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1. Lea Zen es E t S Taia i i Ip HU 4 D L A i Your Practice Your Preference Your Productivity Solution 7 USER MANUAL I j j I Y y P OHLHO T1E 00 User Manual 1 Opal CHIRO v5 1 0 Tech Support 1 800 366 5343 User Manual 2 Opal CHIRO v5 1 0 Table of Contents 1 Tala cele 0 old 0 9 ccc es 4 BASIC Keyboard Dia ege E 4 Image View CRIS le DE 4 Annotation CUSTOM ZAtlON DE 5 2 General Chiropractic Tools 7 Mark SG OO D 7 RF a CT ar nc reteset cs verr erste ssc son E E E octane soe eeaneereedueoeas Luminar CUVE TOO EE 9 lei Die E E EEE N A A TS E A A A A E EE E E 10 Prende EV TOO kenes a E A E AE A EER 11 Sigi LANE E 12 Horizontal Orthogonal Ange 13 FIOM IZ Gta UVC n E ss uueanterdnaeaanaseseuieese acieeeonieaacaetuaedee 14 TEC ay ha E a et ar saa iow totiec eu vaeeices ava S A 14 SA Sr e EE 15 Vertebrae IMC TOO EE 16 EE VS FC IU Ics ee 17 Center TEE 18 El Ee RTE 19 CS E 19 3 Ilium Analyse 21 4 Advanced Orthogonal Tools 25 Step By Step Analysis for Advanced OrthoOgoniall cccssccccscssssecessseseecessecescesseecesseaeeceseneeeeens 26 Verner aC UNAS eege 27 NF TSS E 27 Vorne AUIS le EE 28 Man ANC NNO NG sss cttse cares deer cats EAE E T E 28 Fr FO Me UH SN Bi E 29 Aa gl 9 02 ol fe CN Bt 29 AXIS SPINOUS eet E 31 Beie VE ee TE 31 CONMOVIE Circles TOI le E 31 PGC ee 31 Axial Circles Templat Ciopraga eE ES 32 ADET e 33 3 Tech Support
2. Select medial aspect of the lacral bone on the eft with a left click Select the medial aspect of the lacral bone on the right with a left click ey SP A4 4 Once 2 points have been plotted the software will generate 2 x s to represent the selected anatomical points 6 Select an x with a left click and drag the x to the lateral margin of the skull 7 Repeat on the other side 8 See Figure 5 15 RULE OF THUMB The distance measured should be less than 4 mm in order to have a reliable reproducible x ray a s 3 Ki Tech Support _ U _ 1 800 366 5343 User Manual 43 Opal CHIRO v5 1 0 p D Figure5 15 Patient Rotation Calculation Step 11 Contact v Use the Contact tool to mark the anatomical point needed in the NUCCA calculations 1 Make sure the Annotation Edit Mode is activated D Activated 2 Left click on Contact tool 3 Plot the Contact point with a single left click on the desired anatomical position NA 2 Figure 5 16 Contact Step 12 Main Calculations v The Main Calculations annotation table shows the NUCCA calculations from all NUCCA corresponding Opal CHIRO tools and techniques used related to Nasium measurements as indicated below 1 Make sure the Annotation Edit Mode is activated PA Activated 2 Left click on Main Calculations An empty NUCCA calculations table is shown in Figure 5 17 Tech Support 1 800 366 5343 CA mm mm mem me
3. K 1 800 366 5343 WZ gt User Manual 3 Opal CHIRO v5 1 0 NUCCA Tools A 35 Step By Step Analysis for NUCCA ccccccccsssecescssseecesseceeceeseceseseaeeceseseseccessueceseseaeeceseseaeecesaeas 35 Vorne ien 36 Vertex Pinal Proces ne ene ee eee ee en ee eee ee ee eee ree 36 VONE EE 37 PRC LUN e A ues sonecavadicarearaaacasauaceascoteceousedeeeetete aaatecepoetaracanaccte 37 CEN Een E 38 PTV SAO CACO EE 38 Beie UR eet EE 39 COMO VIC Cir eS TEmo E E a T A E S A 39 A e 40 Axial Circles E ue 40 VORE OS a A E E E 41 era dLE E 42 AUS CRECE EIDO ar A E A AR 42 Patient eege uneapa innne EN OTEO ar rn E Na aaa TENi 42 CONA dE 43 Man AGU AU ONS ei a a 43 PLEASE NOTE NUCCA Tools section is currently UNDER CONSTRUCTION led le Oe le TT a le Ee Kee EE 45 engel DEN 46 EICH e E 49 YS CCM EE 50 ER el gt Sane oO E fe ne a eee 51 LONGT TEE 52 PERT feed Le a fc AE meee ee E een ete nt men ee A ea arn E ne oe ee 55 glate RO CaCO EE 57 NTO sei sm E E E A EE A E E sano E E E een tainaan eran 57 1g e E EE 60 Chiropractic Toolbon EAR D Fi Bs n d g Tech Support Y 1 800 366 5343 Pe User Manual Opal CHIRO v5 1 0 1 Introduction Opal RAD Chiropractic tools are built as an enhanced feature to the existing library of annotation tools in Opal RAD Please note the term annotation and chiropractic tool will be used interchangeably 1 1 Basic Keyboard Functionality The Opal RAD Chiropractic
4. Left click to plot the points 9 The dip dot lines will now determine the Axial Surface Circle Size The circle will disappear and the plotted points will remain as annotations during this phase Again hovering the cursor over any created condyle point makes the circle visible Step 5 Lower Angle Make sure the Annotation Edit Mode is activated D Activated Left click on the Lower Angle tool Plot the 1 point by left clicking an anatomical point on the very lateral superior margin of C2 on the left 4 Click drag and Plot the S point by left clicking an anatomical point on the very lateral superior margin of C2 on the right 5 This will determine the bisection point See Figure 6 11 Tech Support w 1 800 366 5343 User Manual 53 Opal CHIRO v5 1 0 Figure 6 11 Bisection Point 6 Next left click to plot the 3 point on the spinous process of C2 See Figure 6 12 e Figure 6 12 Spinous Process 7 Then proceed to the lower cervical region Plot a point on the left lateral margin of the lowest clearly visible cervical vertebra with a single left click See Figure 6 13 Tech Support 1 800 366 5343 User Manual 54 Opal CHIRO v5 1 0 Figure 6 13 Point plotted on Left Lateral Margin 8 Then plot a point on the right lateral margin with a single left click See Figure 6 14 Keep in mind you can adjust these points Figure 6 14 Point plotted on the Right Lateral Margin Tech Su
5. 4 5 Left click to engage template Frontal Figure 2 4 Circumscale Tool Template shown with Mark Spot tool for reference in this example 6 line touches all 4 points simultaneously so the axial circle is a 6 2 5 Extended Line Tool v Provides a straight line through selected anatomical points based on what is required for the specific analysis being performed Make sure the Annotation Edit Mode is activated A Activated Left click on the Extended Line tool Left click to begin drawing your line on the chosen anatomic structure Drag your mouse to position the line E E Left click on the second anatomic structure to set the extended line See Figure 2 5 Tech Support 1 800 366 5343 User Manual 12 Opal CHIRO v5 1 0 Figure 2 5 Extended Line Tool Annotation shown with Mark Spot Annotation for reference 2 6 Horizontal Angle v This tool generates a horizontal angle on a Lateral Sagittal view to determine the proper angle needed to set the x ray tube to capture the AO joint for Frontal Nasium view v For example Used to display how superior the atlas vertebrae is located in degrees in relation to the True Horizontal bottom edge of film 1 Make sure the Annotation Edit Mode is activated A Activated 2 Left click on the Horizontal Angle tool 3 Left click on the desired anatomical structure to plot the 1 point Note the degree of angle measurement will display 4 To plot the 2
6. 5 Vertex Skull Line template Before amp After 6 To move the template hover your cursor over the small square in the center of the template Left click hold the mouse button and move the mouse to position your template Left click to engage template 7 Toincrease or decrease the size of the template use the and keys on your keyboard 8 Press key on your keyboard to display the Horizontal Vertex Line 9 Select Vertex Atlas Line tool 10 Plot two points with a left click to place first dot drag line then left click to place second point See Figure 4 6 Figure 4 6 Notice the preY angle measurement in the AO Vertex calculation will actively measure as you plot your points using the Vertex Atlas Line tool 11 You have now successfully calculated the AO Vertex in prey 12 Click on the Main Calculations table shown earlier to display the AO Vertex Calculation annotation PreY table See Figure 4 7 Tech Support S 1 800 366 5343 13 User Manual 22 Opal CHIRO v5 1 0 F i Figure 4 7 Transpose the calculated preY from AO Vertex table to the pop up display as shown by the red circle in Figure 4 7 Then click OK The prey value will populate the Main Calculations table See Figure 4 8 gt Li ipreY 0 83 R FEM Ee ee Ee Figure 4 8 Notes o The calculation box may be moved by hovering over it turns pink and the 4 arrow crosshair appears and using the left mouse button
