How to Anonymize Studies Using Pixelation Tool

This step by step guide explains anonymizing studies using the redact tool in the ProViewer to pixelate PHI.

This guide is split into 3 sections:
“Preparing the Viewer”, “Using Redact Tool” and “Sharing Anonymized Study”

Preparing the Viewer

1. Open the ProViewer of the study you intend to anonymize in the Cimar Cloud.
   
2. Add “Redact” tool to toolbar.
    If it isn’t there click “Settings” in the left side of the top menu and you should see this menu:
   
   Select “Toolbar” on the left and scroll to the bottom of “Available Tools” where you will find “Redact” in the “Quality Control” section.
   Hold down the mouse over it and drag it to the middle column named “Toolbar”.
   Here you can position it where you find best suited.
   After you click “Save” followed by “Close” you will now have the “Redact” tool available in the main menu when viewing the study.
3. Now we need to determine what data is displayed via secondary reports and what is “burnt” into the original image. We can remove all overlays by clicking “View” in the menu and selecting “Hide All”.
   This will make the viewer display only the image and no overlaying information that has been pulled from DICOM tags and other study data.

Using Redact Tool

The Redact tool has three main settings to choose from. The tool works identical in all 3 settings but the number of images affected by the tool will depend on the chosen setting.

The option highlighted in blue is the one currently set. To choose another one simply click the selected option.

• “Draw Image Region” means the tool will only affect individual images
• “Draw Series Region” means the tool will affect all images in the selected series
• “Draw Study Region” means the tool will affect all series within the selected study.
• “Clear All Regions” will reset the selected areas
• “Redact All Regions” will pixelate the selected areas across either single images, full series or the full study depending on the setting chosen

1. To select a region, click at the corner of a point you wish to select and simply drag the cursor across to the opposite corner as shown in the image below.
   
   The area on the right is in the process of being selected. This can be determined by A) The darker shade of red compared to the two on the left and B) The two selections on the left both have “Image Region” printed at the top. This tells you which setting is chosen. This example will only pixelate this singular image but if for example “Draw Series Region” had been selected it would pixelate all images in the series at the same selected area.
2. When happy with the selected areas, click the “Redact All Regions” shown in the previous image. A pop up will appear asking you to confirm the action and letting you know that a new study will be created.
   After clicking “OK” the system will let us know the study has been added to the queue for Redaction.
   The ProViewer can now be closed to return to the studies list.
3. A copy has been made in the system with the pixelated images. The original images are still stored but if we choose the most recently updated study this will show us the pixelated images.
   
4. Clicking “Images” on the top study in this example (The new anonymized copy) will display this image:

Share Anonymized Study

To share an anonymized study we simply follow the usual sharing procedure but ensure we select the copied study that has had the pixelation added to it.

1. Tick the box on the left for the right study and select the “Actions” dropdown and choose “Share.
   

2. From the share popup we select where/who we wish to share the study with and click “Share Studies”
   

The study has now been anonymized used the “Redact” tool to pixelate any PHI that was “burnt” into the image by the modality.