Reconciling unmatched imaging studies
Manually attach a DICOM study to the correct scheduled imaging order when the images arrived without a worklist match — for vets, nurses, and receptionists who manage imaging.
In short
When an imaging machine sends a study without selecting a worklist entry, the images arrive in Lupa without linking to any pet's record. The Reconcile studies wizard lets you find that study, pick the right order, and attach them together in a few clicks.
Why this matters
Imaging machines occasionally send studies without a worklist entry — walk-in patients, emergencies, or cases where the operator typed details directly on the machine rather than selecting from the list. When that happens, the images arrive in Lupa but don't appear on the pet's timeline or against the scheduled order.
Before morning consults, for example, a nurse might notice that last night's emergency ultrasound never attached to the patient's record. Rather than re-exporting from the machine or contacting support, they can open the wizard, find the orphaned study, and link it to the correct order in under a minute.
How to reconcile a study — step by step
Open the wizard
Go to the Imaging page (under Diagnostics).
Click Reconcile studies in the toolbar. The "Reconcile unmatched studies" wizard opens.
Step 1 — Select study
The wizard shows unmatched studies from your store's registered machines — studies that have arrived but are not yet linked to any order.
Narrow the list if needed:
Use the Modality list to filter by imaging type (for example, US or CT).
Use the Machine list to filter by a specific machine.
Click Refresh to reload the list if you have just sent a study from the machine.
If the banner "Showing the most recent studies" appears, there are more unmatched studies than can be displayed at once. Use the filters to narrow the list before scrolling.
If the study isn't in the list:
Use the search bar labelled "Can't find the study? Search by patient name or accession" and type the patient name or accession number. Results from your store's machines appear below.
Select the study you want to attach by clicking it, then click Next.
Step 2 — Select order
Lupa searches your scheduled imaging orders and ranks them by how closely they match the incoming study. Each candidate shows:
A confidence badge — High match, Possible match, or Weak match — based on how well the identifiers align.
A field-by-field comparison showing the Accession number, Patient ID, Patient name, Date of birth, and Modality from the study alongside the values on the order. Fields that differ are highlighted so you can see at a glance what caused the mismatch.
A High match means a strong identifier (accession number or patient ID) agrees. A Possible match means supporting fields like name and date of birth agree but a strong identifier differs or is missing. A Weak match means only partial information overlaps — review carefully before proceeding.
If no candidates appear, the message "No matching orders found" is shown. Check that the order exists and is still scheduled.
Select the correct order and click Next.
Step 3 — Review
This step shows a side-by-side comparison of the incoming study's identifiers and the worklist order's identifiers, so you can confirm the match before committing.
Optional — update image tags in the imaging server:
At the bottom of the review step you will see the option "Also update the image tags in the imaging server". This is turned off by default.
Leave it off (the default) when you only need the study to appear on the correct pet's record in Lupa. The images are linked to the order; the DICOM tags stored on the imaging server are left as they arrived.
Turn it on only if images from this study will be exported or shared outside Lupa and need to carry the correct identifiers. This rewrites the study's identifiers on the imaging server to match the order.
Click Next when you are satisfied with the review.
Step 4 — Confirm
A summary shows:
The patient and order the study will be attached to.
Any fields that will change.
Whether the image tags on the imaging server will be rewritten or left unchanged.
Click Match & attach to complete the reconciliation. You will see a confirmation message: "Study attached to order".
Click Back at any step to return to the previous step without making any changes.
What happens afterwards
The study appears on the pet's timeline and against the correct imaging order, exactly as if it had matched automatically.
The imaging orders list refreshes to reflect the newly attached study.
An audit record is kept of the original identifiers the study arrived with.
Tips
Check the confidence badge first. A High match is almost always correct. For Possible match or Weak match, compare the field-by-field table carefully — look at the date of birth and modality to corroborate the name match.
Walk-in patients often arrive with a blank accession number. The wizard marks blank fields as missing (not as a mismatch), so you can still find the right order by name and date of birth.
Emergency studies may have been sent with a manually typed patient name that differs slightly from the record. The wizard uses fuzzy name matching, so minor spelling differences won't prevent a match from appearing.
Leave tag rewriting off unless you have a specific reason to update the imaging server. Linking in Lupa is sufficient for the study to appear on the pet's record and be viewable in the image viewer.
If you reconcile a study and then realise you selected the wrong order, contact your practice manager — the action is recorded in the audit trail.
Troubleshooting
The study I'm looking for isn't in the list and doesn't appear in search.
Check that the machine that sent the study is registered and active in Lupa's settings. Studies are only shown from machines associated with your store. If the machine was recently added, try clicking Refresh.
"No matching orders found" appears after I select a study.
The order may not exist yet, or it may have already been completed or cancelled. Confirm the order is scheduled in the imaging orders list before attempting reconciliation.
The "Showing the most recent studies" banner appears.
Your store has more unmatched studies than can be displayed at once. Use the Modality or Machine filters to narrow the list, or search directly by patient name or accession number.