Viewing Protocol Best Practices

Viewing protocols, also known as hanging protocols, are at the core of radiologists’ efficiency. The name of the game in radiology has always been to reduce the number of extra clicks to maximize radiologist reading efficiency. Over time, a number viewing protocol best practices have surfaced.

Here are a few viewing protocol best practices that you should consider to improve efficiency and interpretation quality for your organization’s radiologists:

MRI and CT

Often, MRI and CT studies take more time to interpret; therefore, special attention should be directed to the viewing protocols used for these modalities. Linking, should be enabled to sync the anatomical position for series of the same plane as the radiologist scrolls. Enabling active scout lines will display a single reference line on series of alternate planes as the radiologist scrolls. Positioning each series into the appropriate viewbox is important for radiologists when the study is loaded. There is no standard way of positioning the series; therefore it is important to offer radiologists functionality to quickly and easily rearrange and store their preferred series layout for each type of study.

Best Practices:

  • Enable active scout line
  • Enable linking
  • Facilitate series rearranging and storage of preferred layout


Typically, X-rays are reimbursed at the lowest rate compared to other modalities. Therefore, in order to sustain a successful operation, viewing protocols for radiologists that read these type of studies must be setup according to best practices. To properly visualize small fractures and other intricacies, it is important to load x-ray studies full-screen on each diagnostic monitor. Protocols should allow radiologists to easily scroll through all of the series in the study by either scrolling with the mouse wheel or by “drag scrolling” which allows the radiologist to scroll by utilizing a left drag motion on the mouse.

Best Practices:

  • Display images full-screen
  • Enable scrolling to next series via wheel or left drag


Ultrasound studies come in various forms. Some US studies contain numerous still images, others contain cine framesets and some contain a combination of both. Also, many US studies contain color images that must be viewable on a color monitor to interpret the physiologic activity properly.   Therefore, flexible viewing protocols are required to satisfy the radiologist. The viewing protocol must support multiple monitor profiles in order to easily move the image viewer from the grayscale diagnostic monitors to a supplemental color monitor with just the click of a button. If the study contains cine framesets, they should play automatically so the radiologist isn’t forced to perform additional clicks to begin the cine.

Best Practices:

  • Multiple monitor profiles to view color images on a supplemental color monitor
  • Auto-play cine framesets


Mammography studies utilize standardized image labeling, which plays right into the hand of viewing protocol modules. Since the majority of mammography studies are screening studies, it is important to offer the radiologist a set of viewing protocols revolving around the four screening views (RCC, LCC, RMLO, and LMLO).

Radiologists should be able to easily scroll into additional views such as implant displacement or diagnostic views. It’s also important to offer functionality which allows the radiologist to easily toggle out the prior study with the next most recent prior study. Radiologists should be able to navigate through a viewing protocol set throughout the read with the click of a button comparing each view in full-screen with its prior study counterpart.

Best Practices:

  • Revolve standard viewing protocol set around the four screening views
  • Enable toggling of prior studies
  • Enable single-click navigation through viewing protocol set

Nuclear Medicine

Unlike most types of radiology studies, nuclear medicine studies help the radiologist visualize physiologic activity, rather than anatomical characteristics. Therefore, unique viewing protocol functionality is required. Color mapping schemes should be utilized to automatically light up areas of increased physiologic activity. As with ultrasound, NM viewing protocols should have multiple monitor profiles to move their image viewer to a supplemental color monitor with just the click of a button. PET and PET/CT studies also fall under the umbrella of nuclear medicine.

Best Practices:

  • Enable automatic color mapping
  • Multiple monitor profiles to view color images on a supplemental color monitor
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