TraumaCad Admin Guide - Voyant Health

TraumaCad 

Administrator’s Guide 

Version 1.6 

A Orthocrat Ltd. Document 

Copyright 2007 

Version 1.6

2 

Important Notice 

TraumaCad Administrator’s Guide 


Copyright and Trademark Notices 

All contents of this document are Copyright 2007 Orthocrat Ltd. 

All rights reserved. TraumaCad is a trademark of Orthocrat Ltd. The trademarks, logos 

and service marks displayed on this document are the property of Orthocrat Ltd. or other 

third parties. Users are not permitted to use these trademarks, logos and service marks 

without the prior written consent of Orthocrat Ltd., or such third parties as may own them. 

Limited License 

Orthocrat Ltd. hereby gives license to review these documents solely for non-commercial 

use within your organization, provided that you do not modify the content of the documents 

and provided any copies made retain all copyright and other proprietary notices contained 

therein. The information provided in these documents is permitted solely to users to provide 

information in support of Orthocrat Ltd. products. No other use of the information provided 

hereunder is authorized. 

Nothing contained herein shall be construed as conferring by implication, estoppels or 

otherwise any license or right under any patent or trademark of Orthocrat Ltd. or any third 

party. Except as expressly provided above, nothing contained herein shall be construed as 

conferring any license or right under any Orthocrat Ltd. or third party copyright. 

Limitation of Liability 

Information provided on this document is provided "AS IS" and is provided without 

warranty of any kind, either expressed or implied, including, without limitation, warranties 

of merchantability, fitness for a particular purpose, and non-infringement. Orthocrat Ltd. 

uses reasonable efforts to include accurate and timely information on this website and 

periodically updates the information without notice. However, Orthocrat Ltd. makes no 

warranties or representations as to the accuracy or completeness of such information, and 

Orthocrat Ltd. assumes no liability or responsibility for errors or omissions in the content of 

this documents. Your use of these documents is AT YOUR OWN RISK. Under no 

circumstances and under no legal theory or provision shall Orthocrat Ltd. be liable to you or 

any other person for any direct, indirect, special, incidental, exemplary or consequential 

damages arising from your access to, or use of, these documents. 

Product information is subject to change without notice. Changes, if any, will be 

incorporated in new editions of publications provided in these documents. Orthocrat Ltd. 

retains the right to make improvements and/or changes in the products and/or the programs 

described in the publications and information provided on these documents at any time and 

without prior notice. Mention of non-Orthocrat Ltd. products or services is for information 

purposes only and constitutes neither an endorsement nor a recommendation of such 

products or services.



3 

Third-Party Information 

These documents may contain information of parties other than Orthocrat Ltd. Such 

information is provided for your convenience and reference only. The said information is not 

under the control of Orthocrat Ltd., and Orthocrat Ltd. is not responsible for the contents of 

such information. The inclusion of this information does not imply any association with their 

operators or any endorsement of the said third parties by Orthocrat Ltd. 

Microsoft is a registered trademark of Microsoft Corporation, Agfa is a registered trademark 

of Agfa-Gevaert Group and Sectra is a registered trademark of Sectra Radisoft AB. 

Disclaimer 

This software is intended as a decision support system for persons who have received 

appropriate medical training, and should not be used as a sole basis for making clinical 

decisions pertaining to patient diagnosis, care, or management. All information derived from 

the software must be clinically reviewed regarding its plausibility before use in treating 

patients. Any deviation of the application of medical information from the program, other 

than the original design or intended use thereof, is not advised and is considered a misuse of 

the software product. For additional guidance, see published studies. 

0344 

This device complies with the Requirements of the 93/42/EEC Directive Concerning 

Medical Devices. 

Authorized representative address: 

CEpartner4U B.V. 

Nijverheidsstraat 5 

2624 BA Delft 

The Netherlands 

Phone: +31 15 257 6682 

Fax: +31 15 257 6683

4 

Table of Contents 


Table of 

Contents 

About This Guide .............................................................................................6 

Contacting Us ...................................................................................................7 

Safety Symbols..................................................................................................7 

Chapter 1, Introducing the TraumaCad Server................ 9 

What is the TraumaCad Server?................................................................9 

Chapter 2, Getting Started with the TraumaCad Server11 

TraumaCad Server Setup Workflow .......................................................11 

System Requirements.....................................................................................13 

TraumaCad Server Requirements............................................................13 

TraumaCad Client Requirements ............................................................15 

Preparing for Installation..............................................................................16 

Installing the TraumaCad Server.............................................................17 

Verifying Proper Operation ..........................................................................23 

Chapter 3, Configuring the TraumaCad Server ............. 29 

Configuring the PACS Servers .....................................................................30 

Configuring DICOM Properties ...................................................................32 

Configuring Logging......................................................................................35 

Reading Log Files...........................................................................................37

Table of Contents 


5 

Download/Update Templates........................................................................ 39 

During the Downloading Process ............................................................... 40 

Completion of the Downloading Process ................................................... 43 

Downloading Templates............................................................................. 44 

Templates Updating Service......................................................................... 46 

Chapter 4, Configuring Security Settings .............................49 

Turning Off Anonymous Access Authentication in IIS.............................. 50 

Adding the Network Service User................................................................ 54 

Adding the Active Directory Group............................................................. 57 

Testing Security Settings............................................................................... 59 

Chapter 5, Scaling X-Rays......................................................61 

Theory of Operation ................................................................................... 63 

Chapter 6, Troubleshooting the TraumaCad Server.......65 

DICOM Connectivity from/to TraumaCad Server ................................ 66 

TraumaCad and Philips Sectra PACS..................................................... 67 

TraumaCad and Agfa PACS.................................................................... 69 

TraumaCad Client Installation ................................................................ 71 

Disabling the Internet Explorer Popup Blocker.......................................... 71 

Defining the TraumaCad Server as a Trusted Site.................................. 72 

TraumaCad ActiveX Debug Mode........................................................... 74 

Enabling TraumaCad Logging for Diagnostic Purposes ....................... 75 

Templates Issues............................................................................................ 76 

Checking Template Availability................................................................. 77 

Viewing TraumaCad Server Logs .......................................................... 78 

Requests for New Templates ........................................................................ 81 

Using Medical Tools ...................................................................................... 81

6 

About This Guide 


About This 

Guide 

TraumaCad is intended for surgeons who are performing preoperative 

evaluation and planning for orthopedic procedures. 

