736-424-G2 Varex NexusDR Operator

Operator's Manual
736-424-G2, Rev. B
Operator's Manual
2 | Nexus DR Operator's Manual, 736-424-G2, Rev. B

©2016, 2023, Varex Imaging Corporation (121 Metropolitan Drive, Liverpool, NY 13088. All rights reserved.)
Nexus DR Operator's Manual, 736-424-G2, Rev. B | 3

Table of Contents
Table of Contents
Part 1. Introduction to Nexus DR.......................................................................1
CHAPTER 1 Introduction to Nexus DR............................................................................3

Powering Up, Logging In, and Powering Down the System..................................................................................................... 4
Cleaning and Disinfecting......................................................................................................................................................... 21
Introduction to Clinical Mode................................................................................................................................................... 23
Part 2. Imaging Patients with Nexus DR......................................................... 35
CHAPTER 2 Creating and Editing Patient Records........................................................ 37

Importing patient information from the worklist server........................................................................................................... 39
Import patient information to the Patient List.......................................................................................................................... 40
Creating emergency patients..................................................................................................................................................... 41
Creating patient records manually.............................................................................................................................................41
Adding studies to new patient records—Preconfigured procedures.........................................................................................43
Adding studies to new patient records — Custom procedures................................................................................................ 44
Adding studies to existing patient records................................................................................................................................45
Editing patient records...............................................................................................................................................................46
Opening patient studies............................................................................................................................................................. 47
Moving images from one patient record to another................................................................................................................. 48
Filtering the Patient List............................................................................................................................................................50
Deleting patient records from Patient List................................................................................................................................50
CHAPTER 3 Acquiring Images....................................................................................... 51

RAD mode................................................................................................................................................................................. 52
vTrigger mode............................................................................................................................................................................52
Simplified guidance for imaging with CsI detectors in vTrigger mode...................................................................................53
Recommended Techniques, Exposure Index, and the Deviation Index................................................................................... 53
Recommendations for imaging pediatric patients.....................................................................................................................76
Reviewing or adjusting X-ray generator parameters................................................................................................................ 77
X-ray generator user interface window.....................................................................................................................................77
Changing the detector exposure mode......................................................................................................................................78
Acquiring images from the Worklist tab.................................................................................................................................. 79
Acquiring images from the patient study................................................................................................................................. 84
Acquiring images in Autonomous Mode.................................................................................................................................. 85
Adding views to an open study................................................................................................................................................ 91
Suspending a patient study........................................................................................................................................................93
Closing a patient with an incomplete study..............................................................................................................................94
Image rejection...........................................................................................................................................................................94
CHAPTER 4 Reviewing and Adjusting Images.............................................................. 97

Prerequisites for adjusting images.............................................................................................................................................98
Basic adjustments to images..................................................................................................................................................... 98
Shutters and image size...........................................................................................................................................................109
Adjusting Automatic Image Enhancement processing........................................................................................................... 116
Showing or hiding the overlay................................................................................................................................................118
Stitching images.......................................................................................................................................................................119
Reverting an image to the default appearance........................................................................................................................123
iv | Nexus DR Operator's Manual, 736-424-G2, Rev. B

Table of Contents
CHAPTER 5 Measurements and Annotations............................................................... 125

Prerequisites for measuring and annotating images................................................................................................................126
Placing preset annotations....................................................................................................................................................... 127
Creating, reorganizing, and deleting preset annotations......................................................................................................... 128
Placing custom text annotations..............................................................................................................................................131
Editing text annotations........................................................................................................................................................... 132
Deleting text annotations from images................................................................................................................................... 133
Placing custom pointers...........................................................................................................................................................134
Editing custom pointers........................................................................................................................................................... 135
Deleting custom pointers......................................................................................................................................................... 136
Calibrating an image for measurements................................................................................................................................. 137
Measurements with two or more points................................................................................................................................. 139
Measuring length or width using two points.......................................................................................................................... 140
Measuring distance using three or more points......................................................................................................................142
Measuring angles in an image................................................................................................................................................ 144
Measuring Cobb angles........................................................................................................................................................... 145
Taking leg measurements........................................................................................................................................................ 147
Editing measurement annotations............................................................................................................................................150
Deleting measurement annotations..........................................................................................................................................152
CHAPTER 6 Archiving and Printing Images................................................................ 153

Prerequisites for archiving and printing images..................................................................................................................... 154
Archiving images..................................................................................................................................................................... 155
Printing images........................................................................................................................................................................ 162
Reviewing and controlling the DICOM queue....................................................................................................................... 177
Part 3. Settings Mode for Operators.............................................................. 181
CHAPTER 7 Entering and Exiting Settings Mode........................................................ 183

Entering Nexus DR Settings Mode.........................................................................................................................................184
Exiting Nexus DR Settings Mode...........................................................................................................................................185
CHAPTER 8 Managing Technologist Initials................................................................187

Technologist initials.................................................................................................................................................................188
Adding technologist initials.....................................................................................................................................................189
Editing technologist initials..................................................................................................................................................... 189
Removing technologist initials................................................................................................................................................ 190
CHAPTER 9 Configuring Logging Settings.................................................................. 191

Configuring logging settings................................................................................................................................................... 192
CHAPTER 10 Diagnostics............................................................................................. 195

Test pattern tab........................................................................................................................................................................ 196
Log files................................................................................................................................................................................... 201
Filtering log files..................................................................................................................................................................... 206
Exporting log files................................................................................................................................................................... 206
Purging the system log............................................................................................................................................................ 207
Creating reject analysis reports from reject logs.................................................................................................................... 208
Troubleshooting with Data Collector...................................................................................................................................... 209
If the detector is dropped........................................................................................................................................................ 211
APPENDIX A. Nexus DR Measurements Accuracy......................... 213
Nexus DR Operator's Manual, 736-424-G2, Rev. B | v

Table of Contents
Measurement factors.................................................................................................................... 214

Measurement types and accuracy................................................................................................ 215
APPENDIX B. Minimum hardware, software,network, and IT

security requirements...................................................................... 217
Hardware requirements................................................................................................................ 218
Network requirements.................................................................................................................. 218
System components — Stationary systems.................................................................................219
System components — Mobile systems......................................................................................222
Interconnections for systems with non-integrated X-ray generators........................................... 224
Interconnections for systems with integrated CMP 200 generators............................................ 252
Windows and anti-malware updates............................................................................................274
Applying Windows updates.........................................................................................................275
Index......................................................................................................................................... 277
vi | Nexus DR Operator's Manual, 736-424-G2, Rev. B

List of Figures
List of Figures
Figure 1: Nexus DR About window..............................................................................................................................................xix
Figure 2: Unlatch Battery................................................................................................................................................................. 5
Figure 3: Battery Removal................................................................................................................................................................5
Figure 4: Insert battery at a slight angle........................................................................................................................................6
Figure 5: Lay the battery down....................................................................................................................................................... 6
Figure 6: Press down on the lifted side......................................................................................................................................... 6
Figure 7: Detector is ready for the user.........................................................................................................................................7
Figure 8: LED Status Indicator........................................................................................................................................................ 7
Figure 9: Unlatch Battery................................................................................................................................................................. 8
Figure 10: Battery Removal..............................................................................................................................................................8
Figure 11: Insert battery at a slight angle...................................................................................................................................... 9
Figure 12: Lay the battery down..................................................................................................................................................... 9
Figure 13: Press down on the lifted side..................................................................................................................................... 10
Figure 14: Detector is ready for use.............................................................................................................................................10
Figure 15: Detector Status LED.....................................................................................................................................................11
Figure 16: Detector Status LED.....................................................................................................................................................11
Figure 17: Unlatch Battery............................................................................................................................................................. 12
Figure 18: Battery Removal............................................................................................................................................................12
Figure 19: Battery Charge Level....................................................................................................................................................13
Figure 20: Reboot Sequence..........................................................................................................................................................14
Figure 21: 4343W detector tether cable........................................................................................................................................15
Figure 22: 4343W detector tether cable and USB slot................................................................................................................15
Figure 23: 4343RC I/O box power switch..................................................................................................................................... 18
Figure 24: Layout of the Clinical Mode menu..............................................................................................................................24
Figure 25: Controls of the Patient List......................................................................................................................................... 25
Figure 26: Imaging Controls with scroll bar................................................................................................................................ 26
Figure 27: Detector not ready........................................................................................................................................................31
Figure 28: Detector ready...............................................................................................................................................................31
Figure 29: Detector acquiring........................................................................................................................................................ 31
Figure 30: Tethered detector not ready........................................................................................................................................ 31
Nexus DR Operator's Manual, 736-424-G2, Rev. B | vii

List of Figures
Figure 31: Detector disconnected................................................................................................................................................. 31
Figure 32: Detector disconnected in Autonomous Mode........................................................................................................... 31
Figure 33: Display panel status details........................................................................................................................................ 32
Figure 34: Refresh Worklist........................................................................................................................................................... 39
Figure 35: Worklist with patients populated................................................................................................................................ 39
Figure 36: Import Patient Icon....................................................................................................................................................... 40
Figure 37: Import indicators and Next button............................................................................................................................. 40
Figure 38: New patient demographics screen............................................................................................................................. 42
Figure 39: Study identification fields............................................................................................................................................ 43
Figure 40: Select the procedure for the study.............................................................................................................................43
Figure 42: Exams and positions....................................................................................................................................................44
Figure 43: Select the desired patient............................................................................................................................................45
Figure 45: Select the patient record to be edited....................................................................................................................... 46
Figure 46: Click or tap the Delete icon.........................................................................................................................................50
Figure 47: Example Exposure Index, Target Exposure Index, and Deviation Index statistics................................................ 76
Figure 48: Varex generator controls............................................................................................................................................. 77
Figure 49: Import Studies window................................................................................................................................................ 80
Figure 50: Click or tap Acquire/Review icon from patient tile (multiple studies).....................................................................80
Figure 51: Import Studies window................................................................................................................................................ 81
Figure 52: Click or tap Acquire/Review icon from patient tile (dual study)..............................................................................81
Figure 53: Click or tap Acquire/Review icon from patient tile (multiple studies).....................................................................82
Figure 54: Select Study option on Acquisition screen............................................................................................................... 83
Figure 55: Autonomous Mode Use Cycle.....................................................................................................................................86
Figure 56: Study information tile...................................................................................................................................................91
Figure 57: Adding positions to an existing study.......................................................................................................................91
Figure 58: Shot selected, ready to acquire.................................................................................................................................. 92
Figure 59: Click or tap Close Patient and then select option from pop-up.............................................................................. 92
Figure 60: Select Suspend............................................................................................................................................................. 93
Figure 61: Adjust the window (contrast) and level (brightness) of the image......................................................................... 99
Figure 62: Draw a Region of Interest (ROI) on the image........................................................................................................ 100
Figure 63: Free Rotation window................................................................................................................................................ 105
viii | Nexus DR Operator's Manual, 736-424-G2, Rev. B

List of Figures
Figure 64: Free Rotation alignment indicators.......................................................................................................................... 106
Figure 65: Shutter and ROI adjustment tools and components.............................................................................................. 110
Figure 66: Adjust processing with the AIE Level slider........................................................................................................... 116
Figure 67: Annotations window................................................................................................................................................... 128
Figure 68: Enter your custom annotation in the text box........................................................................................................ 131
Figure 69: Cursor changes...........................................................................................................................................................134
Figure 70: Drag the pointer..........................................................................................................................................................134
Figure 71: Pointer selected.......................................................................................................................................................... 136
Figure 72: EXAMPLE: Calibrating an image for measurements.............................................................................................. 138
Figure 73: Image with three Cobb angles: A, B, and C............................................................................................................ 146
Figure 74: EXAMPLE ONLY: Cobb angle on image...................................................................................................................146
Figure 75: Print Preview button in Review Mode...................................................................................................................... 163
Figure 76: Print Preview button in the Print Preview area....................................................................................................... 163
Figure 77: Print Preview Warning................................................................................................................................................164
Figure 78: Print Preview area with images................................................................................................................................ 164
Figure 79: Default Printer Settings options................................................................................................................................167
Figure 80: Print Preview shot list................................................................................................................................................168
Figure 81: Example: Ruler on printed image............................................................................................................................. 168
Figure 82: Tile selection............................................................................................................................................................... 170
Figure 83: Custom print layout page dividers........................................................................................................................... 172
Figure 84: Open the DICOM Queue window.............................................................................................................................. 177
Figure 85: DICOM Queue..............................................................................................................................................................178
Figure 86: DICOM Queue..............................................................................................................................................................180
Figure 87: Settings Mode login / logout screen.........................................................................................................................184
Figure 88: Settings Mode log in / log out screen...................................................................................................................... 185
Figure 89: General screen — Setup tab..................................................................................................................................... 188
Figure 90: Technologist initials selected.................................................................................................................................... 189
Figure 91: Tech Initials edited......................................................................................................................................................190
Figure 92: Logging screen — Configure Logger tab................................................................................................................ 194
Figure 93: Test Pattern list........................................................................................................................................................... 196
Figure 94: SMPTE test pattern.....................................................................................................................................................197
Figure 95: Logging screen — filtered Audit Log tab................................................................................................................ 202
Figure 96: Logging screen — filtered Reject Log tab...............................................................................................................203
Nexus DR Operator's Manual, 736-424-G2, Rev. B | ix

List of Figures
Figure 97: Logging screen — filtered Acquisition Log tab...................................................................................................... 204
Figure 98: Logging screen — filtered System Log tab.............................................................................................................205
Figure 99: Purge Log window......................................................................................................................................................207
Figure 100: Diagnostics screen — Data Collector tab..............................................................................................................210
Figure 101: Wireless detector in vTrigger mode....................................................................................................................... 225
Figure 102: Non-integrated interconnections with detector as WAP...................................................................................... 226
Figure 103: 4343RC in vTrigger mode configuration................................................................................................................ 227
Figure 104: 4343Rv3 in vTrigger mode configuration...............................................................................................................228
Figure 105: Single XRpad2 3025 in vTrigger mode................................................................................................................... 229
Figure 106: Single XRpad2 4336 in vTrigger mode interconnections..................................................................................... 230
Figure 107: XRpad 4343 F interconnections in vTrigger mode................................................................................................231
Figure 108: Dual wireless detectors interconnections..............................................................................................................232
Figure 109: 2530W-G5 and 4336W-G5 interconnections...........................................................................................................233
Figure 110: 4343W or untethered 4343W and 2530W-G5 interconnections............................................................................ 234
Figure 111: 4343W or untethered 4343W and 4336W-G5 interconnections............................................................................ 235
Figure 112: 4343W tethered and 2530W-G5 detector interconnections.................................................................................. 236
Figure 113: 4343W tethered and 4336W-G5 detector interconnections.................................................................................. 237
Figure 114: 4343W with tether and wireless 4343W interconnections.................................................................................... 238
Figure 115: Wireless and 4343RC in vTrigger mode configuration......................................................................................... 239
Figure 116: Wireless and 4343Rv3 detectors in vTrigger mode.............................................................................................. 240
Figure 117: 4343Rv3 and 4343RC detectors in vTrigger mode................................................................................................ 241
Figure 118: Dual 4343Rv3 detectors in vTrigger mode.............................................................................................................242
Figure 119: Dual 4343RC detectors in vTrigger mode.............................................................................................................. 243
Figure 120: Dual XRpad2 4336 detectors, vTrigger...................................................................................................................244
Figure 121: XRpad2 4336 and XRpad 4343 F, vTrigger, non-integrated generator.................................................................245
Figure 122: Dual XRpad 4343 F in vTrigger mode.................................................................................................................... 246
Figure 123: Dual 4343W with optional tether and wireless detector interconnections......................................................... 247
Figure 124: 4343W with optional tether, 2530W-G5, and 4336W-G5 interconnections.......................................................... 248
Figure 125: wireless, 4343Rv3, and 4343RC interconnections................................................................................................ 249
Figure 126: Wireless and dual 4343Rv3 interconnections — vTrigger................................................................................... 250
Figure 127: wireless and dual 4343RC detectors interconnections — vTrigger.................................................................... 251
Figure 128: Wireless detector and integrated CMP 200 generator.......................................................................................... 253
Figure 129: Detector as WAP, integrated with CMP 200 X-ray generator................................................................................254
x | Nexus DR Operator's Manual, 736-424-G2, Rev. B

List of Figures
Figure 130: 4343RC and integrated CMP 200 generator...........................................................................................................255
Figure 131: 4343Rv3 and integrated CMP 200 generator......................................................................................................... 256
Figure 132: XRpad 3025 and integrated CMP 200 generator................................................................................................... 257
Figure 133: XRpad2 4336 and integrated CMP 200 generator................................................................................................. 258
Figure 134: XRpad 4343 F and integrated CMP 200 generator................................................................................................ 259
Figure 135: 4336wv4 and 4336Wv4+ detectors and integrated CMP 200 generator.............................................................. 260
Figure 136: 2530W-G5 and 4336W-G5 interconnections and an integrated CMP200 X-ray generator................................. 261
Figure 137: 4343W and 2530W-G5, integrated CMP 200 X-ray generators interconnections................................................262
Figure 138: 4343W and 4336W-G5, integrated CMP 200 interconnections............................................................................. 263
Figure 139: 4343W tethered and 2530W-G5, integrated CMP 200 interconnections..............................................................264
Figure 140: 4343W tethered and 4336W-G5, integrated CMP 200 interconnections..............................................................265
Figure 141: 4343W tethered and 4343W, integrated CMP 200 interconnections.................................................................... 266
Figure 142: Dual 4343Rv3 and integrated CMP 200.................................................................................................................. 267
Figure 143: Dual 4343RC detectors and integrated CMP 200.................................................................................................. 268
Figure 144: Wireless and 4343Rv3 detectors with integrated CMP 200 generator................................................................ 269
Figure 145: 4343Rv3 and 4343RC detectors with integrated CMP 200................................................................................... 270
Figure 146: Dual XRpad2 4336 detectors and integrated CMP 200 generator....................................................................... 271
Figure 147: Dual XRpad 4343 F and integrated CMP 200 generator....................................................................................... 272
Figure 148: XRpad2 4336 and XRpad 4343F with integrated CMP 200 generator..................................................................273
Nexus DR Operator's Manual, 736-424-G2, Rev. B | xi

List of Tables
List of Tables
Table 1: LED Status Details............................................................................................................................................................. 7
Table 2: LED Status Details........................................................................................................................................................... 11
Table 3: LED Status Details........................................................................................................................................................... 11
Table 4: Battery Hot-Swap Operation Time.................................................................................................................................. 13
Table 5: Clinical menu at idle........................................................................................................................................................ 24
Table 6: Simplified Guidance for Image Acquisition with CsI detectors in vTrigger mode..................................................... 53
Table 7: Recommended techniques for 4343W, 4336W-G5 , and 2530W-G5 (Premium CsI)................................................... 54
Table 8: Recommended techniques for 4343W and 4336W-G5 (DRZ+).....................................................................................60
Table 9: Recommended techniques for 4343W , 4336W-G5, and 2530W-G5 (Standard CsI)...................................................66
Table 10: Typical doses for small patient pediatric imaging with Nexus DR............................................................................72
Table 11: Typical doses for medium child pediatric imaging with Nexus DR...........................................................................73
Table 12: Typical doses for large child pediatric imaging with Nexus DR............................................................................... 74
Table 13: Typical doses for average adult imaging using Nexus DR with a CsI detector....................................................... 75
Table 14: X-ray generator user interface parameters..................................................................................................................78
Table 15: Detector LED behavior in Autonomous Mode............................................................................................................ 87
Table 16: Free Rotation tools.......................................................................................................................................................105
Table 17: Effect of Predefined Image Size Function on Image Size........................................................................................ 109
Table 18: Shutter and ROI adjustment tools and components................................................................................................ 110
Table 19: Anatomical points.........................................................................................................................................................149
Table 20: Length measurements..................................................................................................................................................149
Table 21: Angle measurements....................................................................................................................................................149
Table 22: Options available for network, media, and local export jobs.................................................................................. 156
Table 23: Print headers.................................................................................................................................................................164
Table 24: Print Preview tools....................................................................................................................................................... 165
Table 25: Default Printer Settings controls................................................................................................................................ 167
Table 26: DICOM Queue — Controls...........................................................................................................................................179
Table 27: DICOM Queue controls and fields.............................................................................................................................. 180
Table 28: General screen — Setup tab controls and fields......................................................................................................188
Table 29: Configure Logger tab — Message options and controls......................................................................................... 194
Table 30: Diagnostics screen — Test Pattern tab controls and fields.................................................................................... 197
xii | Nexus DR Operator's Manual, 736-424-G2, Rev. B

List of Tables
Table 31: TG18 test patterns........................................................................................................................................................ 198
Table 32: Logging screen — Audit Log tab controls and fields controls............................................................................... 202
Table 33: Logging screen — Reject Log tab controls and fields............................................................................................ 203
Table 34: Logging screen — Acquisition Log tab controls and fields....................................................................................204
Table 35: Logging screen — System Log tab controls and fields.......................................................................................... 205
Table 36: Diagnostics screen — Data Collector controls and fields....................................................................................... 210
Table 37: Pixel pitch......................................................................................................................................................................214
Table 38: Imaging computer components — Full systems only..............................................................................................219
Table 39: 4336Wv4 detector components...................................................................................................................................219
Table 40: 2530W-G5 (LUMEN 2530W) detector components....................................................................................................219
Table 42: 4343W with optional tether detector components.................................................................................................... 219
Table 43: 4343W (LUMEN 4343W) detector components (wireless only)................................................................................220
Table 44: XRpad 4343 F components......................................................................................................................................... 220
Table 45: XRpad2 4336 wireless components........................................................................................................................... 220
Table 47: Wireless detector battery components...................................................................................................................... 221
Table 48: 4343Rv3 detector.......................................................................................................................................................... 221
Table 49: 4343RC detector components.....................................................................................................................................221
Table 50: Wireless access point (WAP) — Full-system mobile or stationary only.................................................................221
Table 51: Software components.................................................................................................................................................. 222
Table 52: Imaging computer components for full-system mobile solutions.......................................................................... 222
Table 55: 4343W with optional tether detector components.................................................................................................... 222
Table 56: 4343W (LUMEN 4343W) detector components (wireless only)................................................................................222
Table 59: 4336Wv4 detector components...................................................................................................................................223
Table 60: Wireless detector battery components...................................................................................................................... 223
Table 61: Wireless access point (WAP) — Full-system mobile or stationary only.................................................................224
Table 62: Software components.................................................................................................................................................. 224
Table 63: IP addresses..................................................................................................................................................................225
Nexus DR Operator's Manual, 736-424-G2, Rev. B | xiii

List of Tables
xiv | Nexus DR Operator's Manual, 736-424-G2, Rev. B

List of Tables
Table 100: IP addresses................................................................................................................................................................263
Nexus DR Operator's Manual, 736-424-G2, Rev. B | xv

Notices
Reasonable precautions have been taken in the preparation of this book, but Varex assumes
no responsibility for errors or omissions or for damage resulting from the use of the information
contained herein. For improvement of product performance, supplementation, or follow-up of
information, the contents of this manual are subject to change without notice.
Caution: Review the Varex Regulatory and Safety Manual before
installing, configuring, using, or maintaining a Varex imaging system.
Trademarks
Product names i5, iCynergy, Nexus, ViVA™, InfiVision, & InfiStitch are trademarks or brand
names of Varex Imaging. The Intel Core™ i5 and i7 Processors are trademarks of Intel,
Santa Clara, Calif. The Pro/1000 network board is a product of Intel. Windows is a registered
trademark of Microsoft Corporation in the United States and other countries; Excel is a product
of Microsoft. Pleora is a brand and trade name of Pleora Technologies, Inc., Kanata, Ontario,
Canada. Optiplex and the Dell logo are registered trademarks of Dell, Inc. Bluetooth® word
mark and logos are registered trademarks owned by Bluetooth SIG, Inc. All other trademarks
are properties of their respective companies.
Translated material
When necessary, Varex secures translation of labels, instructions for use, and components for
the user interface from a qualified supplier employing trained experts in medical, electronics,
and IT/software terminology. Each translated item that Varex commissions is based on the
original English version release created by Varex. At times, a translated manual may not be
the same revision as its English counterpart.
Contacting Varex
Our Technical Support department is open during weekdays from 8:15 a.m. – 5:00 p.m., USA
- Eastern Time (08:15 – 17:00). After normal business hours, on weekends, and on holidays,
calls are forwarded to our answering service, and a Product Support Specialist will respond to
your inquiry as soon as possible.
Prerequisites
We can better assist you with your service needs if you have the following available when you
call:
• Software version and serial number. See Locating the software version and serial
number on page xviii.
• TeamViewer software might be needed for technical support purposes. Familiarize
yourself with how to access it. See Starting the TeamViewer application on page xix.
Procedure
• Use the following numbers for technical support and order services:
Contact Information
Customer Care and Technical Support +1 315-234-6810
Parts and Order Services +1 315-234-6800
Nexus DR Operator's Manual, 736-424-G2, Rev. B | xvii

Locating the software version and serial number
The software version and serial number are located in the About screen of the Nexus DR
software. The serial number is also located on a sticker on the side of the imaging computer.
Procedure
1. Log on to the system.
2. Click or tap on the logo at the top-left of the Clinical Mode main menu.
The About screen displays and contains the software version and serial number
information.
xviii | Nexus DR Operator's Manual, 736-424-G2, Rev. B

Starting the TeamViewer application
About this task
TeamViewer software allows remote control and desktop sharing for technical support
purposes. If you contact technical support, you may need to use TeamViewer to allow a
technical support representative to access to your Nexus DR computer to help you resolve a
support issue.
Access TeamViewer from the About window in the Nexus DR application.
Procedure
1. Click or tap the Nexus DR logo at the top-left of the Clinical Mode main menu.
The About window displays.
Figure 1: Nexus DR About window
2. Click or tap TeamViewer.

The TeamViewer application starts.
Nexus DR Operator's Manual, 736-424-G2, Rev. B | xix

About this documentation
This manual, combined with manufacturer-provided training, provides the information required
to use the Varex digital imaging system.
Additional Information: Please read and follow the safety and
equipment handling practices in this manual and the Regulatory and
Safety Manual.
Revision history
The following table shows when this document has been revised and a description of the
major updates for each revision.
Revision Issued (YYYY-MM-DD) EC Description of release
A 2022-08-01 0004398 The manuals were updated in V4.12 to include the
following changes: added guidance on shutdown
frequency; G5 removed from references to the
Varex 4343W detector; added support for: the
DT504T AIO PC, the 2530W-G5 detector, the
4343W detector with optional tether, free image
rotation, updated calibration history, reference
image for acquisition profile rotation and flip
settings, 3x1 and 1x3 DICOM print layouts, Greek
language, searching the Patient List on the Study
Description; the Varex I/O box for non-integrated
generators with detectors in RAD mode is no
longer needed; added Appendix A. Nexus DR
Measurements Accuracy and Appendix B. Minimum
hardware, software, network, and IT security
requirements; the Dell Latitude 5400, Cybernet C22,
and Dell 7070 PCs are deprecated; MD and Rx Only
have been added to the back cover.
B 2023-02-17 0005413 The manuals were updated in V4.13 to include the
following changes: Added support for Autonomous
Mode with the 4336W-G5, 4343W, and 2530W-
G5 detectors, and use of the 4343W with optional
tether in wireless mode. The print preview feature
was enhanced. DAP measurement units are now
configurable in Service Mode.
Part
1
Introduction to Nexus DR
Contents
• Powering Up, Logging In, and Powering Down the System on page 3
Chapter
1
Powering Up, Logging In, and Powering Down
the System
Contents
• Powering Up, Logging In, and Powering Down the System on page 4
• Cleaning and Disinfecting on page 21
• Introduction to Clinical Mode on page 23

1. Powering Up, Logging In, and Powering Down the System
Because Nexus DR requires communication with the host X-ray generator the attached detector,
and the table or positioner, the various components of the room must be powered up in a certain
sequence.
Powering Up, Logging In, and Powering Down the

System
Because Nexus DR requires communication with the host X-ray generator the attached
detector, and the table or positioner, the various components of the room must be powered up
in a certain sequence.
Powering up the equipment

About this task
Important: At the beginning of every day, at the beginning of a shift in 24-hour facilities, or to
service the system you may need to turn on some or all of the equipment required for Nexus
DR operation.
Power up Nexus DR and related equipment.
Procedure
1. If the table is not powered up, turn it on.
2. If the X-ray generator is not powered up, turn it on.
3. Turn on the Nexus DR computer.
The computer will perform self-test routines and start the Windows operating system
automatically. It will stop and wait for you to login at the main user selection screen.
4. If present, turn on the WAP.

5. Turn on the detector.

Options Instructions
4336Wv4 See Detector Power-on and Power-off Sequence
(4336Wv4) on page 5.
2530W-G5 (LUMEN 2530W), 4336W-G5 (LUMEN See Detector Power-on and Power-off Sequence
4336W), 4343W (LUMEN 4343W) (2530W-G5, 4336W-G5, 4343W) on page 9.
4343W tethered See Powering on the tethered 4343W on page 14.
4343Rv3 See Powering up the 4343Rv3 detector on page
17
4343RC See Powering up the 4343RC detector on page 18
XRpad2 3025 See Powering up the XRpad 3025 detector on page
18
XRpad2 4336 Powering up the XRpad 4336 detector on page 18
XRpad 4343 F Powering up the XRpad 4343 F detector on page
19
Detector Power-on and Power-off Sequence (4336Wv4)

Installing the battery and powering up the detector (4336Wv4)
Procedure
1. Insert the battery into the charger to wake-up the battery from sleep mode (only applies to
batteries that are new).
2. Slide the battery latch button to the right until there is an audible click and red is visible.
Doing this will cause one side of the battery to lift out of the battery compartment.
Figure 2: Unlatch Battery
3. Grab the lifted side of the battery and finish removing.

Figure 3: Battery Removal
Operator's Manual, 736-424-G2, Rev. B: Nexus DR | 5

4. Insert battery at a slight angle so that the side with contacts sits over the adjoining contacts
in the battery compartment.
Figure 4: Insert battery at a slight angle
Note: When inserting the battery the angle of the battery should
not be more than 20 degrees, inserting a battery at a larger angle
could cause damage to the battery contact pins.
5. Lay the battery down, one side will be slightly lifted.
Figure 5: Lay the battery down
6. Press down on the lifted side of battery snapping it into place in the battery compartment.
Figure 6: Press down on the lifted side

7. The detector is now ready for user.

Figure 7: Detector is ready for the user
The detector will automatically power on when battery is inserted.

