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1. n ma p jajan f ES As d pee m aa sa Nano rade n zm ES me ordi 3 zm E scram 5 ES m on E 95 ma oun wama maras E E mam n pe m mawan ja m E E Re 3 p PA mem E Za Image 81 Final printout customisation Click Preview to check the printout Ax CEPH AxCEPH docx Copyright 2010 Page 71 of 98 papane ees Baron Ro F O2 I SAGITALHTRELATIONS ange sm ij lange ae im TERS inge EEE VERTIKALNI RELATIONS ne FC an DENTAL ANALYSIS rien TI ree io rde IAT TA ELI m fine Tem name Tj TISSUE ANALYSIS mer ine imi za ao Lower tore EX Diem mem Image 82 Example of printout radiograph on the left elements on print layer on the right measurement groups in the bottom section AX CEPH Users Guide Copyright 2010 Page 72 of 98 6 11 Export to MS Excel x E ism Click Excel button to export measurements patient information the radiograph and print layer to MS Excel Click the upper part to automatically export data in the predefined template On th
2. Cephalometric X ray Analysis Software Users Guide www axceph com AX CEPH CEPHALOMETRY SOFTWARE DOCUMENTATION Ax CEPH Users Guide Audax d o o Tehnolo ki park 18 Ljubljana 51 1000 Telephone 00 386 1200 40 50 Fax 00 386 1 423 47 00 www axceph com AX CEPH Users Guide Copyright 2010 Page 2 of 98 Table of Contents 1 ABOUT THIS GUIDE 1 1 WHo SHouLo Use IT 1 2 TYPOGRAPHICAL CONVENTIONS 2 INTRODUCTION 21 PURPOSE 22 Glossary 23 PROGRAM WINDOW LAYOUT MAKING ANALYSES BASED ON PREDEFINED ANALYSIS TYPE 31 WoRKFLOW 32 PREPARING DATA FOR THE ANALYSIS 33 PRINTING AND SAVING 4 DIGITAL FILTERS IN IMAGE PROCESSING 44 IMAGE MANIPULATIONS AND DISPLAYING 42 FILTERS Suow 44 ANNOTATIONS SYMBOLS 45 INTERACTIONS 46 47 CHANGING BACKGROUND COLORS 48 STORING DERIVED IMAGE 5 VIEWING ANALYSES PERFORMED 51 8 52 HARDCOPY 6 CREATING A CUSTOM ANALYSIS TYPE 61 HowTOSTART 62 GEOMETRIC FEATURES 63 MEASUREMENTS 64 ANEXAMPLE OF CREATING CUSTOM ANALYSIS TYPE FROM SCRATCH 65 ANEXAMPLE OF HOW TO MEASURE WITS APPRAISAL 66 Cotors 29 30 33 38 39 42 BES 45 45 45 47 48 49 58 62 65 Ax CEPH AxCEPH docx Copyright 2010 Page 3 of 98 67 68 69 6 10 en 612 613 EDITING STANDARD VALUES AND STANDARD DEVIATIONS LINKING STANDARD VALUES AND STANDARD DEVIATIONS WITH ANGLES AND MEASUREMENTS LAY
3. sharpen Median WAP cure Gray level Image 53 Operations history list 4 6 2 Storing History PRESCRIPTION CTRL R After having entered all modifications and you would like to store operations history you can store itas a prescription Press the key combination CTRL R A new window is opened where you click Save history as prescription Then enter the name of the prescription and confirm it In the next step assign any of the funclion keys F9 to F12 to the prescription To assign function key drag and drop the prescription on it Ax CEPH AxCEPH docx Copyright 2010 Pago 43 of 98 user xc LES Image 54 Assigning key to prescription The operations are displayed together with the parameters in the right hand side window You can delete it by marking it and selecting Delete prescription Selecting the assigned prescription key deletes only this But having selected prescription then both the assigned key and the prescription are deleted 4 7 Changing Background Colors Change background color in the editor by pressing lt CTRL gt lt B gt A color scheme is displayed Where you can make appropriate changes Confirm it by clicking Ok 4 8 Storing Derived Image Having finished operations and you are satisfied with the way the derived image turned out you store it The following options are available 1 Click Save
4. Image 34 Description of image manipulation and displaying Use the editor to view and edit derived and original images The name of the currently open image is displayed in the titlebar Ax CEPH AxCEPH docx Copyright 2010 Page 31 of 98 Image 35 Various layout options Use the mouse wheel to zoom the image in or out Turn the mouse wheel towards you to zoom out or away from you to zoom in If the image is Zoomed in to a level where It no longer fits the screen the Navigator window appears for easier orientation around the image Image 36 Navigator A dashed bounding box borders appear in the Navigator window marking which area of the image is displayed Place the mouse pointer over the box the pointer changes to a crosshairs left click and drag the box to quickly navigate the image Close the Navigator by clicking the cross x icon It is closed automatically when displaying the whole image You can also use the sliders on the right and at the bottom to move around the image Or simply click in the image hold and move in the desired direction In the bottom section you can find a toolbar Use it to modify brightness and contrast levels Initially the values are by default set to 0 zero That is contrast and brightness are set at neutral levels AX CEPH Users Guide Copyright 2010 Page 32 of 98 Note CONTRAST AND BRIGHTNESS LEVELS ARE GENERALLY BEST LEFT THEIR DEFAULT VALUES OTHERWISE SOME
