CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust

PACS Guidance for Clinicians and Ward Staff

PACS Guidance for

Clinicians and Ward
Staff
Reference: 945
Written by: Melissa Slocombe
Peer reviewer: David Hughes
Approved: December 2019
Review Due: January 2023

Purpose
This guidance outlines the access and use of Picture Archiving Communication
System (PACS) for Clinicians and Ward Staff at Sheffield Children’s (NHS)
Foundation Trust.

Intended Audience
Clinicians and Ward Staff.

Author: Melissa Slocombe Review date: January 2023

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

Table of Contents

Introduction
Intended Audience
Guideline Content
Getting started – hints and tips

Introduction
PACS was introduced to Sheffield Children’s NHS Foundation Trust in 2007. X-ray
film is no longer produced in the department and all of our radiographic images and
reports are accessible on PACS. Radiology reports can also be viewed on RIS and
Sunquest ICE. Our current PACS system is provided by AGFA Healthcare, operating
Enterprise Imaging (EI) and Xero viewer. These systems replaced IMPAX 6.5.2 in
July 2018.

Intended Audience
Xero is a web based client and is a Hospital wide system used by everyone within
Radiology, clinicians, nurses, AHP’s, MDT Coordinators and some clerical staff.
EI is used in Radiology, Accident and Emergency and by Orthopaedics and
Neurology. Xero viewer is the system that is used by the rest of the Trust.

Users are given the appropriate access and profiles on Xero and EI by the IT
Department with advice from the PACS Team where necessary. User level and
profiles are determined by staff grade/role.

Guideline Content
PACS Office/Team

The PACS office is open from 8.30am until 5pm and the team can be contacted on
extension 60813 or schpacs@nhs.net. Melissa Slocombe is the PACS Manager
supported by Deputy PACS Manager Peter Halson. The team is supported by
Angela Bates and designated PACS Administrators.

How is PACS viewed?

Xero is accessible via the Xero icon.

Author: Melissa Slocombe Review date: January 2023

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

Xero can be viewed on all PC’s and terminals throughout the Trust. There are also a
number of PACS specific work stations in Radiology, Accident and Emergency and
other areas of the Trust which are used to view Enterprise Imaging. The work
stations have high resolution monitors and should always be used to view
unreported images where action is to be taken on the findings. Please contact the
PACS office if you are unsure or need help in locating these.

How do I get access to PACS?

Existing Trust staff can log in to Xero using their Novell Username and password. New
members of staff can access Xero in the same way once they have been allocated a Novell
Username and password by the IT department and have completed the online training. For
access to Enterprise Imaging please contact the PACS Team who will advise if access is
required and to organise one to one Training. If you would like any help or advice on the
system access required please contact the PACS office on extension 60813 or email
schpacs@nhs.net
How do I organise Xero training?

Even if you’ve already used a PACS system at another Trust you will still need to
receive training on how to use this system. Once you have been given access to
Xero you should use the e-learning training described below.

Xero users also have the option to use Xero Xtend which has additional tools and
functionality.

Training information can be found using the following links:

https://global.agfahealthcare.com/main/enterprise-imaging/universal-viewer/

http://rcu1eivadmin1.sch.nhs.uk/xero_elearning/

http://rcu1eivadmin1.sch.nhs.uk/xtend_elearning/

User guides and training material can also be accessed from the section in Xero
viewer (top right of screen) and it is possible to access a quick start guide and a
video tutorial. This provides a simple guide to using the system.
Training material can also be accessed from the home page of the trust intranet.

What do I do if I need to get patient images transferred to another hospital?

If a patients images are required at another hospital the PACS team can transfer
them via IEP (Image Exchange Portal). Most hospitals in the country use and have
access to this network. Out of hours and in emergency situations we also have a
direct link (we can directly push and receive directly to PACS) to some local trusts
which include, Sheffield Teaching Hospitals, Rotherham and Doncaster/Bassetlaw
Hospital, however, IEP is the preferred method for image transfer.

Please contact the PACS office on extension 60813 or schpacs@nhs.net who will
assist with the image transfer.

Author: Melissa Slocombe Review date: January 2023

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

For urgent, out of hours transfers please contact the on call radiographer on
extension 17389 or Bleep 070. Please provide full patient details including the SCH
hospital number, state the Consultant the patient is under the care of, who requires
the images at the external Hospital and the type and date of the imaging to be sent.

What do I do if I need to get patient images transferred from another hospital?

If your patient has had imaging at another hospital and you require these putting on
the PACS system at SCH, the PACS team should be able to acquire them via IEP
(Image Exchange Portal), as most hospitals use and have access to this network.
Out of hours and in emergency situations we have a direct link function (we can
directly push and receive directly to PACS) to some local trusts which include,
Sheffield Teaching Hospitals, Doncaster/Bassetlaw and Rotherham but not currently
Barnsley, Chesterfield Leeds, Grimsby/Scunthorpe and Goole. However, IEP is the
preferred method for image transfer as there is a full audit trail.

