user's manual - anmedrtg.plcontaining 2D and 3D images and place Planmeca Promodel orders. This...

user's manual

10017352_6

3D Viewer

EN

TABLE OF CONTENTS

1 INTRODUCTION ..............................................................................................11.1 System recommendations ............................................................................................. 11.2 User requirements ......................................................................................................... 1

2 START-UP OF PLANMECA ROMEXIS VIEWER ............................................22.1 Starting Planmeca Romexis Viewer Launcher from CD ................................................ 22.2 Selecting the interface language .................................................................................... 22.3 Selecting images for viewing ......................................................................................... 22.4 Starting the Planmeca Romexis Viewer ......................................................................... 22.5 Opening new images when the Planmeca Romexis Viewer is open ............................. 3

3 START-UP OF PLANMECA ROMEXIS VIEWER DEMO VERSION ...............43.1 Starting the Planmeca Romexis Viewer Launcher from CD .......................................... 43.2 Selecting the interface language .................................................................................... 43.3 Selecting images for viewing ......................................................................................... 43.4 Starting the Planmeca Romexis Viewer ......................................................................... 43.5 Opening new images when the Planmeca Romexis Viewer is open ............................. 5

4 PLANMECA ROMEXIS 3D VIEWER USER’S MANUAL AND PRODUCT INFORMATION ................................................................................................5

5 2D IMAGING MODULE ....................................................................................65.1 Toolbars ......................................................................................................................... 65.2 Using the Image Browser ............................................................................................... 75.3 Selecting Image Browser Display Mode ........................................................................ 85.4 Selecting previous/next category ................................................................................... 85.5 Using Image thumbnails ................................................................................................ 95.6 Opening an Image ....................................................................................................... 105.7 Opening a Study .......................................................................................................... 115.8 Closing All Images ....................................................................................................... 115.9 Adjusting the layout ...................................................................................................... 125.10 Using the measurement tools ...................................................................................... 135.11 Using the drawing tools ................................................................................................ 155.12 Using the viewing tools ................................................................................................ 175.13 Using image processing tools ...................................................................................... 195.14 Copying image to Clipboard ......................................................................................... 225.15 Printing images ............................................................................................................ 22

6 USING 3D MODULE ......................................................................................246.1 Introduction .................................................................................................................. 246.2 Menu Toolbar ............................................................................................................... 246.3 Opening a 3D volume .................................................................................................. 26

7 3D EXPLORER ..............................................................................................277.1 Layer Slide Bar and Maximize ..................................................................................... 287.2 Volume Adjustments .................................................................................................... 287.3 3D Rendering adjustments .......................................................................................... 29

8 PANORAMIC MODULE .................................................................................348.1 Layer and Curve Slide Bar ........................................................................................... 358.2 Adjustment tools .......................................................................................................... 358.3 Panoramic tools ........................................................................................................... 378.4 Adjusting panoramic images ........................................................................................ 388.5 3D Rendered view adjustment ..................................................................................... 39

Planmeca Romexis Viewer 1User’s manual

TABLE OF CONTENTS

The manufacturer, assembler, and importer are responsible for the safety,reliability and performance of the unit only if:- installation, calibration, modification and repairs are carried out by qualifiedauthorized personnel

- electrical installations are carried out according to the appropriaterequirements such as IEC 60364

- equipment is used according to the operating instructions

Planmeca pursues a policy of continual product development. Although everyeffort is made to produce up-to-date product documentation this publicationshould not be regarded as an infallible guide to current specifications. Wereserve the right to make changes without prior notice.

COPYRIGHT PLANMECA Publication number 10017352 Version 6Released 10 January 2011

9 3D CROSS SECTIONS MODULE ..................................................................409.1 Adjusting slices in cross sections views ....................................................................... 409.2 Adjusting axial slices .................................................................................................... 429.3 Adjusting panoramic slices .......................................................................................... 429.4 Cross Sectional Scroll Bar ........................................................................................... 429.5 Adjust tools .................................................................................................................. 439.6 Nerve ........................................................................................................................... 469.7 3D Rendered view ....................................................................................................... 47

10 IMPLANTS .....................................................................................................4810.1 Implant tools ................................................................................................................ 49

11 TMJ MODULE ...............................................................................................5311.1 TMJ Tools ................................................................................................................... 54

APPENDIX A: PLANMECA PROMODEL .............................................................56

1 QUICK GUIDE FOR PLACING PLANMECA PROMODEL ORDERS ...........57

2 PLACING PLANMECA PROMODEL ORDERS ............................................5811.2 3D Master Menu Toolbar with Planmeca ProModel Order ......................................... 5811.3 Overview of Planmeca ProModel Order Form ............................................................ 59

APPENDIX B: MANUAL OPENING OF 2D AND 3D IMAGE FILES ...................62

1 OPENING DICOM FILES ...............................................................................63

2 OPENING DICOMDIR IMPORT CATALOG ..................................................64

2 Planmeca Romexis Viewer User’s manual

INTRODUCTION

1 INTRODUCTION

Planmeca Romexis Viewer is a freely distributable viewer software for 2D images andPlanmeca 3D DICOM files (*.dcm). It has the ability to read DICOM Multiframe imagesdisplaying the slice views, rendered presentation, panoramic, cross sections and TMJviews.

With Romexis Viewer you can also import Planmeca DICOMDIR image catalogscontaining 2D and 3D images and place Planmeca Promodel orders.

This manual describes Planmeca Romexis Viewer system recommenadations andcontains user instructions for the software.

1.1 System recommendations

Planmeca Romexis Viewer runs on Java Runtime Enironment 1.6 compatible operatingsystems, such as Microsoft Windows an MacOS.

For optimal experience the Java Runtime Environment and Planmeca Romexis Viewershould be installed on the computer.

Recommendation for Planmeca Romexis Viewer hardware is 2GHz Core Due orequivalent, 2GB RAM, 300 MB local disk storage for the Planmeca Romexis Viewersoftware and 250 MB per 3D image.

NOTE Planmeca Romexis Viewer has been tested with Windows 7, Windows Vista,Windows XP SP 3 and MacOS 10.6. Therefore, other operating systems are notsupported by Planmeca.

1.2 User requirements

On Windows Vista and Windows 7 operations systems the recommended user accounttype for running the Viewer Launcher is Administrator and the recommended UAC level is2 or lower.


START-UP OF PLANMECA ROMEXIS VIEWER

2 START-UP OF PLANMECA ROMEXIS VIEWER

2.1 Starting Planmeca Romexis Viewer Launcher from CD

With Windows operating system

1. Insert the Planmeca Romexis Viewer CD into the CD drive. The Planmeca RomexisViewer Launcher starts up automatically (if Windows autorun is enabled).

2. The Viewer Launcher can also be started by double-clicking the Start.exe file found fromthe root of the CD.

With Mac operating system

1. Insert the Planmeca Romexis Viewer CD into the CD drive.

2. Start the Viewer Launcher application by double-clicking the Start.app file.

2.2 Selecting the interface language

Select the interface language from the drop-down menu on the upper right corner of thescreen (step 1 in the image below).

2.3 Selecting images for viewing

Select the images which you want to open in Planmeca Romexis Viewer (step 2 in theimage below).

To select multiple images use Ctrl and Shift keys.

2.4 Starting the Planmeca Romexis Viewer

To run the program from the CD click START Viewer from CD .

or

To copy the program and images to the local hard disk and run the viewer from thereselect COPY Viewer and Start (step 3 in the image below).

Step 1Step 2

Step 3


START-UP OF PLANMECA ROMEXIS VIEWER

NOTE For optimal experience select the option COPY Viewer and Start.

NOTE NOTE The Planmeca Romexis Viewer requires approximately 300 MB local diskstorage for the Planmeca Romexis Viewer software and 250 MB per 3D image.

Once the programme has been copied to hard disk you can start it as follows:

On Windows operating system

From the Start menu select All programs > Planmeca > Romexis Viewer

On Macintosh OS:

The Romexis Viewer is copied onto the current user Desktop.