7. Application 1 3 Annotation Customization and Edit Features User Manual gt Opal CHIRO v5 1 0 Within the Opal Viewer it is possible to customize various annotation features to include annotation font size and annotation color s To access this module wi 1 Hover over the Main Menu icon w 2 Select Settings gt gt Edit gt gt Annotation Options tab See Figure 1 1 Interface Options 7 Show Annotations I One Click Annotations Je Show One Click Annotations Button I Annotation Edit Mode Use Dot Cursor Show Annotations On Thumbnails Show Measurements in Inches Allow Annotation Edit while Create Allow Drag Create IT Dont Fully Draw on Edit Iw ROI Show Size lisc Options Scale is Pixel Size Annotation Font Scale by Annotation Point Scale By Figure 1 1 Annotation Options TAB Tech Support NU VEZ 1 800 366 5343 found in the upper left corner of the Opal Viewer User Manual Opal CHIRO v5 1 0 1 3 1 Color Settings Color Grayscale CoorSet1 E EH Cer Sa 7 SC Cer Sai 3 B Ce Color Set Rtl LU Geier Sea 8 Cl H Colorect RJ CH Figure 1 2 Color Set 1 5 Allows you to customize the color that displays when an annotation is applied to an image SET Color Edit Allows you to customize the color that displays when an annotation is highlighted for editing EDIT Color Hover Allows you to customize the color that displays when a user h
8. appear See Figure 4 11 4 To move the template hover the cursor over the small box in the center of the template When the template changes annotation color and the 4 arrow crosshair appears hold the left mouse key down and move the mouse around to position the template 5 To rotate Use lt and gt keys to rotate the template 6 Once properly positioned press the key on the keyboard to enable the Enter Discovered Value box and enter the value as indicated on the template then click OK gt A E e A 3 EE i 7 y N a S 4 pen K z r tu WHK f fc a hr E 3 Za A toh ae RK my E SCH AP 7 The Main Calculations annotation will now append itself to reflect the A value Cd A C rd DN n A C WI V fl f r Ae e oy i i UW ir 8 MA t iri AJO tthe eT A7 iri ea Ga SB H Figure 4 12 Axial Circle tool Step 7 Optional Use the Aberrancy tool to analyze a Frontal shot that appears aberrant 1 Make sure the Annotation Edit Mode is activated L Activated 2 Select Aberrancy tool 3 Left click on the image The Aberrancy Template will appear See Figure 4 13 Figure 4 13 Aberrancy Template Tech Support 1 800 366 5343 User Manual 34 Opal CHIRO v5 1 0 4 To move the template hover the cursor over the small box in the center of the template When the template changes annotation color and the 4 arrow crosshair appears hold the left
9. base of the odontoid process on both sides at right angles to the plane of the superior articulating surfaces in the reg ofC1 Left click on the image The Axial Circle Template will appear See Figure 5 10 To move the template hover the cursor over the small box in the center of the template When the template changes annotation color and the 4 arrow crosshair appears hold the left mouse key down and move the mouse around to position the template To rotate Use lt and gt keys to rotate the template Once properly positioned press the key on the keyboard to enable the Enter Discovered Value box and enter the value as indicated on the template then click OK Size range from 4 12 E Tech Support ion of the inner edges of the lateral masses Figure 5 10 Axial Circle tool 1 800 366 5343 User Manual 41 Opal CHIRO v5 1 0 STEP 7 Vertex Calculations 1 Double click on the Vertex Calculations annotation and enter values for Nasium Laterality Condyle Circle and AT as found in Steps 6 and 7 Figure 5 11 Nassium Laterality ip we Condyle Cirde 5 AT 4 o Figure 5 11 Vertex Calculations 2 Click OK The NUCCA Vertex calculations annotation will update with the reflected entered information Figure 5 12 wg Figure 5 12 NUCCA Vertex Annotation Step 8 Intermastoid Line v Use the Intermastoid Line IML tool to determine head tilt 1 Make sure t
10. factors Figure 6 22 Figure 6 25 Tech Support wy 1 800 366 5343 WIZ User Manual 63 Opal CHIRO v5 1 0 7 Chiropractic Toolbox Chiropractic Toolbox allows a user to create and customize their own personal Toolbox of icons for most frequently used Chiropractic Tools and Annotations 1 Hover over the Main Menu icon found in the upper left corner of the Opal Viewer 2 Click on Settings gt gt Edit to get to the Administrative Settings Module See Figure 7 1 Annotations ChiroPractic Overlay Config Modality Options Options Cache Path c opal cache viewer Keep In Cache For Hours 72 Check OnCall Every Seconds 150 Hard Disk Swapping Occurs At MB 1228 Extemal Tools Integration Magnify Glass Size 200 px Factor 4 Loge i Opal3D W L Acceleration 70 0 Ignore Windows Bar lw Ask on Close Figure 7 1 ll Tech Support wy 1 800 366 5343 WIZ User Manual 64 Opal CHIRO v5 1 0 3 Click Toolbox Options See Figure 7 2 4 Click on the to expand the series Click on the to minimize the series Opal Viewer Settings i Box Rectangle Figure 7 2 5 Click on the individual functionality icons for customizing your toolbox Highlight with a single left click which icon you would like to display in your toolbox 7 Then select the gt larrow icon to move that functionality over to the selected list The function that you are sendi
11. generate a middle point from the previous middle point of the vertebrae and point 3 to represent the center of the spinal column gt Plot Point 4 on the left side of the next vertebrae in question gt Plot Point 5 on the right side of the next vertebrae in question The software will generate a middle point of the vertebrae exactly between points 4 and 5 gt Plot Point 6 at the junction of the lamina or tip of the spinous process A line will be generated that passes through the center of the spinal canal See Figure 2 11 Se Tech Support wy 1 800 366 5343 WIZ x CR Figure 2 11 Vertebrae Line Tool Z 2 12 Center Line Vertical v Finds a center vertical line between points Make sure the Annotation Edit Mode is activated wi Activated Left click on the Center Line Vertical tool Left click on the 1 anatomical point Left click on the 2 anatomical point 1 Ss 3 4 5 A center vertical line will be generated Figure 2 12 Figure 2 12 Center Line Vertical Tech Support 1 800 366 5343 User Manual 17 Opal CHIRO v5 1 0 User Manual 18 Opal CHIRO v5 1 0 2 13 Center Line Horizontal v Finds a center horizontal line between points 1 2 3 4 Ss Make sure the Annotation Edit Mode is activated LA Activated Left click on the Center Line Horizontal tool Left click on the LU anatomical point Left click on the 2 anatomical point A center horizont
12. image using the entire skull surface to construct a central skull line Left click on the Vertex alt tool Left click on the image and hold down the mouse button to drag a box around the entire skull oe E Figure 6 23 Then single left click to place In some cases due to the lack of contrast variance between the soft tissue of the neck and the posterior aspect of the skull one may have to use only the anterior 2 3 of the skull to determine the reliable central skull line See Figure 6 25 Tech Support 1 800 366 5343 User Manual 61 Opal CHIRO v5 1 0 Figure 6 23 5 Next plot a point on the center of the transverse foramina on the left 6 Then plot a point on the center of the transverse foramina on the right 7 Foran example of the placement of points as shown by the in Figure 6 24 Tech Support wi 1 800 366 5343 User Manual 2 Opal CHIRO v5 1 0 Figure 6 24 8 Left click on the annotation to set and display the measurements 9 To change the Threshold press the or key on your keyboard to change the way the curve fit occurs This allows the software to perform an edge detection algorithm to determine the Central Skull Line based on the points it can detect Note You can also adjust the plotted points with a left click to move and adjust in Figure 6 25 10 Go back to the Nasium Calculations Table and you will see the software has added the calculations needed for determining adjustment