Please contact the PACS office on extension 60813 or schpacs@nhs.net who will
assist with the image transfer. Please provide full patient details including the SCH
hospital number, state the Consultant the patient is under, the type of imaging that
you require and the date of the imaging. Please only request the images that you
require and not the full imaging history where possible. For out of hours transfers
please contact the on call radiographer on extension 17389 or Bleep 070.

If you require a formal radiology report on the external imaging from SCH
radiologists you must fill in a request card with relevant clinical information and take
this to the PACS office.

How long do external images take to get to SCH PACS via IEP?

This is reliant on how quickly the request is processed at the external Hospital.
Studies containing a large number of images will take longer to transmit. They are
generally received within a few hours. If you require images urgently the PACS team
can raise the priority to ‘clinical emergency’ however this is strictly for emergency
situations only.

Images automatically download on to the PACS system and can be viewed on Xero
by searching by the patient name without any intervention from the PACS team. If
you are expecting images from other Trusts and are unable to view them, please
contact the PACS team on extension 60813.

What do I do if I cannot log onto PACS or have forgotten my password?

If you are having a problem logging onto Xero/EI and have any password issues
please contact the IT Helpdesk on 17235 . For training please contact the PACS
office on extension 60813 who will be happy to help.

Author: Melissa Slocombe Review date: January 2023

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

How do I export studies for a presentation?

If you require images for a study or presentation we can export them as JPEG’s
anonymised onto a memory stick or disc for you. Please contact the PACS office
who will assist you.

How do I send images to be discussed at MDT’s and conferences?

Images can be put onto MDT lists by emailing details to Radiologysecs@nhs.net,

please specify full patient details, which images are needed and which MDT list.

Can I set up/access teaching files?

If you need access to teaching files please contact the PACS office on extension
60813 or email schpacs@nhs.net

Getting Started – Xero hints and tips

Logging in to Xero and Xero Xtend

Click the Xero Viewer icon to launch the software and the login page will open….

Enter your Novell Username and Password when prompted.

Author: Melissa Slocombe Review date: January 2023

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

Searching

From here you can search with the patient’s hospital ID (remembering the RCUC
prefix), first/last name, location, age, study date, accession number or modality. You
can also use two or more of these criteria to narrow your search if you wish. When
you have entered your criteria press search, this will then populate your list. If your
list does not contain what you were looking for, check that all fields are correct e.g.
that you have not selected a specific modality etc.

Selecting your patient

When you have the patient or exam you require double click on the bar to select a study

This will bring you into the image area.

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

If there is more than one image available in the same exam you will have an
available series window on the right hand side, this can be minimized, moved or
hidden. The report, if available is displayed on the left side of the screen. The report
display can be removed by clicking on the X at the top right of the report. To display
the report again click

and then

from the drop down menu.

If you cannot see your available series window click on this icon

Be aware that sometimes these reports will not be verified, if they have been done
by a registrar for example, check the report carefully.

Select this icon to look at the images and reports from previous imaging
examinations.

Author: Melissa Slocombe Review date: January 2023

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

Displaying multiple studies

To view multiple studies for a particular patient tick the required images and click

to open the imaging

The image area

When you are viewing an image you may want to manipulate it, there are several
tools in this area to allow you to do so. If at any time you wish to revert to the original
image press:

To close your image down click on the arrow at the top left of the screen next to the
patient’s name.

Magnification/Zoom

This icon is standard magnification, click once on the icon, once on the image and
then use to roller ball to zoom in and out. If you do not have a roller ball on your
mouse use the page up page down keys to zoom in and out. There are several
other types of magnification when you select from the drop down arrow (shown
below), we shall explain these within the training.

Author: Melissa Slocombe Review date: January 2023

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

Window Level

Window level is usually the default tool when you open an image, so without clicking
on this icon it will usually be open already. Left click on the image and then move
the mouse around to change the contrast. On the drop down menu (shown below)
there are several other ways to window which we will show you in training.

Different options will be available on the drop down menu for each imaging modality.

Image navigate/flip/rotate

There are several options which you can use by clicking on the icon and then
clicking on the image (left click), these options will be explained in training.

Author: Melissa Slocombe Review date: January 2023

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

Active Target

Finds the location of a point of interest in another displayed series using cursor
mode.

Link series can be found on the drop down menu, this manually links together
images in different series.

Other tools

Other tools such as measurements, ratios, angles and mark up can be found by
clicking on the drop down menu next to this icon

The icon above relates to annotating images, these annotations will only be saved if
you have the ‘PACs save’ function on your account, if decide you need this, please
contact the PACS office.

Author: Melissa Slocombe Review date: January 2023

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CAEC Registration Identifier 945 Sheffield Children’s (NHS) Foundation Trust
PACS Guidance for Clinicians and Ward Staff

Extended tools/MIP/MPR/3D Viewing

Used for viewing 3D series, tool not available for all imaging modalities

Help

Click this icon to bring a list of help topics

Author: Melissa Slocombe Review date: January 2023

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