NOTE If you have copied Planmeca Romexis Viewer previously to hard disk, older imagesmay be shown on the viewer launcher patient list as well when starting viewer fromhard disk.

2.5 Opening new images when the Planmeca Romexis Viewer is open

When the Viewer is already running, open new images via Viewer Launcher as follows:

1. Close Planmeca Romexis Viewer from the File Menu by selecting Exit or click the redcross button on the top right corner of the Romexis Viewer window.

The Viewer launcher appears on top of the screen.

2. Select the images to be viewed from the image list.


START-UP OF PLANMECA ROMEXIS VIEWER DEMO VERSION

3 START-UP OF PLANMECA ROMEXIS VIEWER DEMO VERSION

3.1 Starting the Planmeca Romexis Viewer Launcher from CD

With Windows operating system

1. Insert the Planmeca Romexis Viewer CD into the CD drive. The Planmeca RomexisViewer Launcher starts up automatically (if Windows autorun is enabled).

2. The Viewer Launcher can also be started by double-clicking the Start.exe file found fromthe root of the CD.

With Mac operating system

1. Insert the Planmeca Romexis Viewer CD into the CD drive.

2. Start the Viewer Launcher application by double-clicking the Start.app file.

3.2 Selecting the interface language

Select the interface language from the drop-down menu on the top right corner of thescree (step 1 in the image below).

3.3 Selecting images for viewing

Select the equipment of which demo images you want to open in Planmeca RomexisViewer (step 2 in the image below).

3.4 Starting the Planmeca Romexis Viewer

To run the program from the CD click START Viewer from CD .

or

To copy the program and images to the local hard disk and start the viewer from thereselect COPY Viewer and Start (step 3 in the image below).

Step 1

Step 2

Step 3

Step 2


PLANMECA ROMEXIS 3D VIEWER USER’S MANUAL AND PRODUCT IN-

NOTE For optimal experience select the option COPY Viewer and Start.

NOTE The Planmeca Romexis demo Viewer DVD requires approximately 4 GB of hard diskspace.

Once the programme has been copied to hard disk you can start it as follows:

On Windows operating system

From the Start menu select All programs > Planmeca > Romexis Viewer

On Macintosh OS:

The Romexis Viewer is copied onto the current user Desktop.

NOTE If you have copied Planmeca Romexis Viewer previously to hard disk, older imagesmay be shown on the viewer launcher patient list as well when starting viewer fromhard disk.

3.5 Opening new images when the Planmeca Romexis Viewer is open

When the Viewer is already running, open new images via Viewer Launcher as follows:

1. Close Planmeca Romexis Viewer from the File Menu by selecting Exit or click the redcross button on the top right corner of the Romexis Viewer window.

The Viewer launcher appears on top of the screen.

2. Select the images to be viewed from the image list.

4 PLANMECA ROMEXIS 3D VIEWER USER’S MANUAL AND PRODUCT INFORMATION

To open the Planmeca Romexis 3D Viewer User’s manual click the User's Guide buttonon the upper menu bar.

For more information on Planmeca products click on Product Information.


2D IMAGING MODULE

5 2D IMAGING MODULE

The Imaging module of the Planmeca Romexis Viewer is used for X-ray image and photoprocessing. The centre of this module is used by the image viewer to show images thatare opened by the user. The image viewer automatically places images into a layoutattempting to maximise their viewable size. The layout can be modified by clicking theLayout button (see section 5.9 “Adjusting the layout” on page 12 for more information onlayouts).

The bottom of the Imaging module is normally employed by the image browser that allowsthe user to open images into the image viewer by double-clicking on them. The imagebrowser can be hidden and made visible using the Browser button (see section 5.2 “Usingthe Image Browser” on page 7 for more information).

5.1 Toolbars

There are three types of toolbars and icons in the Imaging module user interface:

1. The top toolbar contains buttons for opening images and general layout options.

2. The vertical toolbar at the far right contains the image processing and annotation tools.When using these tools any function (i.e. zooming) can be applied on all open images inthe image viewer (not on images in the image browser).

3. Each open image has its own horizontal toolbar image above the image. These viewingand processing tools affect only that respective image. The vertical image toolbar can beopened using the wrench button. See “Horizontal image toolbar” on page 19 for moreinformation.

NOTE All illustrated features are not available in Planmeca Romexis Viewer.


2D IMAGING MODULE

5.2 Using the Image Browser

The image browser is opened by default in the lower part of the screen when the Imagingmodule is opened. The image navigator can be opened and closed by clicking the ImageBrowser button from the top toolbar. The image browser shows all the images the patienthas, with different image types in their respective categories.

The Image Browser is opened by default in the lower part of the screen when the Imagingmodule is opened. The Image Browser can always be opened and closed by clicking theImage Browser button in the top toolbar. The Image Browser Shows all images of thepatient grouped according to the image type. Different display modes are available toprovide an instant view of all images of the specific image type. The Settings and Defaultscan be used to easily choose a preferred default display mode.

The following screen components are present in the image browser.

The following image type categories are provided:

• Panoramic: Panoramic and SmartPan exposures and scans.

• CBVT: 2D snapshots made in the Romexis 3D Module.

• Cephalometric: Cephalometric exposure and scans. Also includes cephalometric imagesmade using the Virtual Cephalometric tool in Romexis 3D Module. (See page D?20)

• Photo: Intraoral camera images, scans and imported photos from handheld cameras.

• Intraoral: Bitewing and Periapical exposures and scan that have tooth sites specified.Intraoral images with no tooth sites specified are placed into a subcategory Other.

Image browser display modes Settings &

defaultsPrevious / NextCategory

Image selection

Refresh

Expand /

Viewstudies

Category Quick Browser- mouse over to see preview

- Double-click to open image shown in the thumbnail

- Click on the thumbnail to open the image type category

Images in the category- Category title- Range of exposure dates- Number of images

in the category

Date / filter

Collapse

selection

browser

images in category

Adjust thumbnail size


2D IMAGING MODULE

Use the image thumbnails to open a category or when in the category double click on thethumbnail to open the image. Single clicking will select images to allow opening of multipleimages into the Image Viewer using the View Selected button. Select a suitable navigationmode using the Display Mode buttons. To select another navigation mode use thePrevious/Next Category buttons.

The All Images mode displays an overview of all patient images

whereas the Category Grid mode allows browsing of a large number of images in asingle category. If the Image Browser is set to be hidden automatically when an image isopened into the Image Viewer, the browser will automaticall reappear when all imageshave been closed in the Image Viewer.

The Image Browser can always be easily reopened using the Image Browserbutton in the top toolbar.

5.3 Selecting Image Browser Display Mode

The following screen components are available in all Display Modes.

• All Categories

• General outline of all patient’s images in one glance

• All Images in Table

• Show all patient images in table format making it easy to move or inactivate multipleimages for example.

• All Images

• Show all patient images divided into collapsible categories

• Category Grid

• Show images in selected category in grid format to maximize number of images shownat one time.

• Category Filmstrip

• Show images in selected category in filmstrip format

• Category Carousel

• Show images in selected category in a 3D carousel

5.4 Selecting previous/next category

Move to the previous or next category when the browser is in one of the selected imagecategory modes (Category Grid, Category Filmstrip and Category Carousel).


2D IMAGING MODULE

5.5 Using Image thumbnails

Single click image thumbnail to toggle image selection. Double click image thumbnail toopen the image. Hovering the mouse cursor over the image so that it is highlighted with alight gray border displays the image properties in a separate window. Clicking on theimage comment field enables editing or adding a comment to the image. If the imagethumbnail is too small while both exposure date and update date are configured to beshown only exposure date will be shown.

Image thumbnails may also have image information symbols shown on top of them thatindicate the following things:

• Image is a SmartPan stack image with multiple layers.