13. mouse key down and move the mouse around to position the template 5 To Rotate Use lt and gt to rotate the template 6 Once properly positioned press the key on the keyboard to enable the Enter Discovered Value box and enter the value as indicated on the template then click OK The Main Calculations annotation will now automatically update several of the Atlas Orthogonal calculations See Figure 4 13 FINAL ATLAS ORTHOGONAL CALCULATIONS READY FOR ANALYSIS Figure 4 13 Main Calculation Annotation Tech Support KI 1 800 366 5343 User Manual 25 Opal CHIRO v5 1 0 5 NUCCA TOOLS File Settings View Tools Images Annotations d or ae MarkSpot About gt Cervical Curve Help gt Lumbar Curve Circumscale Extended Line Horizontal Angle Horizontal Orthogonal Angle Horizontal Level Vertical Level Center Point Vertebrae Line Ilium Analysis Advanced Orthogonal VW d Main Calculations Plane Line Cephalometer Angular Rotation Condyle Circle Condyle Circles Template Axial Circle Axial Circles Template Intermastoid Line Atlas Check Line Patient Rotation Contact Vertex Calculations Vertex Frontal Line Vertex Spinal Process VertexSquare The list of all NUCCA Tools are highlighted above See Figure 5 1 g d Orthospinology Center Line Vertical Center Line Horizontal Gonstead Ruler G
14. the way the curve fit occurs This allows the software to perform an edge detection algorithm to determine the Central Skull Line based on the points it can detect 8 Once you are satisfied with the measurements press the key on the keyboard 9 The software will now draw the Central Skull Line See Figure 6 6 Tech Support 1 800 366 5343 48 User Manual 49 Opal CHIRO v5 1 0 H VI Gift 4 f A W e SS 1 LU Figure 6 6 Central Skull Line 10 Use Pan IA and or Zoom ke to see the atlas occipital condyles the Articular surfaces of the axis and lower cervical region Step 2 Plane Line 1 Make sure the Annotation Edit Mode is activated LL Activated 2 Left click on the Plan Line tool 3 Using the left click function plot 2 points by selecting the inferior aspects of the posterior arches of the atlas at the edge of the lateral masses 4 Left click 1 point 5 Left click the 2nd point 6 Left click to place the Plane line It is helpful to use the W L feature to clearly identify accurate anatomical point selections See Figure 6 7 Tech Support 1 800 366 5343 User Manual 50 Opal CHIRO v5 1 0 Figure 6 7 Plane Line Step 3 Condyle Circle 1 Make sure the Annotation Edit Mode is activated LZ Activated 2 Left click on the Condyle Circle tool 3 Plot 2 points on the left outside 1 3 of the occipital condyle surface approx inches apart 4 Plot 2 points on the rig
15. Lower Angle Factor HF Total Height Factor Figure 6 17 Nasium Calculations Table Zoomed Tech Support 1 800 366 5343 User Manual 34 Opal CHIRO v5 1 0 6 4 Patient Rotation v Used to determine if Nasium view is acceptable regarding patient placement Note Excessive image rotation decreases the validity and accuracy of the measurement process v Can be done at beginning of analysis or anytime during the analysis Make sure the Annotation Edit Mode is activated PA Activated Zoom into the image Left click on the Patient Rotation tool Select medial aspect of the lacral bone on the left with a left click Select the medial aspect of the lacral bone on the right with a left click E EE a MH Once 2 points have been plotted the software will generate 2 x s to represent selected anatomical points 6 Select an x with a left click and drag the x to the lateral margin of the skull 7 Repeat on the other side 8 See Figure 6 17 1 RULE OF THUMB The distance measured should be less than 4 mm in order to have a reliable reproducible x ray d Ee Figure 6 17 1 Patient Rotation Calculation 6 5 Vertex Vertex Algorithm Analysis 1 Make sure the Annotation Edit Mode is activated PA Activated 2 Zoom into the image See Figure 6 18 3 Left click on the Vertex tool Tech Support 1 800 366 5343 User Manual 58 Opal CHIRO v5 1 0 Figure 6 18 4 Begin by outl
16. Ruler George s Lines Center Point Figure 2 0 General Chiropractic Tools 2 1 Mark Spot Tool v Used to mark a chosen anatomical point Make sure the Annotation Edit Mode is activated 7 Activated Left click on the Mark Spot tool 3 Left click anywhere on the image that you would like to place a dot annotation NOTE Every single left click will produce a dot annotation 4 Triple click on the last plotted point OR select End Annotation tool Ei to deactivate Mark Spot tool Figure 2 1 Tech Support WI 1 800 366 5343 Wiz User Manual 8 Opal CHIRO v5 1 0 d End Annotation P i dck kb Figure 2 1 Mark Spot Tool with End Annotation 2 2 Cervical Curve Tool v Used ona lateral view of the cervical spine v Displays an arc of a circle with the radius of 17cm 170mm v Indicates a patient s cervical curve in relation to the textbook normal and how much adjustment their spine is in need of based on the deviation in mm and degrees Make sure the Annotation Edit Mode is activated I Activated 1 2 Left click on the Cervical Curve tool 3 Left click on the top of the posterior aspect of the anterior tubercle This is the 1 point of 3 4 Left click on the middle of the anterior vertebral body of T2 This is the 2 point of 3 5 Left click on the left side of spine if the curve should display on the left side OR Left click on the right side of the spine if the curve should display on th
17. al line will be generated Figure 2 13 LE Figure 2 13 Center Line Horizontal 2 14 Gonstead Ruler v The Gonstead Ruler is a digital version of the ruler used in analog analysis to determine measurements in mm draw a line to measure length identify end plate lines or apply Gonstead feather lines 1 Make sure the Annotation Edit Mode is activated 7 Activated Select Gonstead Ruler tool 3 Left click on the image to place the Gonstead Ruler tool on the image See Figure 2 14 Tech Support 1 800 366 5343 User Manual 19 Opal CHIRO v5 1 0 Figure 2 14 Initial Placement of Gonstead Ruler 4 To move the template hover your cursor over the small box in the center of the Template The cursor changes to crosshairs Left click and hold the left mouse key down to drag and move Gonstead Ruler template into position 5 To rotate the template press lt or gt keys For example if using the tool to identify vertebral end plate lines 6 To place a vertical line on the vertebral end plates using the Gonstead Ruler press key on the keyboard 7 Continue to check the entire vertebral column lining up the ruler edge and marking it with a Horizontal line 2 15 George s Lines v This tool is used on a lateral view of the cervical spine to generate measurements in mm between vertebrae Make sure the Annotation Edit Mode is activated A Activated Left click on the George s Line tool Begin
18. an Window and Level tools to adjust the image until there is a good view of the frontal atlas features 8 Select Atlas Frontal Plane Line tool to find the Atlas Frontal Plane Line AFPL 1 800 366 5343 User Manual 31 Opal CHIRO v5 1 0 SE Left click on a left atlas point and then a right atlas point A line will connect the two points as shown in Figure 4 10 and the software will calculate the ACD and AFP angles and display those measurements on the Main Calculations table Make sure to move the x on both sides of the AFPL to the edges of the skull before committing the measurement Step 4 Use the Axis Spinous Process tool to find Axis Spinous Process AxSP Cervical Spine Line CSL Make sure the Annotation Edit Mode is activated A Activated Select Axis Spinous Process tool This is a 5 Point Tool of plotting Begin plotting your 5 points as referenced in the order listed in Table 4 1 by a single left click to plot each point e Left base of dens Odontoid Left lateral C2 body e Right base of dens odontoid Right lateral C2 body eTip of Spinous Process eLeft Lateral body of C6 or C7 eRight lateral Body of C6 or C7 Table 4 1 Axis Spinous Process 5 Point tool NOTE During the AxSP plotting several new calculations are automatically appended to the Main Calculations Annotation Step 5 Use the Condyle Circles Template tool to find the Condyle Circle C 1 Make sure the Annotat