Note: When a battery is inserted into the detector, the detector will
boot into Standby mode and the LED Status Indicator will blink at 1
second intervals.
Figure 8: LED Status Indicator
Detector LEDs (4336Wv4)

Table 1: LED Status Details
LED Behavior Status
Green and Yellow Solid Booting
Green Slow Blinking (every 1.5 seconds) Not associated
Green Blinking (Once per second) Service Cable Connected
Green Fast Blinking (Twice (2) per second) Associated to the Access Point
Green Solid Linked to VSP
Yellow Solid Panel Error
Note: The Service Cable does not provide power to the detector
when tethered. Before servicing, ensure that a fully charged battery is
inserted.
Warning: Changes or modifications not expressly approved by
the manufacturer could void the user’s authority to operate the
equipment.
Warning: Precautions should be taken to not open detector module.
Depending upon the type of scintillator used, opening the detector
module may expose the user to potentially toxic materials.

Warning:
IP54
Detector able to withstand water spray from any direction.
Note: Accessory or optional equipment connected to the analog
and digital interfaces must be certified to the respective IEC
standards (i.e., IEC 60601-1 for medical equipment). Furthermore,
all configurations shall comply with the system standard IEC
60601-1-1. Anyone connecting additional or optional equipment
to the signal inputs or signal outputs as part of a configuration for
medical equipment is therefore responsible for compliance with
the equipment standard IEC 60601-1. If in doubt, consult technical
support personnel.
Removing the battery and powering off the detector (4336Wv4)

About this task
When the battery is removed from the detector, Nexus DR displays a message indicating that
the detector is disconnected.
Procedure
1. Slide the battery latch button to the right until there is an audible click and red is visible.
Doing this will cause one side of the battery to lift out of the battery compartment.
2. Grab the lifted side of the battery and finish removing.


Detector Power-on and Power-off Sequence (2530W-G5,

4336W-G5, 4343W)
This section describes how to power the following detectors on and off:
• 2530W-G5
• 4336W-G5
• 4343W
Inserting the battery and powering on the detector (2530W-G5,

4336W-G5, 4343W)
Procedure
1. Place battery into X-ray detector making sure the battery latches into place..
If a battery must be removed first, see Removing the battery and powering down the
detector (2530W-G5, 4336W-G5, 4343W) on page 12
2. Insert battery at a slight angle so that the side with contacts sits over the adjoining contacts
in the battery compartment.
Figure 11: Insert battery at a slight angle
Note: When inserting the battery the angle of the battery should
not be more than 20 degrees, inserting a battery at a larger angle
could cause damage to the battery contact pins.
3. Lay the battery down, with the side opposite of the battery contacts slightly lifted.
Figure 12: Lay the battery down

4. Press down on the lifted side of battery, the battery will snap into place in the battery
compartment.
Figure 13: Press down on the lifted side
5. The X-ray detector is now ready for use.

Figure 14: Detector is ready for use
The X-ray detector will automatically power-on when battery is inserted.

Note: When a battery is inserted into the X-ray detector, the
LED Status Indicator will turn orange as it boots. After booting, it
connects to the configured wireless router and is in Standby Mode,
where the LED Status Indicator will blink twice (2) per second. If
the X-ray detector does not connect to the configured wireless
router, it will blink slowly.
6. See Detector LED Status Indicator (4336W-G5, 4343W) on page 11 for information
about the LED signals the detector will display.

Detector LED Status Indicator (4336W-G5, 4343W)

The detector LED provides information about the detector status.
Figure 15: Detector Status LED

LED Behavior Status
Orange Solid Booting
Green very slow blinking (every 1.5 seconds) No connection to the detector
Green Fast Blinking (twice (2) pers second) Connected to the detector
Green Solid Link opened, detector controlled remotely
Green Slow Blinking (Once per second) Connected to the Service Cable or Tether Cable
Yellow Solid Detector error
Purple Blinking Battery Hot-Swap Active (battery exhausted or removed)
Blue Blinking Battery is able to charge
Detector LED Status Indicator (2530W-G5)

The detector LED provides information about the detector status.
Figure 16: Detector Status LED

LED Behavior Status
Orange Solid Booting
Green very slow blinking (every 1.5 seconds) No connection to the detector
Green Fast Blinking (twice (2) per second) Connected to the detector
Green Solid Link opened, detector controlled remotely
Green Slow Blinking (Once per second) Connected to Tether Cable
Yellow Solid Detector error
Purple Blinking Battery Hot-Swap Active (battery exhausted or removed)

Removing the battery and powering down the detector (2530W-G5,

4336W-G5, 4343W)
About this task
When the battery is removed, Nexus DR displays the message: Detector Battery
voltage is too low. If the battery is not replaced before the supercapacitor is discharged,
the panel is disconnected.
Procedure
1. Press-in the battery latch until an audible click is heard. The latch will stay in closed
position.
2. Place a finger in opening on either side of the latch and lift the battery out.
Warning: Do not use the battery latch as a handle. Ignoring

this warning may cause damage to the battery latch or increase
the likelihood that the X-ray Detector may be dropped causing
substantial product damage.
Note: Removal of the Battery does not automatically power-off
the X-ray Detector. The X-ray Detector will stay powered-on for
approximately 3 minutes or until discharged after battery removal.

X-ray Detector Battery Charge Level and Hot Swap (2530W-G5,

4336W-G5, 4343W)
This section describes the battery charge status display, and battery hot-swap.
Note: New batteries are shipped from Varex in shut-down mode.
Before installing into the X-ray detector, the battery must be inserted
into the 1 or 3-bay charger to remove it from shut-down mode.
Note: For additional PDF information about the Varex Imaging
Wireless Battery and Chargers, visit www.vareximaging.com.
Battery Charge Level (2530W-G5, 4336W-G5, 4343W)

The Battery charge level is found on the battery. Press the indicator button on the Battery and
charge level will illuminate. Each LED illuminated represents 25% charge.
Figure 19: Battery Charge Level
Battery Hot-Swap (2530W-G5, 4336W-G5, and 4343W)

The X-ray Detectors are equipped with a hot-swappable battery. When a discharged battery is
removed from the X-ray Detector, the User will have a set amount of time for the battery hot-
swap to occur.
Table 4: Battery Hot-Swap Operation Time

X-ray Detector Operation Time
2530W-G5 3 minutes
4336W-G5
4343W
Warning: If a fully charged battery is not re-inserted within the time

window, the X-ray Detector will power-OFF.
Note: Acquisition and calibration features are not available while hot-
swapping a battery.

Rebooting the detector (2530W-G5, 4336W-G5, and 4343W)

Sequence
About this task
The X-ray Detector may be rebooted if needed. To reboot:
Procedure
1. Remove the tether cable
2. Insert and remove the Battery 4 times within an 8 second window.
Figure 20: Reboot Sequence
The power cable must not be connected when attempting to reboot the X-ray Detector via
the battery.
Detector Power-on and Power-off Sequence (4343W with

tether)
Powering on the tethered 4343W
This task describes how to power on the 4343W detector using the tether cable. No battery is
inserted into the detector in this configuration.
Procedure
1. Complete the connections between the imaging computer and the detector.
2. Plug the AC power cable into an outlet or power strip.
The detector powers on.

4343W detector tether

The tether cable for the 4343W detector with optional tether has a combination power and
USB-C connector at one end, and a brick with Ethernet and AC power ports at the other
end. The computer connects to the brick using an Ethernet cable to facilitate communication
between the detector and the PC. The AC power cord also connects to the brick to provide
19V of power to the detector.
Figure 21: 4343W detector tether cable
Figure 22: 4343W detector tether cable and USB slot

Connecting the tether cable for the 4343W detector

The 4343W detector can be powered by battery or tether cable.
About this task

See 4343W detector tether on page 15 for information about the tether.
Procedure
1. If present, remove the overlay to reveal the screw holding the USB door in place.
2. Completely remove the screw and the USB door.
3. Plug the tether cable into the USB slot and tighten the thumb screw into the threaded hole
to secure the connection.
The tether cable is securely connected to your X-ray detector.

4. Plug the other end of the tether Y-cable as follows:
a)Connect one branch of the Y-cable to an Ethernet cable.
b)Connect the Ethernet cable to the Ethernet port on your PC.
c) Connect the other branch of the Y-cable to the AC power supply for the detector.
The x-ray detector is now on tether power.

Powering off the tethered 4343W detector

This task describes how to power off the 4343W detector using the tether cable. No battery is
inserted into the detector in this configuration.
Procedure
Unplug the detector's AC power cable from the power source.
The detector has a supercapacitor that will power the detector for up to 5 minutes after
power is disconnected. After the supercapacitor is exhausted, the detector powers down.
Rebooting the tethered 4343W detector

This task describes how to reboot the tethered 4343W detector. No battery is inserted into the
detector in this configuration.
Procedure
1. Power down the detector.
See Powering on the tethered 4343W on page 14.
2. Power the detector back up.
See Powering off the tethered 4343W detector on page 17.
Powering up the 4343Rv3 detector

Prerequisites
Complete the tasks in Powering up the equipment on page 4.
Procedure
Plug the detector in to its power source.

Powering up the 4343RC detector

Prerequisites
Procedure
Turn on the detector's I/O box.
Figure 23: 4343RC I/O box power switch
Powering up the XRpad 3025 detector

Prerequisites
• Complete the tasks in Powering up the equipment on page 4.
• Ensure a charged battery is inserted into the XRpad2 3025 detector.
• Ensure the wireless access point is plugged in and powered on.
Procedure
1. For wired and multipanel configurations, press the button the back of the ASUS AC66U
wireless access point to turn it on.
It can take up to 2.5 minutes to intialize.
2. On the XRpad2 3025 detector, press the power button for 1 second to turn it on.
When the power button LED stops flashing and remains constant, the detector is ready for
use.
Powering up the XRpad 4336 detector

Prerequisites
Procedure
On the XRpad2 4336 detector, press and hold the power button for 2 seconds.
During the initialization, the detector LED is a steady blue, then quickly flashes blue, the
steady blue again.

Powering up the XRpad 4343 F detector

Prerequisites
Procedure
1. Flip the power switch on both of the XRpad IPU to the ON position.
The AC Input LED turns on (green), and the DC Output LED turns on (yellow).
2. Press and hold the power button on each of the XRpad 4343 F to power it up.
During the initialization, the detector push button LED flashes. After the X-ray detector
is powered on, the X-ray detector display comes on and shows the current status of the
X-ray detector. The X-ray detector LED will turn from flashing to constant on. After the
Radiography Imaging Software has initialized the detector, the X-ray detector LED starts
flashing.
3. For wired and multipanel configurations, press the button the back of the ASUS AC66U
wireless access point to turn it on.
It can take up to 2.5 minutes to intialize.
Logging in to Nexus DR
After the equipment is powered on, you can log in to the Nexus DR computer. The permissions
associated with your login credentials determine the tasks you are allowed to perform.
Prerequisites
Before logging in to the system and beginning work, ensure that all of the equipment in the
system is powered up and completely initialized.
About this task

The user name may be specific to you, such as your first or last name, or may be generic for
your department or role, such as Tech or RadTech. If you do not know your login information,
contact your supervisor or the department manager.
Procedure
1. On the Windows login screen, swipe up on the touchscreen or press ENTER on the
keyboard.
2. Select your user name.
A password field displays.
3. Enter your password using the keyboard or touchscreen virtual keyboard.
Your password displays as dots or asterisks as you enter it.

4. Press ENTER, click or tap the arrow next to the password field to login.
The application starts automatically and opens in Clinical Mode.
Results
You may now use any of the features available in Clinical Mode, including creating and
managing patient records, image acquisition, review, processing, and archiving.
Powering down Nexus DR

Powering down Nexus DR involves exiting the software, shutting down the PC, and the other
equipment in the system.
About this task

Important: The Nexus DR computer and the x-ray generator should be powered down
once per day. Where daily power cycles are not possible or feasible due to patient load or
scheduling, the uptime duration may be extended up to 7 days, with the Nexus DR hardware
power cycled no less than once per week.
Note: For systems using the CLAYRAD1 X-ray generator, the
generator is powered down automatically when you power down
Nexus DR.
Procedure
1. In the Nexus DR application, select Settings.
2. Select Exit Application.
3. In the window that displays, select OK to close the application or Power Down to close the
application and shut down the computer.
4. Turn off the X-ray generator.
5. Unplug the detector cables or remove the battery.
See the detector manuals for information about shutting down the detectors.
6. If necessary, power down the table.
Important: The X-ray table is not typically powered down under normal circumstances.
Power down the table only when required to do so by your facility, or when servicing or
troubleshooting the equipment.

Cleaning and Disinfecting

The detector is likely to become contaminated during use. The specific material most likely to
become contaminated is the X-ray grade carbon fiber input window and housing.
Warning: When the detector system is going to be cleaned or
disinfected, be sure to remove the battery pack. Ignoring this warning
may result in explosion, fire, or electrical shock, which may result in
severe personal injury, death, or substantial product damage.
Chemicals for Cleaning and Disinfecting

All chemicals listed below are approved for use can be used for cleaning and disinfecting
detector surfaces. To achieve full cleaning and disinfecting results, perform the procedures
in Cleaning the X-ray Detector on page 22 and Section Disinfecting the X-ray Detector on
page 22 for each cleaning product.
A list of chemicals is presented below:
• CAVI-Wipes from Metrex
• Isopropyl Alcohol
• 70% aqueous solution
• Mild Soap and Water
• Ethanol 70%
• Chlorine Bleach, 3% aqueous solution
• Quaternary Ammonium Components
• Steris Coverage Plus NPD
• 1 part Coverage Plus NPD to 255 parts Water

Cleaning the X-ray Detector

About this task
To clean the X-ray detector:
Procedure
1. Remove the battery from the X-ray detector.
2. Locate and read the cleaning instructions specified on the product label. Follow the product
instructions for cleaning.
Note: If you are using a disinfectant other than those specified,
we recommend you consult a specialist for the procedure for
disinfection.
3. Dispense wipe from container.
4. Visually inspect the device. If contamination is present, use a wipe to remove the
contamination from the device surface. Use multiple wipes, as applicable, to remove the
visible contamination.
5. Take care to remove contamination from seams, joints, and other difficult-to-reach areas.
6. Dispose of each wipe used for cleaning.
7. If visible residue from the cleaning product is evident after air-drying, remove the residue
with a general Isopropyl Alcohol wipe, and let air-dry.
Disinfecting the X-ray Detector

About this task
To disinfect the X-ray detector:
Procedure
1. Remove the battery from the X-ray detector.
2. Locate and read the cleaning instructions specified on the product label. Follow the product
instructions for cleaning.
Note: If you are using a disinfectant other than those specified,
we recommend you consult a specialist for the procedure for
disinfection.
3. Wipe the entire surface of the target areas of the system until they are visibly wet with the
chemical solution. Target areas include any surface that was cleaned and/or any other
surfaces potentially contaminated during system use.
4. Take care to wet seams, joints, and other difficult-to-reach areas.

5. Ensure that the surfaces remain visibly wet for the maximum necessary disinfection time
specified on the product label.
a)If a disinfection time is not specified on a chemical label for the concentration used,
ensure that the surfaces remain visibly wet for a minimum of 10 minutes.
b)Use additional fresh wipes as needed to ensure continuous wet contact time during
the specified disinfection period.
c) Let air-dry.
d)If visible residue is evident after air-drying, remove the residue with a general
Isopropyl Alcohol wipe, and let air dry.
e)Do not re-use wipes. Discard wipes and gloves into the correct waste container.
Warning: Do not use flowing liquid or immersion on the detector,
battery, battery compartment, or battery charger.
Introduction to Clinical Mode

The Nexus DR imaging software has two modes of operation: Clinical and Settings.
Technologists and other X-ray imaging professionals use Clinical Mode to acquire images of
patients, review and manipulate those images, and send the images to a central archive or
printer.
Field engineers and other service professionals use Settings Mode to configure, calibrate, and
maintain the imaging system.

Introduction to the Clinical Mode main menu

After you log in to the system, Nexus DR starts automatically in Clinical Mode. All patient
imaging activity takes place in this mode. The application is idle when you are in Clinical Mode,
but have not opened a patient session.
Many software features are not available when the application is idle.
The ribbon at the top of the screen remains displayed at all times. Below the ribbon, the
remainder of the screen varies with the task you perform.
The following figure shows the layout of the Clinical Mode menu. When the software is idle,
you can perform the following actions:
Figure 24: Layout of the Clinical Mode menu
Table 5: Clinical menu at idle

Item Action
A Select Patient List to display and manage patients.
B Select Worklist to query and import from the worklist.
C Select the product name to display the About screen, where you can access system
information, TeamViewer software, and the Operator's Manual.
D Show or Hide the X-ray generator controls. Note that generator controls display
continuously when a patient study is open.
E Select this icon to display the status of DICOM jobs with the DICOM queue window.
F Select the keyboard icon to display the touchscreen keyboard.
G Select this icon to display system messages.
H Review real-time detector status.
I Select this icon to enter settings mode.
J Review the free space portion of the Nexus DR computer hard drive.

Controls of the Patient List menu

When the Patient List displays, new controls appear next to the tabs. These controls provide
the main functions of the Patient List view, such as creating patient records, searching the
existing patient list, and deleting patient records.
Figure 25: Controls of the Patient List
Icon Function Description

Refresh View Refreshes the Patient List view. Can be used to reset selections and
return the list to the default state, with no records selected.
Search Options Enables the search fields immediately beneath the tabs and control
buttons. Search fields can be used to filter the displayed view to meet
specific criteria.
Create Patient Start the process of creating a patient record. When this button is
clicked or tapped, the view immediately changes to the new patient
information window.
Add Emergency Patient Creates a patient and opens it directly in Acquisition Mode. Chest PA
is the default position. Additional positions can be added through the
Add Position feature of Acquisition Mode.
Archive/Export Features Marks patient, study, or image records for DICOM export. If records
are selected when this icon is clicked or tapped, they are marked for
export immediately. Any records selected after the icon is clicked or
tapped are also marked for export. The export job does not begin until
the Next button (visible only when export icon is enabled) is clicked or
tapped and a destination is selected in the subsequent window.
Move Images This feature is available only when enabled in Settings Mode. Moves
images from one patient study to another.
Delete Records Permanently removes the selected patient or study from the Nexus
DR system.

Imaging controls
After acquiring an image or opening a patient study in review mode, the right side of the
screen displays a menu of controls related to the image processing features of Nexus DR. The
following figure provides an overview of each of the controls available.
For full information about Imaging Controls, see Reviewing and Adjusting Images on page
97.
Figure 26: Imaging Controls with scroll bar
Icon Feature Description

Scroll the toolbar These arrows move the toolbar up or down in the
direction of the selected arrow. They are visible only
when there are more tools than space allows.
Revert Image This control returns the image to its original state.
Free Rotation This control opens the Free Rotation window. In

this window, you can rotate the image incrementally
left or right, 180 degrees, drag to rotate to a custom
angle, plumb and level the image, and reset the
image to perpendicular or horizontal depending on
the degree of rotation. See Free Rotation on page
105.
Rotate 90-degrees (Counter- This control rotates the image 90 degrees in the
clockwise) counter-clockwise direction.
Rotate 90-degrees (Clockwise) This control rotates the image 90 degrees in the
clockwise direction.


Horizontal Flip This control flips the image around the horizontal
axis from top to bottom.
Vertical Flip This control flips the image around the vertical axis
from left to right.
Cropping Control Allows you to create, adjust, or remove the cropping

boundaries.
Annotations Allows you to create, adjust, or remove digital

annotations (text and pointers).
Insert Marker (Left) Creates a left marker “L” annotation in the image.
Insert Marker (Right) Creates a right marker “R” annotation in the image.
Window/Level This control allows you to adjust the contrast

(window) and brightness (level) of the image by
dragging the mouse in the image.
Window/Level (Region of Interest This control allows you to adjust the contrast
Only) (window) and brightness (level) of the image area
marked by the Region of Interest (ROI) by dragging
the mouse in the image.
Advanced Image Processing Allows you to adjust the current image processing,
or apply a new processing profile and save a copy
of the image.
Grid Suppression Toggles grid suppression processing for a specific
image on or off during image review. If the grid
suppression feature is enabled in Settings mode it
is available globally. In Review Mode, this feature
is used to toggle the grid suppression processing
on (blue) or off (gray) manually. When enabled, grid
suppression is applied only if a grid is present.
Measurements Allows you to measure dimensions in the image,
including length, distance, and angles.
Zoom This control allows you to change the scaling of the

image displayed on the screen.
Invert This control reverses the polarity of the image.
Show/Hide Overlays Shows or hides overlays configured in Service

Mode.
Add Position Allows you to add a new position to the open study.
Reject Image Marks the current image as rejected. The software

automatically creates a duplicate position to acquire
a replacement image.


Print Preview Opens the print layout and preview tool.
Stitching Stitches aquired images together. This feature is

available when licensed.
Urgent Send Sends all images in the study that have not been
sent or have been reprocessed since previously
sent to all default DICOM servers. Multiple DICOM
servers can be configured as default. Requires
configuration of DICOM server.
Close Patient Launches a pop-up menu. Select Suspend to
suspend the study and return to the idle screen. Or,
select Close to close the current patient session and
returns to the idle screen.
Fields
The Nexus DR user interface indicates information about fields using visual cues.
• Required fields have a red border. When you click or tap inside the field, a message is
displayed indicating that the field is required.
• Editable fields have a dark background.
• If an entry is incorrect, the field border is red and a message indicating the nature of the
error is displayed.
• Read-only fields have a lighter background. You cannot edit them.

Managing messages
System messages are displayed in a drop-down list at the top of the Nexus DR application in
both Clinical and Service Modes automatically as they are encountered.
About this task

The list of messages can be hidden and redisplayed, and messages can be deleted from the
list. Messages are still captured in logs.
Procedure
1. To delete messages, select the X next to the message you want to delete.
2. To hide the list of error messages, select the up arrow.

3. To display the list of error messages, select the exclamation point at the top of the screen.

Reviewing the status of the panel

Real-time information about the status of the panel is displayed in the Clinical Mode user
interface. Autonomous Mode is entered through the Panel Status window of the Clinical Mode
menu.
Procedure
Use one of the following methods to review the status of the panel:
• Look at the Panel Status area of the Clinical Mode menu.
• Open the Panel Status window. See Opening the Panel Status window on page
32.
View detector status

The Panel Status window provides additional information about the status of a panel,
Exposure Mode options.
Icon Description
If present, this icon shows the wireless signal strength.

More green bars in the icon means stronger signal. Two or more bars
are required for image acquisition.
If present, this icon shows the battery charge level and percent
remaining. Five percent or more is required for image acquisition.
Fifteen percent or more is required for calibration.
Detector status bar

The status bar indicates whether the detector is ready for acquisition. When the status bar
is green, the detector is ready for acquisition. When an acquisition is started, the status
indicator indicates the progress of the acquisition, and the following message is displayed:
Acquiring. Please wait...

The following images show some of the states of the detector status bar.
Figure 27: Detector not ready
Figure 28: Detector ready
Figure 29: Detector acquiring
A tether can be used with some detectors. When a detector is tethered, the battery and
wireless icons are replaced with the detector tether icon.
Figure 30: Tethered detector not ready
Figure 31: Detector disconnected
As shown in the following image, the panel is disconnected from Nexus DR when it is in
Autonomous Mode. At this point, Nexus DR can be exited and the detector can be used to
acquire images.
Figure 32: Detector disconnected in Autonomous Mode

Opening the Panel Status window

About this task

On systems with multiple detectors, the status of the active, or currently selected, detector is
larger than other detectors configured on the system.
Procedure
In the Panel Status area of the ribbon, complete one of the following actions:
Open the status window of the active panel. Select the status indicator for the desired panel. The
indicator becomes larger, meaning that it is now the
active detector.
Open the status window of an available, but not a. Select the status indicator for the desired panel.
active panel. The indicator becomes larger, meaning that it is
now the active detector.
b. Select the status indicator again. The Panel
Status window opens.
Panel status, exposure options, and Autonomous Mode

For instructions on accessing this window, see Opening the Panel Status window on page
32.
Figure 33: Display panel status details
The window also provides options for changing the Exposure Mode, and if enabled, entering or
exiting Autonomous Mode.

Exposure Mode — Normal. In Normal mode, the panel provides a 1 second integration time.
Exposure Mode — Long. The panel provides a 4 second integration time. The longer integration
time is sometimes needed for shots requiring a higher dose.
Enter Autonomous Mode/Exit Autonomous Mode Use this button to enter or exit Autonomous
Mode.
The Enter Autonomous Mode button is disabled when you are in Service Mode, the detector
battery is below 40%, the wireless connection is too weak, or when any other condition occurs
where Autonomous Mode is not allowed or will not function properly.
Exposure mode is often set in acquisition profiles, but you can change it manually on this
panel, before acquiring the image.


Part
2
Imaging Patients with Nexus DR
Contents
• Creating and Editing Patient Records on page 37

• Acquiring Images on page 51
• Reviewing and Adjusting Images on page 97
• Measurements and Annotations on page 125
• Archiving and Printing Images on page 153
Chapter
2
Creating and Editing Patient Records
Contents
• Importing patient information from the worklist server on page 39

• Import patient information to the Patient List on page 40
• Creating emergency patients on page 41
• Creating patient records manually on page 41
• Adding studies to new patient records—Preconfigured procedures on page 43
• Adding studies to new patient records — Custom procedures on page 44
• Adding studies to existing patient records on page 45
• Editing patient records on page 46
• Opening patient studies on page 47
• Moving images from one patient record to another on page 48
• Filtering the Patient List on page 50
• Deleting patient records from Patient List on page 50

2. Creating and Editing Patient Records
Nexus DR maintains a Patient List to manage patient records and associated images. This patient
list resides locally on the Nexus DR computer and you manage it through the Patient List view of
Clinical Mode. Before you can acquire images with Nexus DR, you must add a patient record and
study to the Patient List.
Create new patient studies in two ways: import them from a worklist or enter them manually. This
chapter guides you through these processes and provides information about filtering the patient list,
editing patient or study information, and adding studies to existing patient records.

Importing patient information from the worklist server

Nexus DR integrates medical information from systems such as worklist servers and Picture
Archiving and Communications System (PACS) storage solutions. Importing patient and
study information from a worklist minimizes human error in data entry and helps maintain
consistency in patient data stored on the systems involved in patient imaging.
Prerequisites
A worklist server must be available and configured for use in Nexus DR. If your worklist server
has not yet been configured on your system, contact your designated Superuser or your
service provider.
About this task

Although not required, use this preferred method of creating patient records on Nexus DR
whenever a worklist is available.
When you create a patient record in Nexus DR from the worklist, the patient demographics
and study information are imported from the worklist server. Then, the study is matched to a
Work Procedure on Nexus DR, which allows the imaging system to load generator settings
and imaging parameters appropriate to the study you will be performing.
Procedure
1. Query the worklist server to obtain patient information.
a)Click or tap the Worklist tab.
b)Click or tap Refresh.
The system queries the worklist server for records of patients scheduled for imaging. A
list of these patients displays on the Worklist tab.
The parameters for record retrieval depend on your system’s DICOM configuration.
Default settings are +/- 3 hours from the current date and time. Or, you can enable
AutoRefresh, which allows automatic retrieval from the Worklist Server upon entering
the application. Configure AutoRefresh in Settings Mode.
Figure 34: Refresh Worklist
Figure 35: Worklist with patients populated

2. After Nexus DR populates the worklist, choose how you wish to proceed.
• Import patients to the Patient List for later image acquisition.
• Acquire images from the patient files on the worklist, saving file and images to
Patient List later.
Import patient information to the Patient List

You can import patient records from the Worklist tab to the Patient List individually, in
multiples, or all at once.
Prerequisites
Ensure that the needed information has been imported from the worklist server.
Procedure
1. On the Worklist tab, click or tap Refresh.
2. Click or tap Import Patient.
Figure 36: Import Patient Icon
3. Select the patient to import.

The import icon appears on each selected tile. You can select one patient or multiple
patients.
4. Click or tap Next.
The selected patients are removed from the Worklist tab.
Figure 37: Import indicators and Next button
5. Click or tap the Patient List tab.

6. Verify that the imported patients appear.

Creating emergency patients

About this task
The Emergency Patient function automatically creates the patient ID and captures the date
and time information for a patient.
For non-emergency patients, see Creating patient records manually on page 41.
Procedure
1. On the Nexus DR imaging computer, click or tap the Emergency Patient icon.
The patient is automatically opened in Acquisition mode. Chest PA is displayed by default.

2. You can acquire the Chest PA and/or add additional shots.
See Adding studies to new patient records—Preconfigured procedures on page 43 and
Adding studies to new patient records — Custom procedures on page 44 for information
about adding procedures to a study.
Creating patient records manually

When a worklist is not available or a required patient is not in the scheduling system, you may
need to enter a new patient record manually.
Prerequisites
Gather the following information:
• Patient demographic information, such as name, ID, date of birth, and any other
identifying parameters required at your site.
• If study information is to be entered at this time, gather the necessary information, such
as Accession number, requested, scheduled, or performed procedure identification, and
any other study parameters required at your site.
Note: The fields required or used at your facility are configured
during installation or applications training. If a field you need cannot
be edited in the windows described in this procedure, contact your
service organization to have the patient data configuration updated.
Procedure
2. Click or tap Add Patient.
The window changes to display the fields for entry of patient information.

3. Enter the patient's last name, patient ID, and any additional patient data needed.
Figure 38: New patient demographics screen
4. Complete one of the following tasks as needed:

Save the patient record and return to the Patient a. Click or tap Save.
List.
The patient record is saved to the Patient List

and a new Patient Demographics screen is
displayed.
b. If desired, you can create a new patient record
or click/tap Cancel to return to the Patient List.
Proceed to the Study Data screen. Click or tap Next.
The study data fields are displayed.
5. Complete the following tasks as needed:

• Create a study with preconfigured procedures.
• Create a study with custom procedures.