•

• Image has been stored into Long Time Archive and full size image is not availablefor viewing before it is restored from Long Time Archive.

• Image belongs to a study.

•

• Image has a diagnosis attached that is viewable through the image propertiesdialog.

Adjusting Thumbnail Size

Use this slider to change image thumbnail size. Setting is remembered separately for eachdisplay mode. The approximate viewing position inside a category is preserved whenchanging thumbnail sizes.

Expanding / Collapsing the Browser

Click the Expand / collapse arrow to show browser in full screen or in default height. Youcan also drag the Image Browser top edge to resize the browser window freely. Clickingon the Collapse Browser arrow will revert the browser to its default height if it has beenresized by dragging.

The border of the selected imageshows in light blue

Image evaluation

Specified The border of the currently highlighted image shows inlight grey

tooth sites

Exposure date Image comment Last updated


2D IMAGING MODULE

Selecting Images

• View/open selected images in full size

• Clear current image selection

• Show number of images selected

When Image Browser option Close Browser On Double Click is selected and you want toopen multiple images first select all of the images to open and then click on View Selected.

Filtering and selecting images by date

• Filter images by exposure date: images with exposure dates that are checked are shownin the browser. Click All Dates to toggle checkmarks for all dates. Click on a year to toggleall images from the selected year.

• Image date filter affects all Image Browser display modes. To reset the filter to show allavailable images first deselect All Dates and then reselect it.

Refreshing the workstation

Reload and update patient’s images from the server. Used, for example, when newexposures which have been taken and saved to the same patient file at anotherworkstation do not yet show on current workstation.

Adjusting settings and defaults

• The Settings and Defaults can be used to adjust the following features among others:

• The default display mode the browser opens in when first opening a patient file

• What information to display on screen with image thumbnail

• How images are sorted

• Reset browser to defaults

Use the settings icon or right-click in the browser window to access the settings anddefaults menus. The settings are user specific so that Romexis will remember the lastsettings for each user.

5.6 Opening an Image

Images can be opened directly by double-clicking on them in the image browser, or byselecting them in the image browser and then clicking the View Selected button. Imagescan be closed by clicking the icon in the image’s horizontal toolbar.


2D IMAGING MODULE

5.7 Opening a Study

A study is a collection of related images of one patient. Studies can be viewed with theStudy tab. A list of existing studies appears, and by clicking the name of a study it ispreviewed in the image navigator. To open an image from the study (for adjustment etc.)select the desired image in the preview and click the View Selected button. To view allimages in the study click the View Study button.

5.8 Closing All Images

All open images can be closed by clicking the button.


2D IMAGING MODULE

5.9 Adjusting the layout

Images open in the viewer can be arranged into a temporary layout with the button.

These layouts are also used to position multiple images for printing. If the same layout isused frequently, it is advisable to define and use a study template instead. See theprevious sections for using studies and chapter G “ADMIN MODULE” (section 2.1“Templates” on page 8) of the Romexis User’s manual for how to define templates.


2D IMAGING MODULE

5.10 Using the measurement tools

Measurement tools

Calibrate for measurementClick the icon, draw the calibration line by holding the left mouse button down, end the line with a right-click and the calibration window appears.

Enter the length and click OK.

NOTE! You should not use the calibration tool on CBVT snapshots as they are automatically calibrated.

Measure angleClick the icon, draw the angle by pressing the left mouse button down.

Measure lengthClick the icon, draw the line by pressing the left mouse button down, end the line with a double-click (or with a right-click). While drawing, release the left mouse button to add a corner point.

Line profileBy clicking the Line Profile icon and drawing a line to the 2D image, the user can view the gray scale profile of the respective line. Min, Max, Average and Standard Deviation of the line profile are also available. If the line profile gray scale values are very near to each other, by ticking the Relative values checkbox the variations between these values are emhazised.


2D IMAGING MODULE

Show histogramBy clicking the Show Histogram icon the histogram of the open image/selected region of interest is shown. A histogram is a graphical representation of the gray scale distribution in the image/area. By default the histogram is drawn in square root scale. Linear scale can be enabled by ticking the Linear scale checkbox. Max, Average and Standard Deviation of the histogram data is also available.

Show measurements, Show/hide values

Measurement tools


2D IMAGING MODULE

5.11 Using the drawing tools

Drawing tools

Draw a line

Draw a horizontal line

Draw a vertical line

Draw an arrow

Draw polyline

Draw curve

Draw rectangle

Draw an ellipse

Draw textClick the icon and point with the mouse where you want to add the text. Type the text to the opening window and click OK.To edit the text later select the text with the Select annotations button (see below) and then double-click the text. Edit the text and click OK.

Select/move/edit annotationsClick the icon and and take the mouse (cross inside the arrow) to the top of the graphics. To move a graphic, select and drag it to a new position.This tool can also be used to edit annotations by moving their control points.


2D IMAGING MODULE

Delete selected annotations or measurements

Show annotationsShows and hides annotations. Even if the annotations are hidden they are still stored with the image.

Select annotations When an annotation (line, arrow, circle, rectangle, curve) is selected, itscolor and line width can be adjusted. Use the Select Annotation tool toactivate the annotation you want to edit. When an annotation is active youcan modify it using the Color and Width settings shown in the ImageToolbar.

Drawing tools


2D IMAGING MODULE

5.12 Using the viewing tools

Viewing tools

Zoom out

Zoom in

Zoom to fitAll open images are fitted to view

1:1All open images are scaled to 1:1

Uniform scaling for all images

Magnifier 2xInvokes the magnifier glass (2x) on the image. The magnifier can be moved on the image.

Show overviewWhen the image is zoomed in, the images can be panned with an overview window.

FlashlightEnables a movable square Flashlight overlay that allows regional filter for Gamma, Contrast & Brightness, Invert, Equalize, Sharpen, and Emboss. Use the mouse scroll wheel to adjust the size of the filter area and right-click to switch between different filters. See also Flashlight setup below.


2D IMAGING MODULE

Flashlight setupSimilar to Flashlight function above but allows setting of Gamma, Contrast & Brightness values. The settings are image specific. Use the mouse scroll wheel to adjust the size of the filter area, and the radio buttons or the right click to switch between different filters.

Pan

Viewing tools


2D IMAGING MODULE

5.13 Using image processing tools

Horizontal image toolbar

Image processing

Adjust contrast and brightnessInvokes contrast and brightness control to all open images. You can adjust the brightness and contrast by dragging the sliders or by moving the mouse on the image while pressing the left mouse button. Horizontal movement changes the brightness and vertical the contrast .

Region of interestUse the Region of Interest tool to specify and select the area of effectfor image processing tools and certain measurements. Use this tooltogether with for example image Histogram tool to view grayscalevalues of a region. Note that it is possible to specify multiple regions and to switchbetween them by using the Reqion of Interest tool. Active region isdenoted in green and inactive regions in blue color. Use DeleteMeasurements tool or Delete key to delete the selected region.


1:1Scales the image 1:1.

Zoom in, zoom out


2D IMAGING MODULE

Show image propertiesOpens the General tab under Image properties window where the tooth numbers (for intraoral images) can be defined, the image can be rotated/flipped and the image file info and exposure parameters can be viewed.

Show image diagnosisOpens the image Diagnosis tab under Image Properties. Shows and allows editing image diagnosis. Diagnosis up to 2500 characters is supported.

Show vertical image processing toolbarOpens the vertical image toolbar.

Maximize the image

Close the image



2D IMAGING MODULE

Vertical image toolbar


Adjust levelsGamma curve can be adjusted by moving the green line in the histogram. The histogram can be cut from the ends by moving the red lines. The levels can also be adjusted by moving the mouse vertically and horizontally on the image.

Use the small double arrow shown in the bottom left corner of the above screenshot to reveal the advanced options. Use the up/down arrows and the 1:1 button to scale the histogram tobring out details. Enable Overlay result histogram to highlight theresulting histogram and Linear scale to draw the histogram in linearscale instead of the default logarithmic scale.