19. appears hold the left mouse key down and move the mouse around to position the template Si To rotate Use lt and gt keys to rotate the template H Once properly positioned press the key on the keyboard NEU VG Figure 5 6 Vertex Square template Step 4 Plane Line v Use the Plane Line tool to mark plane lines on a frontal view image v The atlas plane line represents the horizontal plane ofC1 and forms a part or all of C1 laterality and the degree of C1 laterality determines the degree of magnitude of C2 odontoid and spinous process displacement Make sure the Annotation Edit Mode is activated Activated 2 Select Plane Line tool 3 Drawa line through the attachments of the posterior ring to the lateral masses through the rami of the jaw Note The attachments are found by starting at the posterior tubercle of C 1 and tracing the inferior border of the ring outward to the outer edges of the lateral masses where a whitish dot is usually found due to the greater attenuation resulting from thicker bone density at these points Additionally a slight bulging area is seen between the superior and inferior aspects of the posterior ring attachments to the lateral masses at their outer edges due to the transverse roots Tech Support AJ 1 800 366 5343 User Manual 38 Opal CHIRO v5 1 0 D VEIZTE Figure 5 6 Plane Line Tool Step 5 Cephalometer v Use the Cephalometer template to find the Cent
20. ates v Using a Nasium Frontal image view Figure 6 3 Tech Support wy 1 800 366 5343 WIZ User Manual 47 Opal CHIRO v5 1 0 Wi E Sow Ne JA A a 7 r Ve y Figure 6 3 Frontal Nasium view Make sure the Annotation Edit Mode is activated HA Activated Left click on the CSL tool Zoom into skull surface Left click at approximately inch outside of the left margin and approximately 1 1 2 inches above the suture line then drag the box along and across the edges of the skull remaining at about the same level as the suture line on the other side You will see as you drag the box the lines will outline where the skull surface is being curve fit 5 Select about 1 1 inches of the skull surface above the suture line then click to place If the suture line on one side is more superior to the other side then select the portion of the skull above the most superior suture line See Figure 6 4 oa Suture Line higher on the right Figure 6 4 Tech Support 1 800 366 5343 User Manual Opal CHIRO v5 1 0 6 Left click a second time for the calculations to display See Figure 6 5 LU Figure 6 5 The example above shows that 758 points were used to curve fit this skull This is an important number to note to ensure the same portion of the skull is used on comparative film to maximize reliability of the analysis 7 To change the Threshold press the or key on your keyboard to change
21. drawing lines on each posterior vertebral body from superior to inferior as indicated Left click on the top of the posterior vertebral body Left click on the bottom of the posterior vertebral body A Se Repeat steps 4 and 5 until all desired lines have been drawn on part or all of the vertebral column 7 Triple click off to the side of the lines drawn OR select End Annotation tool Ei and the software will generate measurements in mm which account for the anterior or posterior offset in relation to the vertebrae immediately below See Figure 2 15 Tech Support 1 800 366 5343 User Manual 29 Opal CHIRO v5 1 0 Figure 2 15 George s Lines Tech Support 1 800 366 5343 User Manual 21 Opal CHIRO v5 1 0 3 ILIUM ANALYSIS The Ilium Analysis provides a full analysis of the pelvis using an AP Bilateral Pelvic view to display different aspects of pelvic sacral misalignment using a 16 point system of anatomically plotted points and a set of calculations to display appropriate lines and measurements in mm and degrees Cervical Curve About Lumbar Curve Help gt Circumscale Extended Line Horizontal Angle Horizontal Orthogonal Angle Horizontal Level Vertical Level Center Point Vertebrae Line Advanced Orthogonal NUCCA gt Orthospinology Center Line Vertical Center Line Horizontal Gonstead Ruler George s Lines Figure 3 1 3 1 Step by Step Ilium Analysis Step 1 Use AP P
22. e the toolbox will display as indicated below Please note the toolbox for reference as shown in Figure 7 5 Rafey Chiropractic ID 024836 Name Chiro CFP DOB 07 22 1957 TimeE 18 04 41 Serf 18 07 54 Man Samsung er 1 Figure 7 5 tor a complete reference on the Opal Viewer Administrative Settings Module please go to the User manual located at OpalViewerAdminUserSettingsManual Bs 4 Es A D Tech Support KP 1 800 366 5343 IZ User Manual Gi Opal CHIRO v5 1 0 Viztek LLC would like to extend a special thanks to the following individuals for their continuous efforts and dedication to the success of this user manual Patricia Kuhta D C Bo Rochester D C Chris Chapman D C Author Irina Nordstrom D Tech Support AJ 1 800 366 5343
23. e Circle in both Cervical Curve Lumbar Curve tools Activate Annotation Edit Mode A Activated Left click on a point on the curve annotation created Press key on keyboard So a Enter the value of the radius of the circle in millimeters mm 2 4 Circumscale v Used on a Nasium Frontal view Zoom and adjust image contrast as needed S This template is used for manually finding the axial and condyle circles Y Specific Application Example Used for assessment of the Superior Articular Surface SAS of C2 For the purpose of determining the angle of the articulation of the lateral articular edge of the occipital condyle and the lateral articular edge of the SAS of C2 v Suggestion Use the Mark Spot tool to mark the lateral articular edges of C2 points plotted about 1 8 inch apart on both sides before placing Circumscale template for reference 1 Make sure the Annotation Edit Mode is activated A Activated 2 Left click on the Circumscale tool 3 Left click the image to place the Circumscale tool on the image Tech Support 1 800 366 5343 User Manual 11 Opal CHIRO v5 1 0 4 Tomove the template hover your cursor over the small square in the center of the template Left click the square and holding your mouse button move the template into position to where the template is placed over the 4 points generated using the Mark Spot tool to find an arc that simultaneously touches all four dots on the cortex See Figure 2
24. e D zx PR y Ny Tech Support 1 800 366 5343 es User Manual 25 Opal CHIRO v5 1 0 4 ADVANCED ORTHOGONAL TOOLS File Settings View Tools Images Annotations wil aA Ki ag ee A Cervical Curve About gt Lumbar Curve Help gt Circumscale Extended Line Horizontal Angle Sy Horizontal Orthogonal Angle i Horizontal Level Vertical Level Center Point Vertebrae Line Ilium Analysis g Main Calculations gt Frontal Cephalic Line Atlas Frontal Plane Line Axis Spinous Process Condyle Circle Condyle Circles Template Axial Circle SS Axial Circles Template Abberancy KH Vertex Calculations Ka Vertex Skull Line eX Vertex Atlas Line Figure 4 1 ke EE NUCCA Orthospinology Center Line Vertical Center Line Horizontal Gonstead Ruler George s Lines The list of all Advanced Orthogonal Tools are highlighted above See Figure 4 1 Important Information Regarding Advanced Orthogonal Calculations 1 To display the Main Calculations for the AO analysis follow the path from the Main Menu gt gt Chiropractic gt gt Advanced Orthogonal gt gt Main Calculations Once Main Calculations have been selected from the series of dropdown displays you must click anywhere inside the main viewing area to actually display the table of calculations 2 Allofthe tools must be utilized in order to successfully complete the Atlas Orthogonal Analysis All ca
