User Manual Cephalometric Analysis System
Contents
1. L lt number gt lt number of first point gt lt number of second point gt lt symbol gt lt description gt To add the line X Y with description Xpto to Ypto you will add next to the line that contains L17 L18 3 8 X Y Xpto to Ypto The letter L refers to a line Must be sure of the number of each point in the point list to draw a correct line Because of this point number cannot be changed and when adding point lines angles or distances always add to end of the corresponding list The syntax to add a new angle A lt number gt lt number of _first_point gt lt number of second point gt gt lt number of third point gt lt number of fourth point gt lt symbol gt lt description gt lt mean value gt lt deviation gt To add the angle Xpto with description Xpto angle you will add next to the line that contains A21 A22 1 8 3 14 Xpto Xpto angle 90 3 The letter A refers to a angle The line with the points 1 8 and with line 3 14 describes the angle For further analysis the mean value and it s acceptable deviation is needed for better information and conclusions When a deviation is not needed just insert in the place of lt mean value gt lt deviation gt the lt mean value gt Since an angle is defined by two lines each one defined itself by two points we have then four points Thus the meaning of 1 2 3 and 4 point is to define the2. INEB In the right upper corner there is an interface a so called Patch which helps the user to zoom a region of the whole picture shown in the left part of the screen so that it becomes more visible To go back to the original size just click out of any image with the right mouse button and select Original Zoom In the menu Options there is an option called Image Adjustments that helps the user to adjust the image in contrast brightness and gamma In the popmenu the user may also make a threshold operation or histogram equalization To visualize the image adjusted click Close but to cancel all modifications click Cancel USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS Het maraairi bum 171 Vries 6 inde ety Trenni me rion aake Hij prar Waan SO Wasence 16 Jorge Correia FEUP INEB Age ated eg Haye Gp Terie i Ler ne oll Brightness is an attribute of visual perception in which a source appears to emit a given amount of light In display systems the relation between the intensity of colour brightness or shading of an area occupied by a display element display group or display image on the display surface of a display device and the intensity of an area not occupied by a display elements a display group or a display image USER MANUAL of CEPHALOMETRIC AN
3. The number of traces and the distance between all the ticks may be changed in the menu Options Settings Scale Factor As the scale factor as been detected the process may continue When the user starts marking the points they are asked one by one indicating the next to be marked bellow the Patch and its corresponding description Jorge Correia FEUP INEB USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS When all the points are marked the application draws the lines needed to the analysis and calculates automatically all the angles and distances specified in the configuration file The user can visualize their values using the procedure described in the next section In the pop menu Displaying the user may chose what information he wants to see points lines angles or distances In case of points or lines the selected one will appear in a different colour from the others In case of an angle or a distance the corresponding value will appear in a little box next to the popmenu The point line angle or distance should be selected in the popmenu bellow Next to the information about the point there is information called X Y and Value This indicates the pixel coordinates and its correspondent intensity Jorge Correia FEUP INEB 10 USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS 11 4 Zooming Jorge Correia FEUP
4. corresponds to PNS P23 H Hioide P24 Pt Pterion P25 TN Tip of the nose P26 Soft Pg Soft tissue pogonion P27 APOcc Anterior point for the occlusal plane P28 VP Ponto velar posterior P29 VA Ponto velar anterior P30 Ponto P Extremidade da tivula P31 Porion Ponto superior do CAE P32 Ponto M Intersec o entre o eixo do dente inciso superior e o plano maxilar P33 AAS Parede anterior da hipofaringe L1 2 1 S N Sella nasion Anteroposterior extent of anterior cranial base L2 2 15 S Ar Lateral extent of cranial base L3 12 15 Ar Go Length of ramus L4 14 12 Me Go Extent of mandibular base L5 1 3 N A Nasion point A L6 1 10 N B Nasion point B L7 1 11 N Pog Nasion pogonion L8 1 12 N Go Nasion gonion line for analysis of the gonial angle L9 18 19 Pal Palatal plane ANS PNS L10 20 27 Occ Occlusal plane APOcc PPOcc L11 6 7 1 Pal Long axis of upper incisor to Pal L12 8 9 1 MP Long axis of lower incisor to mandibular plane L13 25 26 EL Aesthetic line Tip of nose soft tissue pogonion L14 17 31 Pl Frank Plano de Frankfurt Al 2 1 1 3 SNA Anteroposterior position of maxilla 82 2 A2 2 1 1 10 SNB Anteroposterior position of mandible 80 2 A3 3 1 1 10 ANB Difference between SNA and SNB 2 2 Jorge Correia FEUP INEB 16 USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS A4 2 1 1 4 S N Pr Anteroposterio