5. Select wa Double click it or click gt to move it to the right hand side box Click the operator minus Select wb Double click it or click gt to move it to the right hand side box Confirm the result by clicking Ok Users Guide Copyright 2010 Page 64 of 98 Image 75 Analysis type including all elements 6 6 Colors w Colors Customsanon You can change the color of individual elements in an analysis type consequently also color of the element in the analysis In addition you can also change default colors of individual elements To do this click Colors button A window is opened listing all elements used in the analysis type Click color by the element and the following two buttons C appear Clicking TS opens a dropdown menu where you can set new default color On the other hand clicking opens Colors window In the top section you have basic colors 48 colors and the bottom section offers custom colors and the button Define Custom Colors Clicking it opens a new window where you can set a new color and you can add it to custom colors by clicking Add to Custom Colors To set new default color select a custom or basic color and confim it by clicking Ok Ax CEPH AxCEPH docx Copyright 2010 Page 65 of 98 Having finished setling default colors click to quit the Color window To discard the new settings click Cancel 6 7 Editing standard values and standard deviations ere
6. The above window section offers options that can be found in the dashboard Here you can enter name of the calculation label description comment and set a unit of measurement Select between millimeters mm degrees percentage or leave blank the left hand side of the bottom section are displayed all measurements plus calculations included in the analysis type The right hand side displays measurements used in creating calculations The Add number field can be found under the Measures in calculation box Use it to add number constant to the calculation There are six buttons in the section between the two boxes Use the upper two in order to move measurements to be included or excluded from calculation The other four are operators In the bottom section you can see the field Calculation which displays the formula used in calculation Ax CEPH AxCEPH docx Copyright 2010 Page 57 of 98 6 4 An Example of Creating Custom Analysis Type from Scratch Below you can see the process used in crealing an analysis type Choose phantom Position landmarks Create planes Create dimensions Calculated dim Link dim to std val Create reports Image 68 Analysis type after entering occlusal plane points A and B AX CEPH Users Guide Copyright 2010 Page 58 of 98 Do the following to create analysis type for calculating ZANB First open Analysis type panel Click New type and enter name of analysis
7. Cek Edit td values for each analysis separately to open the window for editing standard values and deviations Set standard Image 76 Window for editing standard values There is a number of buttons with the following meaning Save table Add a standard value Delete a standard value Add new patient type for example mixed dentition adult AX CEPH Users Guide Copyright 2010 Page 66 of 98 Export to Excel Import from Excel 6 8 Linking Standard Values and Standard Deviations with Angles and Measurements P Standard values Click Link button to open a window for linking standard values and standard deviations with measurements Image 77 Window for linking measurements with standard values and deviations On the left hand side you can see all measurements included in the analysis type On the right you can on the other hand see all standard values which were added using the edit button To open the window for editing mean values click E Ax CEPH AxCEPH docx Copyright 2010 Page 67 of 98 link measurement with standard value you first have to select it in the left box and select standard value from the right box In the end click to link them up You can remove a link by selecting it and clicking 6 9 Layers Set layers in order to group elements The following two layers have been predefined 1 The Analysis layer which
8. aa Image 13 Moving a single line A single line can be moved in two ways AX CEPH Users Guide Copyright 2010 Page 18 of 98 a moving one of the two green endpoints The other endpoint remains in place the line is resized and rotated to follow the moving endpoint b Selecting a line anywhere in between the endpoints moves the whole line without resizing it 3 2 8 2 Line Through One Point Image 14 Moving a line that runs through one point 1 line is the child of a point it be moved in two ways By moving the green endpoint The point remains in place the line is resized and rotated to follow the moving endpoint b moving the line s parent point Select and move the point as described above The green endpoint remains in place the line is resized and rotated to follow the moving point Such lines cannot be selected as a whole and moved around 3 2 8 3 Line through two points Paint aw Point Image 15 A line that runs through two points A line that is the child of two points can only be moved by moving one of the two points Such lines are colored blue Ax CEPH AxCEPH docx Copyright 2010 Page 19 of 98 Point Image 16 Moving a line s endpoint causes the line s child elements to move accordingly It may happen that a point is moved indirectly because its parents are moved With proper positioning you can construct a complex mechanism analysis type 3 2 8 4 Perpe
