MEDSTRAT

1. MEDSTRAT Contact/ Tech Support 1.800.882.4224

2. 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

3. 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

4. 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

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

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

7. 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

8. 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

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

10. 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)

11. 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

12. “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

13. 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

14. 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.

15. 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

16. 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

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

18. 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

19. Tabs

20. 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.

21. 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

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

23. 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.

24. Save

25. Print

26. Duplicate

27. Export

28. Manage

29. 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

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

31. 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

32. 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.

33. 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

34. 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.

35. 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

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

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

38. 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

39. 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

40. 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

41. 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

42. 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.

43. 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