This guide is intended for TraumaCad system administrators. It describes 

the initial installation and setup stages of the TraumaCad server and how 

to perform ongoing configuration modifications when required. 

This guide contains the following chapters: 

• Chapter 1, Introducing the TraumaCad Server, page 9, describes 

the purpose of the TraumaCad server and the TraumaCad DICOM 

workflow. 

• Chapter 2, Getting Started with the TraumaCad Server, page 11, 

describes the process of getting the TraumaCad server up and 

running. 

• Chapter 3, Configuring the TraumaCad Server, page 29, 

describes how to configure the TraumaCad server using the control 

panel. 

• Chapter 4, Configuring Security Settings, page 49, describes how to 

configure TraumaCad security settings so that each time a 

TraumaCad client is launched it requests an authorized user name 

and password. 

• Chapter 5, Scaling X-Rays, page 61, describes how to use the scaling 

sphere for X-ray calibration. 

• Chapter 6, Troubleshooting the TraumaCad Server, page 65, 

describes how to troubleshoot problems that may arise.

Contacting Us 


7 

Contacting Us 

USA Office 

173 S. Portland Ave. 

Floor 3 

Brooklyn, NY 11217, USA 

Telephone 1-877-2111-804 

Fax 1-801-881-5239 

Sales@traumacad.com 

Israeli Office 

35 Efal St, 12th floor 

Petah-Tikva, 49511, Israel 

US Toll free number: 866-717-0272 

UK Toll free number: 0800-404-8204 

International Telephone +972-3-9290929 

International Fax +972-3-9236413 

Support@TraumaCad.com 

Safety Symbols 

! 

The following symbols are used throughout the documentation. Please pay 

particular attention at specific points in a procedure when one of the 

following messages appears. 

WARNING! 

A WARNING! denotes a hazard. It calls attention to a procedure that, if not 

correctly performed or adhered to, could result in injury or loss of life. Do not 

proceed beyond a warning note until the indicated conditions are fully understood 

and met. 

NOTE: 

Notes provide pertinent information to help obtain optimum performance from the 

program. 

IMPORTANT: 

Denotes important information to which you should adhere.

8 

Safety Symbols 


This page is intentionally left blank.

Introducing the TraumaCad Server 


9 

3Chapter 1 

Introducing the 

TraumaCad Server 

What is the TraumaCad Server? 

The following describes the purpose of the TraumaCad server and the 

TraumaCad DICOM workflow. 

The TraumaCad server centralizes access to the archived PACS DICOM 

images in order to enable the orthopedic surgeon to seamlessly perform 

preoperative planning. The TraumaCad server enables them to find 

(C-FIND), retrieve (C-MOVE) and commit (C-STORE) DICOM images 

from and to a PACS server, as follows: 

2 

Image Queries (C-Find) 

3 

1 4 

HTTP / HTTPS 

Image Retrievals (C-Move) 

5 

Send Images (C-SEND / C-Store) 

TraumaCad TM Clients 

Optional Firewall 

TraumaCad TM Sever 

PACS Server

10 

Introducing the TraumaCad Server 


► The following describes the TraumaCad DICOM 

workflow: 

1 A user of the TraumaCad client application requests to query or 

retrieve a DICOM image. 

2 This request is made through the TraumaCad server which performs 

the query (C-FIND) or retrieval (C-MOVE) on behalf of the 

TraumaCad client. The session number is retained in the server’s 

session table. 

3 The TraumaCad server receives the image information or the images 

from the PACS server and forwards them to the TraumaCad client 

for templating though the HTTP port (port 80) or HTTPS (port 443). 

4 When the user requests to do so, the TraumaCad client requests the 

TraumaCad server to commit (C-STORE) the templated image to the 

PACS. 

5 The TraumaCad server forwards this request to the PACS and 

delivers the files to it. 

NOTE: 

No medical data is stored on the TraumaCad server. The TraumaCad 

server disconnects from the client after 30 seconds of inactivity on the client 

application. The images are deleted from the server’s memory cache and the 

session table holding the session number is cleared.

Getting Started with the TraumaCad Server 


11 

4Chapter 2 

Getting Started 

with the 


Server 

TraumaCad Server Setup Workflow 

The process of getting the TraumaCad server up and running is as follows: 

Step 1 

Verifying System 

Requirements 

Step 2 

Preparing for Installation 

Step 3 

Installing the 


Step 4 

Configuring the 


Step 5 

Verifying Proper TraumaCad 

Server Operation 

Step 6 

Configuring Security Settings 

[Optional] 

Step 7 

Installing TraumaCad Clients

12 



Step 1: Verifying System Requirements: Verify that the machine on 

which the TraumaCad server will be installed and the machines on which 

the TraumaCad clients will be installed meet the requirements listed in 

the System Requirements section on page 13. 

Step 2: Preparing for Installation: Before installing the TraumaCad 

server, follow the instructions in the Preparing for Installation section on 

page 16. 

Step 3: Installing the TraumaCad Server: Install the TraumaCad 

server software, as described in the Installing the TraumaCad Server 

section on page 17. 

Step 4: Configuring the TraumaCad Server: Configure the 

TraumaCad server, as described in Chapter 3, Configuring the 

TraumaCad Server on page 29. 

The first two sections of this chapter (Configuring the PACS Servers 

and Configuring DICOM Properties) must be configured before the 

server can operate. 

All other settings are installed with defaults that will enable you to work 

comfortably. 

Step 5: Verifying Proper TraumaCad Server Operation: Check that 

at least one TraumaCad client can connect to the TraumaCad server 

and that it can query, retrieve and commit images from and to the PACS, as 

described in the Verifying Proper Operation section on page 23. 

Step 6: Configuring Security Settings: [Optional] Configure 

TraumaCad security settings so that each time a TraumaCad client is 

launched it requests an authorized user name and password, as described in 

the Chapter 4, Configuring Security Settings section on page 49. 

