When a vet decides during a consult that a patient needs an X-ray, ultrasound, or CT scan, the order goes straight from Lupa to the imaging machine's DICOM worklist. The radiographer sees the patient on the modality without any paper request or re-typing, and once the study is acquired, the images flow back into Lupa attached to the right pet — ready to view, download, share with a client, or send to a referral specialist.

💡 In short: Open a pet or appointment → New Imaging Request → choose the target machine, modality, body region, and urgency → submit. The order appears on the modality's worklist. Once the study is acquired and pushed to your Orthanc server, it shows as Completed in Lupa, where any vet can open the viewer, download images, or share a secure link.

⚠️ Send the order from Lupa, not from the modality console. If a study is started directly on the X-ray or ultrasound machine without a Lupa worklist entry, the images come back to Orthanc with no patient match and won't auto-attach to the right record. Always create the order in Lupa first so the worklist has the right pet, accession number, and ordering vet. If a study does arrive unmatched — for example after a walk-in or an emergency where there was no time to place the order first — use Reconcile studies on the Imaging tab to attach it manually (see Reconciling unmatched studies below).

📍 Prerequisites:

You can create an imaging order from three places — they all open the same form:

The New Imaging Request form is the same regardless of where you opened it from. Pet, client, and ordering clinician are pre-filled — you just need the four imaging fields:

Click Submit Request. Lupa:

🔒 Why the accession number matters. It's the single ID that lets Lupa, the modality, and Orthanc agree on which images belong to which order. If you ever need to manually upload a DICOM file (Step described below), Lupa uses the accession number to attach the upload to the right order.

Every imaging order shows up in three places at once:

The Imaging tab on Diagnostics is the easiest place to see what's outstanding across the whole practice. A search box lets you filter across study description and patient name, and dedicated filters let you narrow by Pet, Modality, Body Region, Urgency, Status, and a Requested At date range — individually or in combination. All columns are sortable. Columns are: Pet, Modality, Body Region, Study Description, Urgency, Status, Requested At, Completed At, and Preview (a thumbnail once images are back). Click the eye icon on any row to open that order's details page. Lupa remembers which tab you last used, so the Diagnostics page reopens on the Imaging tab the next time you visit.

The toolbar on the Imaging tab also contains a Reconcile studies button. Use this whenever images have arrived in Orthanc without matching a worklist order — for example after a walk-in or an emergency scan. See Reconciling unmatched studies below.

Click the eye icon (View Details) on any row in the Imaging tab to open the order details page.

The header shows the pet card (name, species, breed, sex, DOB, current weight), the study description, the ordering clinician, the requested date, and the order status.

A collapsible DICOM Details section underneath holds the technical IDs your IT support might need: the Accession Number, the target machine, modality, body region, Orthanc Study ID, Study Instance UID, and Worklist ID. Each ID has a copy-to-clipboard button so you can paste it into a Lupa support ticket without reading numbers down the phone.

For a Completed order, the rest of the page is the image viewer.

Two options live in the toolbar:

Use Download All if you're sending DICOM files to a referral hospital that needs the originals — but for most client and referral handovers, Share Study (next section) is faster, more secure, and tracks access.

If the status is still Scheduled, the page shows "Please check back later for results" with two action buttons:

Sometimes images arrive in Orthanc without matching a worklist order — the radiographer may have started the study directly on the machine during a walk-in or emergency, or entered patient details manually instead of selecting from the worklist. These studies don't auto-attach to a pet record. The Reconcile studies wizard lets you find the study and link it to the correct scheduled order without leaving Lupa.

Go to Apps → Diagnostics → Imaging tab and click Reconcile studies in the toolbar. The wizard opens as a pop-up with four steps: Select study, Select order, Review, and Confirm.

The wizard lists unmatched studies from your practice's imaging machines. Use the filters at the top to narrow the list:

If there are more unmatched studies than can be displayed at once, a notice tells you the list is capped. Use the modality or machine filters to narrow it down.

If you can't see the study in the list, use the search bar at the bottom of the step — labelled Can't find the study? Search by patient name or accession — and type a patient name or accession number.

Click the study you want to attach. The wizard moves to the next step.

Lupa searches your scheduled imaging orders and ranks them by how closely they match the incoming study. Each candidate shows a confidence badge:

The field comparison table shows each identifier (Accession number, Patient ID, Patient name, Date of birth, Modality) side by side: the value from the incoming study on the left and the value from the worklist order on the right. Mismatches are highlighted so you can see exactly what caused the auto-attach to fail.