The Min, Max, Avg (Average), and StdDev (standard deviation) valuesshow the corresponding grayscale values in the image or in theRegion of Interest when one is active.

When pseudocolours are enabled, this dialog is also used to selectcolours and to alter their balance. To do so, use the handles on the topofthe dialog to adjust the colour balance. Double-click on a handle tochange the colour for its range.

Click the small down arrow to apply preset colours.

Adjust brightness and contrast of the image

Adjust sharpness of the imageAdjusting can be done by using the sliders or by moving the mouse on top of the image.

Sharpen the imageSharpens the image according to the settings in the tool above.


2D IMAGING MODULE

5.14 Copying image to Clipboard

The image can be copied to the Windows clipboard by right-clicking the image andselecting Copy to clipboard from the pop-up menu.

5.15 Printing images

Images with patient information can be printed to Windows printers.

Soften the image

Noise removal

Invert the image

Apply Ceph filter to bring up more facial soft tissue. Adjust the vertical green lines to specify the area of effect. Use the Gain slider to adjust the strength of the filter, higher values will bring out more tissue.

Apply pseudocoloursUse the Adjust levels dialog to modify the colours.

Image OperationsShows history of image operations. Click on an operation in the history to which to revert the image.

Save modificationsRomexis saves image modifications automatically when the image is closed. In case you want to save the image while working with it use the Save button.

Revert to originalRemoves filters and grayscale adjustment from the image and shows it without preprocessing as it was when received from the X-Ray unit.

Undo

Redo



2D IMAGING MODULE

Print Setup

In the Print Setup window the scale for intraoral images can be specified, the pagemargins can be set and the orientation of the page can be defined.

Printing an Image

Open the image you want to print and click the Print button. The preview window appears.The image is printed in the layout which is shown on the screen.

Print Cropping

To adjust the area included in the prints, use the Adjust Print Crop tool available in thevertical toolbar, see “Using the measurement tools” on page 13 for more details.

Printing Multiple Images

Open all the images you want to print and arrange them with the Layout button to adesired layout. To align images right-click an image and select Alignments from theopening pop-up menu.

Select the desired alignment from the opening window.

Repeat this for each image. In case you want to see how the images are printed, click thePrint button to see the Preview.


USING 3D MODULE

6 USING 3D MODULE

6.1 Introduction

The 3D Module of the Planmeca Romexis Viewer consists of four different tabs:

1. Volumes: the list of open images

2. Explorer: sagittal, coronal, axial and rendered view

3. Panoramic: panoramic view and curve

4. Implants: cross sectional slices, nerve drawing and implant planning

The layout of the 3D Module tabs is divided into three parts:

1. Menu: Toolbar on the top

2. 3D Volume Viewing: Main part of the 3D Module with the view display

3. Volume Adjustments: Located on the right containing the image processing tools.

The menu toolbar functionality is explained in the following chapter.

6.2 Menu Toolbar

The Planmeca Romexis Viewer menu toolbar contains buttons common to all PlanmecaRomexis Viewer tabs. Functions available on this toolbar include volume adjustments,measurements, saving of 3D views, reset view and zoom.

Adjust Levels

If the adjustment of the sliced views is not satisfactory, the adjustments can be donemanually by using the Adjust Levels window. The gamma curve can be adjusted bymoving the green line in the histogram. The value can be seen in the box in the middle ofthe window. The histogram can also be cut from both sides by moving the red lines, whichaffects the adjustment of contrast and brightness.

By clicking the arrows in the middle the histogram can be scaled up or down. This buttonrestores the original scale of the histogram.


USING 3D MODULE

NOTE A histogram is a graphic representation of the intensity distribution in the volume.

Measure Length

Click the icon and draw the line by holding the left mouse button down. End the line with adouble-click (or with a right-click).

Measure Angle

Click the icon to draw an angle into a sliced view by holding the left mouse button down.Drag to draw the first line and then click and drag to draw the second line.

Save Current View

Saves the view currently displayed. Enter a name into the opening dialog.

Select a Saved View

Selects one of the saved views from a list.

Delete a View from the Saved Views

Deletes one of the saved views from a list.

Reset View to Default Orientation

Restores the original adjustments of the views.

Show/Hide Orientation Lines

Shows and hides the orientation lines of the sliced views.

All views have orientation lines to facilitate the comprehensive view and the relation toeach other. This means, for example, that the view of the coronal plane is indicated with agreen line in the sagittal plane, axial plane and with a green auxiliary plane in theperspective view. Likewise the sagittal and axial planes are indicated. With the RenderedVolume Auxiliaries icons you can switch the auxiliary lines in the rendered volume on oroff.

Zoom Mode

When the Zoom Mode icon in the menu toolbar is activated the sliced views can be scaledup or down. Move the mouse pointer over the desired view and turn the mouse wheel intothe appropriate direction.


USING 3D MODULE

DICOM images drop-down list

The top part of the Planmeca Romexis Viewer also contains a drop-down list of theDICOM images located in the Planmeca Romexis Viewer folder. By clicking the image listdrop-down button, a list of all the 3D volumes in shown.

View

A 3D volume can be opened by selecting an image from the drop-down list and clickingthe View button.

Properties

By clicking the Properties button, you can see the properties of the image selected fromthe drop-down list.

6.3 Opening a 3D volume

In the Volumes tab patient’s 3D volumes are listed and axial-view thumbnail is displayed.Thumbnail’s axial slices can be scrolled with arrow or mouse wheel. To open a 3D volumeselect the volume and click the View button or double-click the volume line.


3D EXPLORER

7 3D EXPLORER

In the Explorer tab the open 3D volume can be adjusted and viewed in three differentdirections.

The 3D volume is displayed simultaneously in four different views: Sagittal (red), Coronal(green), Axial (blue) and 3D rendered view. The red, blue and green lines across the viewsindicate the slicing planes in the views.

The position in the volume can be freely adjusted by holding down the left mouse buttonand moving the mouse in the view. All views are connected to each other, which meansthat moving one view will affect the other views as well, except for the rendered volume.While moving the mouse on one view the two other views automatically move to thecorresponding position. The viewing angle can be rotated freely by holding down the rightmouse button while moving the mouse.

When orienting the image, you can recognize anterior, posterior, left, and right anatomiesby the A/P/L/R letters respectively on the edges of the views. These will automaticallyupdate to denote the nearest anatomy to the edge.

When moving the mouse cursor on top of the image, a Hounsfield Unit (HU) value will beshown at the bottom right of the current view. The value shown is an average value of 3 x3 pixel area under the mouse cursor.



3D EXPLORER

7.1 Layer Slide Bar and Maximize

Clicking the Maximize icon in the top right corner of the relating view opens a fullsized window, showing the image.

At the right border of each view, the coronal, sagittal and axial views, is a layer slide bar. Ineach case the slide bar can be moved to scroll through the image layers of thecorresponding view. For example, scrolling the slide bar of the coronal view moves theview inside the layers forward or backwards. The corresponding orientation lines in thetwo other views as well as the auxiliary plane in the 3D rendered view automatically moveto the appropriate position.

NOTE It is also possible to scroll through the image layers using the mouse wheel, whenthe Zoom Mode is deactivated (see “” on page 28).

7.2 Volume Adjustments

Volume Adjustments at the far right contains the image processing tools, explained inmore detail below.

The Adjust tools can be applied on the slice views, meaning the coronal, sagittal and axialview and enable the modification, examination and measurement of the views.

Thickness

Defines the displayed slice thickness of the slice views.

The resampling/thickness can be adjusted from the drop-down menu.

Adjust Contrast, Brightness and Sharpness

Regulates the contrast, brightness and sharpness of the coronal, sagittal and axial view.By dragging the sliders the brightness and the contrast can be adjusted.

NOTE When the Zoom Mode is deactivated the same action, turning the mouse wheel overa view, will scroll through the image layers as the Layer Slide Bars do (see 7.1“Layer Slide Bar and Maximize” on page 28).