Step 7: Installing TraumaCad Clients: TraumaCad Clients can now 

be installed.



13 

System Requirements 

The following describes the requirements for the TraumaCad server, 

below, and the TraumaCad client, as described on page 15. 

! 


Requirements 

IMPORTANT: 

Before installing the TraumaCad server, please verify that all prerequisite 

software components are installed and that the minimum hardware requirements 

are met, as described below. 

This section assumes that the reader is familiar with basic Windows 2003 

server administration. 

To install the TraumaCad Server, you must be logged-on as a user 

with administrative privileges. 

Software Server Requirements 

• Windows 2003 Server standard edition (English only). 

• MS Internet Information Services (IIS) 6. 

• MS windows update (including all the patches and hot fixes available). 

• Microsoft ASP.NET. 

• Microsoft .NET Framework v1.1 or higher. 

• IE version 6 Service Pack 1 (or above). 

• I386 directory from the installation CD. 

• VCN, PCAnywhere or MS Terminal (recommended for remote 

diagnostics). 

• If the IIS server requires an SSL certificate, then this certificate must be 

installed on the TraumaCad server prior to its installation.

14 



Hardware Server Requirements 

Minimal Server Hardware Requirements 

• Pentium 4 or Xeon® (3 GHz or faster) 

• 512 MB RAM or more 

• Hard Drive: 

• Up to 85 MB for the software 

• Up to 800 MB for digital templates 

• Permanent Internet connection 

• 1024x768 screen resolution 

• Open internet access to http://ortho-cad.com/Templates (for automatic 

templates library updates) 

Recommended Server Hardware Requirements 

• At least two processors of 

• Intel Xeon® (3.0GHz) 

• Dual-Core AMD Opteron (2.8Ghz) 

• 2-4GB RAM 

• Hard Drive (OS in mirror): 


• Up to 2 GB for digital templates 



• Open internet access to http://ortho-cad.com/Templates (for automatic 

templates library updates)



15 

TraumaCad Client Requirements 

! IMPORTANT: 

Before installing TraumaCad on a client, please verify that all prerequisite 

software components are installed and that the minimum hardware requirements 

are met, as described below. 

This section assumes that the reader is familiar with basic Windows XP 

administration. To install TraumaCad client, you must be logged-on as a 

user with administrative privileges. 

Software Client Requirements 

• Windows XP professional 32-bit (English only*) 

• Windows XP Professional SP2 (English only) 

• MS windows update (including all the patches and hot fixes available) 

• Microsoft .NET Framework v1.1 SP1 

• IE version 6 Service Pack 1 (or above) 

• I386 directory from the installation CD 

• VCN, PCAnywhere or MS Terminal (recommended for remote 

diagnostics) 

*Note: For non-English installations, please contact TraumaCad support 

(support@traumacad.com). 

Hardware Client Requirements 

Minimal Client Hardware Requirements 

• Pentium 4 (2.4 GHz or faster) 

• 512 MB RAM or more 

• Hard Drive: 


• Up to 500 MB for digital templates (cache directory) 



Recommended Client Hardware Requirements 

• Pentium 4 or Xeon (3 GHz or faster) 

• 1024-2048 MB RAM or more

16 



Preparing for Installation 

Before installing the TraumaCad server, perform the following: 

• Verify that the system on which the TraumaCad server is to be 

installed complies with all system requirements as specified in the 

System Requirements section on page 13. 

• If you want the TraumaCad server application to run using SSL, then 

you must install an SSL certificate on the machine before installing the 

TraumaCad server application. 

If you decide that you want the TraumaCad server application to run 

using SSL after the TraumaCad server application has already been 

installed, the TraumaCad server must be uninstalled and then 

reinstalled. 

• Before installing TraumaCad server, define TraumaCad as a 

DICOM node in your PACS server and supply the configuration details 

to the TraumaCad support representative and/or the implementation 

engineer as follows: 

• IP address of TraumaCad server 

• Application Entity (AE) Title of TraumaCad Server 

• Port to be used for DICOM traffic (C-FIND, C-MOVE, C-STORE) 

• Please visit the following URL in order to check the connectivity of the 

TraumaCad server computer to our online licensing server: 

http://ortho.securelm.net/LicenseIssueWs/IssueService.asmx 

If a list of services is displayed, it means that the TraumaCad server 

can connect to our server. 

If this list is not displayed, it means that the TraumaCad server 

computer is not connected to the Internet, or that the firewall/proxy in 

your organization is blocking this connection. In this case, contact your 

system administrator to enable this connection. 

Also, please email the log file (typically under C:\Program\ 

Files\OrthoCad\TraumaCad\SecureLM.log) to 

Support@TraumaCad.com.



17 

Installing the TraumaCad Server 

NOTE: 

Installation and configuration of the TraumaCad server must be performed 

before installing TraumaCad clients. 

Before installing the TraumaCad server, make sure that you have 

followed the instructions provided in the System Requirements section on 

page 13 and the Preparing for Installation section on page 16. 

► To install TraumaCad: 

1 Make sure that you have the latest TraumaCad server installation 

program provided by the TraumaCad support team. This can be 

downloaded from the web through a link provided by the 

TraumaCad support team or from a CD supplied in the 

TraumaCad installation package. 

2 Launch the TraumaCad installation program. The following window 

appears after a few moments:

18 



3 Click Next and then accept the terms of the license agreement in the 

window that follows. 

4 Click Next and then Next again to display the following window: 

If you would like to work with the IIS server through SSL, then this 

certificate must be installed on the TraumaCad server prior to its 

installation. 

If it is, then check the Use SSL checkbox and proceed to the next step 

below. 

If you want to work with the IIS server through SSL and this certificate 

has not yet been installed on the TraumaCad server, then stop 

installation by clicking Cancel until the installer closes (by clicking 

Yes in the Are you sure you would like to stop the installation 

message window, install the certificate, and restart the installation 

process from the beginning).



19 

5 Click Next to display the following window: 

6 Click Install and wait up to several minutes while the following 

window is displayed:

20 



The following two icons should appear on your desktop: 


Control Panel 


DICOM Logs 

• TraumaCad Server Control Panel: provides the web pages 

through which you can configure the TraumaCad server, as 

described in Chapter 3, Configuring the TraumaCad Server on 

page 29. 

