View a patient's imaging

PulStar includes a DICOM viewer for showing X-ray, MRI and fluoroscopy images to patients during a visit.

Important: The imaging viewer is for patient education only. It is not intended for diagnostic use, and images may not be shown at diagnostic quality. It has no measurement or annotation tools.

Open the viewer

During a session: open the anatomy panel and choose the Imaging tab, next to Neuropatholator.
When reviewing visits: choose the Imaging tab on the review screen. The selected visit's analysis chart stays beside the images.

The viewer always shows the current patient's imaging. The first time you open it, PulStar asks you to confirm that you understand it is for patient education only.

Import images

With the patient open, click Import… in the imaging viewer.
Choose DICOM files, a folder, a ZIP archive, or photos (JPEG, PNG or HEIC).

Images are added to the patient's imaging library, grouped by study. If the files name a different patient, PulStar asks before importing them. Files that were already imported for this patient are skipped.

To remove a study, Control-click its title in the study list and choose Delete Study….

Work with images

To	Do this
Change brightness and contrast	Drag on the image: horizontally for contrast, vertically for brightness. Or choose a preset from the Window menu, such as Bone or Spine.
Move the image	Hold `⌘` and drag.
Step through frames	Scroll with the mouse or trackpad.
Play a cine loop	Click the play button. Set the speed in frames per second, and turn looping on or off.

Some videos use MPEG-2, which macOS cannot play.

Connect to an imaging server

If your practice uses an imaging server (PACS), PulStar can search it and retrieve studies for the current patient.

Choose PulStar > Preferences, click DICOM, then turn on Enable DICOM server access.
Choose the Protocol your server uses, DICOMweb or DIMSE, and enter its host and port. Your server administrator can tell you these.
For DICOMweb, enter the base path and how PulStar signs in. For DIMSE, enter the Calling and Called AE titles. DIMSE retrieves studies with C-GET, which the server must support.
Turn on Use TLS if the server supports it, then click Test Connection.

If the server's certificate was issued by your practice or hospital rather than a public authority, PulStar shows its fingerprint and asks whether to trust it. Check the fingerprint with whoever runs the server first. PulStar then accepts only that certificate, and asks again if it changes.

Passwords, tokens and private keys are stored in this Mac's Keychain and are not synced.

To retrieve studies, open the imaging viewer for a patient, click the server button (the antenna icon beside Import…), search by name, modality or date, then click Retrieve or Retrieve All. The button appears once a server is set up.

If a connection fails, turn on Log DICOM network activity, try again, then click Show Log File and send the file to PulStar support. The log contains no patient information.

Storage