NOTE The rendered volume can be zoomed with and without the Zoom Mode activated.

Crop Volume for 3D Rendering

Crops the rendered volume. It is applied to the sliced views and affects only the 3Drendered volume view.

After clicking the Crop icon, move the mouse pointer on one sliced view. Press the leftmouse button and a white framed rectangle appears. By dragging the mouse on the viewthe cropped area can be defined. The rectangle also appears at the two other slicedviews, to be able to define an exact area for the cropping. After selecting the area pressthe right mouse button to start the cropping process.


3D EXPLORER

Select Annotation(s)

Toggle editing mode for annotations and measurements. When active, select anannotation or measurement to bring up handles that can be used to edit the control pointsof the selected item.

Export View to Other Tabs

Exports the currently displayed view of the slices to the Panoramic and Cross Sectionstabs. The processed slices are shown in the other tabs like in the Explorer.

7.3 3D Rendering adjustments

There are two different 3D rendering styles available in Romexis; Surface style and X-raystyle. The default rendering style is Surface Style. For instructions on how to change therendering style see “START-UP OF PLANMECA ROMEXIS VIEWER” on page 2

The 3D Rendering tools can be applied to manipulate the rendered volume.

Adjusting Contrast, Brightness and Sharpness

Regulates the contrast, brightness and sharpness of the rendered volume. By draggingthe sliders the brightness and contrast can be adjusted.

Setting 3D Rendering Cutoff Threshold

Moving the slider determines the threshold for which gray scale values are shown in the3D rendered view.

Adjusting 3D Rendering Transparency

Moving the slider to the top increases the transparency of the 3D rendered view.

Surface style rendering X-ray style rendering


3D EXPLORER

Adjusting Levels

If the adjustment of the 3D volume rendering is not satisfactory, the adjustments can bedone manually by using the Adjust Levels window. The gamma curve can be adjusted bymoving the green line in the histogram. The value can be seen in the box in the middle ofthe window. The histogram can also be cut from both sides by moving the red lines, whicheffects the Adjustment of the Contrast and Brightness (see “” on page 28).

Scale histogram

By pressing the arrows in the middle, the histogram can be scaled up or down. The button restores the original scale of the histogram.

Threshold

The black line increases or decreases the threshold and consequently has the samefunction than the slider Set 3D Rendering Cutoff Threshold.

Pseudo Colour modification

The buttons left and right of the gamma value, named F and R, modify the pseudo colours.Pressing the button alters and allocates the colour selection for different tissuesautomatically, based on the curve of the histogram. To modify the Pseudo Coloursmanually, drag the rectangles above the histogram left or right. With this, the position andrange of the specific colour can be altered. By double clicking the rectangle, the colourscan be changed for an individual selection. The button resets the settings of thePseudo Colours. From the arrow button ready made color maps can be selected.

NOTE A histogram is a graphic representation of the intensity distribution in the volume.

Show Pseudo Colours in 3D Rendering

Available only in X-ray Style rendering.

Clicking this icon changes the greyscale to colours. In the Adjust Levels window of the 3DRendering, the colours for the different tissues can be modified.


3D EXPLORER

Rotate Light Direction

Available only in Surface Style rendering.

The rendered volume view has three coloured planes indicating the coronal, sagittal, andaxial planes. These planes help you in orienting the three slice views in relation to the 3Drendering and actual anatomy. The planes can be shown/hidden by pressing thecorresponding buttons at the right side of the rendered volume views as follows:

Show coronal plane (green).

Show sagittal plane (red).

Show axial plane (blue).

Show / Hide all planes.

The following options are also available:

Show/Hide Volume Boundaries:

The 3D volume is by default surrounded by a volume boundary box that may in somecases help properly orienting the 3D volume. Use this button to turn the boundaries on/off.

Show Perspective in 3D Rendering:

This button will turn on linear perspective that provides a more natural view of theanatomy. By default the rendering is shown in an isometric style that has no perspectiveeffect.

When in the default non perspective mode, hold down the right mouse button and movethe mouse up and down to produce a slicing effect in which the anatomy is sliced out asyou move the mouse up. This effect can be used to slice of thin layer of the anatomy or toclear obstructing anatomy from the view for example.

Show/Hide Orientation Lines:

Toggles visibility of orientation lines and measurements in rendered view only.

Rendering overlay

3D Rendering overlay allows volumetric coloring of the 3D volumes based on the grayscale values in the image. It allows coloring of soft tissue and airways for exampleenhancing the informative value of the 3D rendering. Use the Show Overlay to turn theoverlay on/off and the Overlay Properties to specify the qualities of the overlay present inthe image.

Show Overlay – Turn the overlay on/off. If no overlay is defined then the OverlayProperties Dialog is automatically presented (see below). On large volumes please bepatient as the display of the overlay may take a while at each time the volume is firstopened.


3D EXPLORER

Overlay Properties – The following properties can be defined for the overlay.

• Color – Specify the color that the chosen gray values should appear in.

• Threshold – Specify the grayscale value to be colorised (between 0-4095).

• Transparency – Specify the level of transparency of the overlay against the rendering.0% for fully opaque and 100% for fully transparent.

• Smoothing - Applies a smoothing filter on the 3D rendereing

3D Rendering Options

Set Rendering Options


3D EXPLORER

The following options are available for Surface style rendering.

To set current rendering setting as the custom preset click the Add button. The currentlyselected option will be shown in the thumbnail circled with white line. To delete the currentcustom preset click the Del button.

NOTE 3D rendered view quality can be changed in Romexis Admin module, see chapter G “ADMIN MODULE”.

Table 1:Rendering presets

Rendering presets

1. Maximum Intensity Projection MIP

2. X-ray

3. X-ray shaded (default)

4. Shaded

5. Shiny

6. Surface

7. Black & White X-ray

8. Soft tissue


PANORAMIC MODULE

8 PANORAMIC MODULE

In the 3D Panoramic tab panoramic views can be generated from the 3D data. Thepanoramic image generated can be adjusted and processed in multiple ways. The imagerange and thickness can be defined as well as the selection of the appropriate curve forthe construction of the panoramic view. Also an export of the displayed view (with Save 2DView) to the can be done, see chapter 5 “2D IMAGING MODULE” . The image can also beprinted from Panoramic tab.

The Panoramic tab contains four views:

• Sagittal view, where the sagittal orientation of the 3D volume can be rotated.

• Axial view, where the axial orientation of the volume can be rotated and where thepanoramic curve is defined and shown.

• Panoramic view, where the generated panoramic image is shown.

• 3D Rendered view

By turning the mouse wheel on top of the sagittal or axial view, the view can be zoomed inor out.


Holding down the left mouse button while dragging the axial or sagittal view will move the3D volume, and holding down the right button will rotate it. Refreshing the views may takea moment.


PANORAMIC MODULE

8.1 Layer and Curve Slide Bar

A slide bar is located at the right border of each view, sagittal, axial and panoramic. In thesagittal and axial view the slide bar can be moved to scroll through the image layers. Thismeans that scrolling the slide bar of the axial view up and down moves the view inside thelayers forward or backwards. The corresponding orientation lines in the sagittal andpanoramic view automatically move to reflect the changes.

Moving the slide bar of the panoramic view modifies the radius of the panoramic curve andthe change is immediately reflected in the axial view by the panoramic curve moving in orout in relation to the patient’s anatomy. When the slider is released, the panoramic view isautomatically updated with the new curve.

8.2 Adjustment tools

The Adjust tools at the top right contains accessories to process the views.

8.2.1 Defining the Slice Thickness of the 3D Volume

The 3D volume thickness can be adjusted from a drop-down menu: .

This affects the display of the image in the sagittal and axial views, but not in thepanoramic view.

8.2.2 Adjust contrast and brightness

Regulates the contrast and brightness of the image views. By dragging the sliders, thebrightness and the contrast can be adjusted. The settings are saved automatically whenthe image is closed.


