data
transmitting. The SYNERGY CCD also provides the control functions responsible for
synchronizing the ready states of the Detector and the X-ray equipment.

The SYNERGY CCD system is composed of following components:

o SYNERGY CCD software, loaded on a CD
o Allengers Medical Systems dongle with USB interface Exposure Synchronizing Device

Equipment for actual operation MIGHT involve:

PC workstation recommended, with monitors, keyboard, pointing device (mouse or

trackball).

o Windows XP & windows 7 operating system

o 1 CPU (i3 or higher Processor) and 8GB RAM
o 1 TB image storage capacity
o Optional Disk Array
o Workstation monitor and In-room monitor with resolution 1,280 x 1,024.
o Uninterruptible power supply (UPS) is extremely recommended to ensure the Uninterruptible
power for the SYNERGY CCD.
o X-ray high frequency Generator Collimator

9 
 
3.2 Operations Performed
Acquisition features

In-room monitors controlling for table-side observation

A second screen beside the table is available for users to view the images during the table-side
operation so that the operator could give a real-time care to the patient. It can be set to display as
same as the screen in the control room, or extract only the image from the control screen and
display it in full-screen mode;

LIH

Last Image Hold (LIH) is available for user to choose during the exposure. The last image can be
saved to the personalized folder at local disk, or temporally in buffer for post-processing;

Image pixel depth from the Camera

Matrix (pixel) Image pixel depth

Pulsed Fluoroscopy 1000*1000 16

Data management

o It’s free for operators to choose the storage methods. Such as store the image as LIH,
LIS (Last Image Save), SAVE, or LOOP whether to the local disk or buffer.
o Images are saved as DICOM format and can be transform to BMP, JPG, TIFF
format for common use;
o Images can be exported to CDs with DICOMDIR and imported later.
o Images can be sent to printers for hardcopies.

Exposure control

o Support Automatic Brightness System (ABS)

o Real-time processing (Smooth and Enhancement)

10 
 
Basic Operation

This section describes the general workflow to carry out the routine work, involving how to use
the SYNERGY CCD application to perform the digital fluoroscopy exams, as well as the related
data management on how to store and deal with the images. It mainly involves the Work list and
Exam User-Interfaces.

Overview for Capturing Image

The general workflow for using the SYNERGY CCD to acquire and send images to the output
devices involves the following steps.

Steps:
1. Identifying the patient and study.
2. Select the procedure needed Using foot switch to take a fluoroscopy; reviewing the
acquired image.
3. After images have been captured, users can select the images needed to send or print.
For convenience, the images can be sent or printed at Work List, Exam or View User-
interfaces.
4. Closing the patient/study.
5. Signing Out from an Acquisition Session.

Getting Started With SYNERGY CCD

This session will describe about the working of Allengers SYNERGY CCD.

Steps
1. To start up the program.
After the SYNERGY CCD program has been installed, an icon will be created on the
desktop for example, you may find the icon.

2. Wait for the initialization and then application Login window will display.
The user can login as Technician or Manager by entering the assigned password and can
also exit the application by clicking on the Exit Tab.

11 
 
Technician Login

Manager Login

12 
 
Exit

After login a Status window will show the initialization status of the Synergy CCD, shown as
below. There are some initialization tasks for Synergy CCD functions, the result of each task
(successful or failed) is displayed once it has been performed, after the initialization is completed
successfully, the application Work-list window will displayed.

13 
 
SYNERGY CCD GUI
A typical SYNERGY CCD system includes System Management, Work Management, Exam
control, Review image and Exit Application. Accordingly, you could find the following five
Interface tab on the SYNERGY CCD GUI:
o System
o Worklist
o Exam
o View
o Exit

14 
 
Various Interface tabs on SYNERGY CCD
System Tab for Settings

15 
 
Work list Tab for the details of the Patients

16 
 
Exam Tab for
f examinee the imagess of the patiients.

17 
 
View Tab to view the images of the patient.

Note : In this version New procedure has been added by the name “Peripheral” which acquires
the frames @ 4FPS

18 
 
Exit Tab to exit the application

19 
 
 Section B
4. System Management

This section involve the function do not used in during the routine workflow but helpful for
administrator to manage the SYNERGY CCD system.

4.1 System User Interface

In System User Interface, management user account and configuration of SYNERGY CCD
system can be done.

Configuration Settings

1. Select the System Tab. Click on configuration settings to make the Hardware and
Network Settings.

20 
 
2. Enter password and login to change the configuration settings.

3. Hardware Settings : Collimator Settings

21 
 
4. Hardware Settings :
Generator Port Settings – Pulse Width Fluoro, Pulse Width Cine etc.

22 
 
5. Hardware Settings :
Camera Port Settings – For setting IP address, MAC address, SYNC MODE, SYNC
POLARITY etc.

23 
 
6. Hardware Settings:

Sync Confihuration - Port No., Baud Rate etc.

