1.1 Signing in

Open your organization’s PACScasso address and choose Sign in. Enter your email and password. If your organization uses single sign-on, you are sent to your organization’s sign-in page instead.

If you forget your password, choose Forgot your password? on the sign-in page. Enter your email and we send a link to choose a new one. For your privacy, the page says the same thing whether or not the address has an account.

1.2 What you see depends on your role

Each person has one role in each organization they belong to. Your role decides which areas appear in the sidebar.

If you work for more than one organization, open the account menu at the bottom of the sidebar and choose the organization under Organization. Each organization’s patients and studies are completely separate.

1.3 Finding your way around

The sidebar on the left holds every area you can use. Administrators also see an Administration section.

• The browser’s Back button, and the back arrow on a study, return you to exactly where you were: the same tab, day, filters and sort. Tabs, filters and sorting are part of the page address, so a reload or a link you send keeps them too.
• To make room for images, collapse the sidebar with the button at its bottom or by pressing [. Press [ again to bring it back.
• To make the sidebar wider or narrower, drag its edge. PACScasso remembers your layout.
• On a phone or a narrow window, open the navigation with the menu button at the top right.

1.4 Light and dark themes

PACScasso follows your device’s light or dark setting. To choose one yourself, open the account menu at the bottom of the sidebar and pick System, Light or Dark under Theme.

1.5 Your account and security

Open the account menu and choose Account and security.

1.6 Help

The account menu also has:

• Help and support: ask our support team a question or report a problem. See Help and support.
• User manual: this manual.
• Service status: whether PACScasso is working normally right now.

2.1 Views

The tabs at the top split the work:

• Unread: studies whose images have arrived and that nobody has reported yet. The most urgent are at the top.
• Mine: studies assigned to you, and studies you have started reading.
• All: every study, whatever its state.

Each study shows its state: Scheduled, Acquiring, Unread, Reading, Preliminary, Final, Cancelled or Did not arrive. Stat and urgent studies are marked.

2.2 Filtering and searching

• Type in Search patients and accessions to find a patient by name or MRN, or a study by accession number.
• Choose one or more modalities under Modality, and a site under Site, to narrow the list.
• To see studies from a period, choose Which date (Arrived, Study date, Scheduled, Transcribed, Signed or Delivered) and set From, To or both. For example, Study date from 2 to 3 November.
• Choose Clear filters to start over.

Filters are part of the page address, so you can bookmark a filtered worklist or send its link to a colleague.

2.3 Sorting and columns

Click any column heading to sort by it; click again to reverse. To sort by more than one column, hold Shift and click another heading: it orders the studies the first column leaves tied (for example, priority, then oldest patient first). Shift-click it again to reverse it, and once more to remove it. Each sorted heading shows its place (1, 2, 3). By default, Unread sorts by priority and then by how long each study has been waiting.

Open Columns to choose which columns appear and in what order (drag them; see Tables in Getting started). Patient and Study are always shown but can move. The columns are: Priority, Age (the patient’s age at the exam, and sex; sort it to list the youngest or oldest first), Indication, Flags (from the exam details, such as Incomplete or Outside priors requested), Location, Reader, Referred by, Images and the workflow dates:

• Scheduled: when the exam was booked for
• Study date: when the technologist started it
• Received (or Waiting, on the unread list): when the images arrived
• Transcribed: when the first report draft was saved
• Signed: when the final report was signed
• Delivered: when the final report first reached the referring physician

The Flags column shows each study’s most important flag; a number such as +2 means there are more, and pointing at it names them all.

To flag a study, point at its row and choose the flag button in the Flags column. Exam details opens over the worklist; set what applies (for example Motion on some images, or Incomplete and why) and choose Save. The flags show on the row at once.

Every column sorts, including every date. Studies without that date yet (for example, not yet signed) always come last. Flags sorts flagged studies first, the most important flag (such as Incomplete) at the top. Your sort is part of the page address, like the filters. Your choice of columns and their order follows you to any computer, and the Studies and Reports lists use the same columns. Drag a heading’s edge to resize a column; widths are kept on this computer.