5. ALYSIS SYSTEM CEPHAS H Boga Creed ia H ogai Jorge Correia FEUP INEB Speck aK Hea kam 125 eme 27 bamn 12 Menace 17 Eqaad aad bia Some devices have non linear behaviours and what gamma correction does is to correct that non linearity Histogram equalization is obtaining the maximum variation of the image histogram resulting by that a better contrasted image USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS 11 6 Face contour and pharynx area Labam rE DI ee Faro Mik Eem pire Hi Tri ANCTLILAR HEASUREHENTS idegi Jorge Correia FEUP INEB Pi R m Ei Oe li zi For the face contour and pharynx marking the user first traces the face contour points the left button mouse clicks and finishes with a right button mouse click During this if the user wants to cancel the operation he must click ESC on the keyboard When the face contour is traced the user must trace the pharynx using the same procedure Note the user should mark as much points as possible for a better performance of the algorithm which estimates the pharynx area Click Report and the report example shown will be displayed The user may chose to view a single report about the examination displayed or compare this examination with another one that has been completely analysed For that a listbox i
6. USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS User Manual Cephalometric Analysis System Version 1 0 0 GEPrPHAAS USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS Cephalometric Analysis System CEPHAS Issue 15th June 2002 Contents Introduction Configuration Installation Starting up the program Image acquisition Setting values and requirements Adding a new patient Open a process patient Change process data 10 Examination selection 11 Examination analysis 11 1 Scale 11 2 Landmark 11 3 Visualize points lines angles or distances 11 4 Zooming 11 5 Image adjustments 11 6 Face contour and pharynx 12 Report 13 Export settings images 14 Print 15 Programmer information OCOnNOAaFBRWND gt Jorge Correia FEUP INEB USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS 1 0 Introduction CEPHAS is a software application specifically designed to perform Cephalometric analyses quickly and easily prompted CEPHAS translates each individual value recorded into its corresponding clinical meaning it integrates the landmark points entered and generates a detailed evaluation CEPHAS allows you to conduct Cephalometric analyses directly from scanned x rays saved to disk CEPHAS will automatically guide you step by step as to the points to click and generates a written summary description When the guided process to locate the individual landmarks has been completed the pr
7. angles and distances draw lines identify contours face and pharynx and visualize a report about the data analysed 11 1 Scale The first operation in the analysis is determining the scale There are two options when doing this part of the analysis existence of a ruler scale acquired with x ray of the patient head or the x ray being in the real scale In case of being in real scale the user have to insert the scanning resolution ls the examination on real scale or does it have a scale factor Scale Factor Real Scale Cancel Otherwise if there is a scale factor the user has to either insert it or the application will automatically xj detect it recommended for better accuracy Insert the resolution of the scanning tapis 150 OF Cancel x Do tou want to insert the scale factor or do you want it to be found Insert Detect Cancel automatically Jorge Correia FEUP INEB 8 USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS 11 2 Landmark E I ia l I ol a a gr Gad ee I l p Pa I 4 E I oe a a a Ae 1 m T Bi m il Ma hra j y a Fp I L a gs When selected the process of detection of scale factor the user must draw a rectangle that encloses all the ticks of the scale with a rectangle in the exact place of the scale and intersecting all the 11 points of the scale corresponding to the five centimetres of the scale Note
8. cia entre plano maxilar e mento ou altura anteroinferior 0 D6 28 29 0 VP VA Largura da velofaringe 13 5 D7 19 30 0 PNS Ponto P Comprimento do palato mole 37 3 Jorge Correia FEUP INEB 17