25. e right side This is the 3 and final point causing the curve itself to display See Figure 2 2 Tech Support W 1 800 366 5343 User Manual 9 Opal CHIRO v5 1 0 Figure 2 2 Cervical Curve Tool Annotation 2 3 Lumbar Curve Tool v Used on a lateral view of the lumbar spine v Displays an arc of a circle with a 19 24cm 190 240mm radius v Indicates a patient s lumbar curve in relation to the textbook normal and how much adjustment their spine is in need of based on the deviation in mm and degrees NOTE Although the range 19 24cm is considered textbook normal for the lumbar curve the average of 22cm 220mm has been chosen by the software and used to represent the textbook normal lumbar curve in this calculation Make sure the Annotation Edit Mode is activated A Activated Left click on the Lumbar Curve tool Left click on the anterior superior portion on the vertebral body of L1 This is the 1 point of 3 Left click on the on the anterior portion of the sacral base promontory This is the 2 point of 3 GE a i a Left click on the left side of spine if the curve should display on the left side OR Left click on the right side of the spine if the curve should display on the right side 6 This is the 3 and final point causing the curve itself to display See Figure 2 3 Tech Support S 1 800 366 5343 User Manual 10 Opal CHIRO v5 1 0 Figure 2 3 Lumbar Curve Tool Annotation Change the Radius of th
26. el Se i I Used to measure the vertical difference between two anatomical points by placing a perfect horizontal line across an image using chosen anatomical points and Measures height in mm between a perfect horizontal and any other chosen anatomical point and provides degrees for the angle created NOTE The dashed line shows the true horizontal and the solid line displays along the chosen anatomical points Make sure the Annotation Edit Mode is activated ra Activated Left click on the Horizontal Level tool Left click a point to automatically create the dashed line true horizontal line Left click to automatically create the solid line where the cursor is attached Drag and drop the 2 point to create the measurement and angle See Figure 2 8 4 e et A Figure 2 8 Horizontal Level Annotation 2 9 Vertical Level v Used to measure the horizontal difference between two anatomical points by placing a perfect vertical line across an image using chosen anatomical points and v Measures height in mm between a perfect vertical and any other chosen anatomical point and provides degrees for the angle created v NOTE The dashed line shows the true vertical and the solid line displays along the chosen anatomical points Tech Support U _ 1 800 366 5343 User Manual 15 Opal CHIRO v5 1 0 Make sure the Annotation Edit Mode is activated A Activated Left click on the Vertical Level tool Left click a p
27. elvis image making sure the image displays the tops of the iliac crests borders of the sacrum and inferior borders of the Ischia See Figure 3 2 Figure 3 2 AP Bilateral Pelvis Image Tech Support S 1 800 366 5343 User Manual 22 Opal CHIRO v5 1 0 Step 2 Use the Ilium Analysis Tool to plot 16 points and perform the Ilium Analysis 1 Make sure the Annotation Edit Mode is activated ra Activated Select Ilium Analysis tool 3 Using the left click plot the following 16 points one plot at a time on the image in the following order Zeg 1 Top of the left iliac crest 9 Medial border of the right ilia 2 Top of the right iliac crest 10 Lateral border of the right sacrum 3 Left sacral groove 11 Lateral border of the right ilia 4 Right sacral groove 12 Top of left femur head 5 Center of the first sacral tubercle 13 Top of right femur head 6 Lateral border of the left ilia 14 Center of symphysis pubis 7 Lateral border of the left sacrum 15 Inferior border of left ischeal tuberocity 8 Medial border of the left ilia 16 Inferior border of right ischeal tuberocity Step 3 Upon plotting the 16th point all lines and measurements in millimeters are displayed on the image as shown in Table 3 1 below E Figure 3 3 Tech Support 1 800 366 5343 User Manual 23 Opal CHIRO v5 1 0 Below find Table 3 1 Ilium Analysis Reference for Lines and Measurements Use in conjunction with Figure 3 4 to fam
28. eorge s Lines Figure 5 1 Important Information Regarding NUCCA Calculations 1 To display the Main Calculations for the AO analysis follow the path from the Main Menu gt gt Chiropractic gt gt NUCCA gt gt Main Calculations Once Main Calculations have been selected from the series of dropdown displays you must click anywhere inside the main viewing area to actually display the table of calculations 2 All ofthe tools must be utilized in order to successfully complete the NUCCA Analysis All calculations will be automatically performed by Opal RAD software once all analysis steps have been completed 4 Toremove the displayed table of calculations click on the NUCCA table to change the color of the table annotation then press the Delete button on your keyboard Friendly Reminder Complete all steps assuring the analysis and calculate before closing the viewer Fi Bs n d g Tech Support Y 1 800 366 5343 Pe User Manual 36 Opal CHIRO v5 1 0 5 1 Step by Step NUCCA Analysis Step 1 Vertex Frontal Line v Use the Vertex Frontal Line tool to find the Horizontal Cephalic Line HCL on the horizontal view 1 Make sure the Annotation Edit Mode is activated 7 Activated Select Vertex Calculations tool This will display the NUCCA Vertex table See Figure 5 2 Proceed to calculate the NUCCA Vertex Figure 5 2 Notes o The calculation box may be moved by hovering over it turns pink a
29. ep Determine the Horizontal Orthogonal Angle v This tool generates a horizontal angle on a lateral sagittal view to determine the proper perpendicular angle for the Frontal Nasium view Left click and drag the Lateral Sagittal View thumbnail so it appears in the image viewing area Make sure the Annotation Edit Mode is activated A Activated Left click on the Horizontal Orthogonal Angle tool Left click to plot the 1 point Note the degree of angle measurement will display Drag the mouse perpendicular to the line of measurement and left click to plot the 2 point ae ee YS a Immediately following the plotting of the 2 point the Horizontal Orthogonal Angle measurement will display See Figure 4 3 du Tech Support NG 1 800 366 5343 WIZ User Manual 27 Opal CHIRO v5 1 0 Figure 4 3 Horizontal Orthogonal Angle Step 1 Acquire Frontal Nasium and Horizontal views of the Step 2 Use the Vertex Skull Line tool to find the Horizontal Cephalic Line HCL on the horizontal view 1 Make sure the Annotation Edit Mode is activated Wi Activated Select Vertex Calculations tool This will display the AO Vertex with prey See Figure 4 4 Proceed to calculate the AO Vertex Kam keen deem nme Figure 4 4 AO Vertex Select Vertex Skull Line tool 5 Left click on the image to place the template See Figure 4 4 Tech Support 1 800 366 5343 User Manual 28 Opal CHIRO v5 1 0 Figure 3
30. he Annotation Edit Mode is activated HM Activated 2 Left click on Intermastoid Line tool 3 Left click to plot the first point 4 Drag and left click to plot the second point which generates the Intermastoid Line IML X D vizre Figure 5 13 Intermastoid Line Tool P Tech Support NG 1 800 366 5343 VZ User Manual 42 Opal CHIRO v5 1 0 Step 9 Atlas Check Line Optional v Use the Atlas Check Line tool to determine the accuracy of the atlas plane line Make sure the Annotation Edit Mode is activated DW Activated 2 Left click on the Atlas Check Line tool 3 Plot 2 points with a left click on the superior attachments of the posterior ring ofC1 which stretch outward across the rami of the jaw 4 The software will generate two lines where two lines are drawn identifying those points from which the superior attachments of the posterior ring ofC1 join the outer edges of the lateral masses NEU Figure 5 14 Atlas Check Line Step 10 Patient Rotation Optional v Use the Patient Rotation tool to check for anatomical symmetry on an X ray v Used to determine if Nasium view is acceptable regarding patient placement Note Excessive image rotation decreases validity and accuracy of the measurement process Y Can be done at beginning of analysis or anytime during the analysis Make sure the Annotation Edit Mode is activated L Activated Zoom into the image Left click on the Patient Rotation tool