2.4 Saved views

A view is a saved set of filters. To save one, set the filters you want, open Views and choose Save this view. Give it a name. Turn on Share with the organization to let colleagues use it too.

To use a view, open Views and choose it. You can delete views you created.

2.5 Opening a study

Click a patient’s name to open the study in the reading workspace (see Reading a study). When you finish and choose Sign and next, PACScasso opens the next unread study for you.

2.6 Previewing a study

To look at a study without leaving the worklist, turn on Preview (beside Columns). Then click a study: a panel beside the list shows its images, with a thumbnail of each series below. Scroll the mouse wheel to move through the images and drag to change brightness and contrast. The panel also shows the indication, the referring physician, how many prior studies there are, the impression if a report exists, and the Exam details, which you can change there with Edit exam details. While the preview is open, the list keeps only the priority, age, flags and waiting columns, to leave room for the images.

Choose Open to read the study in the full workspace, or double-click the study in the list. Choose Close preview, or turn Preview off, to go back to the full-width list. The preview needs a wide window; on a narrow one, clicking a study opens it as usual.

2.7 Assigning studies

Radiologists and administrators can assign studies.

1. Tick the box beside each study, or Select all.
2. In the bar that appears, choose Assign to and pick a radiologist, or Return to the pool to make the studies available to everyone again.
3. To change urgency, choose Set priority and pick Stat, Urgent or Routine.

If some of the selected studies can’t be changed (for example, a study that is already final), PACScasso changes the rest and tells you how many it skipped.

Administrators can also assign studies automatically with routing rules. See Settings in the administration chapter.

3.1 The side panel

The tabs on the right are:

• Report: write and sign the report. See Reporting.
• Clinical: everything known about the patient and the exam.
• Notes: what staff and outside parties have said about the study. See Notes and messages.
• Images: the series and files that make up the study, and where they came from.
• Share: send the study to someone outside the organization.

People who can’t read reports (technologists and front desk) see the other tabs only.

3.2 Clinical context

The Clinical tab gathers what you need before reading. It starts with Progress and Exam details (below), then:

• Indication: why the exam was ordered.
• Referring physician: who ordered it, their practice, and how to reach them: Phone (choose it to call), Fax, Email (choose it to write) and NPI.
• Location and Scanner: the site and the device that acquired the images, with the device’s AE title.
• Accession, Scheduled, Received and Images (series × images).
• Insurance: the payer, member ID and authorization status, when recorded.

3.3 Focus mode

Choose Focus mode (the expand button at the right of the viewer’s toolbar) to fill the screen with the images and report. Choose Exit focus mode, or press Esc, to leave it.

3.4 A second monitor

Choose Open in a new window in the viewer’s toolbar to put the images in their own window. Drag that window to your second monitor and keep the report on the first.

3.5 Images and their origin

The Images tab lists each series with its number of instances, transfer syntax and size, and whether its integrity has been checked: Verified, Not yet checked or Mismatch. Under Transfers you see where the images came from and every place they have been sent.

4.1 Moving through images

• Scroll with the mouse wheel, or press ↑ and ↓, to move through the images of a series.
• Choose Play (or press C) to play through them as a movie. Choose Stop to stop.

4.2 Brightness, contrast, zoom and pan

Presets sets brightness and contrast for common tissues: Default, Soft tissue, Lung, Bone and Brain.

Rotate and flip turns the image (Rotate right, Rotate left) or mirrors it (Flip horizontal, Flip vertical).

4.3 Measuring

Measurements are in millimetres when the images carry their pixel size. They are saved with the study, so colleagues see them and they are still there when you return.

4.4 Key images

Press K, or choose Key image, to mark the image on screen as significant. Key images are listed with the report.

4.5 Layouts and comparison

Layout sets how many viewports you see: One, Two side by side, Two stacked, Three side by side, Four or Six. Choose a viewport to make it active; tools act on the active viewport.