If no scheduled orders could be matched to the study at all, you'll see No matching orders found. Check that the order exists in Lupa and is still scheduled before trying again.

Click the order you want to link the study to. The wizard moves to the next step.

This step shows the full side-by-side comparison of the incoming study and the selected order. You can edit the identifier values here if you need to correct them before attaching.

At the bottom of this step is an optional toggle: Also update the image tags in the imaging server. This is off by default.

Click Next to proceed.

The final step summarises exactly what will happen: which patient and order the study will be attached to, which fields will change, and whether the image tags in Orthanc will be rewritten. Read this carefully, then click Match & attach to apply.

Once confirmed, the study appears on the pet's record and on the matched order, and Lupa shows a "Study attached to order" confirmation. The order is removed from the unmatched list.

Once a study is Completed, you can hand it to a client, a referring vet, or a specialist as a time-limited, browser-based link. The recipient doesn't need a Lupa account and never receives the underlying DICOM files — they open the same image viewer the practice uses, in their browser, for as long as you've authorised.

Then click Generate Link. The URL is automatically copied to your clipboard and a "Share link created and copied to clipboard" toast appears. Paste it into an email, SMS, or chat — whatever your practice uses to communicate with the recipient.

The same dialog lists every active share for this study. For each one you can see when it was created, when it expires (e.g. "expires in 6 days"), and the view count (e.g. "5 views" or "5/10" if a max is set).

⚠️ You can't extend or change a share link after creation. Settings are fixed at the moment you click Generate Link. If a recipient needs more time or more views, generate a new link — leaving the old one in place or revoking it as you prefer.

This is a one-time setup per modality, normally done by a practice manager working with IT support. Once a machine is configured and Active, every staff member can place orders against it.

📍 You'll need from your IT or imaging vendor:

Then click Save. The machine appears in the table with an Orthanc Connection status of Registered or Not Registered and a Status dropdown defaulting to Active.

The Status dropdown on each row controls whether staff can place orders against the machine:

⚠️ Set retired machines to Retired — don't delete them. If a machine has any imaging orders linked to it, Lupa will not allow deletion and will ask you to mark the machine as inactive instead. Even for machines with no linked orders, deleting removes the record permanently — use Retired to take a machine out of service while keeping the audit trail intact.

✅ From practices running daily imaging through Lupa:

Which imaging modalities does Lupa support? Any DICOM-compliant modality — Lupa works at the standard DICOM level rather than integrating with specific vendors. The supported modality codes are CR, DX, CT, MR, US, NM, PT, RF, XA, and OT. If your equipment can produce DICOM and push it to an Orthanc server, it will work with Lupa.

Do I have to start from a consult to place an imaging order? No. You can also start from the pet's record (handy for drop-off imaging that isn't tied to a same-day appointment) or from the Imaging tab on the Diagnostics page. Whichever you pick, the order is linked to the pet and will appear in their record. Linking it to an appointment as well — by starting from the consult — keeps the medical history tidy.

Where are the images actually stored? On your practice's Orthanc DICOM server, not in Lupa. Lupa stores the order metadata, the accession number, and the link to the study — and retrieves images on demand for the viewer. This means image storage is governed by your Orthanc setup, including any backup and retention policies you've configured with your IT.

Can I import images that were captured outside Lupa? Yes. Open or create the matching order, click Upload DICOM, and pick your file. Supported formats are .dcm, .zip (of DICOM or image files), .jpg, .jpeg, .png, and .pdf. Useful for second-opinion DICOMs from a referral, images on a CD from another clinic, or photos and PDFs you want stored against the study. Make sure the file's accession number matches the order, or upload via a new order created for the purpose.

Does the recipient of a share link need a Lupa account? No. Share links are deliberately accountless — the recipient clicks, the viewer opens in their browser. They never see DICOM files directly and can't download them. Access is governed by the expiry, the optional view cap, and your ability to revoke the link at any time.

Can I extend the expiry on an existing share link? No — a link's settings are fixed at creation. Generate a new link with a longer window and either send the new one alongside the old or revoke the old one. Each link has its own access count.

Who in the practice can place imaging orders, view studies, or share them? Anyone with access to the patient's record — imaging follows the same access rules as the rest of the pet's clinical record. Configuring imaging machines is the only piece that's typically restricted to staff with admin access to Settings.

Can I share a study with a referring vet without exposing client information? The share link viewer shows the images and the study description but doesn't expose the client's contact details. For full referral handover with case history, use the Communications tools in Lupa rather than imaging shares alone.