Ipsoft Full Version 0 User Manual November 26, 2004 Software Version 0 Table of Contents



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Dental CAD


Open your patient, then start DentalCAD by clicking the Analysis icon:

This will open the DentalCAD screen.


Saving, Retrieving, and Deleting DentalCAD Files:

Saving and Retrieving


Each time you save a new file in DentalCAD, you will be asked about the “stage” of the analysis. Select the one that seems appropriate:

Then click OK. Afterwards DentalCAD creates a new entry in the “Diagnosis” box in the leftmost section of your DentalCAD screen:



To open that file the next time around, simply click that entry, and the file will be shown on the screen.

Deleting a File


When you delete a file in DentalCad (by highlighting a link in the Diagnosis window and clicking the Red “X” on the toolbar), you will be asked to confirm your decision (see below). Click “Yes” to delete the file or “No” to keep it.

After you have clicked Yes, the entry in the Diagnosis box will disappear.


Cephalometric Analysis Program Instructions

Starting the analysis program:


The analysis program is a separate program that is opened in IPSoft by one of two methods:

  1. on the menu bar, click one-time on program-analysis

  2. click one-time on the analysis icon (7th from the left)

  3. Maximize the window if it does not fill your screen by clicking on the upper right hand corner, second box from the right side (next to X)



Scanning a Cephalometric x-ray:


There are 3 scanners that will allow the scanning of cephalometric and panoramic x-rays. These are

  1. “Epson1680 with a transparency lid”. This scanner is a professional model and will give the best quality image. Part # E1680-PRO.

  2. Microtek i900

  3. UMAX Powerlook 1000 with UTA 1000 transparency adaptor (part # 491919 at cdw.com)

Place the x-ray face down on the scanner so that the Nose is facing the hinge of the scanner and the top of the head is to your right (vertical positioning). If scanning into Adobe, then place the x-ray so the nose is facing to the left and the top of the head is facing the top of the scanner (hinge).





    1. Directly into the DentalCAD analysis program: Push the “Acquire image” button, select Twain driver of the scanner you are using (Epson is used for this example). You should see the scanner window open.


Ceph x-ray settings Study model settings


Change the settings, if necessary:

      1. Settings should be: Document source= TPU for Pos. film

Image type= 8 bit Gray (Std)

Screen/Web (since you measure on screen)

Resolution= 96 (dpi or dots per inch)



      1. click “Preview” this gives a low resolution scan of the entire glass

      2. identify the area you want scanned. Start on one corner with your mouse, then hold down the left click button and “drag” to the opposite corner. I move from upper left to lower right, but you can go any way you wish. Then adjust the horizontal or vertical lines by positioning the cursor on the middle of the line and “left drag” the line as you wish to include the structures to be traced. * reducing the vertical (top of head to chin) area is most important to allow the calculation data to be displayed below the x-ray, making for the best printed look.

      3. Click “Scan”. The image you selected will be scanned and will appear in DentalCAD. If you need to rotate the image, this can be done clicking the filter button, followed by the appropriate rotate button.


    1. into adobe Photoshop: Open the adobe Photoshop program.

      1. Click on the menu bar (top of your screen) “file-import-Epson Twain Pro 32bit”

      2. Settings should be: Document source= TPU for Pos. film

Image type= 8 bit Gray (Std)

Screen/Web

Resolution= 96 (dpi or dots per inch)


      1. click “Preview” this gives a low resolution scan of the entire glass

      2. identify the area you want scanned. Start on one corner with your mouse, then hold down the left click button and “drag” to the opposite corner. I move from upper left to lower right, but you can go any way you wish. Then adjust the horizontal or vertical lines by positioning the cursor on the middle of the line and “left drag” the line as you wish to include the structures to be traced.

      3. Click “Scan”. The image you selected will be scanned and appear behind the setup window. Repeat preview, identify area to be scanned, and scan for as many x-rays as you have to scan.

      4. Click “close” in the setup window (under the preview button) and the setup window will disappear, showing you the x-rays you have scanned. The top of the stack will have a blue line on the top of the window indicating that this is the image that is “selected”.

      5. Editing the x-ray:

        1. rotating: if you scanned the x-ray in the vertical position instead of the horizontal, then click “image-rotate canvas-rotate 90 degrees clockwise or counter clockwise” repeat until your x-ray is as you wish.

