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Joints A templating software designed by Medstrat that is web based but requires a core download to run on your computer Requires a user name and password that can be assigned by Tom Tjalsma or Bill Sherman This includes sales force, hospital, offices or physicians Can be added to a hospital, surgeons office or home for no cost or fee. All xrays in Joints can be imported directly into Zimmer SMS, printed or exported to a DICOM or JPEG file If you want a Joints account, please email Bill Sherman with your: First and Last Name and your email address

Why use Joints Only takes about 3 minutes of your time to template and import into SMS If you import into SMS, all of your team can see your sizes and templated xrays If “Relay” is set up it let’s you obtain xrays in a matter of minutes with little effort Gives you an accurate measurement of implants + or – 1 implant size 95% of the time (Odell Woods/ Daniel) Let’s you tailor your implant request If using DICOM you do not need magnification markers Surgeons can have templating software on their home, office or hospital computers for no cost or fee

Definitions/Modality PACS: Picture archiving and communications system DICOM: Digital Imaging and Communications in Medicine CR: Computed Radiography; uses an xray plate that is reusable DR: Digital Radiography; uses a plate that is directly connected to a server (either wired or wireless) Most images are taken either CR/DR but they are all DICOM. All DICOM images can be printed to look like regular film xrays Some offices still use the old xray hard xrays

Software Download Go to www.Medstrat.com Click on Downloads tab and log in with your user name and password

Software Download Username: first name initial then last name @zimmergl: example: bsherman@zimmergl Password: Zimmer1 (you can change it if you want to)

Software Download If downloading Joints select either MAC or Windows Browser If downloading Joints Relay select either Mac or Windows The viewer is for viewing only and not templating

Software Download Follow Software Download Wizard You will need your username and password to log on to Joints Product Key (Joints Relay does not need a product key) 3T-4U-AC-ZS-SV-99-9D Download and Install Templates See next slide

Download and Install Templates Click on the Manage tab, then Manage Templates

Download and Install Templates Click on Show all Available then Install; to install all templates at once, highlight all templates Then Click Install (it takes about 20 minutes depending on internet speed)

Upload an Image or Series Three ways 1. Push directly from PACS or imaging system (via Joints Relay): DICOM only 2. Drag and Drop (via Joints Relay): DICOM Only 3. Import to Joints: DICOM or JPEG If DICOM you do not need mag marker but you can if you want to If JPEG you will need a mag marker

“Push” Image upload How to: is specific to PACS software Must always have Joints Relay running when doing a “push” or “Drag and Drop” upload DICOM images load directly to specified user’s “To-Do” tab in Joints. Must set up Joints Relay at office or hospital Need administrative privileges to download and run software. May need to speak directly to imaging software help desk to learn how to add a “push” upload Need IP Address, AE Title, AE port When relay is configured it will display all three items above

Drag and Drop Upload When images are dragged and dropped into Relay Folder they will be added to your “To Do” tab in Joints Relay Folder will automatically appear on desktop once Joints Relay is opened and running DICOM images only Joints Relay must be up and running

Import an Image Click on Study, Import, then either DICOM or Plain Images (for JPEG Images), find Folder assigned to images (either a CD/DVD/USB or on the hard drive and click on Import.

Import an Image DICOM images will automatically import the patient information but JPEG image information will have to be manually inputted. DICOM images do not need a magnification marker But you can use one if you want to. For DICOM find folder and upload images. JPEG images need a magnification marker

Import a JPEG Image Click “Ok” when: Import to… Zimmer-Great Lakes window comes up Click on Manual Entry Add Patient Name and ID then click Accept Patient ID can be whatever you want but I always make it the name

Import a JPEG Image Type in Study Description and Body Part Examined then click accept. Image will begin to upload

Tabs Everything: Everything you have in your “personal” Joints server To Do: All images waiting to be templated Templated: All images templated but not “Planned” Planned: All images templated and linked to a case in SMS Training: All images added to your “personal” Joints server to practice with Zimmer -Great Lakes: All images you have in your “personal” Joints server

Tabs

How to Template Click on “To Do” tab Double click on patient to be templated If you want to have the AP and Lateral in the same window click on box cut into 4 quadrants on top left of the Joints Viewer page And select 1x2.

Templating Click on the crossed wrench and screwdriver DICOM: you do not need to calibrate Make sure Magnification is 115% for knees and 120% for hips JPEG: Click calibrate and manipulate red calibration marker to appropriate magnification marker If you want a full circle make: Arc Length 180 deg Type diameter or length of marker in the Diameter box in mm Click submit

Templating Ensure correct planning items are checked Body Part, Zimmer, Plane, Side, Orientation Select Implants you wish to template

Templating From this point you can do multiple things. Click on file and one of the tasks below Save: Saves templated Films but they can still be adjusted (all templated xrays must be saved in order to print or send to SMS) Print: Allows you to print the xrays with templates on them Duplicate: Allows you to copy the image with the templates burned into them. This allows you to export images with templates on them. Export: Export allows you to export one image or the entire series in either a DICOM or JPEG format Manage: Allows you to send the templated images to SMS. Other administrative functions.

Save

Print

Duplicate

Export

Manage

Sending Images to SMS You must first ensure you preferences are set. When you have the image opened: Click on Edit, preferences Case with patient info must be in SMS before sending images to SMS

Sending Images to SMS Add your SMS user name and password under the “CASE” tab.

Sending Images to SMS Before sending to SMS ensure you have saved your images. They do not need to be labeled anything specific. Click file, then save Select file, manage plan, type in surgeons name, click add

Sending Images to SMS Highlight the images to be sent to SMS and click accept Joints will automatically send images to SMS but not in the case yet. Click save once all images have been sent.

Adding Images to SMS Case Open SMS and find the case in which images are to be added. On the bottom, select plans and link plan

Adding Images to SMS Case Find patient to be added to SMS and click on the plan number. The plan will be added to your SMS case.

Viewing Images in SMS Find case to be viewed. Go to bottom of screen and select the plan select the plan number Select Files and open up the images

Setting up a Relay Download relay from Mestrat website just like you did with Joints

Setting up a Relay Open up Relay via the link created on your desktop Label the organization whatever you want Select Configure

Setting up a Relay Under physician; select add Add physicians information and click ok You can add as many surgeons as you like to send images from that relay

Setting up a Relay Under Joint Reps select “Username” and in “contains” type the username you want images sent to. Select “search” and it will ask for your Joints username and password, enter it and click ok Highlight the name and select add

Setting up a Relay Change AE name to Zimmer_Surgeon Click Accept You can add as many reps as you like You can close this screen

Setting up a Relay Notice each surgeon has there own AE Title and AE Port regardless of how many Reps. The IP Address, AE Title and AE Port are what is needed when setting up a “Push” from an office or hospital PACS. This is why it is important to change the AE title to the surgeon name

Drag and Drop Notice the folders that are created for each surgeon when they are added to Relay. This is where you drag and drop your DICOM images to be sent to Joints. The folders will go away when Relay is closed. All files that are dragged into these folders will disappear once they are sent to Joints.

Tips Preferences: Set knee magnification to 115% and hips to 120% Select “compressed” on Joints main screen. This lets the images download faster. If you are going to export a DICOM image, ensure you create a duplicate study so the images are burned on the xray