31. ht outside 1 3 of the occipital condyle surface approx inches apart 5 See Figure 6 8 for reference where the red circles show the approximate placement of the four plotted points Figure 6 8 Sy Tech Support wi 1 800 366 5343 User Manual 51 Opal CHIRO v5 1 0 6 The software will now curve fit the occipital Condyle Circle determine the best fit circle and measure the circle size at this point Hovering the cursor over any created condyle point makes the circle visible See Figure 6 9 8 4 d Figure 6 9 Condyle Circle 7 The circle will disappear and the plotted points will remain as annotations during this phase Step 4 Axial Circle Make sure the Annotation Edit Mode is activated LZ Activated 1 2 Left click on the Axial Circle tool 3 Plot the following points in the order shown beginning on the left side 4 Plot the 1 point on the left lateral margin and surface of the axis articulation 5 Follow the lateral surface to the medial surface and left click to plot Notice 2 plotted dots These 2 dots represent the 3 32 inch dip dot line 6 Plot the 3 point on the right lateral margin with a left click 7 Follow the Articular surface in and select that surface with a left click Notice the active axial circle as you plot the points See Figure 6 10 C Tech Support wy 1 800 366 5343 WIZ User Manual gt 2 Opal CHIRO v5 1 0 kb Figure 6 10 Active Axial Circle
32. iliarize yourself with the digital version of the Ilium Analysis results 1 Iliac Crest Lines 2 Horizontal Plane Line of the Sacrum Sacral Baseline 3 Femur Head Line 4 Ischium Lines Ischial Tuberocity Lines 5 Sacral Center Line 6 Lines of Medial Ilia Border 7 Lines of Lateral Ilia Border 8 Lines of Lateral Border of Sacral Ala 9 Width of Left and Right Ilium Width between lateral Iliac border amp medial iliac border in mm 10 Width of Left and Right Sacrum Rotation of sacrum in mm 11 Height of Left and Right Innominates Top of Iliac Crest to bottom of Ischeal Tuberocity in mm 12 Vertical difference in height of femur heads 13 Horizontal difference between Center of Sacrum and Center of Symphysis Pubis Figure 3 4 Reference to Table 3 1 for Ilium Analysis a a gt Tech Support 1 800 366 5343 User Manual 24 Opal CHIRO v5 1 0 Making a Correction to an Already Plotted Point During the Analysis If an error is made where one of the points was not placed in the correct location make a note of which point was placed in error and continue plotting the remaining points The noted incorrectly placed point can be adjusted at the end of the analysis by activating the Annotation Edit Mode Eh icon hover over the plotted point to be moved then left click drag and drop the point to its correct location You may also press the ESC key on the keyboard to cancel the Ilium Analysis and begin again
33. ining the lateral margins of the ethmoid junction with 2 points on the left then 2 points on the right 5 The software will then automatically locate the center anterior portion of the skull based on the markings of the ethmoid junctions See Figure 6 19 i Figure 6 19 6 Next left click to plot the center of the transverse foramen of atlas on the left 7 Left click to plot the center of the transverse foramen on the right 8 See Figure 6 20 to see an example of the 2 plotted points on the transverse foramen Tech Support 1 800 366 5343 User Manual 59 Opal CHIRO v5 1 0 Figure 6 20 IMPORTANT Notice the RIGHT marker is on the reading left See Figure 6 21a To change this marker Right to Left or Left to Right to conform to the corresponding side of the patient single click the annotation to highlight changes color then press the F key on your keyboard to flip it See Figure 6 21b Figure 6 21a Figure 6 21b 1 800 366 5343 Tech Support User Manual 60 Opal CHIRO v5 1 0 Software automatically offsets the center of the odonotoid points based on the Nasium analysis in degrees Go back to the Nasium Calculations Table and you will see the software has added the calculations needed for determining adjustment factors Figure 6 22 Figure 6 22 6 6 Vertex alt Alternative Method to Analyze the Vertex Make sure the Annotation Edit Mode is activated ZZ Activated Zoom into the
34. ion Edit Mode is activated A Activated 2 Optional Use the Mark Spot tool to mark lateral articular edge s of the occipital condyle as shown in yellow in Figure 4 11 Tech Support 1 800 366 5343 User Manual 32 Opal CHIRO v5 1 0 3 Select Condyle Circles Template tool Left click on the image The Condyle Circle Template will appear See Figure 4 11 5 To move the template hover the cursor over the small box in the center of the template When the template changes annotation color and the 4 arrow crosshair appears hold the left mouse key down and move the mouse around to position the template 6 To rotate Use lt and gt keys to rotate the template 7 Once properly positioned press the key on the keyboard to enable the Enter Discovered Value box and enter the value as indicated on the template then click OK Enter Discovered Value Cancel 8 The Main Calculations annotation will now append itself to reflect the C value EA TE ADS E en Figure 4 11 Condyle Circl Step 6 Use the Axial Circle Template tool to find the Axial Circle A 1 Make sure the Annotation Edit Mode is activated A Activated Select Axial Circles Template tool 9 Optional Use the Mark Spot tool to mark desired anatomical structures as shown in yellow in Figure 4 12 Tech Support 1 800 366 5343 User Manual 33 Opal CHIRO v5 1 0 3 Left click on the image The Axial Circle Template will
35. l Center Point Vertebrae Line Ilium Analysis Advanced Orthogonal NUCCA E Orthospinology y S Line lateral film Center Line Vertical Nasium Calculations Center Line Horizontal Gonstead Ruler Ge ee George Sis e memei Condyle Circle See Axial Circle Lower Angle Patient Rotation Vertex About Help alt Figure 6 1 6 1 S Line lateral film v This tool will generate the S Line upon plotting 2 points as indicated below v Using lateral C Spine image Figure 6 1 Figure 6 1 Lateral C Spine view 1 Make sure the Annotation Edit Mode is activated HA Activated 2 Left click on the S Line lateral film tool fs 4 d J Tech Support WI 1 800 366 5343 User Manual Ap Opal CHIRO v5 1 0 3 Leftclick to plot the 1st point on the inferior aspect of the posterior arch exactly behind the lateral mass This will generate a moveable line 4 Left click to place the 2 point approximately 1 4 inch behind the i plotted point remaining on the inferior aspect of the posterior arch 5 The software will then display a dropdown menu allowing you to select the appropriate S Line Select the S Line with a single left click 7 The S Line has now been generated See Figure 6 2 Figure 6 2 6 2 Step by Step Orthospinology Analysis Step 1 Central Skull Line CSL v This tool determines the central skull line without using templ