Adding studies to new patient records—Preconfigured

procedures
Nexus DR provides some preconfigured imaging procedures to ease the process of creating a
study. You can also create custom imaging procedures.
About this task

See Adding studies to new patient records — Custom procedures on page 44 for
instructions.
Procedure
1. Enter the required study information in the fields at the top of the view.
Figure 39: Study identification fields
2. Click or tap the Procedures tab and select the procedure from the list.
You can filter the list of procedures by clicking or tapping an anatomical region in the blue
body illustration on the left. Or you can enter a search term into the field above the list. The
list of views to be acquired populates on the right when you select the desired procedure.
Figure 40: Select the procedure for the study
3. After you enter the study information and assign the views to be acquired, click or tap
Next.
The system enters Acquire Mode, prepares the panel for acquisition, and awaits the first
exposure for the study.

Adding studies to new patient records — Custom

procedures
In some instances, you may want to create a study with custom procedures instead of the
preconfigured procedures that come with Nexus DR.
Procedure
2. Select the Positions tab.

Figure 42: Exams and positions
3. Select the desired exam from the Exam list.

4. Click or tap the desired positions.
To filter the list of exams, click or tap an anatomical region in the blue body on the left.
The system enters Acquire Mode, prepares the panel for acquisition, and awaits the first
exposure for the study.

Adding studies to existing patient records

When a patient returns for follow-up imaging or other similar circumstances, you may have
to add a new study to a patient record that already exists in the Nexus DR patient list. This
process is most often done when worklist is not available.
Prerequisites
You must have the required study information, such as Accession number, requested,
scheduled, or performed procedure identification, and any other study parameters used at your
site.
Procedure
2. Select the desired patient record.
If needed, use Search Options to find the desired patient record. See Filtering the Patient
List on page 50.
Figure 43: Select the desired patient
3. Click or tap the Add Study icon in the patient tile.
The procedure or position selection screen appears.



• Create a study with preconfigured procedures.
• Create a study with custom procedures.
Editing patient records

When information about a patient or study changes or when entering information for an
emergency patient, you will need to edit the patient or study information in the Nexus DR
patient database. Perform this procedure from the Patient List window in Clinical Mode. You
can edit only patient records created manually.
About this task

Note: Patient records imported from worklist cannot be edited.
Procedure
List on page 50.
Figure 45: Select the patient record to be edited
3. In the selected patient’s tile, select the Edit icon.
The Edit Patient window displays.

4. Edit the patient information, and complete one of the following actions:
Save the changes. Click or tap Next.
The changes are saved and you are returned to the

Patient List.
Cancel the changes. Click or tap Cancel.
The changes are canceled and the window is closed.

All changes are permanently discarded.
Opening patient studies

An open patient study is required to acquire images with Nexus DR. Opening a study gives
you access to images that already exist in the study and allows you to add additional images if
needed.
Prerequisites
If a patient study does not already exist or a new study is needed, see the topic, Adding
studies to existing patient records on page 45.
Procedure
The studies contained in that patient record display.
List on page 50.


Options Description
Double-click or double-tap the selected study. The study opens to the first available view that has
not yet been acquired and prepares the panel for
acquisition. If all views have been acquired, the
study opens to the first acquired image and the panel
remains in standby.
In the far right column, click or tap the desired If an image has already been acquired for that view,
view. it opens in review mode. You can select a different
image from the right column of the patient list. If the
view has not been acquired, the view profile opens
and the panel prepares to acquire the image.
What to do next
After the study is open, you are ready to acquire or work with the images in the study.
Moving images from one patient record to another

Prerequisites
• The Move Images feature must be enabled in Settings Mode.
• The target patient record must contain an unacquired image before an image can be
moved into it.
About this task

If an image is acquired into the wrong patient, it can be moved into the correct patient record.
Procedure
1. Select the patient record that contains the image you want to move.
2. Select the study containing the image to move.
3. Select Move Image.
4. Select the image to move.
The image is marked for movement.
5. Select Next.
The Move Image window is displayed.

6. In the Move Image window, search for the patient record you want to move the image into.
Option Instructions
Display all available patient records. Leave the search cr fields empty, and click or tap the
magnifying glass icon.
Search for a specific patient record. a. Enter the search criteria you want to use in the
text fields.
b. Click or tap the magnifying glass icon.
You can search on patient name, ID, accession number, study description, start date and
end date. You can also search on partial entries. For example, if a patient's name is Jones,
you can enter Jo in the Name field,
7. Select the patient record.

8. Click or tap OK.
The Move Images confirmation screen is displayed.
9. In the Approver field, type your initials.
Your initials must be entered for tracking purposes.
10. Click or tap OK.
The image is moved into the patient record with the name assigned to the empty position.

Filtering the Patient List

Use the Nexus DR search options to find specific patient records in a large list of patients.
About this task

The search function filters the patient list according to parameters you enter. You can enter
partial values in the Name, patient ID, Accession #, Study Description, Start Date and End
Date fields to display groups of patient records that share similar values. Use longer values or
more than one parameter to make the filtering more specific.
Procedure
2. Click or tap Search Options to display the search fields.
3. Enter the filter parameters and click or tap Refresh.

Note: Entering complete values or more than one filter parameter
can help to find specific patient studies. Entering partial values
may yield multiple results.
Deleting patient records from Patient List

You can use Delete Mode to remove patient records from the Patient List.
Procedure
2. Click or tap the Delete icon to begin Delete Mode.
Delete Mode allows you to select more than one record.

Figure 46: Click or tap the Delete icon

You can select multiple patient tiles for deletion. A blue delete indicator marks each patient
tile you select.
5. In the Confirmation window, select Yes to confirm.

Chapter
3
Acquiring Images
Contents
• RAD mode on page 52

• vTrigger mode on page 52
• Simplified guidance for imaging with CsI detectors in vTrigger mode on page 53
• Recommended Techniques, Exposure Index, and the Deviation Index on page 53
• Recommendations for imaging pediatric patients on page 76
• Reviewing or adjusting X-ray generator parameters on page 77
• X-ray generator user interface window on page 77
• Changing the detector exposure mode on page 78
• Acquiring images from the Worklist tab on page 79
• Acquiring images from the patient study on page 84
• Acquiring images in Autonomous Mode on page 85
• Adding views to an open study on page 91
• Suspending a patient study on page 93
• Closing a patient with an incomplete study on page 94
• Image rejection on page 94

3. Acquiring Images
The primary purpose of Nexus DR is the acquisition and processing of diagnostic X-ray images.
Images are captured with the Varex detector and transferred to the Nexus DR computer for
processing and temporary storage. In this chapter, you will learn how to acquire images using
Nexus DR.
RAD mode
RAD mode requires a serial connection between the X-ray generator and the imaging
computer.
Because of the need for an intermediary electrical interface between the X-ray generator and
the detector in RAD mode, you must be careful to select the workstation that is configured with
the intermediary device when operating in RAD mode.
vTrigger mode
vTrigger is a circuit inside the detector that senses the electrical current generated in the
photodiode array when the X-ray beam interacts with the detector's active area. When that
current is detected, the circuit triggers the receptor’s integration process in the same way as
would an external signal from the generator. By removing the need for an electrical interface to
or from the generator, vTrigger allows Nexus DR to be installed with a wider array of existing
X-ray equipment, requiring only the presence of an X-ray exposure to initiate image capture.
As when using film or CR, the generator is in complete control of the X-ray exposure, including
exposure factors, initiation of the exposure, and exposure timing and termination.
In vTrigger mode, the detector automatically senses the X-ray exposure and captures an
image.
During a typical patient study, the detector is positioned on the far side of the patient from the
source X-ray tube, such that the X-ray beam will pass through the patient and strike the active
area of the receptor. After setting appropriate collimation for the anatomy to be imaged, you
will set an appropriate technique from the controls of the room’s X-ray generator.
After verifying that the detector is ready and armed (indicated top-center of the Nexus DR
display), you initiate an X-ray exposure using the exposure switch embedded in or attached to
the generator control console. The generator controls initiation, timing, and termination of the
exposure.
After the detector automatically detects the exposure, it transfers the resulting image to the
workstation, where you can review positioning and exposure quality. Using the Nexus DR
software, you can also adjust the digital shutters, apply different types of image processing,
and send images to DICOM-compliant devices such as PACS and film printers.
For guidance in acquiring images using vTrigger, see Simplified guidance for imaging with CsI
detectors in vTrigger mode on page 53.

3. Acquiring Images
Simplified guidance for imaging with CsI detectors in

vTrigger mode
Review the settings for anatomy, tube current, tube voltage, exposure time, and source to
image distances when using CsI detectors in vTrigger mode.
The following table provides simplified guidance for imaging patients with CsI detectors in
vTrigger mode.
Table 6: Simplified Guidance for Image Acquisition with CsI detectors in vTrigger mode
Tube Current
Some direct Source
Nominal radiation to Image
Anatomy Collimation on panel Tube Voltage Exposure Time Distance (SID)
100mA or
Spine 16mA or greater
greater
Set the tube
100mA or
Abdomen/Pelvis 16mA or greater voltage Set the SID
greater according to according to
10 ms or more
the anatomical the anatomical
Skull 64mA or greater 10mA or greater
region and body region
Thorax 20mA or greater 10mA or greater thickness
Extremities 25mA or greater 10mA or greater
Note:
• Tight collimation or highly attenuating grids may require higher kVp or
increased mA.
• Radiation field should not be limited to bone only.
Recommended Techniques, Exposure Index, and the

Deviation Index
The Exposure Index is useful in determining the appropriate exposure factors and calibration
for the Nexus DR system. Review the techniques that are recommended for use in clinical
imaging.
Information about the Exposure Index and Deviation Index can also be found in Exposure
Index and Target Exposure Index on page 75 and Deviation Index on page 76. You
will find these visual indications useful in determining appropriate exposure factors for your
specific system.
Note: The techniques provided here are recommended levels only.
The ALARA Principle should be observed wherever possible to
reduce patient dose while maintaining clinically useful image quality.
If you can reduce techniques below the levels specified without
adversely affecting image quality, you should do so.

3. Acquiring Images
When imaging pediatric patients, refer to tables that are specifically labeled for pediatrics.
Recommended techniques for Premium CsI detectors

Table 7: Recommended techniques for 4343W, 4336W-G5 , and 2530W-G5 (Premium CsI)
Patient Acq SID
Part View size Mode (cm) Grid kVp mAs EI Target
PA 16-18cm AEC 180cm Y 90kVp 1.0mAs
PA 20-24cm AEC 180cm Y 110kVp 2.0mAs 150
PA 28+cm AEC 180cm Y 110kVp 5.0mAs
Chest
LAT 23-26cm AEC 180cm Y 90kVp 2.0mAs
LAT 31-33cm AEC 180cm Y 110kVp 5mAs 200
LAT 34-38cm AEC 180cm Y 110kVp 6mAs
PA 11cm mAs 60cm N 60kVp 1.0mAs

Pigg-
PA 15cm mAs 60cm N 65kVp 2.0mAs 150
O-Stat
LAT 13cm mAs 60cm N 65kVp 2.5mAs
AP (KUB) 12-15cm AEC 100cm Y 70kVp 8.0mAs

AP (KUB) 16-20cm AEC 100cm Y 70kVp 10mAs
Abdomen 250
AP 12-15cm AEC 100cm Y 70kVp 12mAs

Pelvis 300
AP/Frog 15-18cm AEC 100cm Y 70kVp 8mAs

Hip AP/Frog 19-22cm AEC 100cm Y 75kVp 10mAs 250

3. Acquiring Images
Patient Acq SID

AP/OBL 18-20cm AEC 100cm Y 65kVp 2.5mAs

AP/OBL 26-30cm AEC 100cm Y 70kVp 5mAs
Ribs 200
Lower 20-25cm AEC 100cm Y 70kVp 8mAs
LAT 26-30Cm AEC 100cm Y 75kVp 8.0mAs
Sternum 200
OBL 16-20cm AEC 100cm Y 75kVp 10mAs
Waters/ 14-17cm AEC 100cm Y 70kVp 10mAs

Caldwell
Caldwell
Sinuses Waters/ 20-22cm AEC 100cm Y 75kVp 15mAs 225

Caldwell

TMJ’s LAT 13-15cm AEC 100cm Y 75kVp 10mAs 225
Nas Bns LAT mAs 100cm N 55kVp 2.0mAs 225
Rheese 14-17cm mAs 100cm Y 70kVp 8mAs

Orbits Rheese 18-20cm mAs 100cm Y 75kVp 10mAs 225
Waters 14-17cm AEC 100cm Y 70kVp 10mAs

Skull 225

3. Acquiring Images
Patient Acq SID

Towne 14-17cm AEC 100cm Y 70kVp 10mAs
LAT/OBL 6-8cm AEC 180cm Y 75kVp 5.0mAs

LAT/OBL 10-12cm AEC 180cm Y 75kVp 10mAs
AP/OM 6-8cm AEC 100cm Y 75kVp 4.0mAs
Cervical
AP/OM 8-10cm AEC 100cm Y 75kVp 5.0mAs 175
Spine
AP/OM 12-14cm AEC 100cm Y 75kVp 10mAs
Swimmers 25-30cm AEC 100cm Y 85kVp 10mAs
AP 10-15cm AEC 100cm Y 70kVp 4.0mAs
250
Thoracic AP 28-35cm AEC 100cm Y 75kVp 10mAs

Spine LAT 18-24cm AEC 100cm Y 80kVp 10mAs
250
LAT 40+cm AEC 100cm Y 95kVp 20mAs

Lumbar LAT 20-28cm AEC 100cm Y 80kVp 15mAs

250
SPOT 28-35cm AEC 100cm Y 85kVp 20mAs

3. Acquiring Images
Patient Acq SID

SPOT 48+cm AEC 100cm Y 95kVp 50mAs
PA/Angle 5-10cm AEC 100cm Y 60kVp 3.0mAs

Clavicle 175

Scapula 175
INT/EXT 5-8cm AEC 100cm Y 65kVp 3.0mAs
Shoulder INT/EXT 12-16cm AEC 100cm Y 70kVp 5.0mAs 175
Y Lateral 25-30cm AEC 100cm Y 75kVp 15mAs
AP/LAT 3-5cm AEC 100cm Y 68kVp 4.0mAs

Humerus AP/LAT 6-8cm AEC 100cm Y 68kVp 5.0mAs 175
AP/OBL/ 3-5cm mAs 100cm N 50kVp 2.5mAs

LAT
Elbow 250
LAT
LAT
AP/LAT 2-4cm mAs 100cm’ N 50kVp 2.0mAs

Forearm AP/LAT 4-6cm mAs 100cm N 52kVp 2.5mAs 250
AP/LAT 6-8cm mAs 100cm N 54kVp 3.0mAs
AP/OBL 2-3cm mAs 100cm N 50kVp 1.0mAs

Wrist 300

3. Acquiring Images
Patient Acq SID

LAT 4-5cm mAs 100cm N 52kVp 2.0mAs
PA/OBL 2-3cm mAs 100cm N 50kVp 1.0mAs

Hand 375

LAT
Finger 250
LAT
LAT

Femur AP/LAT 9-12cm AEC 100cm Y 70kVp 8.0mAs 300
AP/LAT 13-16mAs AEC 100cm Y 75kVp 12mAs
AP/OBL/ 5-7cm AEC 100cm Y 60kVp 3.5mAs

LAT
Knee 275
LAT
LAT
Tib/Fib AP/LAT 8-10cm mAs 100cm N 52kVP 3.0mAs 275
AP/LAT 11-13cm mAs 100cm N 56kVP 4.0mAs
AP/OBL/ 6-8cm mAs 100cm N 50kvp 2.0 mAs

LAT
Ankle 225
LAT
AP/OBL/ 10-12cm mAs 100cm N 54KVp 3.0mAs
LAT
LAT 3.5cm mAs 100cm N 52kVp 2.5mAs

Heel LAT 5-7cm mAs 100cm N 54KVp 3.0mAs 275
AXIAL 5-7cm mAs 100cm N 65kVp 6.0mAs

3. Acquiring Images
Patient Acq SID

AXIAL 8-10cm mAs 100cm N 70kVp 10mAs

Foot 275

Toes 275
Soft AP/LAT 6-8cm mAs 100cm N 60kVp 3.0mAs

Tissue 200
Neck AP/LAT 9-15cm mAs 100cm N 60kVp 6.0mAs

3. Acquiring Images
Recommended techniques for DRZ+ detectors

Table 8: Recommended techniques for 4343W and 4336W-G5 (DRZ+)
Patient Acq SID
Chest PA 16-18cm AEC 180cm Y 90kVp 2.5mAs
PA 20-24cm AEC 180cm Y 110kVp 3.5mAs 210


Pigg-O-
PA 15cm mAs 150cm N 65kVp 3.0mAs 210
Stat

Abdomen 350

Pelvis 420

Hip 350

3. Acquiring Images
Patient Acq SID

Ribs 280
LAT 26-30Cm AEC 100cm Y 75kVp 12mAs
Sternum 280
Waters/
14-17cm AEC 100cm Y 70kVp 12mAs
Caldwell
Caldwell

Caldwell

Nasal LAT
mAs 100cm N 55kVp 3.5mAs 315
Bones (NO GRID)
Rheese 14-17cm AEC 100cm Y 70kVp 10mAs

Orbits Rheese 18-20cm AEC 100cm Y 75kVp 15mAs 315
Rheese 20-22cm AEC 100cm Y 75kVp 18mAs

Skull 315

3. Acquiring Images
Patient Acq SID


Cervical
AP/OM 8-10cm AEC 100cm Y 75kVp 10mAs 245
Spine
350
Thoracic AP 28-35cm AEC 100cm Y 75kVp 15mAs

350

Lumbar LAT 25-30cm AEC 100cm Y 80kVp 18mAs

350

3. Acquiring Images
Patient Acq SID


PA/Angle 10-15ccm AEC 100cm Y 65kVp 6.0mAs
Clavicle 245
PA/Angle 20-25cm AEC 100cm Y 75kVp 10mAs

Scapula 245
INT/EXT 16-20cm AEC 100cm Y 75kVp 10mAs

AP/OBL/
3-5cm mAs 100cm N 55kVp 3.5mAs
LAT
Elbow 350
LAT
LAT
AP/LAT 2-4cm mAs 100cm’ N 55kVp 2.5mAs

Forearm AP/LAT 4-6cm mAs 100cm N 57kVp 3.0mAs 350

Wrist 420

3. Acquiring Images
Patient Acq SID


Hand 490
AP/OBL/
1-2cm mAs 100cm N 48kVp 2.5mAs
LAT
Finger 350
LAT
LAT

Femur AP/LAT 9-12cm AEC 100cm Y 70kVp 10mAs 420
AP/OBL/
5-7cm AEC 100cm Y 60kVp 5.0mAs
LAT
Knee 385
LAT
AP/OBL/ 11-13cm AEC 100cm Y 70kVp 12mAs
LAT
Tib/Fib AP/LAT 8-10cm mAs 100cm N 55kVP 5.0mAs 385
AP/OBL/
6-8cm mAs 100cm N 55kvp 3.0mAs
LAT
Ankle 385
LAT
LAT
LAT 3.5cm mAs 100cm N 60kVp 3.2mAs

Heel LAT 5-7cm mAs 100cm N 60kVp 5.0mAs 385

3. Acquiring Images
Patient Acq SID


Foot 385

Toes 385
Soft AP/LAT 6-8cm mAs 100cm N 60kVp 3.5mAs

Tissue 280

3. Acquiring Images
Recommended techniques for Standard CsI detectors

Table 9: Recommended techniques for 4343W , 4336W-G5, and 2530W-G5 (Standard CsI)
Patient Acq SID
Chest PA 16-18cm AEC 180cm Y 90kVp 1.5mAs 175
LAT 23-26cm AEC 180cm Y 90kVp 3.0mAs 250

Pigg-O- PA 11cm mAs 150cm N 60kVp 1.5mAs 175

Stat
Abdomen AP (KUB) 12-15cm AEC 100cm Y 70kVp 10mAs 300

Pelvis AP 12-15cm AEC 100cm Y 70kVp 14mAs 350

Hip AP/Frog 15-18cm AEC 100cm Y 70kVp 10mAs 325


3. Acquiring Images
Patient Acq SID

Ribs AP/OBL 18-20cm AEC 100cm Y 65kVp 3.0mAs 250
Sternum LAT 20-25cm AEC 100cm Y 70kVp 6.0mAs 250
LAT 26-30Cm AEC 100cm Y 75kVp 10mAs

Caldwell
Caldwell
Caldwell

Nas Bns LAT mAs 100cm N 55kVp 3.0mAs 300
Orbits Rheese 14-17cm mAs 100cm Y 70kVp 10mAs 300

Skull Waters 14-17cm AEC 100cm Y 70kVp 12mAs 300


3. Acquiring Images
Patient Acq SID

Cervical LAT/OBL 6-8cm AEC 180cm Y 75kVp 6.0mAs 215

Spine
Thoracic AP 10-15cm AEC 100cm Y 70kVp 5.0mAs 300
Spine
Lumbar AP/OBL 10-15cm AEC 100cm Y 70kVp 12mAs 300

Spine

3. Acquiring Images
Patient Acq SID

Clavicle PA/Angle 5-10cm AEC 100cm Y 60kVp 4.0mAs 225

PA/Angle 10-15ccm AEC 100cm Y 65kVp 5.0mAs
Scapula AP 5-10cm AEC 100cm Y 60kVp 5.0mAs 225

INT/EXT 16-20cm AEC 100cm Y 75kVp 10mAs

Elbow AP/OBL/ 3-5cm mAs 100cm N 50kVp 3.0mAs 275

LAT
LAT
LAT
Forearm AP/LAT 2-4cm mAs 100cm’ N 50kVp 2.5mAs 275

Wrist AP/OBL 2-3cm mAs 100cm N 50kVp 1.5mAs 375


3. Acquiring Images
Patient Acq SID

Hand PA/OBL 2-3cm mAs 100cm N 50kVp 1.5mAs 425

Finger AP/OBL/ 1-2cm mAs 100cm N 48kVp 2.0mAs 275

LAT
LAT
LAT
Femur AP/LAT 5-8cm AEC 100cm Y 65kVp 8.0mAs 350

AP/LAT 9-12cm AEC 100cm Y 70kVp 10mAs
Knee AP/OBL/ 5-7cm AEC 100cm Y 60kVp 4.0mAs 325

LAT
LAT
LAT
Part View Patient Acq SID GridkVp mAs EI Target
size Mode (cm)
Tib/Fib AP/LAT 5-7cm mAs 100cm N 50kVp 4.0mAs 325
Ankle AP/OBL/ 6-8cm mAs 100cm N 50kvp 3.0mAs 325

LAT
LAT
LAT
Heel LAT 3.5cm mAs 100cm N 52kVp 3.5mAs 325

LAT 5-7cm mAs 100cm N 54KVp 4.0mAs

3. Acquiring Images
Patient Acq SID

Foot AP/OBL 3-5cm mAs 100cm N 50kVp 2.5mAs 325

Toes AP/LAT 1-2cm mAs 100cm N 50kVp 2.0mAs 325

Soft AP/LAT 6-8cm mAs 100cm N 60kVp 4.0mAs 250

Tissue

3. Acquiring Images
Typical doses for common pediatric DR imaging — CsI

Typical doses for common imaging of small, medium, and large pediatric patients are provided
in the following tables.
Table 10: Typical doses for small patient pediatric imaging with Nexus DR
Exam Position Small Patient (Newborn - 3 years old)
ESE
1
Size (cm) kVp mAs SID (cm) Grid (µGy)
Skull AP/PA 15 70 8 100 Yes 0.5
Skull Lateral 12 65 6 100 Yes 0.3
Chest PA/AP NA NA NA NA NA NA
Chest Lateral NA NA NA NA NA NA
Chest PA/AP 11 60 1.0 150 No 0.001
(Pigg-O-
Stat)
Chest Lateral 13 65 2.5 150 No 0.04
(Pigg-O-
Stat)
Thoracic AP 15 70 4.0 100 Yes 0.3
Spine
Thoracic Lateral 20 75 12 100 Yes 0.9
Spine
Lumbar AP 15 70 12 100 Yes 0.7
Spine
Lumbar Lateral 25 80 15 100 Yes 1.4
Spine
Abdomen AP 15 70 8 100 Yes 0.5
Hand PA <2 50 1.5 100 No 0.03
1 Measurements in this column are in ESE (Estimated Skin Entrance ) dose in µGy.

3. Acquiring Images
Table 11: Typical doses for medium child pediatric imaging with Nexus DR
Exam Position Medium Child (4 years old - 9 years old)
ESE
Size (cm) kVp mAs SID (cm) Grid (μGy)
Skull AP/PA 18 75 8.0 100 Yes 0.9
Skull Lateral 13 65 10.0 100 Yes 0.50
Chest PA/AP 18 90 1.0 180 Yes 0.03
Chest Lateral 24 90 2.0 180 Yes 0.06
Chest PA/AP 13 65 1.5 150 No 0.001
(Pigg-O-
Stat)
(Pigg-O-
Stat)
Thoracic AP 18 70 5.0 100 Yes 0.4
Spine
Thoracic Lateral 25 85 12.0 100 Yes 1.3
Spine
Lumbar AP 15 75 12.0 100 Yes 0.9
Spine
Lumbar Lateral 30 80 20.0 100 Yes 2.2
Spine
Abdomen AP 20 70 12.0 100 Yes 0.8
Hand PA 2 50 1.5 100 No 0.03

3. Acquiring Images
Table 12: Typical doses for large child pediatric imaging with Nexus DR
Exam Position Large Child (10+ years old)
ESE
Size (cm) kVp mAs SID (cm) Grid (μGy)
Skull AP/PA 19 75 10.0 100 Yes 1.0
Skull Lateral 14 70 10.0 100 Yes 0.6
Chest PA/AP 20 95 1.5 180 Yes 0.06
Chest Lateral 28 95 3.0 180 Yes 0.09
Chest PA/AP 15 65 2.0 150 No 0.003
(Pigg-O-
Stat)
(Pigg-O-
Stat)
Thoracic AP 22 75 7.0 100 Yes 0.6
Spine
Thoracic Lateral 30 85 12.0 100 Yes 1.5
Spine
Lumbar AP 20 80 12.0 100 Yes 1.1
Spine
Lumbar Lateral 35 85 20.0 100 Yes 2.5
Spine
Abdomen AP 25 75 18.0 100 Yes 1.5
Hand PA 2 50 1.5 100 No 0.03

3. Acquiring Images
Typical doses for common imaging using Nexus DR

Typical doses for imaging the average adult (CsI).
Table 13: Typical doses for average adult imaging using Nexus DR with a CsI detector
Adult
Patient
Size ESE ESE
Exam Position (cm) kVp mAs SID (cm) Grid (µGy) (mR)
Skull AP/PA 20 75 12.0 100 Yes 1.1
2 129
Skull Lateral 14 70 8.0 100 Yes 0.5 57

Chest PA/AP 20 110 1.5 180 Yes 0.06 7
Chest Lateral 32 110 5.0 180 Yes 0.2 27
Thoracic Spine AP 20 70 5.0 100 Yes 0.3 40
Thoracic Spine Lateral 30 85 15.0 100 Yes 2.4 274
Lumbar Spine AP 25 80 15.0 100 Yes 1.9 214
Lumbar Spine Lateral 36 85 25.0 100 Yes 4.5 512
Abdomen AP 25 75 12.0 100 Yes 1.3 149
Hand PA 3 50 1.5 100 No 0.03 4
Exposure Index and Target Exposure Index

The Exposure Index (EI) is a calculation associated with the overall quality of a DR image.
The Exposure Index (EI) calculation is based on the pixel intensity within the detected or
user-selected Region of Interest (ROI), adjusted for the base sensitivity of the receptor that
captured the image.
For each general area of the body, Nexus DR is programmed with a Target Exposure Index
(TEI), a range in which the Exposure Index is optimal for image processing. The TEI is
determined by the panel and position used for imaging. EI does not describe or measure
patient dose.
Exposures above or below the Target Exposure Index range can suffer degraded image quality
due to too much or too little radiation reaching the detector. For example, image processing
may cause overexposures to go unnoticed, while the increased noise in underexposures
reduce image quality.
2 Measurements in this column are in ESE (Estimated Skin Entrance ) dose in µGy.

3. Acquiring Images
Deviation Index
The Deviation Index (DI) is a logarithmic value based on the ratio of the EI to the TEI. The
DI helps you determine whether the EI of a DR image is within the optimal range. When you
acquire a DR image that is not within the optimal range, the DI can also help you determine
how to adjust technique to achieve an optimal image.
When you acquire a DR image, keep the following in mind:
• When the DI is 0.0, the EI is within the optimal range. The closer the DI is to 0.0, the
closer the EI is to optimal.
• The DI changes by ± 1 for each +25%/-20% change in EI (or one step in a standard
generator mAs control).
You can display information about the Exposure Index, Target Exposure Index, and Deviation
Index for an image by selecting the Show/Hide Overlay icon in the image processing tool bar.
These statistics display in the upper right corner of the image.
Figure 47: Example Exposure Index, Target Exposure Index, and Deviation Index statistics
Recommendations for imaging pediatric patients

When imaging pediatric patients, Varex provides the following recommendations:
• Use special care when imaging patients outside the typical adult size range
• Measure patient thickness and set appropriate child size technique.
• Avoid using anti-scatter grids for patient thickness less than 10-12cm.
• Radiate only the necessary anatomy, employing appropriate collimation and shielding.

3. Acquiring Images
Reviewing or adjusting X-ray generator parameters

About this task
You can review or adjust X-ray generator parameters as needed in Clinical Mode.
Procedure
1. From the Patient List, select the generator controls icon.
The control window opens.