9. ect 7 0 Adding a new process patient S From the Process menu window click New process When the process input form appears to enable you to insert a new patient s data the following ten fields must be completed Process Number Patient Name Birth Date Day Month Year Address Location Post Code Sex Phone Number New Process Patient Input Form This procedure must be done before any adding of examinations to the process When this procedure is finished the program itself will look for the examination and will present to the user all the files found ready to be analysed The processes are introduced in a database generated in the application where there are structures that contain other structures A patient has a structure with all its personal data and this structure itself has an array of structures corresponding to the number of examinations added to the process This final structure has all the information necessary to the analysis about the examination angles distances points marked surfaces etc It will be impossible to move to any other window if these obligatory fields have not been filled out therefore it is advisable to click Ok only when these data do actually have to be inserted To cancel a patient input form click Cancel on the patient input form Jorge Correia FEUP INEB 6 USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS 8 0 Open a process patient dx ae From t
10. erform a good acquisition the scanner must be transmissive Jorge Correia FEUP INEB 3 USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS 3 0 Installation Insert the CD and double click Setup following the instructions that will appear on the screen to install CEPHAS Clearly the programmer reserves the right to edit or modify the program without prior notice 4 0 Starting up the program Once the installation is done lt and Windows is running set p the screen resolution to 800 x 600 pixels click Start C gt CEPHAS and the window shown here will be displayed Menu 5 0 Image acquisition The images to be elaborated must be captured beforehand with a scanner and saved in a directory created specifically for the purpose CEPHAS images The name given to an image must not exceed 50 characters including spaces path and extension given that longer names could provoke errors The protocol to name the image is indicated as follows lt process numb gt _ lt acquisition date gt _ lt acquisition order in present day gt lt extension of capture gt SO an examination made in 26 01 2002 for the process 1234 and being the third examination to this process in the same day and saved in BMP format should have the name 1234 26012002 3 BMP Note that the month being January still need to have the zero present without it and error in the application will occur Jorge Correia FEUP INEB 4 USER MANUAL o
11. erior and inferior point of the bony chin It is constructed by intersecting a line drwan perpendiculary to the line connecting Me and Pog with the bony outline P13 Me Menton Is the most caudal point in the outline of the symphysis it is regarded as the lowest point of the mandible and corresponds to the anthropological ganthion P14 Go Gonion The intersection of the lines tangent to the posterior margin of the ascending ramus and the manibular base P15 Ar Articulare The point of intersection of the posterior margin of the ascending ramus and the outer margin of the cranial base P16 Cd Condylion Most superior point on the head of the condyle P17 Or Orbitale Lowermost point of the orbit in the radiograph P18 ANS Anterior nasal spine Is the tip of the bony anterior nasal spine in the median plane P19 PNS Posterior nasal spine The intersection of a continuation of the anterior wall of the pterygopalatine fossa and the floor of the nose It marks the dorsal limit of the maxilla P20 PPOcc Posterior point for the occlusal plane The most distal point of contact between the most posterior molars in occlusion P21 Ba Basion Lowest point on the anterior margin of the foramen magnum in the median plane P22 Ptm Pterygomaxillary fissure The contour of the fissure projected onto the palatal plane The anterior wall represents the maxillary tuberosity outline the posterior wall the anterior curve of the pterygoid process This