Every sequence (at the top of Layout) puts each series of the study in its own viewport, choosing the layout that fits. For an MRI with sagittal, coronal and axial sequences, you see the three planes side by side.

• Hanging protocols arrange the series the way your organization prefers for each kind of study.
• When comparing with a prior (see Reading a study), the prior appears in its own viewport, labelled Prior.
• Sync scrolling scrolls every viewport together, so the current study and the prior stay at the same position.

For studies acquired as a volume, Layout also offers reconstructions: Multiplanar (MPR) shows the other two planes of an MR or CT, and Projection (MIP) shows a maximum-intensity projection of a PET.

4.6 Documents

Some studies include documents, such as scanned requisitions or structured reports. They appear in the series strip and open as pages instead of images.

4.7 Saved views and your toolbar

• Saved views keeps the current layout, series and brightness settings under a name, so you can return to them. Choose Save this view, give it a name and choose Save.
• Toolbar lets you choose which tools appear on the toolbar. Your choice applies on any computer.

4.8 Viewer shortcuts

5.1 Writing a report

A report has these sections: Technique, Comparison, Findings and Impression. Type into each one. The clinical history comes from the order’s indication and is printed on the report.

• Templates: choose a template to fill the sections with your organization’s standard text for the modality. Some templates ask coded questions (for example a BI-RADS category for breast imaging); choose an answer from the list.
• Macros: type a dot, a macro’s shortcut, then Tab to insert its text. For example, .nl then Tab might insert “No acute abnormality.” Administrators set up macros under Settings.

PACScasso saves as you type. The status beside the buttons shows Saving…, Saved or Unsaved changes. If saving fails, your text stays on screen and PACScasso keeps trying.

5.2 Dictation

Under Dictation, choose Record to record yourself with your computer’s microphone. Choose Stop when done. The recording is saved with the study.

• Play and Pause play it back. Back 5 seconds repeats the last few seconds.
• Delete recording removes it, after you confirm.

Transcriptionists play the recording and type the report. The first time you record, your browser asks for permission to use the microphone. If you blocked it, allow it in your browser’s site settings.

Your organization may use an external dictation system instead. Administrators set this under Settings.

5.3 Signing

When the report is complete:

• Sign signs the final report.
• Sign and next signs it and opens the next unread study.
• Sign preliminary signs a preliminary report, when your organization allows it. A preliminary report can later be signed as final.

An impression is required before signing. A signed report is locked: nobody can change it, including you. To add to it, write an addendum.

5.4 Addenda

Under Addenda, choose Add addendum, write it, and choose Sign addendum. The original report stays exactly as it was signed; the addendum appears below it with its author and time.

5.5 History, PDF and attachments

• History opens Report history: every saved draft, signature and addendum, with who did it and when.
• PDF downloads the report as a PDF, in your organization’s report format (see Report format in the administration chapter).
• Attachments: choose Attach to add a PDF, PNG or JPEG to the report, such as a worksheet.

5.6 Critical results

If a finding needs urgent communication, choose Critical result. Describe the Finding, choose the Urgency (Critical, Urgent or Unexpected), and choose Flag. The result appears under Quality until someone records who was told and the referring physician acknowledges it.

5.7 Report lists

Reports in the sidebar lists reports by state:

• To type: studies the radiologist dictated, waiting for a transcriptionist. Recording a dictation on an unread study moves it here (its state becomes Dictated).
• Drafts: reports started but not signed.
• To sign: preliminary reports waiting for a final signature.
• Signed: final reports.

Turn on Only mine to see just your own. Search, sort and choose columns as on the worklist.

5.8 Transcriptionists

Transcriptionists see the worklist and report lists, open studies, play dictation and type reports. They can’t sign. Depending on your organization’s signing rules, drafts typed by a transcriptionist go back to their radiologist to review and sign.

6.1 Adding a note

1. Open the study and choose Notes.
2. Type in Write a note.
3. Leave To set to Note for our staff, and choose Add note.

Notes for staff are seen only by people in your organization.