• TraumaCad DICOM Logs: provides a log of all the DICOM 

communication between the TraumaCad server and the PACS, as 

described in the Reading Log Files section on page 37. 

7 Click Finish.



21 

8 The Online Activation window is displayed, as shown below: 

9 Paste or type the activation key that was received from the 

TraumaCad support team by email or that is printed on the 

TraumaCad server installation box, into the Activation Key field 

and click the Activate Online button. 

Its format is similar to x-xxxx-xxxx-xxxx-xxxx. 

! IMPORTANT: 

During this stage, the TraumaCad server must be connected to the 

Internet to enable online license activation.

22 



10 Click OK to display the control panel, as shown below: 

11 A message appears in red at the top of this window to indicate that two 

initial configuration steps must be performed before the TraumaCad 

server can function properly. 

! 

IMPORTANT: 

Make sure to perform the following two procedures before trying to use 

TraumaCad TM . 

• Configuring the PACS Servers, as described in the Configuring 

the PACS Servers section on page 30. 

• Configuring DICOM Properties, as described in the Configuring 

DICOM Properties section on page 32.



23 

Verifying Proper Operation 

After you have installed and configured the TraumaCad server, you 

should check that at least one TraumaCad client can connect to the 

TraumaCad server and that it can query, retrieve and commit from and to 

the PACS. An example procedure for doing this is provided below. 

NOTE: 

You should also verify that each workstation on which a TraumaCad client will 

be installed meets the requirements listed in the TraumaCad Client 

Requirements section on page 15. 

► To prepare a TraumaCad client: 

1 Use Internet Explorer to access the TraumaCad server home page. 

The address is: 

http: //< TraumaCad server IP address>/tcwservice/index.aspx 

When a workstation accesses the TraumaCad server for the first 

time, the following window is displayed: 

2 Click Install to download and install the TraumaCad client ActiveX 

control package to this workstation.

24 



3 Click the Start Here button to install the TraumaCad client. After 

installation, the TraumaCad window opens, as shown below: 

4 Verify that the PACS server that you defined as described in the 

Configuring the PACS Servers section on page 30 appears as a radio 

button at the top middle of the window. 

5 Verify that the address of the TraumaCad server appears in the title 

bar of the window.



25 

6 Query the PACS for patient information by clicking the Query button. 

7 Retrieve an image from the PACS by double-clicking a patient name in 

the list. One or more images should appear as thumbnails on the left, as 

shown below:

26 



8 Commit an image to the PACS by: 

• Selecting an orientation (AP or Lat, Left or Right) and clicking the 

button. The image then opens in the main view and the 

Calibration window appears on the left, as shown below: 

• Click the Skip Calibration button. 

• Click the Text Annotation tool and type in a textual 

annotation. 

• Click OK and the annotation will appear on the image. 

• Click Next and choose any procedure.



27 

• Click Next until you see a window similar to the following: 

• Click the Commit button. The following message indicates that the 

image was successfully committed to the PACS. 

If any of these processes do not work, then: 

• Check the PACS configuration on the TraumaCad server by 

verifying the correctness of the PACS IP address, AE titles and ports. 

• Check the TraumaCad server configuration on the PACS by 

verifying the correctness of the TraumaCad server IP address, AE 

titles and ports. 

• Restart the IIS on the TraumaCad server and test the workstation 

again.

28 



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Configuring the TraumaCad Server 


29 

5Chapter 3 

Configuring the 


Server 

About This Chapter 

This chapter contains the following sections: 

• Configuring the PACS Servers, page 30 

• Configuring DICOM Properties, page 32 

• Configuring Logging, page 35 

• Reading Log Files, page 37 

• Download/Update Templates, page 39 

• Templates Updating Service, page 46

30 



Configuring the PACS Servers 

This step describes how to configure the TraumaCad server to connect to 

the PACS servers in order to access DICOM images. 

► To configure the connection to the PACS servers: 

1 Click the button to display the following window: 

2 Click on the Add Server button to display a table as shown below:



31 

3 Define a PACS server to which the TraumaCad server can connect 

by filling in the following fields. Double-click a field to edit it. 

Each row represents a single PACS. You can define more than one 

PACS by filling in one per row, as follows: 

• Server Name: PACS server name. 

• Application Entity Title: PACS AE title. 

• PACS Query System Port: This is the port used to query and 

retrieve images from the PACS (C-FIND and C-MOVE). 

• Server IP Address: The IP address of the PACS server. 

• DICOM Send Port: This is the port used for committing images to 

the PACS (C-STORE). 

4 Click Save Settings after you enter each row.

32 



Configuring DICOM Properties 

This step describes how to configure the TraumaCad server as a DICOM 

node. It determines the way that the TraumaCad server interacts with the 

PACS systems. 

► To configure DICOM properties: 


2 Fill out the Local DICOM Properties, as follows: 

• DICOM Server Port: This is the port number to be used to query 

(C-FIND), retrieve (C-MOVE) and commit (C-STORE) from/to the 

PACS from TraumaCad. 

• Local Application Entity: TraumaCad Application Entity in the 

PACS.



33 

3 If you only defined one PACS server in the Configuring the PACS 

Servers section, as described on page 30, then this PACS server 

automatically appears in the Default Server Settings area in the 

Default QR Server and the Default Send Server fields. In this case, 

skip to Step 4. 

If you defined more than one PACS server in the Configuring the 

PACS Servers section, as described on page 30, then you can specify 

which PACS server is used for each type of operation: 

• In the Default QR Server dropdown field, select the PACS server to 

be used by default for querying and retrieving (C-FIND and C- 

RETREIVE) to/from the PACS. 

• In the Default Send Server dropdown field, select the PACS server 

to be used by default for sending (C-STORE) to the PACS. 

In this case, you must select the Default PACS radio button, which 

indicates that the system will use the servers specified in the Default 

QR Server and the Default Send Server fields. 

In the example below, the configuration on the left shows the definition 

of a single PACS server, and the configuration on the right shows the 

definition of different PACS servers. 