PANORAMIC MODULE

8.2.3 Defining Data Range

By pressing the Define Data Range button the area of interest for the panoramic imagecan be defined. You can select from which part, lower or upper jaw, the panoramic imageis created. In the appearing window move the sliders up or down to adust. The left sliderrestricts the upper jaw and the right slider the lower jaw.

8.2.4 Show / Hide Settings

To set up the display of the orientation overlays, press the Show / Hide Settings button. Inthe Show/Hide Settings window you can select the overlays to be shown.

8.2.5 Move and rotate volume

Toggles editing mode to move/rotate volume and annotation and meassurement editing.Use the left mouse button to move and right button to rotate the volume. Select anannotation or measurement to activate handles for editing the control points.


PANORAMIC MODULE

8.3 Panoramic tools

With the Panoramic imaging tools, the panoramic view can be defined and adjusted bydrawing a curve to the axial view and choosing a range to be displayed.

8.3.1 Draw Panoramic Curve

Romexis automatically places the panoramic curve. To define a new curve, click the DrawPanoramic Curve icon. Use the left mouse button to place points for the curve on the axialview. When you are done, click the right mouse button and the new panoramic view will becalculated.

NOTE All created panoramic curves will be saved and listed in the Select Panoramic Curveoption.

8.3.2 Delete Current Panoramic Curve

Clicking the Delete Current Panoramic Curve icon deletes the panoramic curve currentlydisplayed. The standard curves are not deleted.


PANORAMIC MODULE

8.3.3 Edit Panoramic Curve

To edit the curve, click the button and move single points in the curve or even the wholecurve by grabbing the green line of the curve. Change the position by dragging the pointsor the entire curve with the left mouse button. To finish editing, click the icon again.

8.3.4 Selecting Panoramic Curve

Pressing this button shows a list of all saved panoramic curves. All curves you draw aresaved and named with the date and time they were created. Click on an entry to recall andapply that curve.

8.4 Adjusting panoramic images

From panoramic view upper right corner adjustment dialog can be opened by clicking thisbutton .


PANORAMIC MODULE

The number of panoramic images, the layer thickness and the distance betweenpanoramic images can be defined in the opening dialog.

8.5 3D Rendered view adjustment

See section 7.3 “3D Rendering adjustments” on page 29


3D CROSS SECTIONS MODULE

9 3D CROSS SECTIONS MODULE

In the 3D Cross Sections / Implant tab cross sectional slices, axial slices and panoramicimages can be created from the 3D data.

The Cross Sections / Implant tab contains four views:

• Axial views

• Panoramic view

• Cross sectional slices view

• 3D rendered view

The views can be expanded by clicking the small dual arrows in the ends of the viewdividers or maximized by clicking the Maximize button.

9.1 Adjusting slices in cross sections views

Clicking the button in the upper right corner mirrors the cross sections.



Clickingthe button in the upper right corner of the cross sections view opens a dialogwhere the number of cross sectional slices, the distance between them, and the width andthe thickness of the slices can be defined.

NOTE The 3D Panoramic Module and 3D Cross Section Module share the same panoramiccurve and data range definition. Therefore when one is changed in either of thetabs, the changes will be reflected in the other tab as well. Sagittal or axial rotationof the 3D volume is defined in the Panoramic Module and also affects the CrossSection Module.

9.1.1 Edit Cross Sectional Slice Interval

To edit the cross sectional slice interval, move the slider up or down. If the section linesare activated in the Edit Orientation Lines (see 9.5.3 “Show / Hide Settings” on page 44)the adjustment is visible in the axial view, indicated by the yellow lines. After moving theslider the cross sectional view gets updated accordingly.

9.1.2 Edit Cross Sectional Slice Width

To edit the cross sectional slice width, move the slider up or down. If the section lines areactivated in the Edit Orientation Lines (see 9.5.3 “Show / Hide Settings” on page 44) theadjustment is visible in the axial view, indicated by the yellow lines. After moving the sliderthe cross sectional view gets updated accordingly.



9.2 Adjusting axial slices

Clicking the button in the upper right corner of the axial view opens a dialog wherethe number of axial slices, the distance between them and the thickness of the slices canbe defined.

9.3 Adjusting panoramic slices

Clicking the button in the upper right corner of the panoramic view opens a dialogwhere the number of panoramic slices, the distance between them and the thickness ofthe slices can be defined.

9.4 Cross Sectional Scroll Bar

At the top of the Cross Sectional View is a scroll bar for to move the cross sections.Moving the scroll bar right or left shifts the visible slices to the corresponding directionalong the panoramic curve. If the Cross section lines option is activated in the EditOrientation Lines (see 9.5.3 “Show / Hide Settings” on page 44), they also get shifted inthe axial and panoramic view. The middle section is indicated by a bright red line and by abright red ruler in the cross sections view.

Using the Cross sectional scroll bar

1. Click on the end arrows to move cross sections voxel by voxel.

2. Drag the scroll box to freely move cross sections around.

3. Click between the scroll box and end arrows to move cross sections in increments of thedistance between the slices.



NOTE Full Arc mode will modify the behaviour of the cross sectional scroll bar.

9.5 Adjust tools

The Adjust tools at the top right contain accessories to process the views.

9.5.1 Adjusting contrast, brightness and sharpness

Regulates contrast, brightnessand sharoness of the image views. By dragging the sliders,the brightness, the contrast and sharpnss can be adjusted. The settings are savedautomatically when the image is closed.

9.5.2 Defining Data Range

By pressing the Define Data Range button the area of interest for the panoramic imagecan be defined. You can select from which part, lower or upper jaw, the panoramic imageis created. In the appearing window move the sliders up or down to adjust. The left sliderrestricts the upper jaw and the right slider the lower jaw. This also affects the cross slicedview.



9.5.3 Show / Hide Settings

To set up the display of the orientation overlays, press the Show / Hide Settings button. Inthe Show/Hide Settings window you can select the overlays to be shown.

NOTE Cross sectional slice numbering can be changed between ordinal and panoramareferenced.

9.5.4 Move / rotate volume

Toggles editing mode to move/rotate volume and annotation and meassurement editing.Use the left mouse button to move and right button to rotate the volume. Select anannotation or measurement to activate handles for editing the control points.

NOTE Rotating cross sectional views is limited to sagittal plane (nodding). Panoramicviews cannot be rotated or moved.

9.5.5 Show/hide renderer

Allows showing and hiding of the 3D rendered view.

9.5.6 Panoramic

With the panoramic imaging tools, the panoramic view can be defined and adjusted bydrawing a curve to the axial view and choosing a range to be displayed.

NOTE Modifications to the panoramic curve in the Cross Sections Tab will effect thePanoramic Tab, as they share the same curve and data range definition.



9.5.7 Draw Panoramic Curve

The panoramic curve is placed automatically by Romexis or taken over by the PanoramicTab. To define a new curve click the Draw Panoramic Curve button. Use the left mousebutton to place points for the curve on the axial view. When you are done, click the rightmouse button and the new panoramic view will be calculated.

NOTE All created panoramic curves will be saved and listed in the Select Panoramic Curveoption.

9.5.8 Delete Current Panoramic Curve

Clicking the icon deletes the current displayed panoramic curve. The standard curves arenot deleted.

9.5.9 Edit Panoramic Curve

To edit the curve, click the button and move single points in the curve or even the wholecurve by grabbing the green line of the curve. Change the position by dragging the pointsor the entire curve with the left mouse button. To finish editing, click the icon again.

9.5.10 Select Panoramic Curve

Pressing this button shows a list of all saved panoramic curves. All curves you draw aresaved and named with the date and time they were created. Click on an entry to recall andapply that curve.



9.6 Nerve

The Nerve tools at the bottom right enable to add and modify nerve channels to the views.