6.2 Sending a message outside

To ask the referring office something, or to reply to a hospital or imaging center:

1. Type your message.
2. Under To, choose the referring physician’s practice or the other organization.
3. Choose Send.

The message is delivered securely: the recipient gets a notification with a link and signs in to read it. Patient details are never put in the notification itself. Replies appear in the same list, marked Outside.

Who you can message is set by your organization: the study’s referring office, and organizations you have a sharing agreement with (see Partner organizations in the administration chapter).

7.1 Finding a patient

Type a name or MRN in Search by name or MRN. Sort by any column (name, MRN, date of birth, phone, number of studies, last study). Choose a patient to open their record.

To look at a patient’s imaging without leaving the list, choose the arrow at the start of their row. It opens to their visits, newest first: each visit is one day at one site, with the studies done on it, their times, flags and state. Choose a study to open it.

You can also press Cmd K anywhere and type a name or MRN.

7.2 Registering a patient

1. Choose New patient.
2. Enter the given and family names, date of birth and sex, and the phone and email if you have them.
3. Choose Register.

If a patient with the same name and date of birth already exists, PACScasso shows them under Possible existing record. Open the existing record instead, or choose Register anyway if it really is a different person. Registering a duplicate by mistake can attach images to the wrong person, so check carefully.

7.3 The patient record

The top of the record shows the MRN, date of birth and age, sex, phone and email. Choose Edit to correct them. Choose New order to book an exam for this patient (see Schedule).

The tabs below are:

• Imaging: every study of the patient, newest first. Choose one to open it.
• History: the patient’s clinical history.
• Identity: identifiers, other names and representatives.
• Merges: duplicate records merged into this one.
• Activity: who opened or changed the record, and when (administrators only).

7.4 Records that need review

When another system (such as a hospital’s registration system) sends details that differ from the record, the difference appears under Needs review on the Patients page. For each field, compare In the record with Incoming, then choose Keep the record or Use incoming. The search box at the top searches this list by name or MRN while you are on Needs review.

7.5 Importing and exporting patients

• Import checks a CSV file of patients before anything is created. It reports how many rows are new patients, how many match existing records, how many need review, and any problems.
• Export downloads the patient list as a CSV file.

8.1 The day

Day lists every exam booked for the day, by time, with the patient, exam, indication, location and state. Use Previous day, Next day and Today to move between days, and All locations to show one site. The header counts how many exams are scheduled and how many are done.

Each exam’s row offers its next step, so the front desk and technologists move it along:

1. Mark arrived when the patient reaches the front desk. The exam becomes Arrived.
2. Check in once forms, consent and screening are done. The exam becomes Checked in.
3. Start when the patient is on the table. The exam becomes Scanning.
4. Complete when the images have been sent. The exam becomes Unread and appears on the radiologists’ worklist.

To skip a step (a patient taken straight to the scanner, say), choose Start or Check in from the More actions menu (···). An exam can still be rescheduled or cancelled until it starts. Each step’s time appears in the exam’s Progress (see Reading a study).

Open the patient’s exam to record how it went under Exam details on the Clinical tab: whether it was complete, contrast, scan notes, what the patient said, whether priors are available, and if the patient left before it was finished (see Reading a study).

Under More actions (the button with three dots) you can:

• Reschedule: choose a new time the same way as when booking (the exam’s current time is outlined as Booked now; choosing a room at another site moves the exam there) and a Reason (for example Patient ill or Insurance or authorization), and add a Note if you like. The move is kept in the study’s exam details, and the study is flagged Rescheduled.
• Did not arrive: record a no-show.
• Cancel exam.

Cancelled exams and no-shows stay on the list, dimmed.

8.2 Booking an exam

Choose New order.