24 
 
7. Network Settings: Image Settings.-

For setting image default parameters like Apply LUT, Raw save, Show clean LIH, Average
mean, Rotate, Hospital name etc.

25 
 
8. Network Settings:

PACS Settings: Image Parameter –

For setting PACS server information like Server AE Title, IP address, Port No, Application
AE Title, Timeout etc of different DICOM NODES..

26 
 
9 . Network Settings:

Worlist Settings: -For setting Worlist settings server information like Server AE Title, IP
address, Port No, Application AE Title, Timeout etc.

27 
 
 Section C
5. Work list Management
5.1 Identifying the Patient and Study
This operation should be executed on the Worklist User-Interface, shown as below. Worklist Tab
is used to display the records of the patients.

Before capturing images, the user must identify with which patient they are to be associated.
Proper identification ensures that the image data are associated with the correct patient
information.

All systems allow the user to identify patients manually. Whether the user is acquiring images
for a new or existing patient, the user can identify a patient manually by:

Creating a new patient record locally.

28 
 
Selecting a patient from those previously entered and currently stored in the database.
Click on Refresh button to display all the existing records of the patients.

29 
 
5.2 Query: To search an exact patient
From the Query Panel in the Worklist page, the user can query a patient/study by various
searching criteria such as Patient ID, Patient Name, Accession Number and date, , Refereeing
Input the key information associated to the desired patient/study, then click Query button. The
Query panel is shown as below:

Search by patient detail.

Search by date and days 

30 
 
5.3 Create New Patient
New Patient button will open the patient form to create a new patient entry. The New Patient
Entry window displays; a sample is shown below

31 
 
5.4 To
o Register an Em
mergenccy Patien
nt

To add
d a patient for emergeency, the usser needs to register thee patient rappidly, and need
n not filll
in the detailed
d infformation. By
B clickingg the Emerrgency buttton, the sysstem will reegister nextt
patient automaticallly with thee name com
mposed of prrefix, currennt date and sequence number,
n andd
sequencce number increases inn 1 step byy each patieent. Then SYNERGY
S CCD loadss the Exam
m
window
w directly foor technicianns to exposee the patiennt.

32 
 
Delete Study button will delete the study of the patient selected. Enter the password to delete
the sudy selected.To delete you need to Login as MGR mode.

33 
 
Can create new patient study and can also edit the existing patient study by the right click on
the grid.

1. Select any patient to move to exam window.

2. Select any patient to move to view window.

34 
 
5.5 Query from HIS
1. This operation should be executed on the Worklist User-Interface, shown as below.
Worklist Tab is used to display the records of the patients from HIS.

35 
 
2. In Worklist tab, yor get patient entry from HIS. To do this you need to click on
Refresh button it will show you all the patien entry from the HIS as shown below.
3. If you already Refresh the list from the HIS then it will ask you to get the list from the
HIS or just want to Referesh the list.

36 
 
Query: To search an exact patient
1. From the Query Panel in theWork list page, the user can query a patient/study by
various searching criteria such as Patient ID, Patient Name, Accession Number and date, ,
Refereeing
2. Input the key information associated to the desired patient/study, then click Query
button.
3. The Query panel is shown as below:

Search by patient detail.

Search by date and days 

37 
 
 Sectiion D
6. Exam Managgement
6.1 Real
R Timee Image Viewingg
The whole study of the Patieent will be loaded in thhe Thumbn nail of the V
Viewer as sh
hown in thee
figure. Each series will be loaaded as a seeparate imag
ge in the Th
humbnail.

38 
 
Click on
n the Thum
mbnail imagee to load thee correspon
nding series in the View
wer.

39 
 
 6.2 Additional Operations

Use the Following Image Processing Tools to diagnose the image

a) PROCESS:
Note: To open these settings PROCESS button.
Settings for the processed image will be displayed, these are :-