9. allows to do changes to an existing element in the database Ax CEPH AxCEPH docx Copyright 2010 Page 83 of 98 9 Superimposition Superimposition tools allow you to place one analysis over another analysis or a photograph over an analysis Any number of analyses and patient photographs may be used Analysis 1 Analysis Analysis Assembly RULES SN ML NL Image 91 Superimposition process in Ax CEPH To superimpose analysis over analysis you have to set cephalometric landmarks For example setting both landmarks S Sella turcica N Nasion both analyses are superimposed according to the interrelation and location of the two points The size of images and image rotation are adjusted accordingly Ax CEPH Users Guide Copyright 2010 Page 84 of 98 9 1 Superimposing Analysis over Analysis 9 1 1 Selecting the Superimposition Panel First you have to open the Superimposition panel You can work in the Analysis and Analysis Type panels simultaneously But you can only work with a stored analysis Ores nen Open scperinposton superinpcsiion t superiroostion Image 92 Selecting the Superimposition panel 9 1 2 Selecting an Analy Clicking the New superimposition button opens the window where you can select an analysis For example let us open the oldest analysis version and click Ok Image 93 Selecting an
10. a point click Point and set it anywhere you want in the image Later you move it around at will 2 Click Point select Point on plane and place the point on the desired line Move the point along the line 3 Click the Point icon and select Point on cross section Place the point on the cross section of two lines Change the color of a point border of the point and label and fill color point surface at will The default color changes according to the type of point that is whether itis a point on plane ora point on cross section Note Ax stores the last element that was inserted in the analysis type Pressing FA creates a new element of the same type Hence you can use this shortcut in stead of continuously clicking the same button in the command ribbon 6 2 2 Plane Use one of the following types of planes independent simply click any two points on the canvas 2 child of a point click an existing point and then anywhere on the canvas 3 child of two points click two existing points on the canvas Ax CEPH AxCEPH docx Copyright 2010 Page 51 of 98 Create a parallel ine in one of the following two ways 1 Parallel plane through a point First select a plane parallel to the existing plane and then just select a point through which the parallel plane should go 2 Parallel plane First select a plane parallel to the existing plane and click anywhere the canvas Create a perpendicular plane
11. analysis This User Manual is structured in a way that those completely new to the program can become productive as soon as possible Advanced users should see follow up for detailed treatment of designing their own analysis types Ax CEPH AxCEPH docx Copyright 2010 Page 7 of 98 2 2 Glossary This User Manual uses some terms that are specific for the program This glossary explains those terms Plane Radiographic cephalometry often refers to straight lines from the two dimensional world of x ray images as planes Planes are represented as lines because they are perpendicular to the radiograph and viewing them from the side makes one of their dimensions invisible Both terms plane and line will be used in this Manual Point Setting cephalometric points landmarks is the basic task of an analysis Measurement measurement is any determined property be it a distance angle or calculated value Layer Layers are used to group elements as required for example by properties When printing only elements included on the print layer are printed Analysis An analysis is the concrete processing of a patient s radiograph Results of analyses are measurements of correlations between hard and soft tissue and their comparison with standard values Results can be displayed on screen printed out or exported to Excel spreadsheet Analysis type analysis type is the computerized correlations between cephalometric points and plane
12. d Dann 0622010 rae Der M Bests Dehin 26 11 200 dm Image 98 Adding links Click the Add link button to return to the panel for linking analyses Just repeat the above procedure AX CEPH Users Guide Copyright 2010 Page 88 of 98 9 2 Superimposing Photo Image over Analysis Photo images can be viewed in profile that is as one dimensional lateral radiograph Hence it is impossible to expect that they will be a 100 match Add add an image click the Add picture button The window for adding image is opened Select it and then click Ok The image is then opened in a special window There you can observe two points First point Second point Move the First point to the position Subnasale and the Second point to the position under the chin Image 99 Moving the First and Second point After having set the points click the Save analysis and return button to retum to the window for superimposing Ax CEPH AxCEPH docx Copyright 2010 Page 89 of 98 Repeat the procedure lo superimpose photo image over analysis Then select two points the patient s soft tissue Note In case the first analysis does not include points otherwise included in the superim posed photo image select it from the tree and click the Change analysis button A window is opened where you can change elements at will They can be added and deleted All changes can be viewed in t