Note: When a patient is open, the generator controls are
displayed continuously.
2. Change the settings as necessary

See X-ray generator user interface window on page 77 for information about the
parameters.
X-ray generator user interface window

Nexus DR improves workflow efficiency by offering direct communication with the generator
through the Clinical Mode of the imaging software. This integration allows both automatic
configuration of exposure mode and factors, through acquisition profiles, and manual
adjustments to the generator when needed. When an acquisition profile is selected, or loaded
by a work procedure, the generator parameters are automatically updated to those preset in
the profile.
Figure 48: Varex generator controls

3. Acquiring Images
Table 14: X-ray generator user interface parameters

Parameter Instructions
Patient Size Select the patient size button and select the desired patient size.
Workstation Select the Workstation button to display the available workstations.
All workstations configured for use on the system are available.
Mode Click or tap the Mode button to select the desired exposure mode.
Focus Click or tap the Focus button to select the focus spot size.
Fields Click or tap the Fields button to select the AEC density chamber field.
Density Click or tap the Density button to select the desired AEC density.
kV, mA, ms, mAs Click or tap the minus (-) or plus (+) sign to increase or decrease the
parameter.
Changing the detector exposure mode

Detectors can be operated in normal or long exposure mode.
Procedure
1. Select the Panel Status Indicator.
The Panel Status window is displayed.

2. In the Exposure column, select the desired exposure mode: Normal Exposure or Long
Exposure.
The selected mode is highlighted and the integration time for the selected mode is
displayed beneath the long mode icon in seconds.
3. To close the Panel Status window, select the Panel Status Indicator again.

3. Acquiring Images
Acquiring images from the Worklist tab

You can acquire images from the patient record on the Worklist tab. Following acquisition,
Nexus DR imports the patient record to the Patient List during the Close Patient function.
This procedure differs slightly depending on whether the patient record contains one study or
more than one study.
Prerequisites
Review the following information:
• Refer to technique charts and estimated doses in Recommended Techniques, Exposure
Index, and the Deviation Index on page 53.
About this task

Note: Occasionally, when Nexus DR imports patient information from
the worklist server, the patient record specifies no studies and shots.
This situation may occur due to an error at the worklist server, often
in data entry of work procedure information. If you open a patient
record imported from the worklist server and find no work procedures
identified, add them manually as described in Adding studies to
existing patient records on page 45.
Procedure
1. On the Worklist tab, click or tap Refresh.
2. Select the patient and first shot for acquisition by completing one of these tasks:
• Acquiring images directly from the Worklist tab on page 80
• Acquiring images from the patient tile on page 81
• Acquiring the first available shot from the study tile on page 82
• Acquiring a specific shot from the study tile on page 83

3. Acquiring Images
Acquiring images directly from the Worklist tab

You can open the Acquisition screen from the Worklist tab in order to acquire images.
Prerequisites
Ensure that you have refreshed the Worklist tab. See Acquiring images from the Worklist tab
on page 79 for instructions.
Procedure
1. Double-click or double-tap on the patient record to proceed directly to the Acquisition
screen.
a)If the patient record contains only one study, the Acquisition screen opens and the
first available shot in the study is selected for acquisition.You can select another shot
from this screen, if desired. Proceed to step 2 on page 80.
b)If the patient record contains multiple studies, the Import Studies window is
displayed. Click or tap Yes to import all studies, or click or tap No to import the first
study in the list.
Figure 49: Import Studies window
After you click or tap Yes, the Acquisition screen opens and the first available shot in
the first study is selected for acquisition. You can select another study and shot from
this window, if desired.
Figure 50: Click or tap Acquire/Review icon from patient tile (multiple studies)
2. Acquire images. See Acquiring images from the Worklist tab on page 79 or Acquiring
images from the patient study on page 84.
3. Click or tap Patient Complete, and select Close from the pop-up menu.
Nexus DR moves the patient record, now containing images, to the Patient List.
You may also suspend the study or close an incomplete study. See Suspending a patient
study on page 93 or Closing a patient with an incomplete study on page 94,
respectively.

3. Acquiring Images
Acquiring images from the patient tile

You can open the Acquisition screen from the patient tile on the Worklist tab and acquire
images.
Prerequisites
Procedure
2. On the patient tile, click or tap Acquire/Review.
a)If the patient contains only one study, the patient tile opens and the study appears in
the middle column. On the patient tile, click or tap Acquire/Review. You can select
another shot from this screen, if desired. Continue to step 3 on page 81.
b)If the patient record contains multiple studies, the Import Studies window is
displayed. Click or tap Yes to import all studies, or click or tap No to import the first
study in the list.
Figure 51: Import Studies window
After you click or tap Yes, the Acquisition screen opens and the first available shot in
the first study is selected for acquisition. You can select another study and shot from
this window, if desired.
Figure 52: Click or tap Acquire/Review icon from patient tile (dual study)
4. Click or tap Patient Complete, and select Close from the pop-up menu.Nexus DR moves
the patient record, now containing images, to the Patient List.
respectively.

3. Acquiring Images
Acquiring the first available shot from the study tile

You can acquire the first available shot from the study tile without selecting it.
Prerequisites
Procedure
2. Click or tap on the desired study.
The study tile opens and the shots in the study appear in the right column. ( Figure 53 on
page 82.)
3. Click or tap Acquire/Review on the study tile.
The Acquisition screen opens and the first available shot is selected for acquisition.
Note: Clicking or tapping Acquire/Review at the study level
opens only the selected study for acquisition. All other studies
remain on the worklist. You can select another shot on the
Acquisition screen, if desired.
Figure 53: Click or tap Acquire/Review icon from patient tile (multiple studies)
respectively.

3. Acquiring Images
Acquiring a specific shot from the study tile

You can select a specific shot from the study tile, otherwise the first available shot is selected
when you click or tap Acquire/Review on the study tile.
Prerequisites
Procedure
2. Click or tap on the desired study.
The study tile opens and the shots in the study appear in the right column. (Figure 54 on
page 83).
The Acquisition screen opens with the desired shot selected for acquisition.You can
select another shot from this screen, if desired.
Figure 54: Select Study option on Acquisition screen
respectively.

3. Acquiring Images
Acquiring images from the patient study

This section guides you through acquiring the basic image types supported by Nexus DR
systems.
Prerequisites
• The patient session must be open and in Acquire Mode. See Opening patient studies on
page 47. Images are captured and associated with that open study so that each image
contains the following information: patient information, the study for which the image was
captured, the date and time of acquisition, other attributes.
• Review the following information:
• Refer to technique charts and estimated doses in Recommended Techniques,
Exposure Index, and the Deviation Index on page 53.
Procedure
1. Press the exposure switch to begin acquisition. Hold the switch until the exposure is
complete.
Nexus DR and the host generator may require a few seconds to prepare for and complete
the exposure.
2. After the exposure has finished, release the exposure switch.
The system stores the captured image to the patient record automatically and displays
it on the screen. The next position in the sequence on the right, if applicable, is selected
automatically for the next exposure.
3. Review the image for positioning and appropriate exposure.
Use the Show/Hide Overlay icon at the bottom of the toolbar to toggle display of the
overlay information configured in Service Mode. The Exposure Index (EI) and Deviation
Index (DI) values for the image display by default. Click or tap the icon to toggle them off.
For additional information about exposure index and the deviation indicator, see
Recommended Techniques, Exposure Index, and the Deviation Index on page 53.

3. Acquiring Images
Acquiring images in Autonomous Mode

In Autonomous Mode, you can acquire images without a connection to the Nexus DR imaging
computer. Images are stored on the detector and uploaded to the imaging computer at a later
time.
Prerequisites
• Autonomous Mode must be enabled in Settings Mode.
• The prerequisites for entering Autonomous Mode must be met.
• Review Autonomous Mode on page 86 before you begin this task.
About this task

The Autonomous Mode option is available only for the 4343W, 2530W-G5, and 4336W-G5.
Autonomous Mode can be enabled for multiple detectors, but only one detector can be placed
in Autonomous Mode at a time. You must reconnect to Nexus DR and exit Autonomous Mode
to transfer the images from the detector into the appropriate patient record.
Note: Autonomous Mode is disabled if the detector is tethered.
Warning: The user is responsible for synchronizing the images with

the respective patient names. Not complying with this requirement
may result in images associated with the wrong patient.
Note: This feature does not record names or personal patient
information. The detector only provides numerically named images.
Procedure
1. Enter Autonomous Mode.
Autonomous Mode is active until you exit Autonomous Mode, the detector has not acquired
an image in 45 minutes, or the battery charge drops below 5%. After 45 minutes without
an exposure, the detector is unable to acquire or save images. You must exit Autonomous
Mode in Nexus DR, transfer any images on the detector, and re-enter Autonomous Mode
to acquire and save images on the detector again.
2. Image the patient.
In Normal Exposure Mode, you must wait a minimum of 10 seconds between exposures.
In Long Exposure Mode, wait a minimum of 15 seconds between exposures. The exposure
mode that is selected when the detector is placed in Autonomous Mode is the exposure
mode the detector remains in until Autonomous Mode is exited. For information about
changing the mode of the detector, see Changing the detector exposure mode on page 78.
Important: Pay close attention to the detector LED when performing multiple image
acquisitions. The detector LED blinks green and yellow when the detector is in
Autonomous Mode, ready for acquisition, and the battery is at an acceptable level (≥40%).
The LED is solid green during acquisition. When the detector battery charge drops below
40%, the LED continues to blink green and yellow until the battery is depleted.

3. Acquiring Images
3. Transfer the images acquired in Autonomous Mode to a patient study on the Nexus DR
imaging computer.
4. Exit Autonomous Mode.
Autonomous Mode
The wireless 2530W-G5, 4336W-G5, and 4343W can be used in Autonomous Mode with
Nexus DR to acquire images without a connection to the imaging computer or wireless access
point.
Overview
When the detector is placed in Autonomous Mode, the detector status indicator in Nexus
DR changes to indicate that the detector is disconnected from the system. During this time,
the detector is ready to acquire images. Images acquired with the detector while it is in
Autonomous Mode are stored on the detector until they are transferred into a patient study on
the Nexus DR imaging computer.
Figure 55: Autonomous Mode Use Cycle
The detector memory is limited to 500 images in Autonomous Mode. When the maximum
image threshold is exceeded, image acquisition is suspended until the number of files is
reduced by transferring them into a patient study.
Autonomous Mode is only accessible from Clinical Mode. If you attempt to enter Autonomous
Mode from Service Mode, the Enter Autonomous Mode icon is disabled.

3. Acquiring Images
Detector battery
Autonomous Mode is affected by the percentage of charge on the detector battery in the
following ways:
• If the battery is below 40%, you cannot enter Autonomous Mode.
• If the detector is already in Autonomous Mode, you can acquire images until the battery
is below 5%. When the battery is below 5%, image acquisition is disabled.
Table 15: Detector LED behavior in Autonomous Mode

Detector and battery status LED behavior
Detector is in Autonomous Mode, ready to acquire, and Blinking green and yellow. The LED continues to blink
with a battery charge equal to or greater than 40%. green and yellow when the battery charge is below 40%
until the battery is depleted.
Detector is acquiring an image. Solid green.
Warnings
Related information
See the following topics for instructions on using Autonomous Mode with Nexus DR:
• Entering Autonomous Mode on page 88
• Exiting Autonomous Mode on page 89
• Transferring images acquired in Autonomous Mode on page 89

3. Acquiring Images
Entering Autonomous Mode

To acquire images in Autonomous Mode, you must enter Autonomous Mode from the Panel
Status window in Clinical Mode.
Prerequisites
Before you begin this task, ensure that the following prerequisites are met:
• The detector battery must be charged to 40% or more of its capacity. If it is below 40%,
you cannot enter Autonomous Mode.
• The WiFi signal is less than or equal to -66dbm to enter Autonomous Mode.
• Any images already stored on the detector from a previous use of Autonomous
Mode must be transferred to the Nexus DR imaging computer into a patient record.
Autonomous Mode is disabled until all images from the past Autonomous Mode session
are transferred.
• Autonomous Mode is only accessible from Clinical Mode.
About this task

Important: Autonomous Mode is available only if it has been enabled in Settings Mode.
Procedure
1. In Clinical Mode, select Detector Status.
The Detector Status window opens.
2. Select the Enter Autonomous Mode button.
The button becomes grey and the detector is disconnected from the imaging computer.
The LED on the detector flashes orange.
You can now image patients. Images are saved on the detector.

3. Acquiring Images
Exiting Autonomous Mode

After you have captured images in Autonomous Mode, you must exit Autonomous Mode in
the Nexus DR application and transfer images into the appropriate patient to use the detector
again.
Procedure
1. In Nexus DR, select the detector status indicator.
2. Select the Exit Autonomous Mode button.
The button transitions to grey and the detector enters Transfer Mode. The detector status
displays, Not Ready.
The images must be transferred to the Nexus DR imaging computer before any images
can be acquired with the detector.
3. Transfer the images from the detector into the appropriate patient study.
See Transferring images acquired in Autonomous Mode on page 89.
Transferring images acquired in Autonomous Mode

After you have acquired images in Autonomous Mode, you must upload them from the
detector into the patient study in Nexus DR.
About this task

Procedure
1. In Clinical Mode, select the panel status indicator.
2. In the Panel Status window, select the Exit Autonomous Mode icon.
The panel is reconnected to Nexus DR and placed in Transfer Mode.

3. Open the patient study.

3. Acquiring Images
4. Select the shot from the list.

The Images on Panel window opens. The patient name and selected shot are displayed in
the top of the window. Images are shown under Select image to import.
5. Select the image that you want to transfer from the panel into the selected shot.
6. Click or tap OK.
The image is transferred to the list in the selected shot.
7. Repeat this procedure for the remaining images on the detector.

3. Acquiring Images
Adding views to an open study

To acquire images with Nexus DR, you must have a patient study open in Acquire Mode. You
can add views to a study, and then acquire the corresponding image, adding it to the study.
Prerequisites
Before you can add position profiles, open the desired study session. See Opening patient
studies on page 47.
Procedure
1. Click or tap the Add Position icon in the study information tile.
The position selection screen appears.

Figure 56: Study information tile
2. Select the Exam that contains the desired position.

3. To filter the list of Exams, click or tap the anatomical region in the blue body on the left.
(Figure 57 on page 91.)
4. Click or tap the desired positions.
The views you select appear on the shot list, to the right.
Figure 57: Adding positions to an existing study

3. Acquiring Images
5. To return the system to Acquire Mode, click or tap on the desired shot.
The system prepares the panel for acquisition and awaits exposure for the view selected in
the list on the right side of the screen.
Figure 58: Shot selected, ready to acquire
6. When you have completed the studies, click or tap the Close Patient icon, and select
Close from the pop-up menu.
Figure 59: Click or tap Close Patient and then select option from pop-up
respectively.

3. Acquiring Images
Suspending a patient study

You can suspend a patient study and return to it at a later time.
About this task

When you suspend a patient study, Nexus DR delays the auto-send action for DICOM images
and for MPPS messages until the next time the study is opened and closed.
Procedure
1. Click or tap Close Patient.
2. In the pop-up window, select Suspend.

Figure 60: Select Suspend
Nexus DR returns to the landing screen in the clinical view.

3. Acquiring Images
Closing a patient with an incomplete study

If necessary, you can close a patient with an incomplete study and complete the study at a
later time.
About this task

If you close a study before acquiring all the images in the work procedure, log a reason for
closure in the Close Patient window. This information is part of the DICOM MPPS data
provided to PACS.
Procedure
1. Click or tap Close Patient.
If the open study contains an incomplete work procedure, the Close Patient window
displays.
2. Select Close from the pop-up menu.
3. Complete one of the following actions:
Option Instructions
If MPPS is enabled: a. To continue with closure, select the reason from
the Discontinued Reason drop-down.
b. Mark the study completed, if accurate.
c. Click or tap Yes to close the patient record, or
click/tap No to return to the study.
If MPPS is not enabled: Click or tap Yes to close the patient record, or click/
tap No to return to the study.
Image rejection
After you save an image to a patient record, you can delete it only by deleting the entire study
in which it resides. When you determine that an image is unacceptable, mark it as rejected.
Rejected images are not archived or printed unless you specifically direct Nexus DR to include
them.
Rejecting an image does not remove it from the system. The image remains with the study
in Nexus DR until that study, or the patient record containing it, is deleted. You can accept a
rejected image into the study by removing the rejection marker from the image.
If your system is configured to log reject reasons, you will be asked to select or enter a reason
when you reject an image. These reasons are tracked in the logs of Nexus DR and can be
exported by a Superuser for analysis. These logs are often used in enterprise monitoring
programs designed to measure and improve the quality of patient care. To promote the
efficacy of such programs, select appropriate and accurate reasons when rejecting images
from patient records.

3. Acquiring Images
Rejecting images
You can reject images at any time after acquisition, including after the procedure has been
completed and the session closed. Similarly, you can accept a previously rejected image into
the study, regardless of when it was rejected or whether the session or study is closed.
Procedure
1. Open the study.
See Opening patient studies on page 47.
2. Select the image you want to reject in the list on the right side of the screen.
3. If the unacceptable image is not already displayed, click or tap the image in the list on the
right side of the screen.
4. Click or tap Reject Image next to the position name.
5. If your system is configured to log reject reasons, you will be prompted to select or enter a
reason for the rejection. If you are prompted for a reason, perform the following steps:
a)Select or enter a reason that most accurately reflects the issue that makes the image
unacceptable. and then complete one of the following actions:
• To cancel the rejection and close the reason window, click or tap X.
• To apply the rejection marker and record the selected reason, click or tap the
check mark.
6. The system automatically creates a new position to acquire a replacement image. Perform
one of the following tasks:
Close the patient without acquiring a replacement a. Click or tap Close Patient.
image.
b. Select Close from the pop-up menu.
Acquire a replacement image a. Verify that the replacement position profile is

selected.
b. Refer to Rejecting images on page 95.

3. Acquiring Images
Accepting an image that was previously rejected

When a you reject an image in error, you can remove the rejection marker. Once you remove
the marker, the image returns to its original place in the study. You can archive or print it like
any other image.
Procedure
1. Open the study and select the rejected image in the far right column.
Rejected images are marked with a red “X” over the thumbnail in the list of image. The
patient session opens with the rejected image displayed in Review Mode.
2. Click or tap Accept Image next to the position name in the list on the right side of the
screen.
The reject marker is removed. You can archive or print the image.

Chapter
4
Reviewing and Adjusting Images
Contents
• Prerequisites for adjusting images on page 98

• Basic adjustments to images on page 98
• Shutters and image size on page 109
• Adjusting Automatic Image Enhancement processing on page 116
• Showing or hiding the overlay on page 118
• Stitching images on page 119
• Reverting an image to the default appearance on page 123

4. Reviewing and Adjusting Images
Nexus DR offers a wide range of post-acquisition processing and review features that you can use
to adjust images before you print or archive them.
Nearly all of these tools are accessible from the Review toolbar. This chapter guides you through
the use of most of the post-acquisition review features of Nexus DR.
For information about measuring or annotating images, Measurements and Annotations on page
125.
Prerequisites for adjusting images

These prerequisites must be met before you can adjust images.
Prerequisites
To work with an image (make measurements, add annotations, print, archive, etc.), the study
containing the image must be open in review mode. Use one of the following methods for
opening a patient study in review mode:
• Open an existing patient study
• Acquire an image from the Worklist tab
• Acquire an image from the patient study
Basic adjustments to images

One of the primary advantages of digital imaging is the ability to change the appearance of
an image after you acquire it. Nexus DR provides many different ways to do this, from basic
brightness and contrast adjustments to complete reprocessing.
This section guides you through use of the basic image adjustments, such as brightness and
contrast (window and level), inverting contrast, and image orientation. You can also magnify
the image displayed on Nexus DR without changing the image sent to archive or printing. This
zoom and pan feature is useful when adding measurements to an image.

Adjusting window (contrast) and level (brightness)

Nexus DR provides the ability to adjust the contrast and brightness of images for improved
quality.
Prerequisites
See Prerequisites for adjusting images on page 98.
Procedure
1. Select the Window/Level icon in the toolbar.
The button is typically enabled by default. The icon is colored light blue when the feature is
enabled.
2. Place the pointer near the middle of the image area.
3. Left-click or touch and drag the pointer to adjust brightness and contrast.
Figure 61: Adjust the window (contrast) and level (brightness) of the image

Adjusting window level (brightness) — ROI

You can adjust the brightness of a specific region of interest (ROI) in an image using the
Window/Level ROI tool.
Prerequisites
About this task

Note: When an image has been rotated with the Free Rotation tool,
rectangles drawn with the Window/Level ROI tool are upright.
Procedure
1. Select the Window/Level ROI icon in the toolbar.
2. Place the pointer near the region of interest.

3. Click or tap and drag the mouse to draw a box around the region of interest.
A green box indicating the region of interest displays.
4. Release the mouse button or lift finger from touch screen.
The window (contrast) and level (brightness) of the image is optimized for the selected
ROI.
Figure 62: Draw a Region of Interest (ROI) on the image

Applying scatter correction with vSharp

Prerequisites
®
vSharp must be enabled in Settings Mode to be available in Review Mode.
About this task

vSharp is the scatter correction feature of Nexus DR. This post-processing feature can
temporarily change image quality by removing data from an image that is determined to be the
result of scatter radiation.
Typically, vSharp does not use a grid. Instead, it takes removes a portion of the data hitting the
panel using an algorithm during post-processing.
This feature can be enabled or disabled for the system, but it must be applied manually to
each image.
Procedure
1. Open the image that you want to apply vSharp® to.
2. Click or tap vS in the tool bar.
The progress bar is displayed until the scatter correction process is complete.
What to do next
After you have applied scatter correction, you can adjust the amount of correction applied. See
Adjusting vSharp scatter correction on page 102.

Adjusting vSharp scatter correction

After scatter correction is applied with vSharp®, you can further adjust the amount of scatter
correction applied by using the Alpha parameter in Advanced Image Processing.
Prerequisites
For more information about vSharp®, see Applying scatter correction with vSharp on page 101.
Procedure
1. Select vSharp® in the Acquisition Mode imaging controls toolbar.
Scatter correction is applied.

2. After scatter correction has been applied, select Advanced Image Processing from the
toolbar.
The Advanced Image Processing window opens to the Current Settings tab by default.
3. Slide the Alpha Parameter control to the left to reduce scatter correction or to the right to
increase scatter correction.
When you close and reopen the Advanced Image Processing window, the Alpha
Parameter slider position is maintained at the applied setting.

Inverting the contrast of an image

You can reverse the gray scale of an image using the Invert tool.
Prerequisites
Procedure
Click or tap on the Invert icon in the toolbar. The gray scale of the image reverses
immediately.
To return to the original contrast polarity, click or tap the same button again or click/tap the
Revert icon (curved blue arrow) to restore the image to its default appearance.
Enabling or disabling grid suppression

Prerequisites
About this task

Grid suppression can be enabled or disabled manually in Review Mode.
Procedure
Click or tap the Grid Suppression tool in the toolbar.

Rotating images using the Free Rotation tool

Use the Free Rotation tool to rotate images in predefined increments of .5° or 180°, freehand
to any desired degree, or by drawing a line on the image.
Prerequisites
Before you begin this task, ensure that the following requirements have been met;
• See Prerequisites for adjusting images on page 98.
• See Free Rotation on page 105 for information about the Free Rotation tools and
function.
About this task

Note: When entering Free Rotation, any zoom settings that have
been applied are removed.
Restriction: Free Rotation cannot be used on stitched images.
Procedure
1. Select Free Rotation from the imaging toolbar.
The Free Rotation window opens.
The Rotate 90 Degrees Left, Rotate 90 Degrees Right, Flip Left Right, and Flip Top
Bottom buttons are active and can be used when Free Rotation is selected.
2. Rotate the images using the tools in the Free Rotation window.
The exposed area of the image is fit-to-screen as it is rotated.

Free Rotation
Free Rotation is used to rotate an image incrementally or by dragging the image with a mouse
or with your fingers on a touchscreen.
Free Rotation allows you to rotate an image in predefined increments, freehand using a mouse
or touchscreen, or by drawing a line on the image. Selecting the Free Rotation button on the
imaging toolbar opens the Free Rotation window and displays the rotation tools. When tools
are active (selected), they are outlined in blue.
Note: When entering Free Rotation, any zoom settings that have
been applied are removed.
Restriction: Free Rotation cannot be used on stitched images.

Figure 63: Free Rotation window
Table 16: Free Rotation tools

Control Description
Rotate Left. Click or tap this button to rotate the image counterclockwise in .5°
increments.
Rotate 180 Degrees. Click or tap this button to rotate the image 180° from its current
position.
Rotate Right. Click or tap this button to rotate the image clockwise in .5° increments.

Control Description
Reset Free Click or tap this button to return the image to its previous 90° position that was passed
Rotation during rotation.
Rotate via Mouse/Touch. Click or tap this button to drag the image to the desired
degree of rotation using a mouse on a PC or your finger on a touchscreen.
Plumb and Level Tool. Clicking or tapping this button allows you to draw a line on the
image. The image rotates to align with the vertical or horizontal axis that is less than 45°
from the drawn line.
When a tool other than the Plumb and Level Tool is selected, vertical and horizontal
alignment indicators are displayed on the image. When the Plumb and Level Tool is selected,
the indicators are removed.
Figure 64: Free Rotation alignment indicators

Rotating images in 90-degree increments

You can rotate images in 90-degree increments as needed using the clockwise or
counterclockwise tools.
Prerequisites
Procedure
Click or tap the image rotation icons to rotate the image in 90-degree increments,
clockwise or counterclockwise, as desired.
Flipping an image
You can flip images horizontally or vertically as needed.
Prerequisites
Procedure
Click or tap the image flip icons to reverse an image across the center axis, horizontally or
vertically, as desired.

Using the Zoom Tool

You can magnify and pan across an image to examine it more clearly using the Zoom Tool
tool.
Prerequisites
About this task

Note: The Zoom Tool feature is strictly a magnification of the image
displayed on Nexus DR. It does not change the appearance of the
image sent to archive devices or printers.
The Zoom Tool is available when no other tools are selected. The pan feature is available
when an image has been zoomed in to.
Procedure
1. Magnify the image as desired:
Option Instructions
Zoom in or out on the image manually using a a. Place the cursor over the image.
mouse. b. Rotate the mouse wheel away from you to zoom
in or toward you to zoom out. The image pans
automatically to ensure that the portion of the
image beneath the cursor remains in view.
Zoom in or out on the image manually using a Place two fingers on the image and slide them away
touchscreen monitor. from each other on the screen to zoom in or toward
each other to zoom out.
Zoom in or out on the image using a preset a. Click or tap the Zoom Tool.
option.
The Zoom Tool sub-menu displays the Fit to

Screen tool and a selection of preset size ratios.
b. Select the desired magnification from the
submenu.
The image retains the last zoom level until you perform one of the following actions:
• Select a different image.
• Close the patient session.
• Open the Free Rotation tool.
• Rotate or flip the image.
2. After you zoom in on an image, you can pan around the image as needed:
• Using a mouse, place the cursor on the image, click and drag the cursor in the
desired direction.
• On a touch screen, place a finger on the image and slide it across the screen in the
desired direction.

3. To reset the zoom level of the image, complete one of the following actions.
• Using a mouse, double-click the image to apply fit-to-screen sizing.
• Using a touch screen, touch and hold to apply fit-to-screen sizing.
• Select the Zoom Tool to display the sub-menu, and select Fit to Screen.
Shutters and image size

Adjusting the size or shape of shutters will cut off any part of the image that is outside of the
shuttered area. Choosing to select a predefined image size or use Fit-to-Screen can affect the
amount of magnification applied to an image. Review this information before adjusting these
attributes.
By default, Nexus DR automatically detects the position of beam collimation and places a
rectangular boundary that aligns with the collimation. The image enclosed within the boundary
is subject to all the image processing functions of the software, while the area outside the
boundary is overlaid with black. This dark overlay is called the shutters.
By matching collimation, the shutters generally enclose a rectangular image by default. You
can adjust the size or shape of this rectangular area, or reset both the size and shape to any
area enclosed by up to 8 points. As with the default shutters, the area outside of the shape
defined by the points will be overlaid in black.
The size of the image displayed on the screen depends on your system configuration. Two
features can contribute to the size of an image: Fit-to-Screen (FTS) and the Image Size
dimensions. While FTS is the default behavior of the system, you can mitigate its effect on
images using predefined Image Size dimensions, which limit the amount of magnification
applied to the anatomy. The table below details the expected behavior with and without
predefined Image Size configuration. You must consider these expectations when making
adjustments to the shutters or image size.
Table 17: Effect of Predefined Image Size Function on Image Size

Predefined
Image Size Expected behavior of displayed image
Enabled The shuttered area is automatically centered within the predefined Image Size area,
which is then centered in the image area and scaled to the largest size that will fit in the
image area. Changing the shutter shape or size does not affect the size of the anatomy
in the image. However, shuttered area that is outside of the predefined Image Size area
is cut off.
Disabled The shuttered image is automatically centered in the image area and scaled to the
largest size that will fit in the image area. Changing the size or shape of the shutter
can affect the size of the displayed anatomy. Very small shutter areas, such as when
imaging fingers or toes, can result in dramatically enlarged anatomy as that small area is
enlarged to fit the image area.
Important: Any shuttered area outside of the configured Image Size is cropped from the
image and is not visible. Any such area will NOT be sent to archives or printers. If you cannot

reduce the size of the shutters to fit within the Image Size area, then you must increase the
Image Size dimensions to encompass the entire shuttered area
Prerequisites for adjusting shutters and image size

These prerequisites must be met before you can adjust the shutters or image size of an
acquisition.
These prerequisites apply to adjusting and replacing shutters, and changing the size of an
image.
Shutters and image size — controls and fields

Adjusting and replacing shutters, and changing the image size require the use of the tools and
image areas of the interface.
Shutters are adjusted in the image area using the Shutters and Image Size tools located in the
Crop window.
Figure 65: Shutter and ROI adjustment tools and components
Table 18: Shutter and ROI adjustment tools and components

Item Description
1 The edge of the detector active area is visible when adjusting image
size and cropping.

Item Description
2 Visible only when predefined Image Size is enabled on your system
and when image size is smaller than 14”x17”. Example shown is
11”x14”.
Defines the area of the “image”. Area outside of this border is cropped.
This is the area that will be scaled to fit the image area when you exit
the cropping tool.
The dimensions of this boundary are defined in the Image Size
settings. The boundary is automatically centered on the shutter area
(4). Image area between the Image Size boundary and the shutter
outline is filled black when you close the cropping tool.
3 The shading created by the collimator blades in the X-ray beam.