1. I1_Noise: The effect of Noise is to remove noise whose value is vary from -100 to 100. If
you increase the value to 100 it will smoth the image & if you decrease value to -100 it
will reomove the grains from the image.
2. I1_Sharpness: The effect of Sharpness is to raise the edges in the image whose value is
vary from -100 to 100. It will increase & decrease sharpness.
3. I1_Contrast: The effect of Contrast is to raise the brightness level in the image whose
value is vary from -100 to 100. It will increase & decrease contrast.
4. I1_Effect: The effect of this parameter is to apply Noise, Sharpness, Contrast to image
whose value is vary from 0 to 100.
b) Invert : Invert the Pixel value of the selected image.
c) PAN : Move the image in the viewer
d) Rotate : Rotates the selected image
40 
 
e) Zoom : Click on im mage and drrag the mou use. This wiill zoom thee image.
f) ROI : TTo adjust thhe brightnesss acoordingg to “Regionn of Interestt”, by click on this buttton you can
n
see the ROI area oon the imag ge.If user in MGR modde than userr can edit R ROI accordin ng to Examm
Proceduure as show
wn below forr both TECH H & MGR mode.
m

g) DSA : To
T apply DSA procedu ure click on DSA button.
h) R-MAP P : To applyy Roadmap click on R--Map button n.
i) PEAK HOLD : To apply Peaak Hold clicck on PEAK K HOLD buutton.
j
j) R-MAS SK : To app ply Remask
king click onn R-MASK button.
k) PIXELL SHIFT : To T apply Pix
xel Shift cliick on PIXE
EL SHIFT button.
b
Note: Left,
L Right, Up, Down Pixel
P Shift will
w works only when you
y select PIXEL
P SHIF
FT button.

I TECH M
In Mode

41 
 
 In MGR MMode
l) WW/W WL: Window w Width/W Window Leveel is used too optimize visualization
v n of specificc structures.
Contrasst and Brighhtness of thee Image willl change
m) STENO OSIS: Stenoosis is used to measure area & leng gth of the blocked
b arterries.
n) L/R: It is used to trransfer the selected im
mage from livve to the refference monnitor.

To save the Fluoro Images.

I  

42 
 
 Thiss will play thee Cine  Thiss will play thee Cine 
Loop in the Reverse  Loo
op in the Forw ward 

This will play the Cin
ne  Thiis will stop th
he Cine 
Loop  plaayback

Use tto close the EExam 
Wind
dow.

o) Proceedure: If we
w want to o take same patient inn other pro
ocedure likke SPINE + NEURO,
ORTH HO then wee can changee the Exam Procedure in EXAM mode
m for thaat particularr patient.

p) Flip-H
H : Flip thee selected im
mage horizo ontally
q) Flip-V
V : Flip the selected immage verticaally
r) Rotatte Clockwisse: Rotate th he selected image clockwise.
s) Rotatte Anti-Cloockwise: Ro otate the selected imagee anti-clock
kwise.

t) Annootation: Draaw annotatiion on Exaam Viewer click on buttoon, all anno

otation willl
show on the view
wer as show
wn below.

43 
 
To draw annotatiion, select any
a annotatiion from thee annotation
n tool as shoown above.

1. Seelect: To reset mouse cursor

c selecct .

2. Liine: To draw
w line on viiewer selectt .

3. Rectangle:
R T
To draw recttangle on viiewer selectt .

4. Elllipse: To ddraw ellipse on viewer select .

olygon: To draw polyg
5. Po gon on view
wer select .

6. Closed-Curv
ved: To draw closed-cu
urved on vieewer select .

7. Po
ointer: To draw
d pointeer on viewerr select .

8. Teext: To draaw textbox on

o viewer select
s .

44 
 
9. Po
oint: To draaw point on
n viewer seleect .

10. Ruler:
R To drraw ruler on
n viewer seleect .
11. Prrotractor: To otractor on viewer seleect
T draw pro .

12. Cross Produ

uct: To draw
w cross prod
duct on view
wer select .

13. Sa ave: To savve annotation image sellect .

Note:: On application login,, user has to o be set annnotation deefault setting
gs as per reequirementss
first tiime.
For deefault settinngs follow th
hese steps:--
1. Riight click oon viewer after
a annotattion button selection, a default seettings menu u will open
n
on
n the screenn as shown below
b & sellect “Defau ult Propertiies”.

45 
 
2. On “Default Propertiess” user can change setttings like Teext, Ruler, Pen, Font ettc as shown
n
beelow.

3. Peen Settings

46 
 
4. Ru
uler Settinggs

47 
 
5. Teext Settingss

48 
 
u) Shuttter Collimaation: To draw
d shutterr collimationn click on . A rrectangle will
w draw on n
the viiewer with edges selecctable. By selecting
s an
ny corner off the rectang
gle, user caan collimatee
rectan
ngle accordiing to requirement as shown
s beloww.

After collimation
n all imagess comes according to coollimation rectangle
r as shown abo
ove.

49 
 
v) GAMMA: For image process you can change GAMMA process from Process 1 – 11.

w) P-FPS: To adjust image play frame rate from 1-30 FPS.