A Single PACS Server 

Different PACS Servers

34 



4 Fill out the TraumaCad Workstation Properties, as follows: 

• Allow Import of DICOM files on the workstations: Check this 

option to specify that the Import Image button is available on the 

TraumaCad workstations. This button enables the users to import 

images from another source, such as: a CD, digital camera and so on. 

• Enable queries on the workstations: Check this option to specify 

that the Query button is available on the TraumaCad 

workstations. This button enables the users to find patients according 

to criteria that they specify, such as: Last Name, patient ID, Study 

Date and so on. 

• Committing Images to: Please refer to Step 3 in the Configuring 

the PACS Servers section, as described on page 30, for a description 

of this field. 

• Commit as Modality: Specify the modality type of the system. If 

this field is left blank, then the original modality type of the image is 

retained. An example of the usage of this field is when a hospital 

would like to indicate that preoperative planning information was 

added as an additional series. In this case, you might enter 

Orthopedic Templating (OT) in this field. 

• Skip auto-calibration feature: Check this option to specify that the 

automatic calibration feature that is used in TraumaCad 

workstations is disabled. 

• Metal Ball Diameter: Enter the diameter of the calibration metal 

ball (if applicable). The default is 1" inch (2.54mm). 

5 Click Save Settings to save all these settings to the TraumaCad 

server. 

NOTE: 

After you have completed this step and the Configuring the PACS Servers step, 

as described on page 30, the red message that was shown on page 22 should 

disappear.



35 

Configuring Logging 

This step describes how to configure the TraumaCad server logging 

options. 

► To configure the TraumaCad server logging options: 


2 Check the Log events and messages option to enable logging on the 

TraumaCad server. This option is selected by default, and we 

recommend that it remain checked. 

3 In the Log files folder field, specify the directory in which to store the 

log.

36 



4 Check one or more relevant options in the Define logging level area in 

order to specify the depth and type of information that is logged by the 

TraumaCad server, as follows. The default option is Warning. We 

recommend that you leave these settings as they are. 

• Debug: For internal use by TraumaCad support representatives. 

• Config: Logs configuration updates and errors. 

• Warning: Logs system warnings. This is the default. 

• Verbose: Logs the maximum amount of information about each 

action and problem. 

• Info: Logs general system actions. 

• Exception: Logs serious system problems. 

IMPORTANT: 

! 

If you detect a problem in the system, we recommend that you check all the 

logging options described above and then repeat the action that caused the 

problem. Afterwards, send the log file by email to Support@TraumaCad.com 


server.



37 

Reading Log Files 

This section describes how to view the log files, which can be used for 

troubleshooting purposes. 

► To view log files: 

Click the 

following: 

button to display a window similar to the 

Each row in the window represents a separate log file. A log file is started 

each new day and each time the TraumaCad server is restarted. 

NOTE: 

Typically, the TraumaCad server should be restarted at least once a month.

38 



The display of the logs shows the following columns: 

• Log File Name: The name of the log file. The name of each log file is 

in the noted format according to the day on which it was recorded. 

• Last Activity At: The date and time of the last activity logged in this 

file. 

• Created At: The date and time of the first activity logged in this file. 

• Display: Provides a link that you can click to view the log entries in 

this log file. The following types of logs are recorded by the 

TraumaCad server: 

• T.C.AuditTrail.YYYYMMDD.log: This log shows the auditing of 

user actions in the system. 

• TCTemplatesService.YYYYMMDD.log: This log shows the 

template updates and update problems on the TraumaCad server.



39 

• TCWService.YYYYMMDD.log: This log shows the actions of the 

main web service of the TraumaCad server. Usually, this log will 

contain error messages and warnings. 

• Download: Click to download the log file to your computer in order to 

provide it to TraumaCad support if needed. 

Download/Update Templates 

This section describes the processing of downloading and updating the 

latest templates to the TraumaCad server. This process is activated in 

order to download and update the latest templates from the Orthocrat online 

database to your local TraumaCad server’s templates library, so that they 

can be served to the TraumaCad workstations. 

It is activated in the following cases: 

• Automatically after installation, and this process may take a few hours. 

• Manually on an as-needed basis, as described in the Downloading 

Templates section on page 44. This option is typically used when the 

TraumaCad server is not continuously connected to the Internet. To 

use this option, connect to the Internet, download and then disconnect. 

• According to a schedule, as described in the Templates Updating 

Service section on page 46.

40 



During the Downloading Process 

This process is activated automatically after installation and may take a few 

hours. During this time, do not access the templates page in the control 

panel. 

While the TraumaCad server is downloading, the following message is 

displayed: 

• The TCTemplatesService is currently updating the local templates 

library. Please try again later (updating may take a few hours). 

• The TCTemplatesService is currently updating the templates library. 

You cannot access this page while the service is downloading. 

• Please try again later or click here. 

Because of the fact that this process may take up to several hours, you may 

want to see how this process is progressing.



41 

► To view the downloading progress: 

1 Right-click My Computer and select Manage from the popup menu. 

2 Under the System Tools branch, select Event Viewer and then 

Templates Service, to display a window similar to the following: 

The TraumaCad templates library currently contains approximately 

16,000 templates, which are downloaded in packages. Each 

successfully downloaded template package appears in the Event 

Viewer as a Success Audit event. 

You can press F5 to see that more Success Audit event rows appear.

42 



3 You can double-click an event to display a window describing the 

event, as shown below: 

! 

IMPORTANT: 

If you suspect that a specific template should appear in the TraumaCad 

workstation and it does not, you can open this window to see if there are 

any TCTemplatesService event Warnings or Errors. If there are, you may 

want to display more information about this event by double-clicking it as 

described above and sending the event log to TraumaCad support, if 

needed.



43 

Completion of the Downloading 

Process 

► To verify that the downloading process is complete: 

1 Right-click My Computer and select Manage from the popup menu. 

2 Under the System Tools branch, select Event Viewer and then 

Templates Service. 

3 If the downloading process is complete, one or more 

Information events will appear at the top of the window, as shown 

below. Double-click one of them. If you see a description that says: 

Templates indexing process ended successfully… 

Then the process has completed.