        2. brightness and contrast. For a dark x-ray, you may wish to add “brightness” to the image, but I personally do not add contrast in adobe Photoshop to x-rays. To lighten (or darken) the x-ray, click “image-adjust-brightness/contrast” and notice a small window appears. Move the arrow right or left, adjusting the image until you like the look. Click OK. If you like the original look, then click cancel and no harm done.

        3. DO NOT crop the image, NOR change the image size in any way. This could cause distortion of size in measuring. Only crop in the DentalCAD program.



Saving the x-ray scan:


Click “file-save”. A window will appear that asks you where you want to save this x-ray on your computer. There is a field that lists “save in”. As a standard, I would suggest that you always save in “my documents”, so you will know where your patient files are located.

Since you will be most likely saving several files for a single patient (study models, photographs, panoramic x-rays, ceph x-rays), I would suggest you make a patient “folder” to keep all the files together. Then you will have an easier time finding them later!!

To create a patient folder, be certain that “my documents” is listed in the save-in field (otherwise the patient folder may be in another patient folder….hard to find later). Click on the “create new folder” icon (2 to the right from the save in field), typing in the patient name or case number to label the folder. Double click on the folder and the folder will then move to the save-in field.

Next, label the x-ray that you scanned. Since it will be kept in a patient folder, it should not be necessary to label it with a name, but just in case…..you might consider adding a name. I usually label by “ceph.start” or “ceph.13months”

Next, identify the FORMAT that you wish the x-ray to be stored. As a standard, we have decided to save all files as “BMP” for bitmap, or “Tif”, the two non-compressed file formats. Click “save”, then OK.




Importing a Cephalometric x-ray


Importing an x-ray is done whenever the x-ray is not directly scanned into the analysis program. The x-ray may have been first scanned into adobe Photoshop, may come from a digital x-ray machine, or may be on a CD ROM from an x-ray lab or class exercise.

Click on import image. Drop down the box “look-in” and double click the CD from the choices. If the x-ray was scanned into Adobe Photoshop, then double-click on “my documents” and find your patients x-ray from the available file folders.

Double-click on your x-ray file (or single click and open) and then “OK” in the next (dental-cad) window. The x-ray should open into the tracing screen.

Rotating the x-ray:


Click on the filters/rotate button and click the appropriate rotation button. After the x-ray has been adjusted to the proper orientation, click “ok”.


Filtering the x-ray:


Click on the filter/rotate button and select the filter or combination of filters that make the tracing points most visible. Click return to original image to restart the filtering process in a different order. After satisfied, click OK. Assuming you have a consistent source of x-ray films, you will develop a favorite “set” of filters to enhance the image. You may return to refilter at any time during the tracing sequence AFTER POSITIONING a point. * if you have previously cropped the x-ray, do NOT try to refilter as you will lose the crop location and the points already placed will be in error when you return to the original image.

Some comments on the filters:



  1. Auto correct image: This will lighten the x-ray, giving a preset “contrast” and “brightness” setting.

  2. Sharpen image: This is the standard sharpen using in all imaging programs. You may sharpen more than one time. For x-rays, inverting the image before sharpening can be helpful. Can be especially helpful on study models before model measuring.

  3. Unsharpen mask: Similar to the Adobe Photoshop filter, but the “inverse Laplacian-Gaussarian Convolution” (anyone know this one?) is used. Works well on x-rays. Using the Gaussian Smooth filter several times before using Unsharpen Mask will reduce the “salt and pepper” effect substantially. This filter does NOT work well on x-rays that are washed out. You may want to try invert image before unsharpen mask, then invert image a second time.

  4. Unsharpen filter: Works best on very bad x-rays. There is NOT very much sharpening, but it also does not enhance the “noise” either. Try inverting the x-ray before using this filter.

  5. Adaptive unsharpen mask: This sharpen filter uses an 8-direction convolution to produce the image mask, and works on all images, good or bad. Using invert image before this filter does NOT seem to make much difference.

  6. Gaussian Smooth: Removes “noise” in the images. Try clicking this filter several times before executing the other filters. Especially good on x-rays with “spots”, also called “salt and pepper effect”.