50 
 
x) Average: For less grain in image during grabbing you can change Average range from 1-16.

51 
 
Useer Prefeerence Settings
S s
1. To
o check Useer preferencce settings rright click on Image vieewer & clickk on “User 
Prreferences”” as shown iin below. 

 
 
 
 
 
 
 
 
 
 
 
 

52 
 
 2. All settings will show you according to Exam Procedure for PULSE FLUORO & CINE as 
shown below. 

   

 
User Preferences PULSE FLUORO 

 
User Preferences CINE 
3. In this you can set exam specific process settings like Gain, IRIS, Average, DRC, WW/WL, 
Image Process etc. 
1) Gain: To set Camera Gain setting from 0 ‐ 7.  
2) SPF: To set procedure specific SPF file for image processing. 
3) Image Process: To set image process type in Process or Unprocessed mode. 
4) Dynamic Range: To set the DRC Range value which vary from 0‐99. 
5) Average Range: To set image averaging which vary from 1‐16. 

53 
 
 6) Width & Level Factor: These factors vary from ‐10 to 10 which apply for both DRC1 & 
DRC2. 
7) WW/WL: To set window width & level value according to user need. It by default 
applied in TECH mode to change auto ticked WW/WL you need to login as MGR mode. 

About Version
1. To know about application version right click on Image Viewer & select “About” as 
shown below. 
 

 
 

 
54 
 
 Section E
7. View Management
7.1 View Tab
View tab window will open when double click on the patient detail in the work list tab. The
below mentioned window will open when there is no image grabbed.

55 
 
The below mentioned window will open when images are grabbed.

56 
 
7.2 Image Processing Tools
Use the Following Image Processing Tools to diagnose the image

57 
 
Image Layout: Will display various frames in a loop

Series Layout: Will display various loops examined.

58 
 
Effects: By using these tools, we can perform different types of effects on the showing image or
whole series

a) Flip Image: Flip the selected image horizontally

b) Reverse: Flip the selected image vertically.
c) Rotate Clock: It is used to rotate the selected images clockwise with an angel of 90
degrees, 180 degrees and 270 degrees.

d) Rotate Anti-clock: : It is used to rotate the selected images anti clockwise with an angel
of 90 degrees, 180 degrees and 270 degrees.

e) Show\Hide Tags: It toggles between the Show and Hide of DICOM tags in all the images
f) Fit Image: It will fit the image to the size of the screen.

59 
 
Zoom: Click on image and drag the mouse. This will Zoom the image.

PAN: using this tool, we can move the image. To do this just click on pan tag and drag on image
using left mouse button.

Invert: It will show the invert/negative value of the image. The Invert command is used to invert
color values in pixels in gray scale, RGB or RGB images.

Magnify: Magnify the particular part of the image

WW/WL: Window Width/Window Level is used to optimize visualization of specific structures.

Contrast and Brightness of the Image will change

Reset: This will reset all the images of series to its original state.

Apply to all: Check to apply the effects on whole.

Cine Play: This will play the Cine Loop of the images in reverse or forward directions

This will play the Cine Loop  This will play the Cine Loop in 
in the Reverse direction  the Forward direction 

This will play the  This will stop the 
Cine playback  Cine playback 
Burn CD/DVD: Insert the CD before clicking the Burn CD option in the software.

60 
 
 Select the CD drive of the 
System 

Disc Capacity will show as 702MB 
when you insert new CD 

Click the Write button to 
start disc burning 

Annotation: Annotations are very useful to highlight the specific part of the image/s. we can
perform this action using this menu

View saved  Save current 
annotations  annotations.
61 
 
 Export: Save the images in the below mentioned formats.

Print:

Convert the grabbed images into PDF format for printing.  Sends the images to different servers.

Send: To send images to PACS.

Sending Options: -

1. Selected loops.
2. All loops.
3. Tagged Images.

62 
 
1. Selected loops: - To send selected loops, you need to select loops from thumbnail. To do
this press CTRL & select loops from the thumbnail & click on Send button.
2. All loops: - For all loops sending you need to be unselect image from the thumbnail &
then click on the Send button.
3. Tagged images: - To send tagged images you need to add images to viewer & right click
on the screen & click on “Tag Image To Send” as shown below.

63 
 
To Un Tag image from the queue, you need to select tagged frame and right click &
select “Un Tag Images” as shown below.

To send Tagged images please check “Send Tagged Images” as shown above.
Note: - For sending, you have to be select at least one node from Dicom nodes.

64 
 
 Section F
8. Exit Management
Exit Tab Working

Log On: Login page will be displayed.

Exit App: Exit the application.

Cancel: Will return back to the previous window.

65