12. f CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS The best solution will be to capture an 18 20 cm square on the x ray with the scanner set at a resolution of 150 dpi then save the images as bitmaps BMP s or JPQ s It is advisable to carry out some trials first in order to adapt results to the hardware currently being used in order to set up an operating standard that will not require any further modification A resolution of 75 dpi would be enough but to notice some important landmarks 150 dpi will be better 6 0 Setting values and requirements The file cephas_config ixt this file can be found in attachment in the main root CEPHAS contains all the information about the points distances and angles measured in the application The current list has 33 points 14 lines 20 angles and 7 distances After the user finishes marking points in the x ray points that are defined in the file the application determines angles and distances that are also defined in the file The importance of the contents of this file is crucial to the correct execution of the analysis If it s needed to add more points distances or angles the following protocol as to be followed The syntax to add a new point is P lt number gt lt symbol gt lt description gt To add the point X with description Xpto you will add next to the line that contains P34 P35 X Xpto The letter P refers to a point The syntax to add a new line
13. first and the second lines that define the angle The syntax to add a new distance D lt number gt lt number of first point gt lt number of second point gt gt lt number of third point gt lt symbol gt lt description gt lt mean value gt lt deviation gt To add the distance Xpto with description Xpto distance you will add next to the line that contains D4 D5 1 8 9 Xpto Xpto distance 90 3 The letter D refers to a distance The distance is described throw the distance of the point 9 to the line 1 8 If only want the distance between two points just put a zero in the third point For further analysis the mean value and its acceptable deviation is needed for better information and conclusions When a deviation is not needed just Jorge Correia FEUP INEB 5 USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS insert in the place of lt mean value gt lt deviation gt the lt mean value gt A distance can be measured throw the distance between two points or from a point to a line As backup the file cephas_config bak have been created so when the main file is changed do not forget to save it and also copy the same file with the extension bak A comment is always preceded by This settings are loaded when the application starts but if you change it while it s running just click on the menu File and click Load Points and the changes will take eff
14. he Process menu window click Open process When the window shown to the left appears select the process to be opened The process number and the patient name identify it Click Open to visualize the process Fia rar ex 12 Waria Joao Pins dti Fiss of lame f dhi Cancel Open a process patient 9 0 Change process data The fields are all possible to be changed with the exception of the process number When done press Ok to accept the changes or Cancel to exit without changes 10 0 Examination selection In the middle of the right side of the application there is a popmenu that contains all the examinations BMP files relative to the process opened Here the user may select the examination to analyse and if this examination hasn t been analysed before the user will be asked if he wants to include it in the process From there the user may start analysing the select examination Jorge Correia FEUP INEB ji USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS The files x rays digitalized must be stored in the directory called images The refresh of the images of a process is made when the process is opened or created so for that if any examination is added to the directory it will not appear in the list To appear the process must be opened again 11 0 Examination analysis The examination analysis consist of determine a scale factor of the examination mark points measure
15. ogram generates a detailed and accurate report With CEPHAS the user will enter the landmarks on a previously scanned x ray with the program guiding the user always during the analysis A determination of the scale factor will be also an important part of the program because this value will be needed for a correct presentation of the results in the final report that will be generated when all the parts of the analysis are completed In this manual the term landmark or point will be used with no distinction NB the manual has been purposely compiled to be concise the programmer advises that after having read the manual through users familiarise themselves with the application using the tool tip text position the mouse pointer over the button that you want to receive information on 2 0 Configuration The minimum system setup requirements are Pentium III with 256 MB RAM A computer with a faster processor and more memory is recommended for instance Pentium IV 1700 MHz processor with 512MB RAMBUS To optimise image display a 17 monitor with good quality video card is advised but 19 monitor is optimal set the screen resolution to 800 x 600 pixels and 65 536 colours This is an important requirement because if the resolution is too low problems will occur in the graphical interface due to the text in the application as a font size fixed In order to make the acquisition of the x rays a scanner must be used and in order to p