13. in one of the following two ways 1 Perpendicular plane through a given point First select a plane perpendicular to the existing plane and then just select a point through which the perpendicular plane should go 2 Custom perpendicular First select an existing plane and then click anywhere on the canvas to add the perpendicular In addition there are two special planes that is the horizontal and vertical plane You can move these two planes only translationally and their direction remains fixed That is regardless of the image rotation used You can use them in measurement and calculations like all other types of planes 6 2 3 Outline Silhouette Insert outlines to analysis types like any other feature Define outlines by selecting it in the tree clicking in the canvas and start creating the outline Additional clicks create new nodes of the outline Finish by double clicking You cannot connect outlines to other elements Change the shape of the created outline by dragging and dropping individual points or by deleting them delete any point by pressing lt CTRL gt click outline deleting an endpoint deletes the outline To move the outline translationally click anywhere between the endpoints and move it Change the label name description color or layer the same way as with other elements existing point cannot be an outline s node AX CEPH Users Guide Copyright 2010 Page 52 of 98 6 2 4 Teeth Outline T
14. includes elements used in creating analysis 2 The Print layer which is used to print an image of analysis In the dashboard set for individual element of the analysis type whether itis included in the analysis layer or print layer You can also select an element and right click it to display context menu which you can use to change layer settings On pint layer em uum Show text Rotate to ronal pentlayer Remove fom print layer Add to aralyss layer Delete analysis layer Delete Image 78 Change layer for individual element using dashboard or by right clicking Click Zl to manage layers A dropdown menu is opened where you can select the print or analysis layer You can also save the layer When saving layers you can store all visible elements to the selected layer This way you can immediately save the visible elements to the print layer and subsequently print them Users Guide Copyright 2010 Page 68 of 98 Trying to use the existing analysis type with new analysis all elements that visible in the analysis type will be visible here also That is why certain elements e g outline are visible but you cannot see it after setting it and opening the analysis layer Image 79 All elements used in analysis type elements required to create analysis elements on print layer 6 9 1 Analysis layer The analysis layer enables you to oin all required elements of the a
15. other hand clicking the bottom part opens a dropdown menu from which you can select the method for connecting a feature to other elements in the analysis type The features in the analysis type can have two statuses colored differently in the tree The newly inserted component is always undefined In contrast to the analysis the features cannot be colored green when creating analysis type because you cannot determine their precise position You can only set their initial position red element is included in the structure and is completely undefined The feature is inserted in the image status identified and it is in initial position To define the status and determine the initial element position select itin the tree and place it in the image Change the name and label of the element make the label visible or hide it by checking or unchecking Show in the Dashboard In addition you can enter a text description Desc of the element change its color and filing color and set layers You can also add a drawing of its position in the image All settings can be viewed in the editor which can be opened pressing lt F3 gt r Image 60 Geometric features Dashboard where you change various properties Users Guide Copyright 2010 Page 50 of 98 6 2 1 Point Click Point on the ribbon to add a point in the analysis type which you can then define as needed 1 To add
16. setting parameters for sharpening Selecting this iler opens new window According to how you set display options you can simultaneously view the original image marked with Before and the resulting image marked with After Of course you can display only the image which is the result of sharpening The same imaging functions are available as in the editor zoom move and navigator Use sliders to set the factor and radius and focus the image as best as possible It is recommended that you take care in setting these two parameters Warning Do not change the parameter Stand Dev By default itis set to values between 0 1 and 0 8 The radius is used to determine the size of the area for sharpening the greater the radius the greater the area calculated for sharpening Proceed by setting the factor to determine the sharpening magnitude To reset default values that is radius 00 click Reset After setting the values click Ok They are saved as default and wil be applied when running Sharpening again and factor AX CEPH Users Guide Copyright 2010 Page 34 of 98 4 2 4 Emboss A relief can be generated based on the color information in the image Increasing the radius raises the embossing height 4 2 5 Gray Level Correction Use gray level correction to set brightness and contrast of images without diminishing the quality of the original image The human eye can perceive around 40 different shades of gray On the other ha