Visible only when the X-ray beam is collimated to a size smaller than
the active image area of the detector.
4 The outline of the digital shutters. All image area outside of this area
will become black when you exit the cropping tool. This shape can be
rectangular, as shown above, or any shape defined by up to 8 points
by using the polygon shutter mode.
Note: When using polygon shutter mode, do not position any part of
the shutter outline outside of the Image Size boundary. Only that area
of the image that is within BOTH the shutter outline and the Image
Size boundary will be displayed. For best results, position the shutter
vertex points first, then adjust the size of the image to encompass the
shutters.
When an image is rotated using the Free Rotation tool, the outline of the digital shutters
follows the borders of the image. The shutter can be moved and reconfigured using the
polygon shutter mode. When a new rectangular shutter is drawn, it is aligned with the screen
border.

Adjusting the shutters

The shutters on an image can be adjusted using the tools in the Crop window. The window is
displayed when you select Crop from the review toolbar.
Prerequisites
• See Prerequisites for adjusting shutters and image size on page 110.
• Review Shutters and image size on page 109.
Procedure
1. Click or tap Crop.
The Crop window is displayed. The menu contains the Shutters and (if enabled) Image
Size sub-menus. The appropriate shutter edit mode (rectangular or polygonal) selected by
default. The image area also changes to show the entire area of the detector, the yellow
outline of the current shutters, the shading of the collimator (if present), and the shading of
the image size boundary (if Image Size is enabled).
2. In the image area, click or tap on vertex points (yellow squares along the shutter outline)
and drag to reshape the shutter area. Repeat this step to reposition other points as
desired.
If predefined Image Size is enabled on your system, the shaded Image Size boundary will
also move as you position the new shutters.
3. If enabled, use the Width and Height drop-down menus to change the Image Size as
necessary.
4. If desired, click or tap the Recalculate EI button to update the Exposure Index value to
reflect the new shutter area.
You can recalculate EI if an abnormal value displays unexpectedly.

5. Click or tap Close.
The new shutter is applied.

Replacing the existing shutters with rectangular shutters

The existing shutters on an image can be replaced with rectangular shutters as needed.
Prerequisites
Procedure
2. Click or tap Clear Shutter.
3. Click or tap OK.

The existing shutter outline is removed from the image area. If predefined Image Size is
enabled, the shaded Image Size boundary will be centered in the image area until you
begin to place the new shutter.
4. Click or tap Rectangular Shutter.
5. In the image area, position the cursor where you’d like to place one corner of the rectangle
and click or tap at that location.
6. Move the mouse diagonally to position the opposite corner and click or tap again.
As you drag to create the rectangle, a preview outline illustrates the size of the new
shutters before you click or tap at the second corner position. If predefined Image Size is
enabled on your system, the shaded Image Size boundary will also move as you position
the new shutters.
7. If you need to adjust any vertex of the new shutter, click or tap the vertex you wish to move
and drag it to a new position, then release the mouse button.


Replacing the existing shutters with polygonal shutters

The existing shutters on an image can be replaced with polygonal shutters as needed.
Prerequisites
Procedure
2. Click or tap Clear Shutter.
3. Click or tap OK.

The existing shutter outline is removed from the image area. If predefined Image Size is
enabled, the shaded Image Size boundary will be centered in the image area until you
begin to place the new shutter.
4. Click or tap Polygonal Shutter.
5. In the image area, position the cursor where you’d like to place the first point, and click or
tap to begin the polygon outline.
6. Move the mouse to the next location and click or tap to place the point.
The preview outline updates in real time as you move the mouse to place points. You
can place up to 8 points. To complete a polygon with fewer than 8 points, double-click or
double-tap at the last desired vertex location. If predefined Image Size is enabled on your
system, the shaded Image Size boundary will also move as you position the new shutters.
7. If you need to adjust any vertex of the new shutter, click or tap the vertex you wish to move
and drag it to a new position, then release the mouse button.


Changing the image size

If enabled, you can use a predefined image size to adjust the size of an image. Predefined
image sizes can help offset the amount of magnification applied to an image by Fit-to-Screen.
Prerequisites
• The predefined image size must be enabled to complete this task.
About this task

Note: These instructions apply only when predefined image size is
enabled. The controls used in this section are not displayed in the
crop sub-menu when predefined image size is disabled.
Procedure
2. To change the width of the image, click or tap the Width drop-down menu and select a new
dimension.
The shaded boundary of the Image Size changes to reflect the new dimension.
3. To change the height of the image, click or tap the Height drop-down menu and select a
new dimension.
The shaded boundary of the Image Size changes to reflect the new dimension.
4. Review the new Image Size boundary.
Any area within the shutters that is NOT within the ROI will not appear in the image.
The new image size is applied.

Adjusting Automatic Image Enhancement processing

Automatic Image Enhancement (AIE) is a complex processing engine for DR imaging. An
image processed with AIE can be altered in two ways. Typically, you can move the slider in the
image processing sub-menu to make adjustments quickly and easily.
Prerequisites
About this task

In some cases, however, the contents, shape, or angle of the anatomy requires a completely
different set of processing parameters. In such cases, you may need to change the anatomy
profile to obtain the desired image quality.
Procedure
1. Click or tap the Advanced Image Processing icon.
2. In the Advanced Image Processing window, click or tap and drag the slider left or right to
adjust the image until you achieve the desired image appearance.
Figure 66: Adjust processing with the AIE Level slider
Move the slider left to soften AIE Level 0 (zero) provides a Move the slider right to
the image balance of contrast increase contrast
and blur details. and detail enhancement. and sharpen details.
(AIE Level -4 shown) (AIE Level 0 shown) (AIE Level 4 shown)
Note: Adjustments applied with the slider are applied immediately.

You are not required to manually save changes made with the
slider.

3. If the range of the slider is insufficient to obtain the desired image characteristics, see
Correcting insufficient slider range for AIE processing on page 117.
4. If the preview image displays properly, but the fully processed image appears all white or
all black, you may need to reprocess the image with the selected ROI. See Reprocessing
the image with the selected ROI on page 118.
Correcting insufficient slider range for AIE processing

When the range of the slider is insufficient to obtain the desired image characteristics, apply a
new profile for image processing.
Prerequisites
Procedure
1. Select the New Settings tab in the Advanced Image Processing sub-menu.
2. Select an alternate anatomical profile by selecting options from the Region, Exam, and
Position drop-down menus.
3. After selecting the new profile, click or tap Reprocess to apply the new profile to the
image. Repeat the process using different anatomy selections until the image appears as
desired.
4. When the image appears as desired, or nearly so, click or tap Save to add a copy of the
image, with the new processing, to the open study.
5. Optional: If desired, you can further refine the image by completing these steps:
a)Select the new image in the views listed on the right side of the screen
b)Click or tap the Advanced Image Processing icon in the Advanced Image
Processing window, and use the slider to further refine the image.

Reprocessing the image with the selected ROI

If the preview image displays properly, but the fully processed image appears all white or all
black, you may need to reprocess the image with the selected ROI.
Prerequisites
Procedure
1. Redraw the ROI in the desired shape (typically the collimated area) by clicking or tapping
and dragging the mouse on the image.
2. Click or tap Reprocess.
Nexus DR applies new image processing based on the manually drawn region of interest.
Showing or hiding the overlay

The Show/Hide Overlay icon at the bottom of the toolbar toggles display of the overlay
information configured in Service Mode. The Exposure Index (EI) and Deviation Index (DI)
values for the image display by default.
Prerequisites
Procedure
Click or tap the Show/Hide icon to toggle the overlay off and on.

Stitching images
Prerequisites
• Ensure that any composite images are created only from acquired images that have
been produced with the correct protocol. See About stitching on page 121 for
information about protocols and tips for stitching images.
• All of the images to be stitched must be acquired before stitching begins.
About this task

Two to four related images can be stitched together to create a composite image. After images
have been stitched together, the composite image can be saved and stored as a DICOM file
for further analysis.
Caution: Composite images should not be used for other diagnostic
purposes.
Caution: The algorithm for stitching reconstruction is specifically

designed for the series of images acquired. Therefore it should
never be used for reconstruction of other types of images or
other anatomical regions. In clinical practice, the reconstruction
or composite image is intended to be used only as an overview
image. Nexus DR takes no responsibility for the incorrect use of
the composite image, or for the use of a reconstruction method and
supported measurements.
Procedure
1. In the image list, select the first image in the stitching sequence.

2. Select Stitching.
The display area turns black.

3. You can stitch images in one of the following ways:
Option Instructions
Select Stitch Selected Step
The next position in the list is selected, and the first

image is shown in the display area.
Drag and drop images. Drag and drop images onto the display area to stitch
them. Each image in the sequence must be selected
manually.
Note: You can delete the last image that was added in the
sequence by clicking or tapping Remove Last Step in the stitching
toolbar.
Note: When manual stitching is enabled, the Add Selected Step

and Drag and drop images tools are disabled.
4. If necessary, select the next image in the sequence.

5. Select Add Selected Step.
The image is stitched to the first image.
6. Repeat steps 4 on page 120 and 5 on page 120 as necessary until all the desired
images are stitched.
Up to four images can be stitched together.
7. Make adjustments to the images as necessary.
See Stitching tools on page 122 for information about the tools available for adjusting
images.

8. If necessary, the position of the images can be adjusted.

a)Select the Positioning Tool.
The Adjust Position of Selected Images window opens. See Stitching tools on page
122 for information about the Positioning Tool.
b)Select the image to move.
c) Select the arrows to move the image to the desired position.
9. When stitching is complete, select Save.
Note: The stitched image is displayed at this point. This figure is

intended only to show the location of the Save icon.
After the stitched image is saved, it is displayed in the shot list.

10. Select Stitching to turn off stitching mode.
About stitching
With Nexus DR, a single composite image can be constructed from a series of X-ray images
specifically taken for this purpose. Composite images can be used for evaluating gross
anatomy, typically long anatomical parts such as extremities or the spine.
Caution: Composite images should not be used for other diagnostic
purposes.
Caution: The algorithm for stitching reconstruction is specifically

designed for the series of images acquired. Therefore it should
never be used for reconstruction of other types of images or
other anatomical regions. In clinical practice, the reconstruction
or composite image is intended to be used only as an overview
image. Nexus DR takes no responsibility for the incorrect use of
the composite image, or for the use of a reconstruction method and
supported measurements.
Acquisition protocol
A well-defined protocol must be followed when stitching images using Nexus DR because the
algorithm used to create a composite image assumes that the correct acquisition protocol has
been followed. It is not possible to determine whether all of the protocol requirements have
been met when stitching images, so it is the operator's responsibility to ensure that all of the
images used in the composite are acquired using the correct protocol.
Tips for acquiring images for stitching

Use the following tips for acquiring images for stitching. These tips address image variation
that cannot be addressed during the stitching process.

• Overlap acquisitions approximately 3cm to 7cm (1in to 2.8in).

• Use the same collimation for every image to be stitched.
• Limit or eliminate patient movement between acquisitions.
Stitching tools
Tool Description
Remove Last Step. Select this tool to delete the last image added to the stitching image
area.
Window Width & Level: Select this tool to adjust the contrast (window) and brightness
(level) of the image by dragging the mouse in the image.
This control reverses the polarity of the image.
Zoom Tool: This control allows you to change the scaling of the image displayed on the
screen.
Positioning Tool. Select this icon to display the Adjust Position of Selected Images
window. Click or tap the image to move in the preview pane of the window. Select the
arrows to move the selected image up, down, or sideways. The Revert button returns
the image to its original position.

Tool Description
Blend Method. Use this tool to adjust areas where the images of a composite image
overlap. Select this tool and select the desired option from the Blend Method Options
drop-down list:
Select the desired option from the list: A: Linear Interpolation: Blend using an absolute
difference value between two images. This option is designed to enhance the visibility of
misregistration during image adjustment. Note: It may help to adjust the window/level to
enhance the overlapped area. B. Minimum: Blend on a pixel-by-pixel basis by selecting
the least dense values from the two images. C. Maximum: Blend on a pixel-by-pixel
basis by selecting the densest values from the two images. D. Average.
Save. Select this icon to save your work.
Reverting an image to the default appearance

After making changes to the appearance of an image, such as window and level, contrast
reversal, rotation, or edge enhancement, you can return the image to its default appearance
with a single click or tap.
Prerequisites
About this task

The default appearance of an image is established when you view the image for the first time
during a patient session. This generally occurs when you acquire a new image in Acquire
Mode. When you revert an image to its default appearance, all changes applied during that
session are removed.
Procedure
Click or tap Revert at the top of the Review toolbar.


Chapter
5
Measurements and Annotations
Contents
• Prerequisites for measuring and annotating images on page 126

• Placing preset annotations on page 127
• Creating, reorganizing, and deleting preset annotations on page 128
• Placing custom text annotations on page 131
• Editing text annotations on page 132
• Deleting text annotations from images on page 133
• Placing custom pointers on page 134
• Editing custom pointers on page 135
• Deleting custom pointers on page 136
• Calibrating an image for measurements on page 137
• Measurements with two or more points on page 139
• Measuring length or width using two points on page 140
• Measuring distance using three or more points on page 142
• Measuring angles in an image on page 144
• Measuring Cobb angles on page 145
• Taking leg measurements on page 147
• Editing measurement annotations on page 150
• Deleting measurement annotations on page 152

5. Measurements and Annotations
Nexus DR provides annotation tools that allow you to place text and measurements on images you
acquire. You can place text quickly using predefined annotations or you can enter custom text with
the keyboard. Measurements can also be placed quickly by dragging and dropping them onto the
image in the desired location.
This chapter guides you through measuring and annotating images acquired with Nexus DR.
Prerequisites for measuring and annotating images

These prerequisites must be met before you measure and annotate images.
Prerequisites
To work with an image (make measurements, add annotations, print, archive, etc.), the study
containing the image must be open in review mode. Use one of the following methods for
opening a patient study in review mode:
Requirements for image calibration

When calibrating an image for measurement, ensure that the following information has been
reviewed and any prerequisites met:
• For best results, the image to be measured must be calibrated using the measurement
calibration tool.
• When calibrating an image for measurement, the selected image must contain an object
of known size, such as a lead marker or catheter. If the selected image does not contain
such an object, the default measurement dimension must be used.

Placing preset annotations

Preset annotations are text markers configured for frequent use. Nexus DR provides a set of
commonly-used predefined annotations, such as Left, Right, and positions such as Supine and
Decub (Decubitus). These annotations can be placed on an image as needed.
Prerequisites
See Prerequisites for measuring and annotating images on page 126.
About this task

Note: The default set of predefined annotations can be modified as
needed. See Creating, reorganizing, and deleting preset annotations
on page 128.
Procedure
1. Click or tap the Annotations icon.
The Annotations window displays.

2. Select the preset annotation.
If needed, scroll to see all options.
3. Click or tap and drag the annotation from the menu to the desired position in the image
area, then release the mouse button at the desired location.
4. To reposition the annotation, click or tap and drag the annotation to a new location.
Note: Annotations are saved automatically when they are placed
in the image area. You do not need to save new annotations.
Note: When images are rotated, annotations remain upright

regardless of the rotation of the image.

Creating, reorganizing, and deleting preset annotations

To customize the list of predefined annotations for your site, you can add annotations to the
list, re-organize existing annotations, or remove unused annotations.
Prerequisites
Procedure
Complete the following tasks as needed:
• Create a preset annotation
• Change the order of preset annotations
• Remove a preset annotation
Creating preset annotations

Annotations can be added to the list of preset annotations as needed.
Prerequisites
Procedure

Figure 67: Annotations window
2. Click or tap Edit.
The Preset Annotations list expands to include management buttons beneath the list.
3. Click or tap Add.
4. Enter the desired text.

Free text is allowed in annotations.
5. Click or tap OK.
The new text appears at the bottom of the Preset Annotations list.

Changing the order of preset annotations

The order preset annotations appear in the list can be changed to fit the needs of your site. For
example, it might be preferable to place the most commonly used annotations near the top of
the list or perhaps an alphabetical listing is preferred.
Prerequisites
Procedure

3. Select an annotation in the list.
4. Use the up and down arrows to move the selected item in the list.
Tip: Place annotations used most often near the top of the list for
easy access.

Deleting preset annotations from the list

When it is determined that a preset annotation is no longer needed, it can be removed from
the system; however, it remains in any images that it was previously placed in.
Prerequisites
Procedure

3. Select an annotation in the list.
4. Click or tap Remove.
The text no longer appears in the list.


Placing custom text annotations

When you need to place text that is not configured in predefined annotations, you can place a
custom text annotation. Custom annotations text markers are configured for a one-time use.
They are not added to the list of preset annotations. Custom text annotations can be up to 30
characters.
Prerequisites
Procedure

2. Click or tap the Custom Annotations icon.
The Custom Annotation text window displays.

Figure 68: Enter your custom annotation in the text box
3. Enter the desired text into the text box.

Free text is allowed in annotations. The new annotation appears at the center of the image.
4. Click or tap the plus (+) button to add the text to the image.
6. Click or tap and drag the new annotation to the desired location, and release the mouse
button.
Note: When images are rotated, annotations remain upright
7. Optional: Edit the font size, color, orientation, or position of the annotation.

Editing text annotations

The appearance of text annotations can be changed as necessary. The content of a text
annotation cannot be altered. Instead, it must be deleted and recreated.
Prerequisites
About this task

If the selected image does not contain an editable annotation, the buttons used in this
procedure are not available.
Procedure

2. Click or tap the annotation you wish to modify.
A border appears around the selected annotation. The Edit Annotations window appears.
3. Make the desired changes to the annotation text:
• Use the font size buttons to increase or decrease the size of the text.
• Select a color from the Pen Color drop-down menu.

• Select the annotation. Then, click or touch and drag the X marker in the top-right
corner of the border to rotate it.

Deleting text annotations from images

Text annotations can be deleted from images as needed.
Prerequisites
Procedure

Delete all text annotations from the image. a. Click or tap Delete All to permanently remove all
text annotations from the image.
A confirmation message is displayed.

b. Click or tap OK.
Delete the selected annotation from the image. a. Click or tap on the annotation.
b. Click or tap Delete.

c. Click or tap OK.
Note: Any measurements deleted in error must be recreated.

Placing custom pointers

Custom pointers can be placed, moved, and resized on an image as needed.
About this task

Text can also be added to custom pointers.
Procedure
1. In Review Mode, select Annotations from the toolbar.
The Annotations window is displayed.

2. In the Annotations window, select Add Pointer.
A text box is displayed on the screen with the pointer.

3. If desired, type text into the text box, and select OK. Otherwise, leave the box empty and
select OK.
If text was added to the box, text is added to the arrow, and achored to the end of the
pointer. If no text is typed into the box, the box does not display.
4. To move the arrow, hover over the middle of the pointer until the cursor changes, then click
or touch and drag the arrow to the desired location.
Figure 69: Cursor changes
5. To change the length or angle of the arrow, click and hold, or touch on one end of the
pointer and drag it to the size and angle desired.
Figure 70: Drag the pointer

6. Click or tap Save.

Note: When images are rotated, pointers maintain their position in
the image, and any text associated with the pointer remains upright
Editing custom pointers

Pointers can be edited after being placed on an image.
Procedure
1. Open the image containing the pointer you want to edit.
2. Complete the following tasks as desired:
Edit the size or angle of the pointer. a. Select the pointer.
b. Click or touch and drag the end of the pointer to
its new location.
Edit the text attached to the pointer. a. Double-click or double-tap the text box.
b. Edit the text as necessary.
c. Click or tap OK.
Remove the text. a. Double-click or double-tap the text box.

b. Delete the text.
c. Click or tap OK.
Move the pointer and text. a. Select the pointer.

b. Hover over the middle of the pointer.
c. Click or touch and drag the pointer to its new
location. The text box moves with the pointer.
Move the text independently of the pointer. a. Hover over the text box or touch the text box until
the cursor changes.
b. Click or touch and drag the text box to its new
location. The pointer does not move with the text.
3. When you have completed your edits, select Close in the Annotations window.

Deleting custom pointers

Pointers can be deleted from images if necessary.
Procedure
1. To delete the pointer, ensure that it is selected in the image, and select Delete in the
Annotations window.
Figure 71: Pointer selected
The following message is displayed:Are you sure you want to delete this
annotation?
2. Select OK.
The pointer is deleted from the image.

Calibrating an image for measurements

Nexus DR has the ability to improve the accuracy of measurements by calibrating to an object
of known size, and then using the calibration in its measurement tools.
Prerequisites
About this task

By default, measurements made in images acquired in Nexus DR use the physical
characteristics of the detector to approximate distances. Due to geometric magnification
inherent to the X-ray beam, default measurements based on the detector can include a
significant degree of error.
To improve the accuracy of measurements, you can calibrate Nexus DR to an object of known
size in the image, such as a lead marker or catheter. The measurement tools will then use
this calibrated value to approximate image measurements. The calibration will automatically
update any distance measurements in the image that were made prior to calibration.
While calibration can improve the accuracy of measurements in Nexus DR, all measurements
made in Nexus DR remain approximations due to variations in the X-ray beam, user
placement of measuring points, and positioning of the anatomy.
Note: In order to achieve accuracy , you MUST calibrate to an object
in the image. See APPENDIX A. Nexus DR Measurements Accuracy
for measurement accuracy information.
Procedure
1. Click or tap the Measurement Ruler icon in the toolbar.
The Measurement sub-menu displays.
2. Select the Calibrate tab.

3. In the image area, click or tap on one edge of the calibration object, such as a lead marker
or catheter.
4. Move the mouse to the opposite edge of the object and click or tap again to create a line
that represents the known dimension (e.g. width, length, diameter).
A line appears between the two points you identified, and the Value input in the
Calibration tab appears near the line.
5. Set the reference distance using one of the following methods:
• For calibrating to a catheter, select the French unit in the calibration sub-menu and
enter the size of the catheter into the Value field.
• If you are calibrating to any other object, set the Unit option to “mm” (millimeters) and
enter the known dimension of the object into the millimeters field.
Figure 72: EXAMPLE: Calibrating an image for measurements
In this example, the diameter of the circle in the technologist’s lead marker is known
to be 20mm. Using the calibration tool, click or tap on the two points identified in
the inlay to create a line across the diameter of the circle. In the Set Calibration
window, enter 20mm as the reference distance. The image is now calibrated for
measurements.
6. Return to the Measure tab to perform measurements on the image.

Measurements with two or more points

Simple, straight-line measurements can be made using a two-point measurement. For more
complex shapes, a multipoint measurement approach might be preferable.
The 2-point measurement creates a straight line from one
point to the other, while the multipoint measurement creates
segments between the points and provides a total distance.
Both methods use the default reference distance based
on the detector or, if the image has been calibrated, the
reference distance set with the measurement calibration tool.
In order to achieve accuracy , you MUST calibrate to an object in the image. See APPENDIX
A. Nexus DR Measurements Accuracy for measurement accuracy information.
For information about measurement calibration, see Calibrating an image for measurements
on page 137.
Note: When images are rotated, measurement lines rotate with
the image. If the text associated with the lines is manually rotated, it
will rotate with the image. Text that is not manually rotated remains
upright when the image is rotated.

Measuring length or width using two points

Use the 2-point mode to measure a simple dimension, such as length or width. The 2-point
measurement provides the distance between a starting point and an end point.
Prerequisites
• See Prerequisites for measuring and annotating images on page 126.
• See Measurements with two or more points on page 139.
About this task

To measure complex dimensions such as the length of a curved object or a circumference, see
Measuring distance using three or more points on page 142.
Procedure
2. Click or tap the 2-point Measurement icon, if not selected by default.

The button is highlighted with blue when enabled.
3. In the image area, click or tap on a location to set the starting point.

4. Move the mouse to another location and click or tap again to set the end point.
A line appears between the two points you identified, and the calculated distance is
displayed next to the starting point.
Note: Measurements are saved automatically when they are
placed or edited. You do not need to save new measurements or
changes to existing measurements.
the image. If the text associated with the lines is manually rotated,
it will rotate with the image. Text that is not manually rotated
remains upright when the image is rotated.
5. If you need to reposition the measurement text, click or tap on the text and drag it to a new
location near the associated line.
6. Edit the points of the measurement line, or change the color of the line and text for better
visibility.

Measuring distance using three or more points

Use the multipoint mode to measure a complex dimension, such as the length of a curved
object or the circumference of an object. The multipoint measurement provides a total distance
between a starting point and an end point, passing through midpoints.
Prerequisites
• See Prerequisites for measuring and annotating images on page 126.
• See Measurements with two or more points on page 139.
About this task

To measure a simple dimension with the 2-point mode, see Measuring length or width using
two points on page 140.
Procedure
2. Select the Multipoint icon.

4. Click or tap at new locations to create mid-points along the path you wish to measure.
You may create up to 6 mid-points to measure the desired path.

5. Double-click or double-tap to create the end point of the measurement.

The total distance from the starting point to the end point, through all midpoints, displays
next to the starting point.
location near the associated line.
7. Optional: Edit the points of the measurement line, or change the color of the line and text
for better visibility.

Measuring angles in an image

You can use the angle measurement tool to approximate angles in Nexus DR.
Prerequisites
About this task

This tool uses a 3-point line to represent an angle and displays the internal angle in degrees
next to the midpoint.
Procedure
2. Select the Angle Measurement icon.

4. Click or tap at a new location to create the mid-point, or vertex, of the angle.

5. Click or tap at the final location to create an angle with the two line segments.
The angle measurement displays next to the vertex.
location near the angle.
7. Edit the points of the measurement line, or change the color of the line and text for better
visibility.
Measuring Cobb angles

About this task
Nexus DR provides the capability to measure Cobb angles for patients with or suspected of
having scoliosis.
Procedure
1. Click or tap the Measurement Ruler icon in the toolbar. Click or tap the Measurement
Ruler icon in the toolbar.
2. Select the Cobb Angle icon.
3. Click or tap on the image and draw the first segment of the angle.

4. Click or tap on the image again and draw the second segment of the angle.
The degree of curvature is displayed on the image.
5. Repeat steps 3 on page 145 and 4 on page 146 as necessary to draw additional
angles.
The lines for each angle are displayed differently. See A (solid lines), B (dotted lines), and
C (dashed lines) in the following image.
Figure 73: Image with three Cobb angles: A, B, and C
6. If possible, you can include the apex of the angle on the image by clicking or tapping an
end point of the first segment and dragging the mouse to draw the second segment to the
desired angle.
Figure 74: EXAMPLE ONLY: Note: Measurements are saved automatically

Cobb angle on image when they are placed or edited. You do not
need to save new measurements or changes to
existing measurements.
Note: When images are rotated, measurement
lines rotate with the image. If the text associated
with the lines is manually rotated, it will rotate
with the image. Text that is not manually rotated

Taking leg measurements

Prerequisites
Review Important areas, length, and angles for leg measurements on page 149.
About this task

To create a leg measurement, define the most important areas and then create tangents. The
measurements are displayed on the screen.
Procedure
2. Select the Leg Measurement icon.
3. Click or tap the center point of the head of the femur.

Point A is placed where you clicked or tapped.
4. Drag the mouse to the center point of the neck of the femur and click or tap.
Point B is placed on the image, and a line is drawn between the first and second points.
5. Drag the mouse to the center point of the kneecap and click or tap.
Point C is placed on the image, and a line is drawn from the neck of the femur to the
kneecap.

6. Complete one of the following steps as needed:

Add point D to the image and add tangent lines to a. Drag the mouse to the center point of the ankle
the measurement. and click or tap once.
Note: Clicking or tapping twice
completes the measurement
and additional lines cannot be
added.
b. Proceed to the next step.
Add point D to the image and complete the Drag the mouse to the center point of the ankle and
measurement without adding tangent lines. click or tap twice. Point D is added to the image, and
a line is drawn from the kneecap to the ankle. The
measurement is complete.
7. Click or tap point C and drag the mouse to draw a segment at a tangent to the bottom of
the femur.
The tangent line is placed on the image.
8. Click or tap point C again, draw a segment at a tangent to the bottom of the tibia.
The tangent line is placed on the image.
9. To adjust points, click or tap and hold on a point, and drag it to the new location.

Important areas, length, and angles for leg measurements

The leg measurement feature enables you to measure the length and angles of the legs in
relation to specific anatomical points of the legs.
Table 19: Anatomical points

Point Anatomy Leg diagram
A Center of the femur head
B Center of the femur neck
C Center of the knee
D Center of the ankle
Segments
Tan1 Femoral tangent
Tan2 Tibial tangent
Table 20: Length measurements

Axis Description
A-B Axis of the femur neck
B-C Anatomical femoral axis
C-D Anatomical tibial axis
A-C Mechanical femoral axis
A-D Mechanical femoral axis
Table 21: Angle measurements

Angle Description
Alfa 1 Angle between A-B and B-C
Alfa 2 Angle between B-C and Tan1
Alfa 3 Angle between A-C and Tan1
Alfa 4 Angle between B-C and C-D
Alfa 5 Angle between A-C and C-D
Alfa 6 Angle between A-C and Tan2

Editing measurement annotations

After creating a measurement annotation, you can edit the length of the line, the position of
mid-points (multi-point and angle measurements only), or the color of the measurement line
and text.
Prerequisites
About this task

For information about editing text and pointer annotations, see Editing text annotations on
page 132.
If the selected image does not contain an editable annotation, the buttons used in this
procedure are not available.
Procedure
2. Click or tap on the measurement.

A border appears around the measurement text, and orange dots mark points in the
measurement.


Move a point in a measurement. Click or tap on the point and drag it to a new location.
The measurement is automatically recalculated after
you reposition a midpoint or endpoint.
Move the line of a measurement. Click or tap on the line and drag it to a new location.
The line and the measurement text are moved
together. The length or shape of the measurement
and the distance or angle measured remain
unchanged.
Improve the visibility of a measurement. Change the color of the line and text by selecting the
desired color from the Pen Color drop-down menu.
Increase or decrease the measurement font size. Click or tap the Increase or Decrease buttons.
Measurements are saved automatically when they are placed or edited. You do not need to
save new measurements or changes to existing measurements.

Deleting measurement annotations

Measurement annotations can be deleted from images as needed.
Prerequisites
Procedure

Delete all measurement annotations from the a. Click or tap Delete All to permanently remove all
image. measurement annotations from the image.

b. Click or tap OK.
Delete the selected annotation from the image. a. Click or tap on the annotation.
b. Click or tap Delete.

c. Click or tap OK.
Note: Any measurements deleted in error must be recreated.
Note: Deleting measurements does NOT delete or remove the

measurement calibration, if performed.

