Inside NewLumen: How the Worklist, Hanging Protocols and Structured Reporting Work Together

Summary

A veterinary imaging workflow is the sequence from study acquisition through reading and reporting. NewLumen, Asteris' cloud-native veterinary DICOM platform, unifies this workflow by connecting the worklist (where studies arrive and are triaged), hanging protocols (automatic layout configurations per modality and body part) and structured reporting (template-based report authoring) in a single clinical environment.

The Problem a Disconnected Workflow Creates

Before examining how NewLumen's three components work together, it helps to name the specific friction they address. In a disconnected veterinary imaging workflow, a radiologist might receive a study through one system, open it in a separate desktop viewer, manually arrange image panes to match their preferred layout, then switch to a word processor or a third application to type a report. Each context switch costs time. Manual pane arrangement is repeated for every study. Free-text reports vary in structure from one radiologist to the next, which makes it harder for referring clinicians to locate findings quickly.

For a solo practice reading its own films, this friction is manageable, if inefficient. For a teleradiology service reading studies submitted by dozens of referring clinics, the friction compounds. A remote radiologist opening a thoracic radiograph from one clinic should see the same layout, the same window and level presets, and the same report template fields as when opening a thoracic radiograph from any other clinic. Without automation, achieving that consistency requires manual effort on every case.

NewLumen addresses each friction point through three interconnected components: the worklist, hanging protocols and structured reporting. They are described separately below, then shown working together in a concrete scenario.

The Worklist: Where Every Study Begins

The worklist is the first surface a radiologist or reading service interacts with when a study arrives. In NewLumen, the worklist is browser-based, which means no local software installation is required to access it. A radiologist logging in from any location sees a single queue of studies submitted by all referring clinics on their account, without switching between separate logins for each practice.

Each row in the worklist draws its information from the DICOM header, the embedded metadata stored in every DICOM image file. The header contains patient name, species, body part examined, modality code, acquisition date and the submitting clinic's identity. NewLumen reads these fields and surfaces them as sortable columns, so a reading service can sort by modality to batch all CT studies together, or filter by referring clinic to prioritize a specific practice's queue.

Study status updates as work progresses: a newly received study is waiting to be read, a study claimed by a radiologist shows as in progress, a study with a signed report shows as reported, and a report delivered back to the referring clinic is recorded against the study. These status labels give practice managers and reading service coordinators a live view of queue throughput without needing to contact individual radiologists for updates.

Opening a study from the worklist is a single click. The viewer loads the study directly, and hanging protocols fire automatically on load. No manual step sits between selecting the case and seeing the images arranged correctly.

Hanging Protocols: Eliminating Layout Work on Every Case

A hanging protocol is a saved display configuration. It specifies how many image panes open in the viewer, which series from the study loads into each pane, what window and level preset applies to each pane, and whether any prior study for the same patient should load alongside the current images for comparison.

Hanging protocols are configured once per modality and body part combination. A thoracic radiograph protocol might open two panes: a lateral view on the left and a ventrodorsal or dorsoventral view on the right, each with a soft-tissue window preset already applied. An abdominal CT protocol might open four panes in a grid, with different series in each. Once configured, these protocols fire every time a matching study opens from the worklist. NewLumen ships with species-tagged protocols for common canine and feline studies, and practices can add their own.

The practical effect is that a radiologist reading thirty thoracic radiographs in a session never manually positions a single image. The layout is identical on case one and case thirty. This matters most in teleradiology, where a radiologist may read studies from multiple clinics using different imaging equipment. The images arrive with different series labels and file structures depending on which modality produced them, but the hanging protocol normalizes the viewing experience regardless of origin.

For practices working in a hybrid setup, where studies are captured locally through Keystone PACS (Asteris' on-premise veterinary PACS) and then forwarded to NewLumen for cloud-based reading, hanging protocols operate identically whether the study came from the local Keystone node or was pushed directly from the imaging device. The protocol logic applies to the DICOM content, not to the submission path.