36. lculations will be automatically performed by Opal RAD software once all analysis steps have been completed 4 Toremove the displayed table of calculations click on the AO table to change the color of the table annotation then press the Delete button on your keyboard Friendly Reminder Complete all steps assuring the analysis and calculate before closing the viewer Tech Support NG 1 800 366 5343 VZ User Manual 26 Opal CHIRO v5 1 0 4 1 Step by Step Advanced Orthogonal Analysis Optional Step Determine the Horizontal Angle v This tool generates a horizontal angle on a lateral sagittal view to determine the proper angle needed to set the x ray tube to capture the AO joint for Frontal Nasium view Make sure the Annotation Edit Mode is activated D Activated Left click on the Horizontal Angle tool Left click the image to plot the 1 point Note the degree of angle measurement will display To plot the 2 point drag the mouse along the line of measurement and left click the point ee a E Upon plotting the 2 point the Horizontal Angle measurement will display yielding the optimum frontal shot See Figure 4 2 6 Keep in mind in Annotation Edit mode the annotation may be edited by hovering over the annotation to highlight its activity The edit with a left click and drag motion to change the angle measurement in relation to the True Horizontal Figure 4 2 Horizontal Angle Optional St
37. nd the 4 arrow crosshair appears and using the left mouse button to move it to its new location IMPORTANT This is the first in a series of calculations to be performed As you continue through the listed steps the NUCCA Main Calculations table will auto populate with your measurements to ultimately provide a complete NUCCA Analysis Select Vertex Frontal Line tool Plot 8 points positioning 2 sets of 4 points around the occipital condyles Upon plotting the 7 point a moveable line will be generated oo e Plot the 8 point marking the Frontal Line on the Vertex view D VIZTE Figure 5 4 Vertex Frontal Line Step 2 Vertex Spinal Process 1 Make sure the Annotation Edit Mode is activated Ki Activated 2 Select Vertex Spinal Process tool 3 Plot 4 points Plotting the 3 point generates a vertical line Click the 4 point to place Tech Support 1 800 366 5343 User Manual 37 Opal CHIRO v5 1 0 NEU Figure 5 5 Vertex Spinous Process Step 3 Vertex Square Optional v The Vertex Square template uses a ruler method with C A measurements to measure the distance from the vertex spinal process Make sure the Annotation Edit Mode is activated E Activated Select Vertex Square template Left click the image to place the template oY To move the template hover the cursor over the small box in the center of the template When the template changes annotation color and the 4 arrow crosshair
38. ng over to the selected list box are the icons that will display in your toolbox Tech Support 1 800 366 5343 User Manual Opal CHIRO v5 1 0 See Figure 7 3 Notice the functionality that has been chosen to display in the user s toolbox in the following steps EL Annotations a E Chiropractic AQ Vertex Skull Line Template Ce Ge H ER AQ AQ Atlas Frontal Plane Line i AO Adal Circles Template AQ Condyle Circles Template z Greis Spinous Process AQ Main Calculations p AO Condyle Circle Finder AQ Adal Circle Finder H Orthospinology 1 Figure 7 3 You may further customize the display of your toolbox as indicated below Number of visible rows e Select the number of rows you would like to have in your toolbox Button Size e Select the desired size of the toolbox buttons you would like to display in your toolbox Button Separation e Select the desired size of separation between the various icons in your toolbox Orientation Ki Select whether you would like your personalized toolbox to be displayed Above Thumbnails as recommended for ease of use or Below Thumbnails Notice in Figure 7 4 the customized toolbox display Number of visible rows Ornentatioan 2 Le e Above Thumbnails Below Thumbnails Button Size i 2 Button Separation P A Figure 7 4 Tech Support WI 1 800 366 5343 65 User Manual 66 Opal CHIRO v5 1 0 Based on the specifications and selection made abov
39. oint to automatically create the dashed line true vertical line Left click to automatically create the solid line where the cursor is attached 1 Ss 3 4 5 Drag and drop the 2 point to create the measurement and angle See Figure 2 8 Figure 2 9 Vertical Level Annotation 2 10 Center Point Tool v This tool generates a center point measured between two plotted points Make sure the Annotation Edit Mode is activated LA Activated Left click on the Center Point tool Left click to plot the first anatomical point Plot all points from left to right Left click to plot the second anatomical point E ae The Center Point is generated See Figure 2 10 Tech Support 1 800 366 5343 User Manual 16 Opal CHIRO v5 1 0 Figure 2 10 Center Point Annotation 2 11 Vertebrae Line Tool v This tool generates a vertical line that passes through six points plotted along the spinal canal 1 Make sure the Annotation Edit Mode is activated A Activated Left click on the Vertebrae Line tool 3 Plot the six points below plotting all points from top to bottom and left to right each performed by a single left click gt Plot Point 1 on left side of a vertebral body gt Plot Point 2 on right side of a vertebral body The software will generate a middle point of the vertebrae exactly between point 1 and 2 gt Plot Point 3 at the junction of the lamina or tip of the spinous process The software will
40. overs over the annotation HOVER 1 3 2 Misc Options Scale is Pixel Size e Check this box if font size should be determined by Pixel Size Annotation Font Scale by e Allows you to customize the font size of an applied annotation e Default is approximately 1 or 1 5 when Scale is Pixel Size S NOT checked e Default is approximately 10 is when Scale Pixel Size S checked Annotation Point Scale by e Allows you to customize the point scale size of the annotation end points e Entera number between 0 1 5 Once you have made your selections and changes click SAVE For a complete reference on the Opal Viewer Administrative Settings Module please go to the User manual located at OpalViewerAdminUserSettingsManual Tech Support WI 1 800 366 5343 Wiz User Manual 7 Opal CHIRO v5 1 0 2 General Chiropractic Tools 1 Hover over the Main Menu icon EI found in the upper left corner of the Opal Viewer 2 Click Chiropractic 3 The list of all Chiropractic Tools available will display See Figure 2 0 File Settings View Tools Images Annotations Fr FF FF Fr F d MarkSpot Cervical Curve Lumbar Curve About Help ertebrae Line Ilium Analysis Advanced Orthogonal NUCCA Circumscale i Extended Line 7 Horizontal Angle Horizontal Orthogonal Angle Orthospinolog Center Line Vertical Horizontal Level Vertical Level Center Line Horizontal Gonstead
41. point drag the mouse along the line of measurement and left click on the second anatomical point 5 Upon plotting the 2 point the Horizontal Angle measurement will display yielding the optimum frontal shot See Figure 2 6 6 Keep in mind in Annotation Edit mode the annotation may be edited by hovering over the annotation to highlight its activity Then edit with a left click and use a drag motion to change the angle measurement in relation to the True Horizontal ei s AF 3 Ki Tech Support _ A 1 800 366 5343 User Manual 13 Opal CHIRO v5 1 0 Figure 2 6 Horizontal Angle 2 7 Horizontal Orthogonal Angle v This tool generates a horizontal angle on a Lateral Sagittal view to determine the proper perpendicular angle for the Frontal Nasium view Left click and drag the Lateral Sagittal View thumbnail so it appears in the image viewing area Make sure the Annotation Edit Mode is activated Z Activated Left click on the Horizontal Orthogonal Angle tool Left click to plot the 1 point Note the degree of angle measurement will display Drag the mouse perpendicular to the line of measurement and left click to plot the 2 point eS Se E Immediately following the plotting of the 2 point the Horizontal Orthogonal Angle measurement will display See Figure 2 7 A Figure 2 7 Horizontal Orthogonal Angle Tech Support NG 1 800 366 5343 User Manual 14 Opal CHIRO v5 1 0 2 8 Horizontal Lev