Chapter
6
Archiving and Printing Images
Contents
• Prerequisites for archiving and printing images on page 154

• Archiving images on page 155
• Printing images on page 162
• Reviewing and controlling the DICOM queue on page 177

6. Archiving and Printing Images
Nexus DR provides image acquisition and processing features, but it does not provide long-term
storage of patient or image data. Consequently, Nexus DR includes a set of DICOM features that
you will use to send patient studies to various devices for review and archiving.
Note: If your service provider has not installed an archive or printing
device on your system, the icons discussed in this section may not display
and you may not have access to the associated functions.
Prerequisites for archiving and printing images

These prerequisites must be met before you can archive or print images.
Prerequisites
• The study to be archived must contain at least one valid image.
• Any post-acquisition processing, annotations, or measurements must be complete
• If you are using Urgent Send or any other method in which you are archiving images to
a DICOM server, a DICOM server must be configured for the Nexus DR system.
• If you are archiving the study to a USB storage device, the device must be connected to
a USB port on the Nexus DR imaging computer and, if necessary, powered up.
• If you are exporting images to CD or DVD media, insert a blank disc into the optical drive
of the computer.
• Review Archive — controls and fields on page 156 before archiving images using a
method other than Urgent Send.
Requirements for printing images

• Any post-acquisition processing, annotations, or measurements must be complete.See
Measurements and Annotations on page 125.
• If you are printing images, verify your DICOM printer is available. Your printer must be
installed and configured in Settings Mode during system setup.

Archiving images
Nexus DR provides DICOM functions for sending images to various devices for archiving in a
variety of ways.
Prerequisites
See Prerequisites for archiving and printing images on page 154.
About this task

Nexus DR provides several different ways to archive images:
• Archive all unsent images in a study using the Urgent Send feature.
• Archive all images in a study.
• Archive a group of patient records.
• Archive specific images in a study.
The images can be sent to multiple network archive devices, CD or DVD media, a USB device,
or a local directory on the Nexus DR computer. A DICOM viewer is exported with the images
exported to a CD/DVD or USB storage device.
Procedure
Archive all unsent images in a study using the See Archiving all unsent images in a study on page
Urgent Send feature. 158.
Archive all images in a study. See Archiving all images in a study on page 158.
Archive a group of patient records. See Archiving a group of patient records on page
160.
Archive specific images in a study. See Archiving specific images in a study on page
161.

The Next icon is located to the right of the Archive icon.
The Archive Patient Images window appears.

4. In the Network Destinations area, select one or more DICOM storage servers.
The archive job is sent to all selected network destinations.
5. Click or tap OK.
You will return to the Patient List.

6. Click or tap the DICOM Queue icon near the logo at the top of the screen.
The DICOM Queue status window opens. The DICOM Queue status window can be
opened at any time.
Archive — controls and fields

Nexus DR provides a number of optional features when exporting images. Most of the options
are available only when exporting to a local directory or optical media.
The table below details the controls found in the Archive Patient Images window.
Table 22: Options available for network, media, and local export jobs
Area Field/Control Availability Description
Network All All configured network DICOM
Destination servers are displayed in this area.
One or more servers can be
selected as the destination of the
archive job.
Media Location Local and USB drives Defines the specific path where
Destination and media the export job will be saved.
By default, the path is the root
directory of the device selected.
Click or tap Browse to the right
of the field to navigate to the
desired path, if other than the root
directory.

Area Field/Control Availability Description

Export as Local and USB drives Controls whether image
and media processing is applied to the
exported images.
In nearly all clinical cases, images
will be exported “Processed”,
such that all applicable image
processing is applied during
the export. Unprocessed export
is generally required only for
certain kinds of service or
troubleshooting.
All jobs sent to network archive
devices are exported as
Processed.
Anonymize Patient Local and USB drives Removes patient information

Data and media during the archive job.
When this option is turned on,
all personally identifiable patient
information is replaced with
unique, random alphanumeric
values. This removes all traces
of the patient’s identity from the
images sent to the destination
device.
Jobs sent to network archive
devices cannot be anonymized.
Export rejected images Local and USB drives Exports only those images in the
only and media archive job that are marked as
rejected.
This option is available only when
the archive job contains at least
one rejected image.
Rejected images cannot be
exported to network archive
devices.
Close Media? Optical media Enable to close media upon

completion of archive.
If you close the media, you cannot
add patient records or images
to it later. Use this option when
the you are ready to identify the
patient on the disc label to ensure
that no other patient images or
data are written to the disc later.
Eject Media? Optical media Enable to eject media upon

completion of archive.

Archiving all unsent images in a study

Nexus DR provides several different ways to archive images. This section guides you through
sending all unsent images in a study to the DICOM server from Review Mode.
Prerequisites
See Prerequisites for archiving and printing images on page 154.
Procedure
After all of the prerequisites for archiving the images are met, click or tap the Urgent Send
icon in Review Mode.
Nexus DR sends all unsent images and all images that were reprocessed since last sent to
all default DICOM servers. Multiple DICOM servers can be configured as default servers.
Archiving all images in a study

Procedure
2. Select the study to be archived.
3. Click or tap the Archive icon in the Patient List controls.
The selected study, and its associated patient record in the left column, are marked with a
light blue icon similar to the export icon. This icon indicates that the records are marked for
export.

5. Export the images using one of the following options:

Export to a network DICOM storage device. a. In the Network Destinations area, select one or
more DICOM servers as the destination for the
archive job. The archive job will be sent to all
selected network destinations.
b. Click or tap OK. You will return to the Patient List.
Export to a local drive or media. a. In the Media Destination area, select the radio
button for the drive, media, or USB drive as the
destination for the archive job. Only one media
destination can be selected at a time.
b. Click or tapBrowse and navigate to the directory
where the archive is to be stored.
c. Complete the rest of the fields as needed. See
Archive — controls and fields on page 156.
d. Click or tap OK. You will return to the Patient List.
opened at any time.

Archiving a group of patient records

Procedure
1. Select the first patient record for archival.
2.
Click or tap the Archive icon in the Patient List controls.
3. Select additional patient records until all desired patients are marked with the blue archive
icon in the top right each patient tile.

In the Media Destination area, select the radio a. In the Media Destination area, select the radio
button for the drive, media, or USB drive as the button for the drive, media, or USB drive as the
destination for the archive job. Only one media destination for the archive job. Only one media
destination can be selected at a time. destination can be selected at a time.
opened at any time.

Archiving specific images in a study

Procedure
2. Select the study to be archived.
3. Click or tap the Archive icon in the Patient List controls.
The selected study will be marked for archival, but this mark is removed when you
select a specific image for export.
4. Click or tap on each image you wish to archive from the study. Each selected image tile
displays a small blue icon in the upper-right corner.

Export to a local drive or media. a. In the Media Destination area, select the radio
button for the drive, media, or USB drive as the
destination for the archive job. Only one media
destination can be selected at a time.
opened at any time.

Printing images
Previewing images before sending them to the DICOM printer allows you to see how images
will print, select the print settings, and add or remove images from the print job.
Prerequisites
• See Prerequisites for archiving and printing images on page 154.
• A printer must be configured on the Nexus DR system.
• See Print Preview area on page 163 for information about the settings in the Print
Preview area.
About this task

Nexus DR allows you to print images, from Review Mode, on a DICOM printer. You can also
preview the images before you print, set up print options, and then add or remove images from
the preview. After you set up the DICOM print job, send it to the DICOM printer. You can view
its progress in the DICOM queue.
Procedure
1. Select an item in the shot list.
2. Select Print Preview.
Note: This icon is available only if the Nexus DR system includes

a configured printer.
3. Select Printer Settings.
4. In the Printer Settings window, set the following parameters: printer, film size, orientation,
layout, and copies.
The print preview area displays updates to match the settings.

6. Add images to the Print Preview area.

Option Instructions
Add the image that is selected in the study shot Select Add Selected Step.
list.
. The image is added to the Print Preview area.

Add all of the images in the study. Select Add All Images.
Drag and drop images onto the Print Preview Select an image and drag it onto the Print Preview
area. area.
7. Make any other adjustments as necessary.

8. Select Print.
The DICOM Queue icon turns green when the print job is in the queue.
See DICOM queue controls and fields on page 180 and Reviewing and controlling the
DICOM queue on page 177 for additional information about the DICOM queue status
window.
Print Preview area

When a printer is configured on the Nexus DR system, the Print Preview area is available for
setting print parameters and printing images.
The Print Preview area is displayed when you select the Print Preview button from the tools at
the bottom of the study shot list.
Note: The Print Preview button is only available when a printer is
configured on the Nexus DR system.
Figure 75: Print Preview button in Review Mode
After the Print Preview button has been selected, the Print Preview area is displayed and the
button remains highlighted.
Figure 76: Print Preview button in the Print Preview area

Selecting the Print Preview button again closes the Print Preview area.
If the images have not been printed, Nexus DR displays a warning and allows you to print or
discard the images, or cancel and return to the Print Preview area.
Figure 77: Print Preview Warning
Figure 78: Print Preview area with images
Table 23: Print headers

Header Description
At the top of the film, a header with three lines is The three lines display the following information if
displayed. available: site name, patient name, patient ID, and
patient date of birth.
At the top of each tile, a single header line is displayed. This header contains the date and time of the study and
the technique values if available.

Table 24: Print Preview tools

Control Description
Page selection drop-down list. When the images in the Print Preview
area span multiple pages, navigate between them by selecting the
desired page from the drop-down list.
Default Printer Settings. Select this button to display the Default

Printer Settings window. The window contains the Printer, Film Size,
Orientation, Layout, and Copies settings. See Figure 79 on page
167 for information about the controls in this window.
Remove Image. Select this button to remove the selected image from
the Print Preview area.
Remove All Images. Select this button to remove all of the images
from the Print Preview area.
Add selected step. Select this button to add the image selected in the
study to the Print Preview area.
Add All Images. Select this button to all all of the images in the study
to the Print Preview area.
Orientation. Select this button to change the page orientation from

portrait to landscape or vice versa.
Layout. Select this button to select the page layout to use.
When Custom Print is the selected layout, the Customizable Page

Tools icon is available in the toolbar. When you select it, the Remove
Selected Tile, Clear Page Layout, and Save Layout buttons are
displayed next to the toolbar. Note that Remove Selected Tile is
active only when a tile is selected.
Remove Selected Tile removes the selected tile from the layout. A
tile must be selected for this button to be active. Images in the tile are
also removed. Tiles remaining in the layout after the tile is removed
are resized as needed to use the space vacated by the removed tile.

Control Description
Clear Page Layout clears the page layout and removes the images in
the layout. This button is active only when the custom layout option is
selected in the Layout menu.
Save Layout saves the custom layout and makes it the default
custom layout going forward.
Film Size. Select this button to select the film size to use.
Rotate 90 Degrees Left. Select this button to rotate the selected

image on the page 90° to the left (counterclockwise).
Rotate 90 Degrees Right. Select this button to rotate the selected
image on the page 90° to the right (clockwise).
Zoom In. Select this button to make the selected image larger on the
page. You may also pan a zoomed image by clicking or touching and
dragging on a specified area.
Zoom Out. Select this button to make the selected image smaller on
the page.

Control Description
Print. Select this button to print the contents of the Print Preview area.
Figure 79: Default Printer Settings options
Table 25: Default Printer Settings controls

Control Description
Printer Select the printer you want to use. This drop-down list contains all the printers
configured for use with the Nexus DR system. If a default printer is configured, it will
appear first in the list.
Film Size Select the desired film size from this drop-down list. The list contains all of the film sizes
configured on the Nexus DR system. The file size can be set per image.
Orientation Select the Landscape or Portrait icon to set the orientation of the printed image. The
initial orientation is configured in Settings Mode.
Layout Select the desired layout for the printed images. Select the Custom Layout icon to
customize the page layout. All other layouts are fixed.
Custom Layout icon:
Layouts can be selected per page.

Copies Click or tap the - (minus) or + (plus) button to increase or decrease the number of copies
to print. You can also type the number into the number field.

The Print Preview shot list displays the list of images from the study that can be printed. A
printer icon displayed on the shot indicates that the image has been added to a page for
printing.
Figure 80: Print Preview shot list
Note: When the option, Display Scaling on Print is enabled in

Settings Mode on the DICOM > Printer tab, a ruler 10cm long is
displayed on the image when it is printed. Each centimeter is marked
on the ruler. For layouts with multiple images, each image has its own
ruler. If an image is less than 10cm wide, the ruler's width is reduced
to the largest number of whole centimeters that will fit on the image.
Figure 81: Example: Ruler on printed image

Zooming and panning on images settings

You can zoom in or out, or pan images in your print layout.
About this task

The zoom and pan settings of the existing image are reset when a tile is divided by drag and
drop, or when switching between layouts. Image rotation always remains the same when
changing the size of an image.
When a tile is removed, then zoom and pan are reset in all tiles that change in size,
When tiles are resized by moving a divider, changing the film size, or changing the film
orientation, the current Zoom settings are kept, and the image position is changed to fit the
available space. If a divider is moved a significant distance, you may see images moved in
unexpected ways.
Procedure
• To zoom in on an image, use one of the following methods:
Zoom tool 1. If there are multiple images on the page, select
the image you want to zoom in or out on.
2. In the Print Preview tool bar, click Zoom In to
zoom in or Zoom Out to zoom out.
Mouse wheel 1. Click on the image you want to zoom in or out

on.
2. Roll the mouse wheel toward you to zoom out or
away from you to zoom in.
Touchscreen 1. Place two fingers on the image you want to

zoom in or out on.
2. Move your fingers toward each other to zoom in
or away from each other to zoom out.
• To pan an image in a print layout:

Option Instructions
Mouse 1. Click and hold on the image.
2. Move the mouse in the desired direction. The
image moves with the mouse.
Touchscreen 1. Touch the image.

2. Slide your finger in the desired direction. The
image moves with your finger.

Selecting tiles
To perform certain tasks on a single image in a print layout, you must select the tile the image
is in.
About this task

Selected tiles are surrounded by a solid green border.
Figure 82: Tile selection
Procedure
Select a tile in one of the following ways.
• Tap or click on the tile you want to select.
• Drag and drop an image into the tile. The tile is selected automatically. If an image
is already in the tile, the image is replaced when you drag and drop a new image on
top of it.
Adding images to print layouts

Images can be added to print layouts in several ways.
About this task

Note: For custom print layouts, a maximum of 9 images per row and
9 images per column can be added to a page. Images must be 10%
of the film size or greater. When adding an image would result in the
image being less than 10% of the film size, no more images can be
added to the page layout.

Procedure
To add images to a print layout, use one of the following methods:
Add the selected step to the print layout. a. Select the step in the shot list.
b. In the Print Preview toolbar, select Add Selected
Step. The image is added to an empty tile. If all
the tiles are in use, the image is placed on a new
page. The new page uses the default print layout.
Add all of the images in the shot list to the print In the Print Preview toolbar, select Add All Images.
layout. All images are added to the layout. If the layout
contains images, the new images are added to empty
tiles on the page. If there are no empty tiles or if there
are more images than available tiles, new pages are
created as necessary to accommodate the images.
The new pages use the default print layout.
Drag and drop an image onto the print layout. Select an image in the shot list and drag and drop it
onto the layout.
If you drop it on an image that is already in the layout,
the image is replaced. If you drop it on an empty
tile, it is added to that tile. For custom print layouts,
new tiles are created where you drop the image. The
divider lines are displayed so you can see where
the image will be placed when you drop it. If adding
the image will result in any of the images already in
the layout being resized to less than 10% of the film
height or width, drag and drop is not allowed.
Click or tap an image in the shot list to add it to Double-click or double-tap an image in the shot list
the print layout. to add it to the page layout. The image is added to
an empty tile. If all the tiles are in use, the image
is placed on a new page. The new page uses the
default print layout.

Resizing image tiles in custom print layouts

The dashed lines displayed in custom print layouts can be dragged to resize image tiles on the
page.
About this task

When touched, or hovered over with a mouse, the line is highlighted. Image size is scaled up
or down as appropriate. Images cannot be scaled to less than 10% of the film width or height.
Figure 83: Custom print layout page dividers
Procedure
Use one of the following methods to adjust a page divider.
Vertical lines can be dragged left or right. Horizontal lines can be dragged up or down. If
moving a divider would result in any image being less than 10% of the height or width of
the film, the divider cannot be moved.
Option Instructions
Using a mouse a. Hover over the dashed line until is highlighted.
b. Click and drag the line to the desired position.
Using a touchscreen a. Touch the dashed line. It should become

highlighted.
b. Slide your finger across the screen until the line is
in the desired position.

Saving custom print layouts

A custom print layout can be saved as the default custom layout for future use.
Procedure
1. After you have created your custom layout, click Customizable Page Tools (A) > Save
Layout (B).
The page layout is saved. When a new custom page layout is created, the saved layout is
displayed by default.
2. Click Customizable Page Tools to close the toolbox.
Removing images from print layouts

Images can be removed from pages in the Print Preview window.
Procedure
1. Select the tile that contains the image you want to remove.

2. Use one of the following methods to remove images from the pages.
Remove a single image from a page. When a single image is removed from a layout, the
image is removed, but the tile remains.
In the Print Preview toolbar, select Remove Image.
Remove all images from all pages. When all images are removed from page layouts, all
of the images, tiles, and page layouts are removed.
The remaining page displays the default page layout.
In the Print Preview toolbar, select Remove All
Images.
Removing tiles from custom print layouts

Tiles can be removed from custom page layouts in the Print Preview window. Tiles can be
removed only when two or more tiles are present on the page.
Prerequisites
Two or more tiles must be present on the page to remove a tile from a custom print layout.
Procedure
1. Select the tile to be removed.
2. From the Print Preview toolbar, select Customized Page Tools.
The Customized Page Tools toolbox is displayed.
3. Select Removed Selected Tile.
The tile is removed. If contains an image, the image is also removed.

After a tile is deleted, the space is occupied by the tile to the left or to the top. If there is no
tile to the left or top, the space is occupied by the tile to the right or bottom.

Changing the selected print layout

In the Print Preview area, you can switch between a customizable and a fixed layout. If there
are images on the page, they are placed in the new layout.
About this task

If the new layout has fewer tiles available than needed for all of the images, new pages are
created as needed. When changing from a fixed to a customizable layout, the largest tile will
be filled first, then the next largest tile, and so on in descending order of size.
Procedure
Change the print layout using one of the following methods:
Option Instructions
To change the print layout in the Default Printer If the page contains images, a new page is added
Settings. with the newly selected page layout applied. The
layout of the original page is unchanged. For pages
that do not contain images, the layout of the page is
changed without adding a new page.
a. Select Default Printer Settings from the Print
Layout toolbar.
The Default Printer Settings window opens.

b. In the Layout area, select the new layout. The
new layout is immediately applied to the selected
page.
c. Click or tap Close..
To change the print layout in the Layout toolbox. Using this method, if the page contains images,
the new page layout is applied, and the images are
rearranged from left to right, top to bottom (fixed
layouts) or largest to smallest (customizable layout).
New pages are added as necessary to accommodate
the images on the page. If the page does not contain
images, the new page layout is applied. No new page
is added.
a. In the Print Layout toolbar, select Layout. The
Layout toolbox is displayed.
b. Select the new layout.
c. Click or tap Close.
Clearing custom page layouts

You can clear a custom print layout from a selected page in the Print Preview window. If the
layout was previously saved, it remains on the system for future use.
Procedure
1. Select the page with the layout you want to remove.

2. In the Print Preview toolbar, select Customizable Page Tools to open the toolbox.
3. In the Customizable Page Tools toolbox, select Clear Page Layout.
The layout is removed from the page. Clearing a saved layout removes it from the page,
but retains it on the system for future use. All other pages retain their layouts.
Deleting saved custom print layouts

You can remove a saved custom print layout from a selected page and Nexus DR in the Print
Preview window.
About this task

Warning: Saved custom print layouts are completely removed from
the system after Save Layout is selected in step 4 on page 176 of
this procedure. To clear the layout from the selected page instead of
removing it from the system, see Clearing custom page layouts on
page 175.
Procedure
1. Select the page with the layout you want to remove.
2. In the Print Preview toolbar, select Customizable Page Tools to open the toolbox.
3. In the Customizable Page Tools toolbox, select Clear Page Layout.
The layout is removed from the page, but not the system.
4. Select Save Layout.
The layout is removed from the system. All other pages retain their layouts.

Reviewing and controlling the DICOM queue

The DICOM queue can be viewed to determine the progress of DICOM processes. In addition,
you can retry, pause, resume, or cancel a process as needed.
Prerequisites
See DICOM with Nexus DR on page 178 for information about DICOM processing in Nexus
DR.
About this task

Many of the DICOM features of Nexus DR function as background tasks that do not interfere
with the use of Clinical or Service Mode. In some cases, however, you may want to review the
status of the DICOM jobs that are in progress.
Procedure
opened at any time.
Figure 84: Open the DICOM Queue window
2. Perform one of the following tasks:

• To review the details of a DICOM job, select the job in the list and review the fields
in the Selected Export Job section. Identification of the job, completion data, and
archive options appear in this area.
• To control a specific job that is not yet complete, select the job in the list. Controls
applicable to the selected job, at the bottom of the window, are enabled.
3. Click or tap the Up Arrow to close.

DICOM with Nexus DR

DICOM (Digital Imaging Communications in Medicine) is a standard for handling, storing,
printing, and transmitting information in medical imaging. It includes a file format definition and
a network communications protocol. Nexus DR can be configured for DICOM.
PACS (Picture Archiving and Communication System) is a high-speed, graphical, computer
network system for the storage, recovery, and display of radiologic images (ultrasound, x-ray,
computed tomography, positron emission tomography, endoscopy, and magnetic resonance
imaging). It is a medical imaging technology that provides economical storage and convenient
access to images from multiple modalities, replacing conventional films with digital images.
It also links the report for imaging studies with the imaging study, thereby making possible to
view both the images and their respective report at the same time.
Many of the DICOM features of Nexus DR function as background tasks that do not interfere
with the use of Clinical or Service Mode. When you send a study to PACS, for example, you
can open another patient for acquisition or review, send print jobs, or use nearly any other
feature of Clinical Mode while the images are being processed and transferred to the PACS
in the background. In some cases, however, you may want to review the status of the DICOM
jobs that are in progress.
Nexus DR usually processes one job at a time, in the order they are sent to the queue. If
you submit a new job before a prior job is complete, the new job is added to the bottom of
the queue and remains pending until earlier jobs are complete. You can use the controls
available in the queue status window to abort jobs that are in progress, remove pending jobs
from the queue, or resubmit jobs that have failed or been aborted.
The amount of time required to complete a DICOM job will vary with the number of patient
records and studies involved, the number of images contained in those records, the number
of jobs in the queue, and the bandwidth available to the destination device. DICOM jobs
involving a small number of images may complete faster than you can open the queue status
window, and therefore may indicate complete immediately when the window is opened. When
using DICOM features that rely on removable media (CD, DVD, or USB), DO NOT remove or
disconnect the media until the DICOM job is complete.
Figure 85: DICOM Queue

Table 26: DICOM Queue — Controls

Item Description
Retry Available only when the status of the selected job is aborted or failed.
Re-submits the selected job to the destination device. Some causes of aborted or failed
jobs involve temporary states such as high workload or network timeouts due to high
traffic. When these conditions cause an aborted or failed transfer, resubmitting the job at
a later time can often result in successful completion.
Cancel Available only when the status of the selected job is pending, aborted, error, or
failed.
Removes the selected job from the queue. Jobs removed from the queue cannot be
resubmitted. If you remove a job in error, it must be recreated as a new job.
Pause Available only when the status of the selected job is processing or sending.
Resume Allows for temporary interruption of a DICOM job from the Nexus DR system. This can
be used where a known transfer issue may be foreseen, such as repositioning a cable or
resetting network equipment. The job can be resumed when the issue is passed and the
destination device has been restored to normal operation. The job will continue from the
point where it was paused.

DICOM queue controls and fields

You can use the controls available in the DICOM Queue status window to abort jobs that are
in progress, remove pending jobs from the queue, or resubmit jobs that have failed or been
aborted.
Nexus DR usually processes one job at a time, in the order they are sent to the queue. If you
submit a new job before a prior job is complete, the new job is added to the bottom of the
queue and remains Pending until earlier jobs are complete.
The amount of time required to complete a DICOM job varies with the number of patient
records and studies involved, the number of images contained in those records, the number
of jobs in the queue, and the bandwidth available to the destination device. DICOM jobs
involving a small number of images may complete faster than you can open the queue status
window, and therefore may indicate complete immediately when the window is opened. When
using DICOM features that rely on removable media (CD, DVD, or USB), DO NOT remove or
disconnect the media until the DICOM job is complete.
Figure 86: DICOM Queue
Table 27: DICOM Queue controls and fields

Item Description
Retry Available only when the status of the selected job is aborted or failed.
Re-submits the selected job to the destination device. Some causes of aborted or failed
jobs involve temporary states such as high workload or network timeouts due to high
traffic. When these conditions cause an aborted or failed transfer, re-submitting the job
at a later time can often result in successful completion.
Cancel Available only when the status of the selected job is pending, aborted, error, or
failed.
Removes the selected job from the queue. Jobs removed from the queue cannot be
resubmitted. If you remove a job in error, it must be recreated as a new job.
Pause Available only when the status of the selected job is processing or sending.
Resume Allows for temporary interruption of a DICOM job from the Nexus DR system. This can
be used where a known transfer issue may be foreseen, such as repositioning a cable or
resetting network equipment. The job can be resumed when the issue is passed and the
destination device has been restored to normal operation. The job will continue from the
point where it was paused.

Part
3
Settings Mode for Operators
Contents
• Entering and Exiting Settings Mode on page 183

• Managing Technologist Initials on page 187
• Logging on page 191
• Diagnostics on page 195
The user interface of Nexus DR is driven by a single application that has two modes of operation:
Clinical Mode and Settings Mode. Clinical Mode is the interface used when imaging patients and
includes access to the patient database, processing features, and archive functions. Settings Mode
is used exclusively for configuration, maintenance, and troubleshooting activities.
When Nexus DR is powered up and a user logs in, the applications starts in Clinical Mode
automatically. All users have access to the functions and features of Clinical Mode. In Settings
Mode, operators can access the Diagnostics menu, Logging menu, Technologist Initials setup tab.
Chapter
7
Entering and Exiting Settings Mode
Contents
• Entering Nexus DR Settings Mode on page 184

• Exiting Nexus DR Settings Mode on page 185

7. Entering and Exiting Settings Mode
Entering Nexus DR Settings Mode

Prerequisites
Power up the equipment and log in to the Nexus DR computer.
Procedure
1. Click or tap Settings.
The Settings log-in/log-out screen is displayed.

Figure 87: Settings Mode login / logout screen
2. Complete the Settings login screen as required.

Option Procedure
Access Settings Mode when you are logged in a. If it is not already checked, select Logon as
with credentials authorizing service-level access, current user.
such as NexusAdmin. b. Click or tap Enter Setting.
Log in to Settings Mode. a. In the User ID field, enter a user ID that has
service-level access, such as NexusService.
b. In the Password field, enter the password for the
user ID.
Cancel the Settings login screen and return to Click or tap the arrow in the upper right corner of the
Clinical Mode. Settings.

Exiting Nexus DR Settings Mode

Procedure
1. Click or tap Settings.
2. Click or tap Exit Settings.

The application returns to Clinical Mode.
Figure 88: Settings Mode log in / log out screen


Chapter
8
Managing Technologist Initials
Contents
• Technologist initials on page 188

• Adding technologist initials on page 189
• Editing technologist initials on page 189
• Removing technologist initials on page 190

8. Managing Technologist Initials
Users with Operator access to the system can add, remove, and edit technologist's initials in
Settings Mode.
Technologist initials
Nexus DR allows you create and manage the predefined list of technologist initials that is
available to clinical users as annotations during image review. The list is located in Service
Mode in the General screen on the Setup tab.
Figure 89: General screen — Setup tab
Table 28: General screen — Setup tab controls and fields

Item Description
A The Tech Initials area displays the list of technologist initials.
B Type the technologist's initials in this field.
C Add button. This control adds the technologist's initials to the list.
D Remove button. This control removes the selected technologist initials
from the list.
E Save button.This control saves your changes.
F Cancel button.This control discards your changes.

Adding technologist initials

Technologist initials are added on the General screen on the Setup tab.
Procedure
1. In Settings Mode, select General > Setup.
2. Click or tap Add.
3. Enter initials, up to 17 characters, into the text box.
Editing technologist initials

About this task
In addition to adding and removing technologist initials, Operators can also edit existing initials.
Procedure
2. In the Tech Initials list, select the initials that you want to edit.
The initials appear in a field below the list.
Figure 90: Technologist initials selected

3. Make your changes in the field.

Figure 91: Tech Initials edited
Removing technologist initials

About this task
Technologist initials can be removed from the system on the General screen on the Setup tab.
Procedure
2. Select the set of initials from the list of technologist initials.
3. Click or tap Remove.

Chapter
9
Logging
Contents
• Configuring logging settings on page 192

9. Logging
Configuring logging settings

Prerequisites
• Review Configure Logger tab on page 194.
About this task

Nexus DR provides a set of log files that can be useful for troubleshooting and gathering
information about system processes and activities. The data and messages that is collected by
these log files is configurable.
Procedure
1. In Settings Mode, select Logging > Configure Logger.

9. Logging

Caution: Do not select the Debug or Trace option for use during
normal system operation. Select these options only when directed
by Varex service engineers.
Enable message types for Select the desired check boxes for each category as needed.
specific categories.
Enable a message type for Click or tap the message type header.
all categories.
Enable all message types Click or tap the category name.
for a category.
Enable all message types Click or tap Select All.
for all categories.
Disable some message Deselect the check boxes for each category as needed.
types for specific
categories.
Disable a message type If all of the check boxes in the message type column are selected, click or tap
for all categories. the header once to deselect all of them.
If some, but not all, of the check boxes in the message type column are
selected, click or tap the header twice. The first click or tap selects the
remaining check boxes in the column. The second click or tap disables all of
the check boxes in the column.
Disable all message types If all of the check boxes in the category are selected, click or tap the category
for a category. name once to deselect all of the check boxes.
If some, but not all, of the check boxes in the category are selected, click or
tap the category name twice. The first click or tap selects the remaining check
boxes in the row. The second click or tap deselects all of the check boxes in
the row.
Disable all message types Click or tap Reset All.

for all categories.