44 



Downloading Templates 

► To download templates: 

1 The process of downloading templates is started automatically after 

installation or can be started by clicking the 

button. The following window is then displayed: 

This window lists the templates that are stored locally on the 

TraumaCad server. The following describes the legend at the bottom 

of the window: 

Black Downloaded Template: Templates that were downloaded and 

are already stored on the TraumaCad server and are up to date. 

Blue Not Downloaded Template: Templates that are not downloaded 

to the TraumaCad server and are available for downloading. 

Red Expired Template: Templates that are stored locally and for 

which a newer version exists and is available for downloading.



45 

2 In the Templates Local Path field, specify the path to which the 

templates will be saved. This value should not be changed without first 

consulting with a TraumaCad support representative. 

NOTE: 

At least 1GB of space must be available on the local drive. 

3 You can use the Filter Templates View field to filter the view of 

templates that are displayed. To do so, enter any text string, such as the 

name of a manufacturer in this field and then click the 

button. 

4 Select the templates that you want to download by using the buttons at 

the bottom of the window or checking the check boxes in the window 

and click . 

Downloading Templates Window Buttons 

The following describes the four buttons that appear at the bottom of this 

window: 

• Select Expired Templates: Check this button to select 

all the templates that are stored locally and for which a newer version 

exists and is available for downloading. 

• Select Undownloaded Templates: Check this button 

to select all the templates that are not downloaded to the TraumaCad 

server and are available for downloading. 

• Select None: Check this button to unselect all the selected 

templates in this window. 

• Download Selected Items: Select the templates 

that you want to download using the buttons described above and then 

click this button to download them to the TraumaCad server.

46 



Templates Updating Service 

This section describes how to define a schedule for updating the templates 

on your local TraumaCad server from the Orthocrat online database 

server. 

► To update templates: 

1 Click the button to display a window similar to 

the following: 

The Templates Service Status area indicates whether this service is 

active. The service should be active at all times, except when the site 

has no internet connection. While the service is stopped, no errors are 

documented in the Event Viewer, which was described in the previous 

pages.



47 

2 In the Service preferences area, you can start, stop or pause this 

service. Stopping the service while it is running may take a few 

minutes. Once you stop it, it remains stopped until the TraumaCad 

TCTemplateService is restarted. 

3 In the Schedule area, select the day of the week on which this process 

should start and the time range within which it should start (we 

recommend to select night hours). 

NOTE: 

Please allow enough time for the template download process to complete, 

which usually takes a few hours. 


server. 

! 

IMPORTANT: 

If you have a problem downloading templates or a template does not appear 

on the TraumaCad workstation, try to resolve it by clicking the Index 

Template Now button and check if this has solved the problem. This 

process may take several minutes.

48 






49 

6Chapter 4 

Configuring 

Security Settings 

This step is optional. You can use it to configure TraumaCad security 

settings so that each time a TraumaCad client application is launched, it 

requests an authorized user name and password, as shown below:

50 



Turning Off Anonymous Access 

Authentication in IIS 

Turn off anonymous access authentication in IIS for the TCWAuth.asmx 

file under TCWLicense, as follows: 

► To turn off anonymous access authentication in IIS: 

1 Open the IIS Manager. 

2 Right-click TCWAuth.asmx and select Properties from the menu. 

The TCWAuth.asmx Properties window is displayed. 

3 In the File Security tab, click the Edit button. The Authentication 

Methods window is displayed. 

• Uncheck the Enable anonymous access checkbox. 

• Verify that the .NET Passport authentication checkbox is 

unchecked. 

• Click OK to exit this window and then OK again in the 

TCWAuth.asmx window.



51 

4 Open the TCWLicense folder under IIS 

(c:\inetpub\wwwroot\TCWLicense) and set the security options for the 

TCWAuth.asmx file, as follows: 

5 Right-click TCWAuth.asmx at c:\Inetpub\wwwroot\TCWLicense 

and select Properties from the menu. The TCWAuth.asmx Properties 

window is displayed.

52 



6 In the Security tab, click the Advanced button. The Advanced Security 

Settings for TCWAuth.asmx window is displayed: 

7 Uncheck the Allow inheritable permissions… checkbox. The 

following window is then displayed:



53 

8 Click the Copy button and then OK. The TCWAuth.asmx Properties 

window is then displayed showing the same users group (without 

inheritable permissions), as shown below: 

9 Make sure that the following users/groups have the following 

permissions: 

• The Administrators group has Full Control permissions. 

• NETWORK SERVICE (in IIS V.6) or ASPNET (in IIS V.5) has 

Read. More details are provided on this subject in the section that 

follows. 

• The desired group (local group or an Active Directory group) has 

Modify, Read & Execute, Read and Write permissions. More 

details are provided on this subject in the section that follows.

54 



Adding the Network Service User 

► To add a network service user: 

1 Open the IIS Manager. 

2 Right-click TCWAuth.asmx and select Properties from the menu. 

The TCWAuth.asmx Properties window is displayed. 

3 In the File Security tab, click the Add button. The following window 

appears: 

4 Click the Locations button to display a window similar to the 

following:



55 

5 Select your local computer name and click OK to display the following 

window: 

6 In the Enter the object names to select area, type NETWORK 

SERVICE and click the Check Names button to find the network 

service user locally on the TraumaCad server. It appears all 

capitalized and underlined when it is found. 

NOTE: 

This network service user is found locally on the TraumaCad server and 

not in the Active Directory of the organization.

56 



7 Click OK to return to the TCWAuth.asmx Properties window in which 

you will now see that the NETWORK SERVICE user has been added, 

as shown below:



57 

Adding the Active Directory Group 

Add the Active Directory group which specifies the groups of users 

allowed to access the TraumaCad application by clicking the Add button. 

► To add the Active Directory Group: 

1 In the Select Users or Groups window, click the Locations button to 

display a window similar to the following: 

2 Select the location of the Active Directory and click OK. 

3 In the Select Users or Groups window, in the Enter the object names 

to select area, type the name of the Active Directory and click the 

Check Names button. 

4 Once the name appears underlined, it can be assigned the following 

permission by checking the appropriate check boxes: Modify, Read & 

Execute, Read and Write.