42. pport wy 1 800 366 5343 WIZ User Manual gt gt Opal CHIRO v5 1 0 See Figure 6 15 9 Now click the Fit Image to Window icon E Figure 6 15 6 3 Nasium Calculation Make sure the Annotation Edit Mode is activated DW Activated Left click on the Nasium Calculation tool 3 Left click anywhere on the image above the Atlas Plane Line and all the calculations will display as a table annotation on the image See Figures 6 16 amp 6 17 4 The calculations tables can be dragged to the side of the Atlas Laterality if necessary by left clicking and holding then positioning the table in one chosen upper quadrant for optimal viewing and professional conformity Note Figure 6 17 are same calculations zoomed in for clarity Tech Support wi 1 800 366 5343 User Manual 56 Opal CHIRO v5 1 0 Figure 6 16 Nasium Calculations Table Orthospinology Calculations Where L Left amp R Right AT Atlas Laterality Head Tilt OD Odontoid Laterality SP Spinous Process Laterality y axis rotation LA Lower Angle Measurement C Condyle Circle rounded down to the nearest whole number A Axial Circle rounded up to the nearest whole number PL Plane Line 2 OO mm e a oes om eee a e ere Ty Ki KI Orthospinology Height Factors PL Plane Line Factors C A Condyle Axial Surface ratio factor A OD Atlas Odontoid Relationship factor ANG Angles Calculation
43. ral Skull Line CSL by generating a centrally located vertical line through the skull 1 Make sure the Annotation Edit Mode is activated a Activated 2 Select Cephalometer tool 3 Left click for placement J D VIZTE Figure 5 7 Cephalometer template Step 6 Angular Rotation v Use the Angular Rotation tool to find the angular rotation of the vertical axis line Make sure the Annotation Edit Mode is activated K Activated Select Angular Rotation tool Begin plotting the 6 points as referenced in the order listed in Table 5 1 by a single left click to plot each point eLeft Articular Pillar of the Lateral boy of C2 eRight Articular Pillar of the Lateral body of C2 eTip of Spinous Process of C2 eLeft Articular Pillar of the Lateral body of C6 or C7 eRight Articular Pillar of the Lateral Body of C6 or C7 Table 5 1 Angular Rotation 6 Point Reference table 4 The acute angle will display 5 Drag the angular measurement into position and plot POINT 6 to place Tech Support 1 800 366 5343 User Manual 39 Opal CHIRO v5 1 0 7 Nr Figure 5 8 Angular Rotation Step 7 Condyle Circles v Use the Condyle Circles Template tool to find the Condyle Circle C NOTE Condylar and axial circles should be measured accurately to obtain the proper vector necessary to correct atlas laterality and the lower angle angular rotation Make sure the Annotation Edit Mode is activated ya Acti
44. rm mm mm mm mem vm P pm e re mn mm em em ml E ee Figure 5 17 Empty NUCCA Main Calculations Table User Manual 44 Opal CHIRO v5 1 0 When all of the NUCCA steps have been completed the table in Figure 5 17 will be automatically populated with NUCCA technique values based on the values obtained throughout the analysis To make changes to the values double click on the table and the following will display Figure 5 18 A N Where A Trans Reset Gel _Reset Trans LT or RT HPP Reset HPP Overides Overrides are optional oP Reset SP Spinous Process id 0 APL Atlas Plane Line AsO Reset A O Atlas Odontoid Relationship C A Condyle Axial values C A Reset ANG Angular Rotation ANG 0 Reset OK Cancel Figure 5 18 Override Table If necessary you may override the auto populated values here in this display window Once any and all overrides have been completed Click OK All updated and final values will be processed and the NUCCA analysis is complete Bs AP y Tech Support Ag 1 800 366 5343 User Manual 45 Opal CHIRO v5 1 0 6 ORTHOSPINOLOGY 4i K IE L I J I CU N File Settings view Tools Images Annotations p p f Cervical Curve Lumbar Curve Circumscale Extended Line d Horizontal Angle KR Horizontal Orthogonal Angle aad Horizontal Level Vertical Leve
45. to move it to its new location o If any adjustments are made by deleting and replacing the HCL or moving any of the AHPL points the calculation will automatically update IMPORTANT This is the first in a series of calculations to be performed As you continue through the listed steps the AO Main Calculations table will auto populate with your measurements to ultimately provide a complete Advanced Orthogonal Analysis Step 3 Use the Frontal Cephalic Line tool together with the Atlas Frontal Plane Line tool to calculate the Atlas Cephalic Displacement ACD Angle and Atlas Frontal Plane Angle AFP on the frontal view Tech Support 1 800 366 5343 Tech Support User Manual 30 Opal CHIRO v5 1 0 1 Make sure the Annotation Edit Mode is activated Activated 2 Select Frontal Cephalic Line tool 3 Left click on the image to place the template See Figure 4 9 H d i d oii Figure 4 9 Frontal Cephalic Line template Before amp After 4 To move the template hover your cursor over the small square in the center of the template Left click and hold your mouse button and move the mouse to position your template Left click to engage template 5 To increase or decrease the size of the template use the and keys on your keyboard 6 Press key on your keyboard to display the Frontal Cephalic Line which is the center of the skull 7 With the frontal image still in the viewing area use the Zoom P
46. tools have several new functional additions when compared to regular Opal RAD annotations These tools have the following functions when using the keyboard for activating functionality e Rotate Left lt Rotate Right gt Will rotate template left or right in 1 10 degree steps e Zoom In Zoom Out Will zoom in out template by a factor of 10 if template is not used for direct measuring not size dependent e Reset Rotation 0 Will reset the rotation level on the template e Invoke Action Will draw a line from template apply the template or request insertion of the value inferred from template e Change template Will change the style of the Center of Skull tool 1 2 Image View Orientation ATTENTION Images are generally captured in an Anterior to Posterior view shown allopathically In the chiropractic field images are usually viewed and annotated from a Posterior to Anterior perspective as though the chiropractor is standing behind the patient in preparation for adjustment Therefore it is highly recommended that all images are captured with the R and L markers included to verify correct anatomical positioning If the image s being viewed is not shown as Posterior to Anterior it is recommended that the Flip Horizontal 12 icon be applied to the image as shown below in Figure 1 0 e D i PN NW Tech Support v 1 800 366 5343 L I Wa d L b Figure 1 0 Flip Applied for Chiropractic
47. vated Optional Use the Mark Spot tool to mark the lateral articular edge s of the occipital condyle as shown in yellow in Figure 5 9 Select Condyle Circles Template tool Left click on the image The Condyle Circle Template will appear See Figure 5 9 To move the template hover the cursor over the small box in the center of the template When the template changes annotation color and the 4 arrow crosshair appears hold the left mouse key down and move the mouse around to position the template To rotate Use lt and gt keys to rotate the template Once properly positioned press the key on the keyboard to enable the Enter Discovered Value box and enter the value as indicated on the template then click OK Size range from 2 6 Figure 5 o i Condyle Circle geen Tech Support 1 800 366 5343 Step 8 Axial Circle User Manual 40 Opal CHIRO v5 1 0 v Use the Axial Circle Template tool to find the Axial Circle A a et mp NOTE Condylar and axial circles should be measured accurately to obtain the proper vector necessary to correct atlas laterality and the lower angle angular rotation Make sure the Annotation Edit Mode is activated ma Activated Select Axial Circles Template tool Optional Use the Mark Spot tool to mark the superior lateral aspects of the axis vertebrae Optional Use the Mark Spot tool to mark a point exactly three thirty seconds 3 32 of an inch below the grooves at the

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