9. Logging
Configure Logger tab

You can determine what information is captured in each Nexus DR log file using the options on
the Logging > Configure Logger tab in Settings Mode.
The Configure Logger tab shows the logging categories captured by each log. You can
choose to capture some information for specific categories or all information for all categories.
Figure 92: Logging screen — Configure Logger tab
Caution: Do not select the Debug or Trace option for use during
normal system operation. Select these options only when directed by
Varex service engineers.
Table 29: Configure Logger tab — Message options and controls

Item Description
Category The categories for which logs can gather information.
Status These messages describe state changes and status updates.
Info These messages are informative descriptions of events.
Debug These messages provide detailed debugging information. This
selection generates an extensive amount of data for debugging
purposes.
Trace These messages provide detailed trace information, even more
detailed than the debug selection. This selection creates an extensive
amount of log data.
Select All This button selects all of the message types for all of the categories.
Reset This button deselects all of the message types for all of the categories.

Chapter
10
Diagnostics
Contents
• Test pattern tab on page 196

• Log files on page 201
• Filtering log files on page 206
• Exporting log files on page 206
• Purging the system log on page 207
• Creating reject analysis reports from reject logs on page 208
• Troubleshooting with Data Collector on page 209
• If the detector is dropped... on page 211

10. Diagnostics
Nexus DR provides a collection of diagnostic utilities that can be used to troubleshoot failures of
system components or functions. Some diagnostics perform simple ping tests or status queries
to components inside of or connected to the Nexus DR computer. These basic diagnostics are
designed to be used by a service engineer during initial assessment of a system fault. Basic
diagnostics can generally be run without special tools or software, though some require a short
serial cable or loop-back termination.
Certain diagnostics provide more advanced utilities that are intended to be used directly by
technical support representatives through remote diagnostics or by a field engineer at the direction
of technical support. These utilities generally require knowledge of proprietary command structures,
access to version databases, and other information not available to field engineers without the
guidance of a Technical Support specialist.
Test pattern tab

Test patterns are used to verify that the shades of grey are properly represented on the Nexus
DR system. You can use them to test the accuracy of a monitor, printer, or PACS system.
Nexus DR supports SMPTE and TG18 test patterns.
Test patterns are selected from the Test Pattern list on the Test Pattern tab.
Figure 93: Test Pattern list

10. Diagnostics
SMPTE test pattern

The Nexus DR test patterns has a series of squares of varying shades of grey progressing
from white to black. You should be able to see all of the squares, and with the exception of the
50% grey squares, each square should be a different color. At the bottom of the test pattern
are two 100% squares, one black and one white, with smaller 5% squares in the middle. Both
of those squares should be visible.
Figure 94 on page 197 shows the test pattern with the percentages for reference.
Figure 94: SMPTE test pattern
Table 30: Diagnostics screen — Test Pattern tab controls and fields
Area Item Description
Print Settings Printer This drop-down list displays the selected printer. You can select any
printer that is configured on the system.
Film Size This drop-down list is used to select the film size to send to the printer.
Layout This drop-down list is used to select the layout to send to the printer.
Print This button sends the test pattern to the printer with the selected print
settings.
Storage Storage This drop-down list is used to select the storage server to send the
Settings test pattern to.
Send Selecting this check box sends a processed image to the storage
Processed server.
Image
Send This button sends the test pattern to the selected storage server
as either processed or unprocessed depending on whether Send
Processed Image is selected.

10. Diagnostics
Area Item Description

Test Pattern N/A Select the test pattern thumbnail that you want to use. Available test
patterns include: SMPTE, TG18-CH, TG18-KN, TG18-LN12-01,
TG18-LN12-18, TG18-MP, TG18-OIQ, TG18-QC, TG18-UN10, and
TG18-UN80.
TG18 test patterns

TG18 test patterns are used to determine the display performance of medical imaging
systems.
Table 31: TG18 test patterns

Test pattern Description³
Reference anatomical PA chest pattern. Good display resolution is necessary for
the fine aspects of this image to display properly.
Reference anatomical knee pattern. The fine trebecular patterns in the femur
require good display resolution to be seen clearly.
Use this test pattern to assess the luminance response of the display. The pattern
consists of a central test region with a certain pixel value occupying about 10%
of the full image area. The rest of the pattern has a uniform background with a
luminance equal to 20% of the maximum luminance. To achieve this luminance
level, assuming that the display device is properly calibrated to the DICOM 3.14
recommendation, the background pixel value is 153.
Use this test pattern to assess the luminance response of the display. The pattern
consists of a central test region with a certain pixel value occupying about 10%
of the full image area. The rest of the pattern has a uniform background with a
luminance equal to 20% of the maximum luminance. To achieve this luminance
level, assuming that the display device is properly calibrated to the DICOM 3.14
recommendation, the background pixel value is 153.

10. Diagnostics
Test pattern Description³

Use this test pattern to assess luminance response (bit depth resolution). This
pattern is designed for visual assessment of display bit depth. It displays 16 vertical
bars that gradually transition from black to white. Each bar covers 1/16 of a 12-bit
pixel value range from 0 to 4095. The small markers indicate 8-bit and 10-bit pixel
value transitions.
This is a multipurpose test pattern similar to SMPTE.
Use this test pattern to assess resolution, luminance, distortion, and artifacts. This
pattern consists of multiple inserts embedded in a midpixel value background for
comprehensive display assessment.
UN test patterns are used for the assessment of luminance uniformity, color
uniformity, and angular response.
UN test patterns are used for the assessment of luminance uniformity, color
uniformity, and angular response.
3. Samei E, Badano A, Chakraborty D. Assessment of Display Performance for Medical

Imaging Systems. College Park, MD: American Association of Physicists in Medicine;
2005:i-154.

10. Diagnostics
Printing test patterns

Printing a test pattern is a way to test whether a printer is accurately representing different
shades of grey.
Procedure
1. In Settings Mode, select Diagnostics > Test Pattern.
2. In the Test Pattern area, select the test pattern that you want to print.
3. Under Printer Settings, select the printer, film size, and layout.
4. Click or tap Print.
Nexus DR sends the test pattern to the selected printer.
Sending test patterns to the storage server

Sending a test pattern to the storage server is a way to verify whether the storage server is
retaining images with the correct shades of grey.
Procedure
1. In Settings Mode, select Diagnostics > Test Pattern.
2. In the Test Pattern area, select the test pattern that you want to send.
3. Under Storage Settings, in the Storage drop-down list, select the storage server.
4. Enable or disable the Send Processed Image option.
5. Click or tap Send.
Nexus DR sends the test pattern to the selected storage server.

10. Diagnostics
Log files
Nexus DR reports on system activities using its logging function. You can use these logs
to investigate activity involving patient records, review information about rejected images
for quality improvement, or troubleshoot abnormal behavior or performance of the imaging
subsystem.
The Nexus DR application creates the following log files:
Audit logs This log collects and reports data on clinical activities as required by
the Health Insurance Portability and Accountability Act (HIPAA) Audit
Controls Standard.
Acquisition logs This log collects and reports data on acquisitions.
Reject logs This log is created and available only when the Log Reject Reason
check box is selected in the System Configure screen on the
General tab. This log collects and reports data on rejected images.
System logs This log collects and reports data on the operation of the Nexus DR
application.
The logs can be viewed on the Logging screen on tabs that correspond to each log. Initially,
when you select a tab, the tab contains no data. To view log data, you must perform a search.
The data collected in each log file is configured in Settings Mode in the Logging screen, on
the Configure Logger tab.
When the application is closed, the system exports the contents of the logs that were captured
during the session to *.json files named in the format, DR-YYYY-MM-DD_hh-mm-ss.s.
• YY-MM-DD is the date that the log file was created, e.g., 2016-06-07 for June 7, 2016.
• hh-mm-ss.s is time that the log file was created, e.g., 12-15-32.5 for 12:15:32.5 p.m.
Log files are stored on the Nexus DR computer in the C:\ProgramData\Varex\NexusDR
\Backup\Current\LogDB directory.

10. Diagnostics
Audit Log tab

This logging tab displays the system data for log entries that meet the criteria defined in the
Search Filter area.
The audit data displayed are:
• Date Time
• User ID
• Auditable User Action
Figure 95: Logging screen — filtered Audit Log tab
Table 32: Logging screen — Audit Log tab controls and fields controls
Item Description
1 The location for entering search (or filter) criteria. The filters are applied after you select
the criteria and click or tap Search. You can also click or tap Search without specifying
any criteria. In this instance, all of the log data is returned.
2 The log data that meets the criteria selected in the Search Filters area.
3 Read-only. The network or local location for the exported log. The field is populated
using the Browse control. Audit and acquisition log files are exported as a CSV file.
They are compressed and password protected. The default log location is: C:\Users
\UserName\Documents, where UserName is the user name currently logged into the
system.

10. Diagnostics
Reject Log tab

Search Filter area.
The data displayed are:
• Summary information • Position
• Reject Reason • Procedure
• Date Time • EI
• User ID • DI
• Tech Initials (when available) • Image
Figure 96: Logging screen — filtered Reject Log tab
Table 33: Logging screen — Reject Log tab controls and fields
Item Description
A The location for entering search (or filter) criteria. The filters are
applied after you select the criteria and click or tap Search. You
can also click or tap Search without specifying any criteria. In this
instance, all of the log data is returned.
B Read-only. The network or local location for the exported log. The
field is populated using the Browse control. Audit and acquisition
log files are exported as a CSV file. They are compressed and
password protected. The default log location is: C:\Users
\UserName\Documents, where UserName is the user name
currently logged into the system.
C Summary information about patients, studies, images acquired, and
images rejected for the log entries that fall within the date range
defined in the Search Filters area. (1, Figure 96 on page 203)
D The log data that meets the criteria selected in the Search Filters area.
E The image that was rejected in the selected log entry.

10. Diagnostics
Acquisition Log tab

Search Filter area. Acquisition logs collect and report data on each acquired image.
The data displayed are:
• Date Time
• Region
• Exam Name
• Position
• EI
• Tech Initials (when available)
Figure 97: Logging screen — filtered Acquisition Log tab
Table 34: Logging screen — Acquisition Log tab controls and fields
Item Description
A The location for entering search (or filter) criteria. The filters are applied after you select
the criteria and click or tap Search. You can also click or tap Search without specifying
any criteria. In this instance, all of the log data is returned.
B Read-only. The network or local location for the exported log. The field is populated
using the Browse control. Audit and acquisition log files are exported as a CSV file.
They are compressed and password protected. The default log location is: C:\Users
\UserName\Documents, where UserName is the user name currently logged into the
system.
C This area displays the number of images acquired within the date range selected in the
Search Filters area.
D The log data that meets the criteria selected in the Search Filters area.

10. Diagnostics
System Log tab

Search Filter area.
The data are:
• Date Time
• User ID
• Thread
• Log Level
• Category
• System Log Message
Figure 98: Logging screen — filtered System Log tab
Table 35: Logging screen — System Log tab controls and fields
Item Description
A The location for entering search (or filter) criteria. The filters are
applied after you select the criteria and click or tap Search. You
can also click or tap Search without specifying any criteria. In this
instance, all of the log data is returned.
B The log data that meets the criteria selected in the Search Filters area.
C Read-only. The network or local location for the exported log. The field
is populated using the Browse control. System log files are exported
as a JSON file. They are compressed and password protected. The
default log location is: C:\Users\UserName\Documents, where
UserName is the user name currently logged into the system.

10. Diagnostics
Filtering log files

About this task
The tabs for each log file are blank when you first click or tap on them. To see log data, you
must perform a search. In cases where the log file is very large, it might be easier to find the
desired information by filtering the search. Selecting search filters is not required, but searches
performed without filters return all of the log entries in the log file.
Procedure
1. In Settings Mode, click or tap Logging, and select the log tab.
2. On the log tab, select the search filters that you want to use, if any.
3. Click or tap Search.
The log entries that meet the search criteria are displayed on the screen.
Exporting log files

About this task
When a problem is complex, service engineers might request that you send the log files to
them for review. Nexus DR has an export feature that is available for each log file.
Log files are exported to a network or local location of your choosing. Only the log file data that
meets the criteria of the search is exported.
Procedure
1. In Settings Mode, click or tap Logging, and select the log tab.
2. On the log tab, select the search filters that you want to use, if any.
The log entries that meet the search criteria are displayed on the screen.
4. Click or tap Browse.
5. Navigate to the network or local directory where you want to save the log file.
6. Click or tap Export.
When the export is complete, a success message is displayed.
7. Click or tap OK.
For information about the naming conventions for exported log files, see Exported log files
on page 207.

10. Diagnostics
Exported log files

Exported log files follow a particular naming convention depending on what log is exported.
Audit, acquisition, and system logs saved in a compressed file in the location you selected.
The file name is in the format LogNameLog_YYMMDD_HHMMSS:
LogName The name of the log you exported.
YYMMDD The 2-digit year, month, and day the file was exported.
HHMMSS The time in hours, minutes, and seconds that the file was exported.
For example, if you exported the audit log on April 20, 2017 at 3:13 pm and 12 seconds, the
file name would be AuditLog_170420_151312.
Reject logs are exported to the location you selected in an uncompressed directory with the
following structure and naming format:
YYYY-MM-DD HH.MM.SS
\images
Rejects.csv
For example, a reject log file exported on April 20, 2017 at 3:13 pm and 12 seconds, would be
in a directory named: 2017-04-20 15.13.12. The log file is always called Rejects.csv,
and the rejected images are stored in the images subdirectory.
Purging the system log

Procedure
1. Click or tap Purge.
2. In the Purge Log window, set the number of days worth of log entries to keep.
Figure 99: Purge Log window
3. Select the log levels you wish to purge from the system log.

10. Diagnostics

Cancel the purge action. Click or tap Cancel.
Close the window without purging entries. Click or tap Close.
Purge log entries. Click or tap Purge.
Creating reject analysis reports from reject logs

About this task
Reports that provide an analysis of rejection logs can be created and used to see the primary
causes of image rejection.
Procedure
1. Select Logging > Reject Log
2. Enter the start and end dates for the desired log period.
The log displays on screen.
4. Click or tap Browse, and navigate to the location where you want save the report.
5. Click or tap Report.
A PDF is created and in the location selected in step 4 on page 208.

10. Diagnostics
Troubleshooting with Data Collector

Data Collector is used for troubleshooting application faults, such as problems with DICOM
services, detector communication, or image quality. This tool collects specific types of
information that you select, and then saves it to a network or local drive. The data can be sent
to Varex support engineers for further analysis.
Prerequisites
Review Data Collector tab on page 210.
Procedure
1. In Settings Mode, select Diagnostics > Data Collector.
2. Select the data to collect.
3. Select the patient image.
a)Select the Patient Image check box.
b)The Select Image button becomes active.
c) In the Select Image window, click or tap on the desired images.
You can select more than one image. To deselect an image, click or tap on it again.
4. Click or tap Browse.
5. Navigate to the desired location for the collected data.
6. Click or tap Collect.
Nexus DR collects the specified data and saves it in a *.zip file to the identified
location. The file name uses the format Data_YYYYMMDDHHMMSS.zip, where
YYYYMMDDHHMMSS is the year, month, day, and time in hours, minutes, and seconds
that the data was collected.

10. Diagnostics
Data Collector tab

Data Collector is used to gather specific types of data that can then be sent in to Varex service
engineering to be analyzed.
The data that can be collected includes system logs, configuration database information,
system information, patient database information, patient images, and calibration. This data
can be saved to a location you specify. Access the Data Collector tab on the Diagnostics
screen.
Figure 100: Diagnostics screen — Data Collector tab
Table 36: Diagnostics screen — Data Collector controls and fields

Item Description
A These check boxes are used to select the data that you want to
collect.
B These fields are used to set the date range for the data to be
collected.
C Read-only. This field displays the location network or local location
where the data will be saved. The Browse control is used to select the
location.
D This control starts the data collection process.

10. Diagnostics
If the detector is dropped...

About this task
Caution: Handle the detector with care. Dropping the detector may
damage it. The detector logs drops and provides a degree of impact
for each instance. Logged drops that can be correlated to panel
damage may void the warranty.
If the detector is dropped, verify that it is operational.
Procedure
1. Inspect the detector for damage.
2. Generate a link to the workstation.
3. Acquire an image from the receptor and inspect it for areas of missing data.
Contact technical support for further assistance.

10. Diagnostics

Appendix
A
Nexus DR Measurements Accuracy
Contents
• Measurement factors on page 214

• Measurement types and accuracy on page 215

A. Nexus DR Measurements Accuracy
Measurement factors
The line measurement result will be different if an image has been calibrated using the
software calibration feature, as compared to the line measurement result of an image which
has not been calibrated by the software. Angle measurements are not affected by the line
calibration. The result for line measurements and the software calibration feature is affected
by a number of factors, although these factors do not affect the accuracy of the software
calculation performed for the line measurements:
• Detector's Pixel Pitch: Uncalibrated measurement only
• Source to Image-Receptor Distance: Uncalibrated line measurement only
• Object to Image-Receptor Distance: Uncalibrated line measurement only
Images that are calibrated using the software calibration feature minimize any error introduced
by the above factors.
To maximize the measurement tool's accuracy, a zoom factor of to 1:1 is recommended.
The software calculates and displays all measurements with a resolution of two decimal places
(such as 0.11 mm, 0.11 degree, etc.).
The size of the smallest element limits the measurement accuracy in the acquisition plane and
is the physical minimum. The detector pixel pitch is the limiting factor for calibration and line
measurements. The pixel pitch is also dependent on the detector model.
Table 37: Pixel pitch

Detector model Detector pixel pitch User displayed units
4343Rv3
4343RC
4336Wv4
4336Wv4PLUS 139 µm .139 mm
4336W-G5
4343W
4343W with optional tether
2530W-G5 131 µm .131 mm
3025 XRpad2
4336 XRpad2 100 µm .100 mm
4343 XRpad

Measurement types and accuracy

Calibration Measurement accuracy
Using the Calibration Measurement feature the measurement accuracy for the calibration line
is equal to +/– two detector pixels (pixel pitch).
Straight line measurements (calibration, length,distance, leg)

Using the Straight Line Measurement feature the line measurement accuracy for the displayed
length is equal to +/– two detector pixels (pixel pitch). This equates to between .2 and .28
millimeters depending on the detector used.
Angle or Cobb angle measurements

Using the Angle or Cobb Angle feature, the angle measurement accuracy depends on the
length of the segments and improves as the length of the segments increase. For an angle
measured between segments which are 100x the detector pixel pitch, the measurement
accuracy of the displayed angle value is equal to +/– one degree.


Appendix
B
Minimum hardware, software, network, and
IT security requirements
Contents
• Hardware requirements on page 218

• Network requirements on page 218
• System components — Stationary systems on page 219
• System components — Mobile systems on page 222
• Interconnections for systems with non-integrated X-ray generators on page 224
• Interconnections for systems with integrated CMP 200 generators on page 252
• Windows and anti-malware updates on page 274
• Applying Windows updates on page 275

B. Minimum hardware, software, network, and IT security requirements
Hardware requirements
The Nexus DR hardware must meet the following requirements:
• Tablet, all-in-one, or small desktop PC.
• Intel Core family CPU, Core i5 or better, "Haswell" 4th generation microarchitecture (or
newer)
• Windows 10 Professional, 64-bit version only. Recommended: Windows 10 IoT, 64-bit
version
• Windows 11 is supported for software-only solutions.
• 256 GB Hard Drive or larger (not intended to be an archive device) Recommended:
Solid State Drive for mobile use
• 8 GB RAM or greater
• Wide-screen display 1366x768 pixels Recommended: 1920x1080 pixels or better;
DICOM compliance Optional: Multi-point touch capability
• Keyboard and mouse are fully supported; for information about non-keyboard
configurations, please contact support for more details.
• Anti-scatter grid: 85 to 103 lp/in with grid suppression; grids 215 lp/in or greater may also
be used, but grid suppression will not be active
Network requirements
The network Nexus DR connects to must meet the following requirements:
• For mobile solutions, a 5 GHz Wi-Fi adapter is required.
• For dedicated room configurations with wireless detectors, use of a wireless access
point (WAP) is recommended. The WAP can be supplied by Varex Imaging Corporation;
please contact the company for more details. Recommended: Asus RT-AC66U
(Universal version); for small form factor: TP-Link TL-WR902AC.
• For dedicated room configurations with wired detectors, two wired network adapters are
typically required.
• The detectors can not share the same subnet or adapter with the sites local network.

System components — Stationary systems

The following tables show the components for stationary configurations.
Table 38: Imaging computer components — Full systems only

Component Part No. Description
Nexus DR configured image 737-661-G1 DT504T AIO PC.
processing computer
• th
Intel® 10 Generation Core™ i5-100500T 6-
core 2.3 GHz processor
• 512GB solid state drive (SSD)
• 16GB random access memory (RAM)
• Microsoft® Windows® 10 IoT Enterprise
• Built-in Wi-Fi and Bluetooth
• 1920 x 1080 pixels, high-brightness (1000
nits) capacitive touch display with fanless
cooling
• Built-in speaker and microphone
• Integrated UPS battery
• AC-DC 100/240V power adaptor with power
cord
USB keyboard and mouse 099-453
Table 39: 4336Wv4 detector components

Components Part No. Description
4336Wv4 detector 122027 (CSI) 117365 Wireless flat-panel detector.
(DRZ+)
Table 40: 2530W-G5 (LUMEN 2530W) detector components

Components Part number Description
Detector: CsI standard 151360 2530W-G5
Service cable 149961 Optional cable for performing service-related tasks.

Detector: DRZ+ 150031 4336W-G5 detector
Detector: CsI premium 150027 4336W-G5 detector, thin
Table 42: 4343W with optional tether detector components

Components Part Number Description
Detector: CsI standard 152176 4343W with optional tether wireless detector


Detector: DRZ+ 152172 4343W with optional tether wireless detector
USB C to RJ45.
Tether Y cable 148710 Cable used to operate the detector tethered and to
charge the detector battery during operation.
Tether power supply 148709 Attaches the tether cable to power the detector.
Table 43: 4343W (LUMEN 4343W) detector components (wireless only)

Detector: CsI standard 146241 4343W wireless detector
Detector: DRZ+ 145452 4343W wireless detector
Detector: CsI premium 146245 4343 wireless detector
Table 44: XRpad 4343 F components

X-Ray Detector 4343 F (MED 95510935-02 Detector. This detector operates in wired mode only.
version with CE Class IIa Medical
Device marking)
XRpad IPU (Interface Power Unit) 95510922H IPU for the XRpad 4343 F detector. Note that in
configurations with multiple wired detectors, there
will be one IPU per detector.
XRpad LPT Detector Cable, 95510929H Cable for connecting the XRpad to the IPU.
6m/20ft
XRpad LPT Detector Cable, 95510931H Cable for connecting the XRpad to the IPU.
3m/10ft
Mains Power cable 95510249H Power cable for the IPU.
Table 45: XRpad2 4336 wireless components

XRpad2 4336 Detector 95510925-02 This detector can be wired or wireless. In wired
mode, the detector requires an IPU. In wireless
mode, the detector communicates directly with the
WAP.

XRpad2 3025 Panel 95510991 This detector can be wired or wireless. In wired
WAP.

Table 47: Wireless detector battery components

Component Part number Description
Detector battery. 142144 Detector battery (non-XRpad)
XRpad2 3025 LBP-2 (Lithium 95510926H Lithium battery pack for the XRpad2 3025 detector.
Battery Pack)
XRpad2 3025 LBC-2 (Lithium 95510927H Slotted battery charger for the XRpad2 3025 Lithium
Battery Charger) battery pack.
XRpad2 4336 LBP (Lithium 95510949H-01 Lithium battery pack for the XRpad2 4336 detector.
Battery Pack)
XRpad2 Lithium battery charger 95510921H Slotted battery charger for the XRpad2 4336 Lithium
battery pack.
Battery charger 82351 Single position
Battery charger 117881 Single-bay, mounting
Battery charger 138737 Power supply for the single-bay battery charger,
65W, 19V
Battery charger 35205 Three-bay battery charger
Battery charger 141920 Three-bay battery charger power supply, 85W, 19V
Battery charger 136331 Single-bay battery charger
Wall mounting hardware for the 117881 Wall mount for the single bay charger
battery charger
Table 48: 4343Rv3 detector

4343Rv3 detector CsI: 128122 4343Rv3 wired, flat panel detector.
DRZ+: 125247
Table 49: 4343RC detector components

4343RC detector: 12908 (CsI) 128867 (DRZ+), 12908 Wired flat-panel detector.
(CsI)
4343RC detector I/O box 128853 Required in all configurations.
Table 50: Wireless access point (WAP) — Full-system mobile or stationary only
ASUS RT-N66U or ASUS RT- 099-702 This component may also be customer supplied.
AC66U WAP
TP-Link TL-WR902AC Wireless 099-731 This component may also be customer supplied.
Router

Table 51: Software components

Nexus DR prerequisites software 737-680-G1 Prerequisite software required for Nexus DR.
Nexus DR Software 737-692-G1 Nexus DR system software
Nexus DR System Backup Thumb 736-804-G2 Contains backup of initial Nexus DR system for the
Drive DT504T AIO PC. Initially contains factory default
image, but may be updated after system installation.
System components — Mobile systems

Table 52: Imaging computer components for full-system mobile solutions
Dell Latitude 5400 laptop Deprecated Laptop PC for mobile applications


Detector: DRZ+ 150031 4336W-G5 detector
Detector: CsI premium 150027 4336W-G5 detector, thin
Table 55: 4343W with optional tether detector components

Detector: CsI standard 152176 4343W with optional tether wireless detector
Detector: DRZ+ 152172 4343W with optional tether wireless detector
USB C to RJ45.
Tether Y cable 148710 Cable used to operate the detector tethered and to
charge the detector battery during operation.
Tether power supply 148709 Attaches the tether cable to power the detector.
Table 56: 4343W (LUMEN 4343W) detector components (wireless only)

Detector: CsI standard 146241 4343W wireless detector


Detector: DRZ+ 145452 4343W wireless detector
Detector: CsI premium 146245 4343 wireless detector

XRpad2 4336 Detector 95510925-02 This detector can be wired or wireless. In wired
WAP.

XRpad2 3025 Panel 95510991 This detector can be wired or wireless. In wired
WAP.
Table 59: 4336Wv4 detector components

4336Wv4 detector 122027 (CSI) 117365 Wireless flat-panel detector.
(DRZ+)
Table 60: Wireless detector battery components

Detector battery. 142144 Detector battery (non-XRpad)
XRpad2 3025 LBP-2 (Lithium 95510926H Lithium battery pack for the XRpad2 3025 detector.
Battery Pack)
XRpad2 3025 LBC-2 (Lithium 95510927H Slotted battery charger for the XRpad2 3025 Lithium
Battery Charger) battery pack.
XRpad2 4336 LBP (Lithium 95510949H-01 Lithium battery pack for the XRpad2 4336 detector.
Battery Pack)
XRpad2 Lithium battery charger 95510921H Slotted battery charger for the XRpad2 4336 Lithium
battery pack.
Battery charger 82351 Single position
Battery charger 117881 Single-bay, mounting
Battery charger 138737 Power supply for the single-bay battery charger,
65W, 19V
Battery charger 35205 Three-bay battery charger
Battery charger 141920 Three-bay battery charger power supply, 85W, 19V
Battery charger 136331 Single-bay battery charger


Wall mounting hardware for the 117881 Wall mount for the single bay charger
battery charger
Table 61: Wireless access point (WAP) — Full-system mobile or stationary only
ASUS RT-N66U or ASUS RT- 099-702 This component may also be customer supplied.
AC66U WAP
TP-Link TL-WR902AC Wireless 099-731 This component may also be customer supplied.
Router
Table 62: Software components

Nexus DR prerequisites software 737-680-G1 Prerequisite software required for Nexus DR.
Nexus DR Software 737-692-G1 Nexus DR system software
Nexus DR System Backup Thumb 736-804-G2 Contains backup of initial Nexus DR system for the
Drive DT504T AIO PC. Initially contains factory default
image, but may be updated after system installation.
Interconnections for systems with non-integrated X-ray

generators
Full mobile systems with a non-integrated generator include the imaging computer. Software-
only solutions include the panel and the Nexus DR software.
Single detector system interconnections — vTrigger

Supported detectors can be connected in vTrigger mode to systems with non-integrated X-ray
generators.