9.6.1 Draw Nerve

To draw a new nerve channel click the Draw Nerve icon. Use the left mouse button toplace points either on the panoramic or on the cross sectional view for a curve depictingthe nerve channel of the patient. When you are done, click the right mouse button and thenerve channel will be displayed as a coloured line in the panoramic view and as dots of thesame colour in the cross sectional views.

9.6.2 Delete Nerve

This option deletes the currently selected nerve channel. To select an existing nervechannel, point the mouse on it and press the left mouse button or open the List of Nerves.If no nerve channel is selected, the action has no effect.

9.6.3 Nerve Properties

By clicking this icon the properties of a nerve channel can be adjusted. A window openswhere you can name the nerve and modify the colour and diameter. To change theproperties a nerve needs to be selected. To select an existing nerve channel, point themouse on it and press the left mouse button or open the List of Nerves and select thenerve from the list.



9.6.4 List of Nerves

The option List of Nerves shows a listing of all nerves visible in the Cross Sectional tab. Inthe opening window nerves can be selected and deleted and their properties can bechanged. To delete a nerve (deletes the nerve from both the list and the cross sectionaltab), select a nerve and click the Delete button. To change the properties of a nerve, selecta nerve and click the Properties button. The Nerve Properties window will appear (forfurther information see 9.6.3 “Nerve Properties”).

9.7 3D Rendered view

See section 7.3 “3D Rendering adjustments” on page 29.


IMPLANTS

10 IMPLANTS

Romexis Viewer Implant tools can be used for planning an implant placement inside a 3Dvolume. The Implant module extends the Cross Sections module and shares all featuresthat it provides. For information on common tools with Cross Sections module such ascross section, panoramic, and nerve adjustments, refer to chapter 9 “3D CROSSSECTIONS MODULE” on page 40.

NOTE Realistic implant models are currently not available in Planmeca Romexis Viewer.

Planmeca Romexis Implant tools were designed for quick and effortless placement ofimplant models into the 3D volume with a minimum number of mouse clicks.

A common workflow to place an implant into a plan is as follows:

1. Add implant model to the plan by using a default choice, drawing to size, or a specificmodel from library.

2. Place the implant to the correct location and use control handles to orient it to match thepatient’s anatomy. You can use all available views (panoramic, axial, and cross-sections)for placement and orienting.

3. You can change the size of the implant model from the Properties window, or in theImplant Library.

4. Verify margins and orientation and place next implant.


IMPLANTS

10.1 Implant tools

Add default implant

Use Add default implant tool to place a pre-selected default implant into the plan. Thedefault implant can be defined in the Implant library.

Free draw placement

Use the Free draw tool to draw an approximation of the implant’s width and height, usingthe patient’s anatomy as a reference for sizing. Then use Implant Library to search andselect the nearest matching real implants from your library. With this method you will getthe correct length and diameter without first having to guess which size would provide thebest fit.

Open implant library

Use the Open Library to place implants directly from the Implant Library. This allows you tofirst browse your selection of available implants and decide on the type before placing animplant into the plan. After selecting the implant type, press the Add button to add theselected implant into the plan. You can then align the implant to match the patient’sanatomy. You can also use the Implant Library to add new implants into the library andmodify existing designs. See below for more information on the Implant Library.

Delete selected implant

Use the Delete selected implant to remove the selected implant from the plan.

Properties for selected implant

Use the Properties button to call up the Properties dialog shown below. This dialog canalso be shown by double-clicking on any implant.


IMPLANTS

Use the Implant Properties dialog to change the name, colour, length, and diameter of theselected implant. The dialog allows setting the length and diameter of the implantaccurately in tenths of a millimeter. Use the Library button to move to the Implant Library.

NOTE If the implant has been added or replaced from the Library, the length and diametercannot be changed as they are fixed to the values that were set in the library. Tochange the measurement of such an implant, use the Replace feature in the Library.

List implants in the plan

The List Implants dialog shows you all implants that are present in the current plan. Use itto change the name, colour, length, and diameter of the listed implants. The dialog allowssetting the length and diameter of the implant accurately in tenths of a millimeter by usinga keyboard entry.


IMPLANTS

10.1.1 Implant Library

Implant Library can be used to manage implants: create new implants, modify, addimplants to plan, replace, and search for implants. Implants that are commonly used canbe freely added and will be automatically grouped by manufacturer and product lines.

A general principle is that implants that have been placed into the plan are not affected byany changes made in the library. To modify implants that are already placed, modify theproperties of an individual implant with the Properties button, use the Replace function, orthe implant list.

New

Create a new implant in the Implant Library by specifying the required information. Notethat you can use the drop-down lists to select existing manufacturers or product lines.When entering numerous implant models, the Copy function explained below may bemore suitable.

Copy

Copy the selected implant to a new one and change one or more properties. This option isuseful when creating groups of implants that share some properties.

Properties

Modify the properties of the selected implant.

NOTE Changing the properties in the library does not affect implants that have alreadybeen placed into the plan.

Delete

Delete the selected model from the library.


IMPLANTS

NOTE Deleting an implant from the library does not affect implants that have already beenplaced into the plan.

Set Default

Set the selected model as the default implant. This default selection is used by the Adddefault implant feature.

Add to Plan

Use Add to Plan to add the selected implant into the current plan and automatically closethe Implant Library dialog. When you add implants from the library, you cannot adjust theirsize with the Properties dialog. To change the size, use the Implant Library and theReplace selected button again.

Replace selected

Use Replace selected to have the currently selected implant in the plan replaced with theimplant model that is currently selected in the Implant Library. The dialog will automaticallyclose. When you replace an implant with another from the library, the dimensions of theplaced implant can no longer be adjusted with the Properties dialog. To change the size,use the Implant Library and the Replace selected button again.

Implant Search

Use the Search function to browse through large libraries for implants with certainproperties. Use the Search options to specify properties of the implant models to searchfor. The Search button executes the search while the Clear button clears the searchresults.


TMJ MODULE

11 TMJ MODULE

Romexis TMJ module allows convenient viewing and diagnosis of the tempormandibularjoint regions. After drawing posterior anterior line (PA line) for each side of the anatomy,multiple dedicated lateral slices and PA slices are provided. These views correspond to adouble lateral-PA exposure but can be easily aligned, rotated and adjusted to give a betterunderstanding of the anatomy in the region. Romexis TMJ module therefore offers similardiagnostic value as TMJ programs available in some X-ray devices but allowing multiplestudies with single exposure to be generated.


Romexis TMJ module is designed to allow quick analysis of the TMJ area. A commonworkflow to view termomandibular joints is as follows:

1. Open the volume to be studied in Romexis Explorer module. The volume can be a fullhead exposure, a single TMJ or both TMJs stitched together with Romexis stitchingfeature. The only requirement is that the TMJ region must be visible in the volume that isused. Orient the volume in anterior-posterior line so that the mandible is aligned correctly(TMJ slices are perpendicular to the axial plane). Also orient the left-right line so that bothcondyles (if visible) are on the same axial plane.

2. Use the Export View to Other Tabs button to apply the new orientation in othermodules.

3. Navigate to TMJ module.


TMJ MODULE

4. Verify alignment of the volume using the Axial view. Use the slider on its right edge tobring condyles into view.

5. Draw right posterior anterior (PA) line using this tool . Start drawing by clicking onthe middle of the condyle and then hold down the left mouse button while dragging todefine the length and direction of the PA line. Romexis will automatically introduce theopposite half of the line and round its total length to nearest millimeter. To finish the line,release the left button and Romexis will automatically populate the slice views.

6. Draw left PA line using this tool . Repeat the process described in step 5. By defaultthe Synchronise Sides tool is enabled so that the left PA line length is

constrained to match that of the right PA line. In this case only the direction of the left PAline needs to be defined. To specify a left PA line of different length, disable theSynchronise Sides tool.

7. Use the view settings dialogs to adjust the number, width and spacing of the PA andlateral slices similar to other 3D modules.