16. r position of alveolar part of premaxilla 84 A5 2 1 1 9 S N Id Anteroposterior position of alveolar part of madible 81 A6 18 19 14 13 Pal Mp Angle between palatal and mandibular plane 25 A7 18 19 20 27 Pal Occ Upper occlusal plane angle 11 A8 14 13 20 27 MP Occ Lower occlusal plane 14 A9 2 1 13 14 SN MP Angle between SN and mandibular plane 32 A10 17 32 1 10 Facial entre o plano de Frankfurt e a recta que passa em Na e o ponto B 90 3 A11 17 31 1 3 Maxilar entre o plano de Frankfurt e a recta N Ponto A 90 3 A12 21 1 24 12 Rickets entre a linha Ba N e a linha Pterion Gnation 90 A13 1 2 2 15 N S Ar Saddle angle 123 5 A14 2 15 15 13 S Ar Go Articular angle 143 6 A15 15 13 13 14 Ar Go Me Gonial angle 128 7 A16 15 13 13 1 Ar Go N Gol upper gonial anlge 53 5 1 5 A17 1 13 13 14 N Go Me Go2 lower gonial angle 72 5 2 5 A18 6 7 18 19 1_ Pal Angle between lower incisor axis and palatal plane anteriorly 90 3 A19 7 8 13 14 1 MP Angle between upper incisor axis and mandibular plane posteriorly 70 5 A20 6 5 7 8 ii angle Interincisal angle between upper and lower central incisor axesm posteriorly 130 6 D1 2 1 0 S N Anteroposterior extent of anterior cranial base 71 3 D2 2 15 0 S Ar Extent of lateral cranial base 32 3 D3 2 14 0 S Go Posterior facial height 71 6 D4 1 13 0 N Me Anterior facial height 114 6 D5 32 13 0 M Me Distan
17. s shown for the examination selection All program values are displayed and its corresponding deviation and mean value The values of the patient examination are compared with the standard values and the result of this comparison is showed in the a last column of the report If the value isn t normal its shown in red If the conclusion is it 14 USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS means that the value is one time bigger than the deviation if its It means that the value is two times bigger if it s five times or more bigger than deviation it s shown gt gt 13 0 Print In the menu File gt Print and Print Setup there is the possibility to print a image of the program and to configure printer properties 14 0 Export settings images In the menu File gt Export Settings the settings configured during the program can be exported to a binary or a text file to be viewed later These settings can be loaded from the binary file later In the same menu the option Export Images allows the user to export to a file some of the images used during the program 15 Programmer information CEPHAS is a software application designed created and distributed by Jorge Correia FEUP INEB Web Site _http www fe up pt ee97078 http www ineb up pt E Mail ee97078 fe up pt Jorge Correia FEUP INEB 15 USER MANUAL of CEPHALOMETRIC ANALYSIS SYSTEM CEPHAS 16 Attachment File cepha
18. s_config txt P1 N Nasion The most anterior point of the nasofrontal suture in the median plane The skin nasion is located at the point of maximum convexity between nose and forehead P2 S Sella The sella point is defined as the midpoint of the hypophysial fossa P3 A Point A subspinale The deepest midline point in the curved bony outline from the base to the alveolar process of the maxilla i e at the deepest point between the anterior nasal spine and prosthion P4 Pr Prosthion Alveolar rim of the maxilla the lowest most anterior point on the alveolar portion of the premaxilla in the median plane between the upper central incisors P5 Is Incisor superius Tip of the crown of the most anteior maxillary central incisor P6 Apl_ Apicale 1_ Root apex of the most anterior maxillary central incisor P7 li Incisor inferius Tip of the crown of the most anterior mandibular central incisor P8 Ap1 Apicale 1 Root apex of the most anterior mandibular central incisor P9 Id Infradentale Alveolar rim of the mandible the highest most anterior point on the alveolar process in the median plane between the madibular central incisors P10 B Point B Supramentale Most anterior paart of the mandibular base It is the most posterior point in the outer countour of the mandibular alveolar process in the median plane P11 Pog Pogonion Most anterior point of the bony chin in the median plane P12 Gn Gnathion The most ant
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