1. Find the Patient.
2. Choose the Procedure. Its preparation instructions for the patient appear under Preparation.
3. Set the Priority and Referring physician. Leave Location at Any location to see every site, or choose one.
4. Choose the Time:
   • Soonest lists the earliest free times, with the site and room. Choose one.
   • Or look at the day’s rooms below it. Each room is a timeline: Booked time is grey, Free time is highlighted, and the patient’s other exams that day are hatched. Point at free time to see the start time, and click to choose it. Use the arrows or the date to see another day.
   • Free times already allow for the procedure’s length, the opening hours, other bookings and the patient’s other exams, so a time you can choose fits.
   • To type a time instead, open Or enter a date and time.
5. Enter the Indication.
6. Under Insurance, choose Add insurance to record the Payer, Member ID, Authorization status and Authorization number.
7. Choose Create order.

PACScasso gives the exam an accession number, and it appears on the day’s schedule.

8.3 Rooms

Rooms shows each room’s exams as a timeline for the day, so you can see which rooms are busy and when they are Free. Rest the pointer on an exam to see a preview: the patient, exam, time, state, flags, indication and, once images have arrived, thumbnails of the first series. Select it to open the study; the back arrow brings you back to Rooms.

8.4 Requests

Requests lists exams that referring physicians have asked for and that are not yet booked. For each one, choose Schedule to book it (the order form opens already filled in), or Decline with a reason. A request from someone not yet registered is marked Not registered.

8.5 Exceptions

Exceptions lists exams that need attention:

• No images: the exam was completed but no images arrived.
• Incomplete: fewer images arrived than expected.
• Overdue: the exam was not started or completed on time.

Choose Resolve, say what was done, and save.

8.6 Reading coverage

Reading coverage shows which radiologist covers each site for each shift (Day, Evening, Night) of the week. Use Previous week and Next week to move between weeks. Administrators choose a radiologist for each slot; empty slots show Not covered.

9.1 Searching the archive

Studies lists every study in the organization, whatever its state. Combine any of these to find what you need:

• Search patients, accessions and procedures: a patient’s name or MRN, an accession number, or words from the procedure, body part or indication (for example “knee” or “chest pain”).
• Modality and Status.
• A date range: choose Which date (Scheduled, Study date, Arrived, Transcribed, Signed or Delivered), then the From and To days.
• The patient’s Sex, and Age at the time of the exam (youngest and oldest, in years).
• Location, Referring physician and Reader.
• Flags: studies with a flag from their exam details, for example every Incomplete exam, or every exam whose outside priors are Not available.

For example, to see only MRIs of women done on 2 and 3 November: choose MR and Female, set Which date to Study date, and set From to 2 November and To to 3 November.

Choose Clear filters to start again. Sort by any column and choose columns as on the worklist.

9.2 Transfers

Transfers shows images arriving and leaving. It has four tabs.

10.1 Sharing a study

To send a study to someone outside the organization, such as a specialist:

1. Open the study and choose Share.
2. Enter the Recipient email.
3. Choose when the link Expires after: 1 day, 7 days or 30 days.
4. Turn Include the report on or off.
5. Choose Create link.

The link is shown once. Choose Copy link to copy it. The recipient opens it in a browser to see the images and, if included, the report; they don’t need an account.

Links lists every link for the study with when it expires. Choose Revoke to stop a link working at once.

10.2 The referring physician portal

Referring physicians sign in to their own portal. They see only the patients and studies they are allowed to see, never the rest of the organization.

• The home page lists their patients’ studies, newest first, with Report ready or In progress. Search with Search patients and studies.
• Opening a study shows the report and the images. They can Download report and Download images.
• Account holds their contact details and notification choices: Email me when a report is ready and Text me when a report is ready.

10.3 The patient portal

Patients see their own imaging on their phone or computer.

• Your imaging lists their studies. A report appears once it is released; until then the study shows In progress. When a report is released depends on your organization’s release policy (see Patient release under Settings).
• They can view their images, Download report and Download images, when your organization allows it.

Under Account, patients can:

• update their Email and Mobile phone and choose how to be notified
• see and manage People who can see your imaging: invite a family member or carer, or choose Stop sharing
• Make a request for a copy of their images, their records, or a correction to their record, and follow its status
• see Who has seen or received your imaging

11.1 Quality

Open Quality in the sidebar. Radiologists see every tab; others see the ones that apply to them. Your organization may turn some of these off (see Features).