Single wireless detector interconnections — vTrigger

The following diagram shows the system connections when using a single wireless detectors
in vTrigger mode with a non-integrated X-ray generator.
The following diagram reflects the interconnections in systems with the following wireless
detectors:
• 4336Wv4
• 4336W+
• 2530W-G5
• 4336W-G5
• 4343W
Figure 101: Wireless detector in vTrigger mode
Table 63: IP addresses

Component IP address
192.168.2.11
Network card on the Nexus DR PC
Subnet mask: 255.255.255.0
Wi-Fi access point 192.168.2.21

Nexus DR PC LAN connection IP address of facility network
Single detector 192.168.2.31/24

2530W-G5, 4336W-G5, or 4343W interconnections with detector as

WAP — vTrigger
The wireless detectors can be used as the wireless access point (WAP) for the system.
detectors:
• 2530W-G5
• 4336W-G5
• 4343W
Figure 102: Non-integrated interconnections with detector as WAP

192.168.2.11
Network card on theNexus DR PC
Subnet mask: 255.255.255.0


4343RC interconnections — vTrigger

The following diagram shows the system connections when using a 4343RC panel in vTrigger
mode and a non-integrated X-ray generator.
The hand switch, X-ray console, X-ray generator, and X-ray tube are provided by the site.
They are not supplied with the Nexus DR system.
Figure 103: 4343RC in vTrigger mode configuration

192.168.2.11
Subnet mask: 255.255.255.0


4343Rv3 interconnections— vTrigger

The following diagram shows the Nexus DR system configuration when using a 4343Rv3
panel in vTrigger mode with a non-integrated X-ray generator.
Figure 104: 4343Rv3 in vTrigger mode configuration

192.168.2.11
Network card (Nexus DR)
Subnet mask: 255.255.255.0


XRpad2 3025 interconnections — vTrigger

The following diagram shows the system connections when using a single XRpad2 3025 panel
Figure 105: Single XRpad2 3025 in vTrigger mode

192.168.2.11
Subnet mask: 255.255.255.0

Single detector 192.168.2.1

XRpad2 4336 interconnections — vTrigger

The following diagram shows the connections for systems with a single XRpad2 4336 detector
Figure 106: Single XRpad2 4336 in vTrigger mode interconnections

192.168.2.11
Subnet mask: 255.255.255.0

Single detector 192.168.2.1

XRpad 4343 F interconnections — vTrigger

The following diagram shows the connections for a system with a single XRpad 4343 F
detector in vTrigger mode with a non-integrated generator.
Figure 107: XRpad 4343 F interconnections in vTrigger mode

192.168.2.11
Subnet mask: 255.255.255.0

Wired detector 192.168.2.158

Dual detector system interconnections — vTrigger

Supported detectors can be connected dually in vTrigger mode to systems with non-integrated
X-ray generators.
4336Wv4 and 4336Wv4+ interconnections — vTrigger

The following diagram shows the interconnections for 4336Wv4 and 4336Wv4+ detectors in
vTrigger mode with a non-integrated X-ray detector.
Figure 108: Dual wireless detectors interconnections

192.168.2.11
Subnet mask: 255.255.255.0

First detector 192.168.2.31/24
Second detector 192.168.2.41/24

2530W-G5 and 4336W-G5 detectors interconnections — vTrigger

The following diagram shows the connections for systems with the 2530W-G5 and 4336W-G5
detectors.
Figure 109: 2530W-G5 and 4336W-G5 interconnections

192.168.2.11
Subnet mask: 255.255.255.0


4343W and 2530W-G5 detectors interconnections — vTrigger

The following diagram shows the connections for systems with the 4343W and 2530W-G5
detectors.
Figure 110: 4343W or untethered 4343W and 2530W-G5 interconnections
Note: The 4343W detector with optional tether is used without the
tether in this scenario.

192.168.2.11
Subnet mask: 255.255.255.0


4343W and 4336W-G5 detectors interconnections — vTrigger

The following diagram shows the connections for systems with the 4343W or untethered
4343W and 4336W-G5 detectors.
Figure 111: 4343W or untethered 4343W and 4336W-G5 interconnections
The 4343W detector with optional tether is used without the tether in this scenario.

192.168.2.11
Subnet mask: 255.255.255.0


4343W tethered and 2530-G5 interconnections — vTrigger

The following diagram show the connections between the 4343W with tether and 2530W-G5
detectors and the rest of the X-ray system.
The tether cable for the 4343W with optional tether detector has a combination power and
USB-C connector (A) at one end, and a brick (B) with Ethernet and AC power ports at the
other end. The computer connects to the brick using an Ethernet cable (C) to facilitate
communication between the detector and the PC. The AC power cord (D) also connects to
the brick to provide power to the detector. If the detector has a battery inserted into it while the
tether is attached, the tether powers the detector and trickle-charges the battery.
Figure 112: 4343W tethered and 2530W-G5 detector interconnections

192.168.2.11
Subnet mask: 255.255.255.0


4343W tethered and 4336W-G5 interconnections — vTrigger

The following diagram shows the connections between the tethered 4343W and the 4336W-
G5 detectors, and the rest of the X-ray system.
Figure 113: 4343W tethered and 4336W-G5 detector interconnections

192.168.2.11
Subnet mask: 255.255.255.0


4343W tethered and wireless only 4343W interconnections —

vTrigger
The following diagram shows the interconnections for a dual detector system with tethered
4343W and wireless only 4343W detectors.
Figure 114: 4343W with tether and wireless 4343W interconnections

192.168.2.11
Subnet mask: 255.255.255.0


Wireless and 4343RC detector interconnections — vTrigger

The following diagram shows the interconnections for wireless and 4343RC detectors in
The wireless detectors currently supported for this configuration are:
• 4336Wv4
• 4336W+
Figure 115: Wireless and 4343RC in vTrigger mode configuration

192.168.2.11
Subnet mask: 255.255.255.0


Wireless and 4343Rv3 detector interconnections — vTrigger

The following diagram shows the interconnections for wireless and 4343Rv3 detectors in
• 4336Wv4
• 4336W+
Figure 116: Wireless and 4343Rv3 detectors in vTrigger mode

192.168.2.11
Subnet mask: 255.255.255.0


4343Rv3 and 4343RC detector interconnections — vTrigger

The following diagram shows the interconnections for 4343Rv3 and 4343RC detectors in
Figure 117: 4343Rv3 and 4343RC detectors in vTrigger mode

192.168.2.11
Subnet mask: 255.255.255.0


Dual 4343Rv3 detectors interconnections — vTrigger

The following diagram shows the interconnections for dual 4343Rv3 detectors in vTrigger
mode with a non-integrated X-ray detector.
Figure 118: Dual 4343Rv3 detectors in vTrigger mode

192.168.2.11
Subnet mask: 255.255.255.0


Dual 4343RC detectors interconnections — vTrigger

The following diagram shows the interconnections for dual 4343RC detectors in vTrigger mode
with a non-integrated X-ray detector.
Figure 119: Dual 4343RC detectors in vTrigger mode

192.168.2.11
Subnet mask: 255.255.255.0


Dual XRpad2 4336 detectors interconnections — vTrigger

The following diagram shows the interconnections for dual XRpad2 4336 detectors in vTrigger
Figure 120: Dual XRpad2 4336 detectors, vTrigger

192.168.2.11
Subnet mask: 255.255.255.0

First wireless detector 192.168.2.1
Second detector 192.168.2.158

XRpad2 4336 and XRpad 4343 F detectors interconnections —

vTrigger
The following diagram shows the system interconnections for XRpad2 4336 and XRpad 4343
F detectors in vTrigger mode with a non-integrated X-Ray generator.
Figure 121: XRpad2 4336 and XRpad 4343 F, vTrigger, non-integrated generator

192.168.2.11
Subnet mask: 255.255.255.0

First wireless detector 192.168.2.1

Dual XRpad 4343 F detectors interconnections — vTrigger

The following diagram shows the interconnections for dual XRpad 4343 F detectors in vTrigger
Figure 122: Dual XRpad 4343 F in vTrigger mode

192.168.2.11
Subnet mask: 255.255.255.0

First detector 192.168.2.158

Triple detector system interconnections — vTrigger

Nexus DR supports the wireless and 4343RC detectors in vTrigger mode configured on one
system.
Dual 4343W with optional tether and 2530W-G5, 4336W-G5 or

4343W — vTrigger
The following figure shows the interconnections between two 4343W with optional tether
detectors and one of the wireless detectors supported for this configuration.
Figure 123: Dual 4343W with optional tether and wireless detector interconnections

192.168.2.11
Subnet mask: 255.255.255.0

Third detector 192.168.2.51/24

4343W with optional tether, 2530W-G5, and 4336W-G5

interconnections — vTrigger
The following diagram shows the interconnections for a triple detector system with 4343W with
optional tether, 2530W-G5, and 4336W-G5 detectors.
The 4343W detector with optional tether can also be operated wirelessly.
Figure 124: 4343W with optional tether, 2530W-G5, and 4336W-G5 interconnections

192.168.2.11
Subnet mask: 255.255.255.0


Wireless, 4343Rv3, and 4343RC detectors interconnections —

vTrigger
The following diagram shows the interconnections for systems with wireless, 4343Rv3, and
4343RC detectors with a non-integrated generator.
• 4336Wv4
• 4336W+
Figure 125: wireless, 4343Rv3, and 4343RC interconnections

192.168.2.11
Subnet mask: 255.255.255.0


Wireless and dual 4343Rv3 detectors interconnections — vTrigger

The following diagram shows the interconnections for systems with one wireless, and two
4343Rv3 detectors with a non-integrated generator.
• 4336Wv4
• 4336W+
Figure 126: Wireless and dual 4343Rv3 interconnections — vTrigger

192.168.2.11
Subnet mask: 255.255.255.0


Wireless and dual 4343RC detectors interconnections — vTrigger

The following diagram shows the interconnections for systems with one wireless and two
4343RC detectors with a non-integrated generator.
• 4336Wv4
• 4336W+
Figure 127: wireless and dual 4343RC detectors interconnections — vTrigger

192.168.2.11
Subnet mask: 255.255.255.0


Interconnections for systems with integrated CMP 200

generators
Single detector system interconnections

Single detectors can be configured for systems with integrated CMP 200 generators.

Wireless detector with integrated CMP 200 generator

interconnections
The following diagram shows the interconnections for systems with a single wireless detector
and an integrated CMP 200 X-ray generator.
• 4336Wv4 • 4343W with optional tether
• 4336W+ • 4343W
• 4336W-G5 • 2530W-G5
Figure 128: Wireless detector and integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0
Dual detector system interconnections on page

192.168.2.21
260Wi-Fi access point

Wireless detector integrated with CMP 200 X-ray generator with

detector as WAP
The wireless detectors can be used as the wireless access point (WAP).
detectors:
• 4336W-G5
• 4343W
• 2530W-G5
Figure 129: Detector as WAP, integrated with CMP 200 X-ray generator

192.168.2.11
Subnet mask: 255.255.255.0
Dual detector system interconnections on page

192.168.2.21
260Wi-Fi access point

4343RC detector with integrated CMP 200 generator

interconnections
The following diagram shows the interconnections for systems with a single 4343RC detector
Figure 130: 4343RC and integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0


4343Rv3 detector with integrated CMP 200 generator

interconnections
The following diagram shows the interconnections for systems with a single 4343Rv3 detector
Figure 131: 4343Rv3 and integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0


XRpad 3025 detector with integrated CMP 200 generator

interconnections
The following diagram shows the interconnections for systems with a single XRpad 3025
detector and an integrated CMP 200 X-ray generator.
Figure 132: XRpad 3025 and integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0

Wireless detector 192.168.2.1

XRpad2 4336 detector with integrated CMP 200 generator

interconnections
The following diagram shows the interconnections for systems with a single XRpad2 4336
Figure 133: XRpad2 4336 and integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0

Wireless detector 192.168.2.1

XRpad 4343 F detector with integrated CMP 200 generator

interconnections
The following diagram shows the interconnections for systems with a single XRpad 4343 F
Figure 134: XRpad 4343 F and integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0

Single wired detector 192.168.2.158

Dual detector system interconnections

4336Wv4 and 4336Wv4+ detectors interconnections — integrated
generator
The following diagram shows the interconnections for systems with 4336Wv4 and 4336Wv4+
detectors and an integrated CMP 200 X-ray generator.
Figure 135: 4336wv4 and 4336Wv4+ detectors and integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0


2530W-G5 and 4336W-G5 detectors interconnections — Integrated

Generator
The following diagram shows the connections for systems with the 2530W-G5 and 4336W-G5
Figure 136: 2530W-G5 and 4336W-G5 interconnections
and an integrated CMP200 X-ray generator

192.168.2.11
Subnet mask: 255.255.255.0


4343W and 2530W-G5 detectors interconnections — integrated

generator
The following diagram shows the connections for systems with a 4343W and 2530W-G5
detectors, and an integrated CMP 200 X-ray generator.
Figure 137: 4343W and 2530W-G5, integrated CMP 200 X-ray generators interconnections

192.168.2.11
Subnet mask: 255.255.255.0


4343W and 4336W-G5 detectors interconnections — integrated

generator
The following diagram shows the connections for systems with a 4343W and 4336W-G5
Figure 138: 4343W and 4336W-G5, integrated CMP 200 interconnections

192.168.2.11
Subnet mask: 255.255.255.0


4343W tethered and 2530W-G5 interconnections — integrated

generator
The following diagram shows the interconnections for a dual detector system with
4343Wtethered and 2530W-G5 detectors, and an integrated CMP 200 X-ray generator.
Figure 139: 4343W tethered and 2530W-G5, integrated CMP 200 interconnections

192.168.2.11
Subnet mask: 255.255.255.0


4343W tethered and 4336W-G5 interconnections — integrated

generator
4343Wand 4336W-G5 detectors, and an integrated CMP 200 X-ray generator.
Figure 140: 4343W tethered and 4336W-G5, integrated CMP 200 interconnections

192.168.2.11
Subnet mask: 255.255.255.0


4343W tethered and 4343W interconnections — integrated

generator
4343W and 4343W detectors and an integrated CMP200 X-ray generator.
Figure 141: 4343W tethered and 4343W, integrated CMP 200 interconnections

192.168.2.11
Subnet mask: 255.255.255.0


Dual 4343Rv3 detectors interconnections — integrated generator

The following diagram shows the interconnections for systems with dual 4343Rv3 detectors
Figure 142: Dual 4343Rv3 and integrated CMP 200

192.168.2.11
Subnet mask: 255.255.255.0


Dual 4343RC detectors interconnections — integrated generator

The following diagram shows the interconnections for systems with dual 4343RC detectors
Figure 143: Dual 4343RC detectors and integrated CMP 200

192.168.2.11
Subnet mask: 255.255.255.0


Wireless and 4343Rv3 detectors with integrated CMP 200

generator interconnections
The following diagram shows the interconnections for systems with wireless and 4343Rv3
• 4336Wv4
• 4336W+
Figure 144: Wireless and 4343Rv3 detectors with integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0


4343Rv3 and 4343RC detectors with integrated CMP 200

generator interconnections
The following diagram shows the interconnections for systems with 4343Rv3 and 4343RC
Figure 145: 4343Rv3 and 4343RC detectors with integrated CMP 200

192.168.2.11
Subnet mask: 255.255.255.0


Dual XRpad2 4336 detectors with integrated CMP 200 generator

interconnections
The following diagram shows the interconnections for systems with dual XRpad2 4336
Figure 146: Dual XRpad2 4336 detectors and integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0


Dual XRpad 4343 F detectors with integrated CMP 200 generator

interconnections
The following diagram shows the interconnections for systems with dual XRpad 4343 F
Figure 147: Dual XRpad 4343 F and integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0


XRpad2 4336 and XRpad 4343 F detectors with integrated CMP

200 generator interconnections
The following diagram shows the interconnections for systems with XRpad2 4336 and XRpad
4343 F detectors and an integrated CMP 200 X-ray generator.
Figure 148: XRpad2 4336 and XRpad 4343F with integrated CMP 200 generator

192.168.2.11
Subnet mask: 255.255.255.0


Windows and anti-malware updates

Because Nexus DR is built on a customized installation of Microsoft Windows, it is subject
to many of the same threats that affect other Windows-based PCs. Computer and network
security should be implemented based on industry best practices for protecting patient health
information.
The threat of downtime resulting from viruses and other malicious software can be further
mitigated by regularly applying updates to the Windows operating system, antivirus, and anti-
malware solutions installed on the Nexus DR computer.
For information about installing Windows updates, see Applying Windows updates on page
275.
For information about malware updates, see Windows and anti-malware updates on page
274.
Windows updates
Caution: Windows updates should be applied manually and only
when instructed to do so by an authorized service representative.
The Windows Automatic Update service is disabled by the factory and must remain disabled
because updates must be performed when the system is out of service. Coordinate with the
radiology department to determine the best time to apply them.
Anti-malware updates
The following anti-malware solutions are preinstalled, and validated and approved for use on
Nexus DR computers.
• Windows Defender
• Windows Firewall
For guidance on installing Windows updates, see Windows and anti-malware updates on page
274 and Applying Windows updates on page 275.

Applying Windows updates

Prerequisites
• Review Windows and anti-malware updates on page 274 and Windows updates on
page 274.
• Coordinate with the radiology department to install updates when the system is out of
service.
• If the Microsoft Updates website is to be used, Nexus DR must be connected to a
network that allows for connection to the internet.
• If scanning for or applying Windows updates using the Microsoft Baseline Security
Analyzer, a USB flash drive or other removable media can be used to move the utility
and necessary update files to the Nexus DR system.
About this task

Caution: Windows updates should be applied manually and only
when instructed to do so by an authorized service representative.
Applying Windows updates as directed by Varex can help mitigate downtime caused by
viruses and other malicious software.
Comprehensive instructions for applying Windows updates are beyond the scope of this
manual. You can find detailed instructions and additional guidance on the Microsoft website.
The following instructions include only the high-level steps required to apply the updates.
Note: Applying Windows updates is considered a maintenance
activity that must be performed when the system is out of service.
When instructed by the manufacturer to apply Windows updates,
you can use the manual Microsoft Update website to perform them,
but the system must not be configured to obtain or apply updates
automatically.
Procedure
1. Ensure that the Nexus DR computer is powered up, and that you are logged in as
NexusAdmin.
2. Close the Nexus DR application.
3. Apply the Windows updates and restart the computer as necessary.
4. Each time the computer must be restarted during this procedure, log back into the
computer as NexusAdmin.
The update installation process continues automatically each time you log back in until all
of the updates are installed.
5. After all of the updates are installed, restart the computer.
6. When the computer restarts, you can remain at the Windows login screen or start the


Index
Index
Numerics 4343W with tether and 4343W detector connections
non-integrated x-ray generator
2530W detectors vTrigger 238
CsI premium
recommended techniques 54, 54
CsI standard
A
recommended techniques 66, 66 about this document xx
2530W-G5 and 4336W-G5 detector connections acquire images
non-integrated x-ray generator from patient tile 81
vTrigger 233 from study tile, first available 82
2530W-G5, 4336W-G5, 4343W detector connections from study tile, specific 83
non-integrated x-ray generator from Worklist tab 79, 80
vTrigger 226 radiation warning 84
4336W-G5 detectors Acquisition Log tab
CsI premium described 204
recommended techniques 54, 54 adjust images 97
CsI standard AIE image processing 116
recommended techniques 66, 66 basic adjustments 98
recommended techniques for DRZ+ 60 prerequisites 98
4336Wv4 and 4336Wv4+ detector connections window (contrast) 99
non-integrated x-ray generator window level (brightness 99
vTrigger 232 window level (brightness—ROI) 100
4343RC detector connections adjusting images
non-integrated x-ray generator stitching 119
vTrigger 227 AIE processing
4343RC dual detector connections adjust 116
non-integrated x-ray generator correcting slider range 117
vTrigger 243 reprocessing with ROI 118
4343Rv3 and 4343RC detector connections annotating images 125
non-integrated x-ray generator deleting measurement annotations 152
vTrigger 241 deleting text annotations 133
4343Rv3 detector connections editing measurement annotations 150
non-integrated x-ray generator editing text annotations 132
vTrigger 228 placing custom annotations 131
4343Rv3 dual detector connections placing preset annotations 127
non-integrated x-ray generator prerequisites 126
vTrigger 242 annotations
4343W and 2530W-G5 detector connections custom pointers
non-integrated x-ray generator deleting 136
vTrigger 234 editing custom pointers 135
4343W and 4336W-G5 detector connections anti-malware update 274, 274
non-integrated x-ray generator archiving images 155
vTrigger 235 all images in a study 158
4343W detectors all unsent images 158
CsI premium archive options 156
recommended techniques 54, 54 groups of patient records 160
CsI standard specific images in a study 161
recommended techniques 66, 66 Audit Log tab
recommended techniques for DRZ+ 60 described 202
4343W with tether and 2530W-G5 detector connections Automatic Image Enhancement
non-integrated x-ray generator adjusting 116
vTrigger 236 correcting slider range 117
4343W with tether and 4336W-G5 detector connections reprocessing with ROI 118
vTrigger 237

Index
C doses
CsI detectors 75
calibrating images 137 DR imaging
change history xx pediatric techniques (CsI) 72
cleaning DRZ+ detectors
chemicals 21 recommended techniques 60
x-ray detectors 22 dual detector connections
Clinical Mode non-integrated x-ray generator
introduction 23 vTrigger 232
main menu 24
Panel Status area 30
Cobb angles
E
measuring 145 edit text annotations 132
configuration emergency patients
log settings 192, 194 creating 41
Configure Logger tab exposure index 53
described 194 target exposure index 75
contact
Parts and Order Services xvii
technical support xvii F
controls
imaging 26 fields
Patient List menu 25 optional 28
Zoom 108 read-only 28
custom annotations 131 required 28
custom pointers filter Patient List tab 50
deleting 136 flip image 107
editing 135 Free Rotation tool 104
using 105
D
G
data collector
described 210 generator
Data Collector user interface window 77
using 209 getting started 3, 4
deleting text annotations 133 grid suppression
detector enabling or disabling 103
guidance for vTrigger 53
if dropped 211
detector modes
H
rad 52 hardware requirements 218
vTrigger 52 hide or show overlays 118
deviation index 53, 76
diagnostics 195
data collector described 210 I
print test patterns 200
send test patterns to storage server 200 image
test pattern 196 re-accept 96
with Data Collector 209 image adjustments
DICOM basic 98
control queue 177 flip 107
described 178 image archiving 153, 155
queue controls 180 all images in a study 158
review queue 177 all unsent images 158
DICOM Queue groups of patient records 160
described 178 options 156
disinfecting prerequisites 154
chemicals 21 specific images in a study 161
x-ray detectors 22

Index
image contrast Windows update 274, 274

invert 103 measuring images 125
image orientation angles 144
changing 107 calibrating 137
image printing 153, 162 Cobb angles 145
prerequisites 154 complex multipoint measurements 142
print preview area 163 deleting measurement annotations 152
image rejection 94, 95 editing measurement annotations 150
image size 109 leg measurements 147, 149
adjustment prerequisites 110 length or width with two points 140
changing 115 prerequisites 126
images two or more points 139
acquiring 51 messages
moving 48 managing 29
revert to default 123 modes of operation
stitching 119 introduction to Clinical Mode 23
imaging multipoint measurements 139, 142
controls 26
import
patients from Worklist 40 N
worklist from server 39
network requirements 218
index
deviation 53
exposure 53 O
indexes
deviation 76 operators
target exposure 75 settings mode 181
invert image contrast 103 orientation
changing image 107
overlays
L hide 118
show 118
leg
measuring 147, 149
log P
acquisition log 201
Acquisition Log tab described 204 panel
audit log 201 guidance for vTrigger 53
Audit Log tab described 202 panel status 30
Configure Logger tab 194 Panel Status area 30
described 201, 206, 207 Panel Status window
export 206, 207 exposure mode options 32
filter 206 open 32
reject log 201 Patient List
Reject Log tab described 203 menu controls 25
system log 201 Patient List tab
System Log tab described 205 deleting patient records 50
troubleshooting 201 filtering 50
logging 191 import from Worklist 40
logging in 3, 4 purpose 37
patient record
closing with incomplete study 94
M patient records
creating emergency records 41
main menu
creating manually 41
idle 24
deleting from list 50
maintenance
editing 46
diagnostics 195
import from Worklist 40
software
patient study
anti-malware update 274, 274
adding views 91
apply Windows update 275

Index
closing incomplete 94 replace with rectangular 113

suspending 93 software maintenance
patient study, acquire images from 84 anti-malware update 274, 274
patients apply windows update 275
acquiring images 51 windows update 274
creating emergency patients 41 Windows update 274
imaging 35 stitching 119
pediatric about 121
imaging recommendations 76 tools 122
preset annotations 127 studies
creating 128, 128 adding to existing patient records 45
deleting 128, 130 adding to new patient records
reorganizing 128, 129 custom procedures 44
printing images 162 preconfigured procedures 43
print preview area 163 opening 47
suspending 93
system componentsmobile systems 222
R system componentsstationary systems 219
system interconnections
rad mode
single detector systems
about 52
vTrigger 224
recommended techniques
three detectors
CsI premium detectors 54
4343W with tether, 2530W-G5, and 4336W-G5
CsI standard detectors 66
detectors 248
DRZ+ detectors 60
two 4343Ws with tethers and one 2530W-G5,
reject images 95
4336W-G5, or 4343W detectors 247
Reject Log tab
wireless with two 4343RC detectors 251
described 203
wireless with two 4343Rv3 detectors 250
reports
wireless, 4343Rv3, 4343RC detectors 249
reject analysis
system interconnectionsnon-integrated x-ray generator
creating 208
224
requirements, hardware 218
system log
requirements, network 218
purging 207
revert image to default 123
System Log tab
review images 97
described 205
prerequisites 98
revision history xx
ROI T
adjust window level (brightness) 100
rotating images target exposure index 75
Free Rotation tool 104, 105 tech initials
remove 190
techniques 53
S pediatric imaging (CsI) 72
technologist initials
scatter correction
described 188, 189
applying with vSharp 101
editing 189
settings mode
managing 187
for operators 181
test pattern
Settings Mode
described 196
entering 184
test patterns
entering and exiting 183
print 200
exiting 185
send to storage server 200
exposure mode options 32
SMPTE 197
open panel status 32
TG18 198
show or hide overlays 118
trademarks xvi
shutters 109
translated material xvi
adjusting 112
triple detector connections
adjustment prerequisites 110
adjustment tools 110
vTrigger 247
replace with polygonal 114

Index
troubleshooting XRpad 4336 detector connections

Acquisition Log tab 204 non-integrated x-ray generator
Audit Log tab 202 vTrigger 230
Reject Log tab 203 XRpad 4343F detector connections
System Log tab 205 non-integrated x-ray generator
with Data Collector 209 vTrigger 231
turning on equipment 3, 4 XRpad2 4336 and 4343 F detector connections
two point measurements 140 non-integrated x-ray generator
typical doses vTrigger 245
CsI 75 XRpad2 4336 dual detector connections
vTrigger 244
U XRpad2 4343 F dual detector connections
Urgent Send feature
vTrigger 246
archiving all unsent images 158
V Z
Zoom control 108
vSharp
applying scatter correction 101
vTrigger
guidance for use 53
vTrigger mode
about 52
W
Windows update 274, 274
apply 275
wireless and 4343RC detector connections
vTrigger 239
wireless and 4343Rv3 detector connections
vTrigger 240
wireless detector connections
vTrigger 225
Worklist tab
acquiring images from 79, 80
importing from server 39
Worklist tab, acquire images from
study tile, first available 82
study tile, specific 83
Worklist tab, acquiring images from
patient tile 81
X
x-ray detector
disinfecting 22
x-ray detectors
cleaning 22
X-ray generator
user interface window 77
XRpad 3025 detector connections
vTrigger 229

Index

736-424-G2 Varex NexusDR Operator

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Operator's Manual

2 | Nexus DR Operator's Manual, 736-424-G2, Rev. B

Nexus DR Operator's Manual, 736-424-G2, Rev. B | 3

Part 1. Introduction to Nexus DR.......................................................................1

CHAPTER 1 Introduction to Nexus DR............................................................................3

Part 2. Imaging Patients with Nexus DR......................................................... 35

CHAPTER 2 Creating and Editing Patient Records........................................................ 37

CHAPTER 3 Acquiring Images....................................................................................... 51

CHAPTER 4 Reviewing and Adjusting Images.............................................................. 97

iv | Nexus DR Operator's Manual, 736-424-G2, Rev. B

CHAPTER 5 Measurements and Annotations............................................................... 125

CHAPTER 6 Archiving and Printing Images................................................................ 153

Part 3. Settings Mode for Operators.............................................................. 181

CHAPTER 7 Entering and Exiting Settings Mode........................................................ 183

CHAPTER 8 Managing Technologist Initials................................................................187

CHAPTER 9 Configuring Logging Settings.................................................................. 191

CHAPTER 10 Diagnostics............................................................................................. 195

APPENDIX A. Nexus DR Measurements Accuracy......................... 213

Nexus DR Operator's Manual, 736-424-G2, Rev. B | v

Measurement factors.................................................................................................................... 214

APPENDIX B. Minimum hardware, software,network, and IT

vi | Nexus DR Operator's Manual, 736-424-G2, Rev. B

Figure 2: Unlatch Battery................................................................................................................................................................. 5

Figure 3: Battery Removal................................................................................................................................................................5

Figure 4: Insert battery at a slight angle........................................................................................................................................6

Figure 5: Lay the battery down....................................................................................................................................................... 6

Figure 6: Press down on the lifted side......................................................................................................................................... 6

Figure 7: Detector is ready for the user.........................................................................................................................................7

Figure 8: LED Status Indicator........................................................................................................................................................ 7

Figure 9: Unlatch Battery................................................................................................................................................................. 8

Figure 10: Battery Removal..............................................................................................................................................................8

Figure 11: Insert battery at a slight angle...................................................................................................................................... 9

Figure 12: Lay the battery down..................................................................................................................................................... 9

Figure 13: Press down on the lifted side..................................................................................................................................... 10

Figure 14: Detector is ready for use.............................................................................................................................................10

Figure 15: Detector Status LED.....................................................................................................................................................11

Figure 16: Detector Status LED.....................................................................................................................................................11

Figure 17: Unlatch Battery............................................................................................................................................................. 12

Figure 18: Battery Removal............................................................................................................................................................12

Figure 19: Battery Charge Level....................................................................................................................................................13

Figure 20: Reboot Sequence..........................................................................................................................................................14

Figure 21: 4343W detector tether cable........................................................................................................................................15

Figure 22: 4343W detector tether cable and USB slot................................................................................................................15

Figure 23: 4343RC I/O box power switch..................................................................................................................................... 18

Figure 24: Layout of the Clinical Mode menu..............................................................................................................................24

Figure 25: Controls of the Patient List......................................................................................................................................... 25

Figure 26: Imaging Controls with scroll bar................................................................................................................................ 26

Figure 27: Detector not ready........................................................................................................................................................31

Figure 28: Detector ready...............................................................................................................................................................31

Figure 29: Detector acquiring........................................................................................................................................................ 31

Figure 30: Tethered detector not ready........................................................................................................................................ 31

Nexus DR Operator's Manual, 736-424-G2, Rev. B | vii

Figure 31: Detector disconnected................................................................................................................................................. 31

Figure 32: Detector disconnected in Autonomous Mode........................................................................................................... 31

Figure 33: Display panel status details........................................................................................................................................ 32

Figure 34: Refresh Worklist........................................................................................................................................................... 39

Figure 35: Worklist with patients populated................................................................................................................................ 39

Figure 36: Import Patient Icon....................................................................................................................................................... 40

Figure 37: Import indicators and Next button............................................................................................................................. 40

Figure 38: New patient demographics screen............................................................................................................................. 42

Figure 39: Study identification fields............................................................................................................................................ 43

Figure 40: Select the procedure for the study.............................................................................................................................43

Figure 41: Study identification fields............................................................................................................................................ 44