17. the image so that it does not fit the window in such a case the Navigator is displayed you can move in it by left clicking the image holding down the button and moving to the desired position 4 5 2 Zoom to selection Selecting Zoom to selection maximizes the selected section of the image to screen size Mark the section you want to view with dotted rectangle and the rest is done automatically AX CEPH Users Guide Copyright 2010 Page 42 of 98 4 5 3 Choose object We have already dealt with the Choose object option but we have always selected only one object Sometimes you want to select multiple objects for example to delete them Place the pointer on the edge of the last object and left click it hold down the button and select all the other objects The selection is confirmed with black squares displayed on the edges 4 6 History 4 6 1 The history table The History table records all the fiters that have been applied The Region column displays whether the operation was performed on the entire image or only on a particular area If the operation is checked this means it was performed You can check the boxes or leave them unchecked The derived image is changed accordingly In order not to perform a certain operation uncheck it so that it will not be applied To completely remove specific operation mark it so that it is selected blue and click Delete filter or press Delete History Regon Operation
18. 010 Page 10 of 98 A given analysis type includes data about 1 geometry landmarks and planes and measurements 2 measurements and their correlations to standard values 3 printout and 4 template for exporting to Excel When making an analysis these are applied to concrete radiographs Making an analysis based a predefined analysis type is simple and involves the following steps 1 Preparing Data for Ihe Analysis a selecting x ray image b entering data about the patient his or her status analysis and x ray procedures c selecting analysis type 2 Identifying landmark points and outlines a correctly placing offered landmark points onto the radiograph b calibrating the image creating or editing outlines teeth hard and soft tissue 3 Printing and saving printing b exporting to Excel c sending by e mail d saving 3 2 Preparing Data for the Analysis 3 2 1 Selecting an X ray Image Start new analysis by clicking the New analysis button A dialog box opens where you locate and select the desired image Most standard image file types are supported JPG TIF GIF as well as single image DICOM files In the case of DICOM files the dialog offers you the option for extracting metadata the name of the patient when the x ray was taken so you don t need to enter manually Ax CEPH AxCEPH docx Copyright 2010 Page 11 of 98 Image 3 Opening an x ray image for the analysis
19. 3 2 2 Entering Data about the Patient His or Her Status Analys and X ray Procedures Data about the patient and the analysis are entered into the Dashboard in the bottom section of the program window The Dashboard changes according to the currently selected element in the tree or on the canvas Select the Data element for entering patient data 144 2010 Active picture jos Geomety vessrenerts Patient rave Geri Hars Sith 15 1877 yeas vesc ay date mame Patent ype Image 4 Dashboard of the Data element Ax CEPH Users Guide Copyright 2010 Page 12 of 98 Image 5 Data about the patient and the analysis Data can be entered and changed anytime during the analysis Ax CEPH AxCEPH docx Copyright 2010 Page 13 of 98 3 2 3 Selecting an Analysis Type Select a predefined analysis type by clicking the Add type button in the Dashboard New type of analysis Types of analy TO EBANG ANA i ANALTZA 20808454 ANALTZA 1 E OPSTA OMETRIISKA ANALIZA OP TA KEFALONETRIJSKA T2 D sah iue 120 Duta D zagreb sawon ageh Image 6 Dashboard section where the analysis type set and the analysis type selection dialog box In the analysis type selection dialog check the analysis type based on which
20. 90 quality which is suitable for sending by e mail due to its small size 2 Or lick Save 100 which is suitable for later printing Regardless of the option you use the image quality is sufficient for performing analyses AX CEPH Users Guide Copyright 2010 Page 44 of 98 5 Viewing Analyses Performed 5 1 Soft copy oun Erat aye anas 5 1 1 Opening an Analysis To open an existing analysis click the Open analysis button and select the analysis 5 1 2 Changing an Analysis In an open analysis the positioning of points and planes can be changed elements and measurements added and removed To save the analysis under the old the existing name click Save analysis But should you want to save the modified analysis under a new name or to keep it before applying changes click Save as and save the analysis under a different name The patient s name is offered by default 5 1 3 Send Analysis by E Mail Click to send the analysis by e mail An e mail message is opened Here you have to enter a recipient the subject and body of the message A file containing the analysis with all the required data is attached to the message 5 2 Hard copy Dee Bee Frnt export Ax CEPH AxCEPH docx Copyright 2010 Page 45 of 98 5 2 1 Print Click the Print bution to print an analysis preview window is opened where you cick il in the top left comer to print he