  7. Invert image: Very powerful filter used on x-rays only. Usually used in combination with other filters.

  8. Remove lines: streaks or lines in the x-rays from the developing rollers or scanning can be removed with this filter.



Cropping the x-ray:


Your x-ray source may NOT be a scanner, but instead a digital ceph or a CD sent to you by an x-ray laboratory. The digital ceph will be in its full form when you “import” into DentalCAD. [note: be sure the imported digital x-ray is in a “Tif” format, NOT Jpeg as this format is not standardized and could make errors in tracing]. To crop the x-ray in size, therefore making the printed image look better (numbers not on the image), click the filter rotate button, then adjust the sides of the x-ray image (dotted lines) to the size you wish.

After adjusting the size, click “Crop”, then “OK”. Beware that you will lose this crop size (cannot get it back exactly) any time you click to “return to original image”. This will make re-filtering during the tracing sequence difficult, since you cannot return to the original image.




Zoom:


To enlarge the x-ray, click on the zoom-in button (far right on drawing controls). To return to the original size, click a second time on the zoom-in button.





Selecting your analysis:


drop down the window for the field “dental analysis type” and select “Cephalometric analysis-McGann”

Starting the tracing:


Drop down the window for the field “points and contours” and select the first point (Nasion). Move your cursor to the location of that point and click the mouse (left click). Adjust the location by “left drag” until you are satisfied with the point or structure location.

To go to the NEXT point, press F2 on your keyboard, and place the second point (sella), etc until the end of the tracing.




Advancing to the next point/structure in the sequence:


Click on the “F2” key at the top of your keyboard, one time to move to the next structure. Click the mouse in the location of the point, then adjust the point/structure as needed. When completed, click “F2” again to go automatically to the next point. You MUST place ALL the points or the program will not allow you to finish and calculate.

Incisor positioning: incisal edge Next rotate the apex


Incisor and Molar positioning


The incisors and molars are in a constant shape. First position the incisal edge or cusps of the molars on the occlusal plane. Click to position the incisor. Click on the structure a second time, and drag the apex to the proper position/angulation.

Structures


The structures are needed for the VTO image. If you do not wish to have a VTO, you may want to click “calculate” to end the ceph tracing after the positioning of the lower molars. The soft tissue points are as shown below:


Tracing the structures.


The F2 key will take you to the next structure (symphysis, mandible, lower profile, upper profile, maxilla). With each structure, click the left click button to position each point. There is no need to click F2 to move to the next soft tissue point, just the next structure.

Start by placing the structure points (squares) on the structure outline. Second, move with a left drag the smaller control points to make the curves.




After the control points are adjusted

Adjusting the structure to the shape on the x-ray


The structures are needed for the VTO feature to work. No measurements are made from these structure points. On each side of an object point (large square), there are 2 other control points. Start at the beginning of the structure with a left click, move the mouse to the next point, left click again….continue until the end of the structure. Then adjust the smaller control points to the structure outline.

Bending the curve with the small points to the structure outline.



Editing for a wrong point or structure:


move your cursor over the point until the identification box indicates the point you wish to move. (note: points under structures may take some fine movements to get the point to highlight). If your point is hidden by a structure, then select the structure and move the structure slightly, then move the point you wish. Return the structure to the original position. Click and drag the point to the new location. The program will automatically re-calculate.


Tracing is complete:


Click Calculate. Next Save your work, labeling the project with “start”, “progress”, or “end”. You should see a line with the name of the “link” in the field on your left.

Printing:


Print the x-ray and tracing by either clicking “file-print” from the menu bar or click on the icon with the printer.


After clicking File-print or the printer icon, this printer window should appear.

The numbers:


To transfer the numbers to the cephalometrics tab in IPSoft, click on the “retrieve numbers from DentalCAD button”. If there are conflicting double measurements, you will need to resolve the conflict.


Ceph summary and double measurements:


The cephalometric summary will be automatically done for you, assuming there are no double measurement conflicts. When there are conflicts in double measurements, the doctor must decide which to select. Consider the following:

  1. Did you select the correct point? If not, move it and recalculate

  2. Did you have confidence in the points that composed the two conflicting measurements. If you were guessing on one point, then choose the measurement that is composed of points you have the most confidence in

  3. Look at the tracing “picture” (found in pictures tab or in the tracing program) and decide which is most logical in the face you see. **This is the most common method to resolve the conflicts. Click on the “DentalCAD” button at the bottom of your computer screen to view the x-ray picture, then return by selecting the IPSoft button, again at the bottom of your computer screen. Reviewing the numbers is a waste of time since the computer is programmed to recognize the conclusion limits.



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