8. To adjust the position of the PA lines verify that the Move / rotate volume tool isdisabled and then use left mouse button to move a PA line or right mouse button to rotate.To adjust the width of the slices (length of the PA line) either use the slice specific settingsmenu or redraw the line.

11.1 TMJ Tools

Draw Right PA Line

Use to draw and define the posterior-anterior PA line for the right side slices.


TMJ MODULE

Draw Left PA Line

Use to draw and define the posterior-anterior PA line for the left side slices.

Synchronise Sides

Enable / Disable synchronisation of left PA line with right PA line. When enabled thedrawing of PA line length will automatically constrained to match the length of existinglines. The length can still be adjusted using the view settings dialog which will then affectboth PA lines simultaneously. When disabled each PA line can be individually defined.


TMJ MODULE

APPENDIX A: PLANMECA PROMODEL


QUICK GUIDE FOR PLACING PLANMECA PROMODEL ORDERS

1 QUICK GUIDE FOR PLACING PLANMECA PROMODEL ORDERS

Planmeca ProModel is designed for dental professionals to use as an assisting tool forpreoperative planning of difficult dental and maxil-lofacial operations. In no circumstancesProModel can be used in vivo.

Overview of the ProModel service:

• ProModel order button opens the integrated order form in 3D Master Menu Toolbarin Romexis version 2.0.0.0.R and later.

• User has three options to place Planmeca ProModel orders via integrated orderinginterface in Romexis version 2.0.0.0.R and later:

o Online order – sends image and order form to Plan-meca’s FTP server.

o Burn ProModel order on CD (not available in Romexis Viewer) – using this optionburns image and order form to portable media which can be mailed to Planmeca.

o Export to My Documents – exports zip-folder which includes the image and orderform to user’s local com-puters My Documents (OS WinXP).

• Using any of the above described ordering methods in Romexis software the patient’simage is automatically anonymized meaning that all patient’s person-related informationis removed from the 3D volume.

• To place a Planmeca ProModel online order with integrated ordering interface in Romexissoftware, computer needs to be online (Internet access) and possible firewalls need to beset to accept outgoing FTP-connections.

• Order confirmation and courier package tracking number will be sent to customer’s emailaccount.


PLACING PLANMECA PROMODEL ORDERS

2 PLACING PLANMECA PROMODEL ORDERS

Planmeca ProModel is a patient specific physical model made from Promax 3D imagedvolume. The ProModel can be used as a supportive tool in preoperative planning of dentaland maxillofacial operations. The ProModel is designed to be used with the originalProMax 3D imaged volume, the ProModel should not be used as only tool for planningoperations.

This user’s manual is valid for Planmeca ProModel order with integrated ordering interfacein Romexis (version 2.0.0.0.R and later) for placing Planmeca ProModel orders.

11.2 3D Master Menu Toolbar with Planmeca ProModel Order

In this manual new features (available in Romexis 2.0.0.0.R and later versions) PlanmecaProModel ordering button and interface are introduced.

The master menu toolbar contains buttons common to all 3D modules. The functions areexplained in detail in Romexis User’s Manual starting from the version 2.0.

Planmeca ProModel order:

Opens the Planmeca ProModel order form to place an order from current 3D volume.Only available in 3D module. Clicking the Planmeca ProModel order button opens the integrated order form in Viewer, please see figure 3.

To place a Planmeca ProModel order from current volume user must fill the required fieldsin the form (bolded). The fields in order form are explained in detail below (see figure 4).



NOTE A volume must be opened in the Explorer tab in order to use the ProModelordering, otherwise the button is greyed.

NOTE Planmeca ProModel is not autoclavable and it is not recommended to use liquiddisinfection by default.

NOTE In case of artefacts caused by high-density objects, such as amalgam or othermetallic bodies it is recommended to use the Artefact Removal tool in yourViewer software before placing Planmeca ProModel order.

NOTE In case of separate mandible and maxilla is needed, patient’s 3D exposureshould be taken with a mouthpiece on.

11.3 Overview of Planmeca ProModel Order Form

• Required fields (in bold) include common information concerning the order (company,name, address, postcode, city, state and country). Order confirmation will be sent to user’semail account, please give a valid email address.

• ProModel ID will be printed on ordered ProModel to make it individual. As a default valueis the person id of the volume under examination. The default value is given by Romexissoftware. This value can be changed, as user likes. It can be in text, numbers or specialcharacters format.



• Comments field (not mandatory) is for special requests, e.g. if user prefer the ProModel indifferent colour than the default white. Also if user likes to have marked ROI in ProModelor give a notice to Planmeca concerning the volume it can be written down in this field.

• Reference is for order processing.

• Price List button opens ProModel price list to your default web browser, if your computeris not online clicking of Price List –button gives the URL of the price list in your default webbrowser. The prices in price list are recommended prices, please contact your localPlanmeca dealer for further price in-formation.

• Include nerves and Implants check box. Tick the Include Nerves and Implants box, ifuser has drawn mandibular nerve or placed implants in the patient’s data in Romexis. Thecolored nerve can be printed in ordered ProModel. Implants will be included as cylinderrepresentations. Note: In order to get the nerves showing in the ordered ProModel, theProModel order should be placed from Romexis 3D Module's Cross Section/Implant tab

• Add Billing Address button will be enabled if user switches the tab from “Same addressfor Delivery and Billing” to “Different Address for Delivery and Billing”. After switching usercan push the Add Billing Address -button and give billing address in case user hasdifferent delivery and billing addresses, please see figure below.

• Add Dealer Information button opens a new window in which user’s local Planmecadealer information can be given. Dealer information is required for billing purposes, thisinformation is filled by your local Planmeca dealer and it needs to be given once. Pleasesee Fig. •.



• Payments of the ProModels by default via bill from your local Planmeca dealer otheroption is COD by UPS or Exchange Col-lect by UPS. Check the availability of the UPSpayment service in your country on www.ups.com.

• Terms and Conditions can be found by clicking the hyper-link in the terms and conditionssection. By selecting this box, I agree to these Terms and Conditions - tab user mustselect the box to place one Planmeca ProModel order.

• Save this order form as a template button. By saving the order form as a template userdo not need to refill all the required fields every time when placing Planmeca ProModelorder.

• After all mandatory fields are filled the Continue button will be enabled. Clicking the buttonopens the last window where user can select the appropriate ordering type. The orderingoptions include:

o Online order

o Burn ProModel Order on CD (Not available in Romexis Viewer)

o Export ProModel Order to My Documents

For most of the fields a help text can be found making the order process as easy aspossible for the user.



APPENDIX B: MANUAL OPENING OF 2D AND 3DIMAGE FILES


OPENING DICOM FILES

1 OPENING DICOM FILES

To open a Dicom File, click on the Open Dicom File button or use the File – OpenDicom File menu option:

Select an image from the list and click Open. By clicking Browse you can browse otherDICOM images from the file system.

To visualize the image go the 3D Module, click the Volumes tab and double-click theimage.


OPENING DICOMDIR IMPORT CATALOG

2 OPENING DICOMDIR IMPORT CATALOG

Planmeca Romexis Viewer allows you to open a set of multiple patients with their patientinformation and images from DICOMDIR.

To start opening images from DICOMDIR, click on the Open DICOMDIR button oruse the File – Open DICOMDIR menu option:

First browse and select the DICOMDIR file to be opened by clicking the Browse button.When an appropriate DICOMDIR file is selected, a tree list with images and thumbnails ispopulated. The tree list on the top left shows each patient in the DICOMDIR and theirimages in a hierarchical list. When an image entry is selected in the tree list, its DICOMtags will be displayed at the bottom and its thumbnail will be highlighted on the right.

To open images, tick them in the tree list and deselect any unwanted patients and images.After you have selected all desired images, click Import.


Planmeca Oy | Asentajankatu 6 | 00880 Helsinki | Finland

tel. +358 20 7795 500 | fax +358 20 7795 555 | [email protected] | www.planmeca.com

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