21. 98 3 3 ing and Saving 3 3 1 Printing Start printing by clicking the Print amp button Printed are analysis information x ray image analysis elements on the print layer and the measurements table The analysis is saved automatically before printing 3 3 2 Export to Excel ax Export the analysis to Excel by clicking the Excel 7 button Excel uses the template that comes with an analysis type The analysis is saved automatically before printing 3 3 3 Send by E Mail Send an analysis by e mail by clicking the e mail button The analysis is sent as a single file containing all information for the recipient to view and edit it 3 3 4 Saving a Save an analysis by clicking the Save Analysis 27 button The created file s name contains key information for example the file Jane_Doe_2_4_2008_1 acx tells us Jane Doe the patients name is Jane Doe 2 42008 the analysis was done on April 2 2008 1 this is the patient s first analysis on that day Ax CEPH Users Guide Copyright 2010 Page 28 of 98 4 Digital Filters in Image Processing any time during the analysis you can use digital filters to process the image and improve its diagnostic value That is make it darker lighter use specially designed filters for highlighting soft tissue etc Use Ax CEPH to store images as derived images Click the Edit button in the Image group of the command ribbon to run the editor window IES zoom T
22. 98 Welcome to the AxCeph Setup Wizard Image 103 Setup wizard Please read the warning and afler reading it proceed by clicking the Next button You can terminate the process by clicking Cancel anytime during the setup agreement pee ou nt scent he tema ft OER srg PE Teena lo moaunaxdoa leonraNT NOTICE Ax CEP Sofware isine copyint ot auoax o audas whose principal laecfeusmessis s Orate poe Cmm Dum Image 104 Customer End User License Agreement for A Licensing Agreement is displayed Please read the agreement carefully you agree with what you have read select accept the agreement and click the Next button Ax CEPH AxCEPH docx Copyright 2010 Page 95 of 98 DE puse ica teneis torte Image 105 Setting application folder and group name in Start menu Proceed by specifying the application folder and group name in Start menu You can also create shortcut view setup summary and finally click Install to begin installing 11 2 Unlocking Application Features Having installed the application you have to enter the product key Otherwise you can only use it to view analyses and superimposed images You can change the existing documents Plus add new elements and save them However you cannot create new documents After having purchased the application you first have to install it on the computer
23. ERS PRINTOUT CUSTOMIZATION EXPORT MS EXCEL CREATE AN EXCEL TEMPLATE SAVING ANALYSIS TYPES 7 CREATING ANALYSIS TYPE FROM PREVIOUSLY STORED TYPE 8 CREATING ANALYSIS TYPE USING PREDEFINED ELEMENTS 9 SUPERIMPOSITION 92 93 94 95 96 10 104 102 103 11 2 SuPERINPOSING ANALYSIS OVER ANALYSIS SuPERINPOSING PHOTO IMAGE OVER ANALYSIS DISPLAY TooLs TOOLS FOR SETTING POINTS MANUALLY EXPORT PICTURE ANALYSIS AND SUPERIMPOSITION RELATION ABOUT PANEL LANGUAGE DISPLAYING APPLICATION DATA ENTERING A PRODUCT KEY AX CEPH SETUP APPLICATION SETUP UNLOCKING APPLICATION FEATURES 66 er 68 70 73 74 79 80 81 85 89 90 90 92 92 93 93 98 98 94 94 96 Ax CEPH Users Guide Copyright 2010 Page 4 of 98 1 About this guide This document is divided into the following chapters Chapter 1 About this guide Chapter 2 Introduction introduces our Ax CEPH software Chapter 3 Making analyses based on predefined analysis types explains how to get started Chapter 4 Digital filters in image processing describes filters and methods for digitaly enhancing x ray images Chapter 5 Viewing analyses performed Chapter 6 Creating a custom analysis type introduces tools to make any analysis type Chapter 7 Creating analysis type from previously stored type explains how to shorten a new analysis type development by using exi
24. INFORMATION IN THE IMAGE MIGHT BE LOST 4 2 Filters The Filters section contains a selection of digital image processing tools Apply them to the whole image or just to selected area To only change a selected area click ROI region of interes in the Show menu that is place the pointer in the top left comer of the selected area drag itto the bottom right comer and release the button You can resize and move the selected area after applying specific filters The fiters and area get recorded in the History table in consecutive order um Median F2 Softening F3 Sharpening F4 Emboss 5 Gray evel Sof F7 Image 37 Filters The data contained in the History table is important since filters are applied consecutively The filter commands are assigned the following function keys except for the Negative option from lt F2 gt to FT 4 2 1 Median Deletes irregular points which deviate from the image Ifa bright dot appears inside a dark field an error during image capture must have occurred Using the filter removes such errors 4 2 2 Softening Use Softening to remove blurred edges between objects in the image 4 2 3 Sharpening Use Sharpening to emphasize borders between bright and dark areas in the image For example sharpen the image in order to highlight the bone structure Ax CEPH AxCEPH docx Copyright 2010 Page 33 of 98 Image 38 Window for