11.2 Analytics

Administrators open Analytics in the sidebar. Choose the period: Last 7 days, Last 14 days, Last 30 days or Last 90 days.

Overview shows:

• Studies received, Waiting to be read, Oldest unread and Did not arrive
• Studies received per day, by modality
• Time to final report: the Median and 90th percentile
• Final reports by radiologist

Every chart has Show as table to see its numbers; sort the table by any column.

Export charges downloads a CSV of billable exams for your billing system.

Radiation dose lists CT exams with their CTDIvol and DLP and the reference level for the exam. Exams Above reference are highlighted.

12.1 Organization

Organization shows the organization’s name and time zone, and its usage: Studies stored, Images and Storage. The storage bar shows how much of your plan’s storage is used; it turns amber, then red, as it fills, and a warning appears when it is almost full.

Locations lists each site with its address and its imaging devices: name, modality, AE title, status (Online or Offline) and when it was Last seen.

12.2 Users

Users lists everyone in the organization with their email, role and status.

• To add someone, choose Invite, enter their Email, choose their Role and choose Send invitation. They appear as Invited until they accept.
• To change a role, choose a new one in the Role column. It saves at once.

12.3 Audit log

Audit log records every sign-in, record opened, report signed, image downloaded, setting changed and access denied, with the time, who did it, the action, the record it concerns and whether it was Allowed or Denied. Sort by any column. The log can’t be changed or deleted.

12.4 System

System shows whether PACScasso’s components are working, and the version you are using.

12.5 Settings

Settings holds the organization’s configuration, in four groups. Choose a section from the list on the left.

13.1 Plan

Plan shows what your plan includes: storage, users, sites and support hours, and how much storage is used. To change your plan, contact support.

13.2 Features

Features turns optional modules on or off for everyone in the organization: Patient portal, Referring physician portal, Image sharing, Peer review, Breast imaging follow-up, Dose monitoring, Reading coverage and Analytics. A change saves at once. When a module is off, its pages and tabs disappear for everyone.

13.3 Agreements

Agreements lists the agreements your organization has accepted (the Business associate agreement, Terms of service and Privacy notice), with the version, who accepted it and when. Choose Open to read one.

13.4 Export all data

Export all data makes a complete copy of your organization’s data in open formats, so you are never locked in:

• Images (original DICOM): exactly as they were received
• Reports (PDF and FHIR)
• Patients
• Orders and schedule
• Audit log

Choose the parts you want and Start export. The export shows its progress while Preparing, then becomes Ready. Choose Download manifest to get the list of files, with a checksum for each so you can check the download is complete. An export stays available for 14 days. One export runs at a time.

13.5 Closing the account

To stop using PACScasso, open Close account, type the organization’s name exactly to confirm, optionally give a reason, and choose Close account.

The account closes 30 days later. Until then everyone can keep working, you can export your data, and you can choose Keep the account open to cancel. After closing, data is deleted, except records under a legal hold, which are kept until the hold is released.

14.1 Asking for help

Open the account menu and choose Help and support.

1. Choose New request.
2. Enter a Subject and describe What happened?
3. Choose How urgent is it?: A question, Something isn’t working or Urgent: work is stopped.
4. Leave Include technical details on, so we can find the problem faster. It adds your browser, PACScasso’s version and recent request IDs, never patient information.
5. Choose Send.

The page lists your organization’s requests with their state (Open, Waiting for you or Resolved) and our latest reply. For urgent problems, call support at any time.

If our support staff need to see your organization’s data to help, an administrator grants them time-limited access under Settings → Support access.

14.2 Service status

Choose Service status in the account menu, or open /app/status (it works without signing in). It shows whether each part of PACScasso is working (Operational, Degraded, Outage or Maintenance): the application, image viewing, reports, site gateways, the portals, and email and fax delivery. Below that are any incidents in the last 30 days, with each update we posted.

14.3 The manual

This manual is always available from User manual in the account menu.