58 



5 Select the other user groups in the Group or user name area and click 

the Remove button, so that only the new TraumaCad group, the 

Administrators group and the network service user remain in the 

window (similar to the following).



59 

Testing Security Settings 

► To test that the security settings operate properly: 

1 Log on to a domain computer using a non-authorized user. 

2 Open TraumaCad home page 

(http:// 

3 When prompted for a user name and password, enter a non-authorized 

user name for the TraumaCad application in the credentials window 

and click OK. The TraumaCad client should not be opened. 

4 Then enter an authorized user name for the TraumaCad application 

in the credentials window and click OK. The TraumaCad client 

should open. 

5 In TraumaCad audit trail log, which is typically located on 

TraumaCad server at the C:\LOG directory, verify that the 

credentials appear of the user marked in the open TraumaCad.

60 




Scaling X-Rays 


61 

7Chapter 5 


In order to enable automatic calibration of images in TraumaCad, all you 

need to do is to place the scaling sphere on the same plane as the bone 

during image acquisition. This means that the bone and the sphere should 

be the same distance from the x-ray plate and the x-ray source. An example 

is shown below:

62 



The following shows an example of a calibrated image in TraumaCad:



63 

Theory of Operation 

This section describes the theory of how the scaling sphere resolves the 

calibration problems inherent in x-rays. 

Reading this section is not mandatory. 

Direct linear measurements cannot be taken from plain x-rays because of 

the unknown magnification factor inherent in the x-ray taking process. 

X-rays are generated at a point source and radiate out in a divergent beam 

from that point. The beam is directed through the person or object to be 

imaged and then the shadow is recorded on the x-ray sensitive plate, some 

distance behind the object. 

There are two ways of determining the magnification factor. 

• To identify the distance from the source of the x-rays to the object and 

the distance from the source to the x-ray plate. 

• To include an object of known size or a radio opaque ruler in the plane 

of interest. 

Scaling Sphere 

Orthocrat’s scaling sphere employs the second method. It provides a scale 

for plain x-rays, CR and DR, such as are commonly used in orthopedics. 

The bone and sphere should therefore be the same distance from the x-ray 

plate and the x-ray source. 

When an x-ray image is scaled using a ruler or simple object, it is 

impossible to verify whether the scale was placed in the correct plane at the 

time of acquisition. The advantage of the sphere is that it is threedimensional 

and its diameter is constant from any angle that the x-ray may 

be taken.

64 




Troubleshooting the TraumaCad Server 


65 

8Chapter 6 

Troubleshooting 

the TraumaCad 

Server 

About This Chapter 

This chapter provides several sections, each of which describes how to 

troubleshoot a different element of the TraumaCad server configuration. 

This chapter contains the following sections: 

• DICOM Connectivity from/to TraumaCad Server, page 66 

• TraumaCad and Philips Sectra PACS, page 67 

• TraumaCad and Agfa PACS, page 69 

• TraumaCad Client Installation, page 71 

• TraumaCad ActiveX Debug Mode, page 74 

• Enabling TraumaCad Logging for Diagnostic Purposes, page 75 

• Templates Issues, page 76 

• Requests for New Templates, page 81 

• Using Medical Tools, page 81

66 



Existing customers can access the TraumaCad support portal which 

contains additional solutions to various problems. In order to obtain a 

username and password for the Orthocrat support portal, please contact 

TraumaCad support (support@traumacad.com). 

You will then get an email containing the support portal link, user 

name and password. 

DICOM Connectivity from/to 


In order to check that the TraumaCad server is connected to the PACS, a 

test can be performed using a Telnet command. 

► To check that the TraumaCad server is connected to the 

PACS: 

1 Open a command line window. 

2 Type: telnet PACS_SERVER_IP PACS_SERVER_PORT, as shown 

below: 

An empty window should be displayed. An example is shown below:



67 

If a window similar to the one shown below is displayed, verify that the 

PACS details of the TraumaCad configuration are correct and that a 

DICOM node on the PACS was configured with the TraumaCad 

details. 

TraumaCad and Philips Sectra 

PACS 

As Sectra PACS supports several transfer syntaxes. In order to support 

TraumaCad’s transfer syntax, a registry entry must be inserted on 

TraumaCad server: 

► To support TraumaCad’s transfer syntax: 

1 Open Notepad.exe on the TraumaCad server. 

2 Copy the segment shown below from this document into Notepad: 

Windows Registry Editor Version 5.00 

[HKEY_LOCAL_MACHINE\SOFTWARE\Medical Connections] 

[HKEY_LOCAL_MACHINE\SOFTWARE\Medical 

Connections\DicomObjects] 

"Log"=dword:00000001 

"LogLevel"=dword:0000003f 

"LogLocation"="C:\\Log" 


Connections\DicomObjects\TransferSyntax] 

@="1.2.840.10008.1.2"

68 



Notepad should appear, as follows: 

3 In Notepad, select Save As from the File menu. 

4 Type Sectra_PACS+Registry.reg and save the file. 

5 Close Notepad and double-click the file. A message is displayed asking 

you to approve the action. 

6 Click OK. 

7 Reboot the TraumaCad server and test using query and retrieve from 

one of the TraumaCad workstations.



69 

TraumaCad and Agfa PACS 

As Agfa PACS supports several transfer syntaxes. In order to support 

TraumaCad’s transfer syntax, a registry entry must be inserted on 

TraumaCad server. 

► To support TraumaCad’s transfer syntax: 

1 Open Notepad.exe on the TraumaCad server. 



[HKEY_LOCAL_MACHINE\SOFTWARE\Medical Connections] 


Connections\DicomObjects] 

"Log"=dword:00000001 

"LogLevel"=dword:0000003f 

"LogLocation"="C:\\Log" 


Connections\DicomObjects\TransferSyntax] 

@="1.2.840.10008.1.2.1 1.2.840.10008.1.2 

1.2.840.10008.1.2.4.57 1.2.840.10008.1.2.4.70" 

Notepad should appear, as follows:

70 




4 Type AGFA_PACS_Registry.reg and save the file. 



6 Click OK. 

7 Reboot the TraumaCad server and test using query and retrieve from 

one of TraumaCad workstations.