25. PH docx Copyright 2010 Page 47 of 98 6 1 How to start To create a new analysis type first select the Analysis type tab above the tools banner and click New type A new window is opened where you enter the name of the new analysis sta an A CE MAA HEI t t Image 57 Entering name of new analysis type Enter the name of the new analysis and confirm it by clicking Ok A generic window for creating new and phantom analysis is opened Swilch views by clicking Choose phantom picture Ax CEPH Users Guide Copyright 2010 Page 48 of 98 Image 58 Basic analysis type window Clicking the first item in tree item 1 in the image above opens the Dashboard where you change the name of the analysis type 2 and add the existing type to a new analysis type 3 The date can also be inserted 6 2 Geometric Features Geometric features consist of primitives such as points planes and outlines They appear as independent elements or are related to other geometric features e g a point lies on the line Add these features to the analysis type using the following commands that can be found in the Tools group in the command ribbon Ax CEPH AxCEPH docx Copyright 2010 Page 49 of 98 d dese Poit Pare Teeth Cognitive features Image 59 Inserting geometric features Some buttons consist of two parts Click the upper part to add individual features On the
26. alysis for superimposition Ax CEPH AxCEPH docx Copyright 2010 Page 85 of 98 9 1 3 Selecting Additional Analyses add new analyses click the Add analysis button A window is opened see image 3 Proceed by selecting an analysis and superimpose it over the one which is being currently opened Image 94 Selecting an analysis The two analyses are displayed side by side The first one is on the left the last one on the right Analyses are added one by one It is recommended that you superimpose each added analysis as you go along to keep things organized The colors are preset But you can change them at will The first analysis is red the next one green sky blue purple etc Users Guide Copyright 2010 Page 86 of 98 9 1 4 Linking up Analyses Select an analysis in tree structure view to superimpose it over the first analysis Image 95 inking up analyses Click the Create link button in the dashboard and the linked fields will color yellow Image 96 Setting up linking constraints The elements of the first analysis are linked up with the elements of the dependent analysis Ax CEPH AxCEPH docx Copyright 2010 Page 87 of 98 Click the Assemble button to superimpose analysis over analysis You can rename the new superimposed image at will Image 97 Renaming link You can create any number of superimposed images
27. analysis The patient s radiograph can be found on the left hand side of the printout Any additional graphical elements of the analysis can on the other hand be found top right The bottom section displays analysis results organized in columns Click Prepare report to edit displayed results and order them into lists For more information on editing printouts see follow up topic on how to create analysis type Begin Paes Bernice Haus F 22 po 1242010 Gule tanayeta 1442010 Norm Difference Bias SAGITALNT RELATIONS angke sua 7427 Te D EEG 7124 85 00 anole ANE 297 200 037 c wes 174 050 FI ZE EEE ax Image 55 Analysis printout Users Guide Copyright 2010 Page 46 of 98 6 Creating a Custom Analysis Create an analysis type in one of the following three ways 1 by modifying an existing type 2 using predefined elements 3 from scratch Analysis type Putting together a mechanism Scratch Naming and description of elements Equiping elements with thumbnails Defining layers analysis Predefined print Defining printouts Defining exports Connecting measurements with standard values elements Image 56 Ways of creating a new analysis type Ax CEPH AxCE
28. ck Image 51 Line with annotation Whenever you want to make changes to annotation or symbols you have to select it first Hover with the pointer over the item 2 and right click it Then select Settings A window for modifying settings is opened Set the parameters accordingly and click To move the line you first have to select it Place the pointer on item 1 and left click it and hold down Drag it to the desired position Do the same with item 2 move the entire object place the pointer on one of the items so that the pointer changes to a crosshairs Then left lick hold down and move it to the desired location Delete the line the same way as the text Ax CEPH AxCEPH docx Copyright 2010 Page 41 of 98 4 4 3 Memo This option is different from the Annotation option because it lets you enter multiple lines to the note Plus by default the color of the frame is different than the color of the text Otherwise all the operations are lke the ones mentioned above see Annotation The only difference is in how you insert or change text 44 4 and Square To mark the area more easily use lines and rectangles They can be used like all other objects Plus you can change color and line width 4 5 Interactions We have already dealt with some of the options offered in the Interactions menu 4 nove Zoom to selection Choose object Image 52 Line with annotation 4 5 1 Move Having resized
29. covers cells from A1 left corner to D14 bottom right corner Mark them Ax CEPH AxCEPH docx Copyright 2010 Page 75 of 98 8 Image 85 of the radiograph to the Analysis worksheet Rightclick outside the image and somewhere inside the marked fields area for example on the red x point in the Image 86 Use Copy from the pop down menu Select the Analysis layer and choose appropriate fiel for pasting Paste the copy by using Paste gt As Picture gt Paste Picture Link Changing anything inside A1 to 014 area will reflect in this inked copy This is more like a dynamically changing snapshot of A1 to D14 area You may do the same with analysis image 62 14 Measurements You can copy other measurement values that is standard values names plus patient information and examination data date the radiograph was made analysis date Copy exported values in the following way Select a cell in the Analysis worksheet and enler the equals sign Then select for example the Patient worksheet select the desired data and press Enter The cell value in the Analysis worksheet is atientlA2 if you copied the patient s name Edit the exported values at will That is change font use them in calculations etc This is beyond the scope of these instructions Users Guide Copyright 2010 Page 76 of 98 own E Image 87 Copying patient s name to the Analysis works