Structured Reporting: From Viewer to Completed Report Without Leaving the Session

Structured reporting replaces the blank page of a free-text report with a template that maps to a specific study type. A thoracic radiograph template covers the fields a radiologist needs to address for that study: cardiac silhouette, pulmonary vasculature, pleural space, mediastinum and visible skeletal structures, among others. An abdominal CT template covers a different set of anatomical regions relevant to that modality and body part.

In NewLumen, the structured report panel opens within the same viewer session as the images. The radiologist works through each field in the template without opening a separate application. When a field is complete, the cursor moves to the next. The template enforces consistent terminology and organisation across all reports produced for a given study type, which means a referring clinician reading a thoracic radiograph report always finds cardiac findings in the same section, regardless of which radiologist in the reading service produced the report.

Because the report panel is linked to the study record rather than saved as a separate file, the completed report is attached to the DICOM study in the platform and can be transmitted back to the referring clinic without a manual export or email step. The referring clinic receives the report through the same channel the study came in on.

Flagging tools in the viewer can surface findings as annotations or measurements alongside the images while the radiologist is working. These annotations are the radiologist's own markings, created during review. They do not populate report fields automatically. The radiologist reviews any annotations they have placed and enters the corresponding findings into the structured report fields by judgment. The report reflects the radiologist's interpretation; the annotations are a working aid during image review.

A Concrete Scenario: Thoracic Radiograph from a Referring Clinic

A small-animal referring clinic acquires a thoracic radiograph series on a patient presenting with a suspected cardiac condition. The clinic's digital radiography (DX) system pushes the DICOM study to NewLumen over a standard DICOM connection. No staff member at the clinic needs to do anything further; the study appears in the reading service's worklist automatically.

The reading service radiologist opens their worklist in a browser. The new study appears in the queue, labeled with the clinic name, patient identifier, modality (DX), body part (thorax) and acquisition date. The radiologist clicks the study. The viewer loads and the thoracic radiograph hanging protocol fires: lateral view on the left pane, ventrodorsal view on the right pane, soft-tissue window preset applied to both.

The radiologist reviews the images. They note enlargement of the cardiac silhouette and place a measurement annotation on the lateral view. They also note mild pulmonary vascular distension. These findings are the radiologist's own observations, recorded as annotations in the viewer.

With image review complete, the radiologist opens the structured report panel. The thoracic radiograph template is already selected, matched to the study type. The radiologist works through the cardiac silhouette field, entering that the silhouette is enlarged on vertebral heart scale assessment, and moves to the pulmonary vasculature field, entering the mild distension finding. Remaining fields covering the pleural space, mediastinum and visible skeletal structures are completed in sequence. The radiologist adds a clinical impression and signs the report.

The signed report is attached to the study record in NewLumen and transmitted to the referring clinic. The worklist entry for that study updates to show the report delivered. The entire process, from the study appearing in the worklist to the report being transmitted, takes place within a single browser session and a single platform.

How the Three Components Depend on Each Other

The worklist, hanging protocols and structured reporting are each useful individually. A worklist that did not trigger automatic layouts would still organize studies. Hanging protocols applied through a separate viewer would still save layout time. Structured report templates in a word processor would still standardize terminology. But the friction eliminated by each component is only fully realized when all three operate within the same session.

When a radiologist opens a study from the worklist and the hanging protocol fires automatically, no time is spent on layout before structured reporting can begin. When the structured report panel is embedded in the viewer, no context switch interrupts the reading session. When the completed report is attached to the study record rather than saved separately, no manual transmission step is required. The integration is the point: each component hands off to the next without requiring the radiologist to bridge the gap manually.

For teleradiology services in particular, this handoff matters at scale. A reading service handling studies from many referring clinics depends on the worklist to keep those studies organized, on hanging protocols to keep the viewing experience consistent across studies from different equipment, and on structured reporting to keep the output consistent regardless of which radiologist in the service read the case. Remove any one of those components and the reading service absorbs the coordination cost manually.

Understanding the mechanism behind each component, and how they connect, gives practices and reading services a concrete basis for evaluating whether their current veterinary PACS workflow handles that coordination automatically or leaves it to individual effort on every case.

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