71 

TraumaCad Client Installation 

TraumaCad application (client side) is comprised of two elements: 

• TraumaCad ActiveX control 

• TraumaCad Client application 

The following must be performed before installing the TraumaCad 

application as a client for the first time: 

• Disabling the Internet Explorer Popup Blocker, as described below 

• Defining the TraumaCad Server as a Trusted Site, as described 

on page 72 

Disabling the Internet Explorer 

Popup Blocker 

In order to install the ActiveX component of the TraumaCad server, the 

Internet Explorer popup blocker must be disabled. 

► To disable the Internet Explorer popup blocker: 

1 Open Internet Explorer. 

2 From the Application menu, select Tools and then Pop-up Blocker. 

3 Click Turn Off Pop-up Blocker, as shown below:

72 



Defining the TraumaCad Server 

Home Page as a Trusted Site 

The TraumaCad server home page URL must be placed in the Internet 

Explorer Trusted Sites page. 

► To define the TraumaCad Server as a Trusted Site: 

1 Open Internet Explorer. 

2 From the Application menu, select Tools and then Internet Options. 

3 In the Internet Options window, select the Security tab and then click 

Trusted Sites, as shown below:



73 

4 Click the Sites button to display the Trusted Sites window, as shown 

below: 

5 In the Add this website to the zone field, type in the URL of the 

TraumaCad server, and click the Add button. 

6 Approve these entries by clicking OK twice.

74 



TraumaCad ActiveX Debug Mode 

The TraumaCad ActiveX control has a debug mode to enable the system 

administrator to make sure that the client workstation meets the software 

prerequisites, as described in the TraumaCad Client Requirements 

section on page 15. 

If you have any failures during client installation, turn on the Active X 

debug mode. 

In order to initiate this mode, type the following URL in the client internet 

explorer: http://TraumacadServerIP/TCWservice/index.aspx?debug=1 

The ActiveX then returns a popup window for each step of the client 

installation process (some of which are shown below). From these 

windows, you may be able to determine the specific error that you are 

facing in the event of such an error.



75 

Enabling TraumaCad Logging for 

Diagnostic Purposes 

TraumaCad client has built-in logging abilities, which are disabled by 

default. To enable logging, apply the required registry key, as described 

below. 

► To enable the logging capabilities of the TraumaCad 

client: 

1 Close the TraumaCad client, if it is opened. 

2 Open Notepad.exe on the client on which to start logging. 



[HKEY_LOCAL_MACHINE\SOFTWARE\Orthocrat\TraumaCad] 

"Log"=dword:00000001 

"LogLevel"=dword:1000 

"LogFolder"="d:\\TMP" 

Notepad should appear as follows: 

Please make sure that the D:\TMP directory exists on the client and 

change accordingly. 


5 Type Enable_TC_log.reg and save the file.

76 





7 Click OK. 

8 Reboot the TraumaCad client and perform a Query and a Retrieve 

test. 

9 Once the tests have been completed, please navigate to X:\LOG. 

X represents the directory in which the files will be located, as shown 

in the registry key, described above. 

10 Zip all the logs and send them to Support@TraumaCad.com with a 

detailed message describing the error that you have witnessed in 

TraumaCad. 

Templates Issues 

If one of your surgeons complains that a specific template cannot be found 

on a TraumaCad client, you may use one of the following options to 

verify that the template was downloaded from TraumaCad properly: 

• Checking Template Availability, page 77 

• Viewing TraumaCad Server Logs, page 78 

If these do not rectify the problem, then make a template request to 

TraumaCad’s templates team, as described in the Requests for New 

Templates section on page 81



77 

Checking Template Availability 

The first option that you should try is to check if the template is available. 

► To check the availability of a template: 

1 Open TraumaCad client on one of the workstations. 

2 In the TraumaCad application, from the Help menu select, 

Templates Version Info, a window similar to the following is 

displayed:

78 



Viewing TraumaCad Server 

Logs 

The next thing to try is to view the logs on the TraumaCad server. This 

can be done in several ways. The first way to try is to view the event log. 

► To view the event log: 

1 Login into TraumaCad server using RDP/VNC. 

2 Open the Windows Event Viewer and navigate to the templates service 

log. 

3 Various information messages and some success audit messages will 

probably be shown. These indicate that the template downloading 

service has downloaded templates and updated the template library.



79 

If error messages also appear: 

• Check that the TraumaCad server has a functioning Internet 

connection to Orthocrat’s online database at: 

ortho-cad.com/Templates 

• Make sure that the templates directory exists at: 

c:\inetpub\wwwroot\TCWservice\Templates 

• Restart the Templates service in the Windows Services console by 

performing the following: 

• Right-click my computer. 

• Select the Manage option. 

• Expand the Services and Application branch of the tree. 

• Click the Services branch. In the window that appears, look for 

TCtemplates Service and make sure that its status is Started. 

• Restart the TCTemplatesService service, by clicking the 

Restart Service button.

80 



If the service still returns errors in the Event Log viewer, 

perform the following: 

• Stop the IIS. 

• Stop the TCTemplates service. 

• Navigate to c:\inetpub\wwwroor\TCWservice\Templates 

and delete the following files: 

• fullDataSet.xml 

• destinationDataset.xml 

• .txt 

• SyncIndex.oti 

• index.oti 

• Start the IIS. 

• Start the TCTemplates service, and monitor the Templates 

Service event log for progress.



81 

Requests for New Templates 

After checking to see that a required template is not available in 

TraumaCad, please access our online form in our support section on our 

website at www.traumacad.com and fill out a template request. This request 

will receive a high priority. 

You may also email our support team at Support@TraumaCad.com, with 

the following details, in order to create a template request: 

• Account name 

• Contact person on site 

• Templates manufacturer name 

• Template name 

• Procedure 

In both cases, creating a template may take between 2-4 weeks (and is 

dependent on receiving the manufacturer’s digital files). 

Using Medical Tools 

TraumaCad user’s guide, which describes all the tools that are available 

in the application, is available for download in the support section on our 

website at www.traumacad.com.

82

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