30. d optional items Angle brackets gt surround keyboard user supplied values Pipe symbol separates mutually exclusive values for an argument Ax CEPH Users Guide Copyright 2010 Page 6 of 98 2 Introduction 2 1 Purpose Analyzing cephalometric x ray image is a part of diagnostic procedures in jaw and dental orthopedics In addition dentists can use it to determine a toothless patient s occlusal plane It is based on a transilluminated radiograph of the head onto which landmark points and lines planes placed Based on the measurement between landmark points in hard and soft tissue are prepared tables and diagrams containing deviations from values that are normal for teeth in given age or race There are several analyses and analysis interpretations available by authors like Ricketts Downs Steiner Segner and others Besides standard analyses dentists orthodontists surgeons can make additional ones This makes it easier for them to formalize irregularities define virtual planes or set a course of treatment Considering the diversity of cases and the time used computer software can greatly aid specialists in making routine but critical calculations in analyses is a program that enables you to integrate your specialist knowledge into the computer and reuse it in cephalometric X ray image analysis The program allows users to make their own analysis types or make additional measurements in a given
31. e other hand click the bottom part to select a template if more than one is available A template can be included in each analysis type Analysis data get exported to three Excel worksheets that is Measurements Image and Patient The Measurements worksheet includes measurements together with calculations set in the Print customisation window Here are also included additional and standard data on measurements The Image worksheet includes the radiograph and print layer The Patient worksheet includes patient information 3 Poi LATIONS P 2 Kat i tease i Image 83 Worksheets image top left patient top right and measurements in the bottom Ax CEPH AxCEPH docx Copyright 2010 Page 73 of 98 6 12 Create an Excel Template To create a template click the export button Excel opens displaying the following three worksheets Measurement Image and Patient The Measurements worksheet lists the following measurements in the order you defined in the Printout customization window Group Name Value Normal value Difference Bias ValueS Measure unit Std deviation The Measurements worksheet lists the following columns in the order you defined in the Printout customization window Patient s name Patient s birthday Date of image Sex Status Age Date of analysis The Image worksheet includes the following the radiograph and image of analysis Finally save
32. e the size color or font of the text you first have to select it if the field is not selected use the command Choose object in the Interactions menu Then right click the text box to open the menu where you can select Settings mmal Audax Image 48 Window for editing annotation new window opens where you can set the style font color size etc The line width is the width of the frame Here you can also change the text at wil Image 49 Content does not fit frame When the text does not fit the frame or the frame is too big resize the frame accordingly That is select it lefi click the annotation having first selected Choose object in the Interactions menu move the black squares to fit accordingly You can also move the selected text AX CEPH Users Guide Copyright 2010 Page 40 of 98 Image 50 Expanded frame To remove annotation you have to select it first Then right click it and select the Delete option You can also delete it by pressing lt Delete gt 44 2 with annotation To inserta line with annotation in the derived image select Line with annotation from the menu Left click the image and hold down see item 1 in the image and then drag the line to the designated position see item 2 On releasing the mouse button a new window is opened Here can edit annotation the same options are available as when editing text Add any text to the field and cli
33. e you can enter the name of new analysis type Click Ok to save it Ax CEPH AxCEPH docx Copyright 2010 Page 79 of 98 7 Creating Analysis from Previously Stored Type When creating analysis type you can add existing types This way you can use predefined types and create new analysis types more easily L Soft sese Soft_tissue_t 2cx D zagreb az MOD 2 MOD Image 89 Using already stored analysis type to create a new New analysis type will be a copy of the chosen one from the list Users Guide Copyright 2010 Page 80 of 98 8 Creating Analysis Type Using Predefined Elements 8 1 1 Using Predefined elements Use predefined elements to create analysis types more easily Here you can use geometric features defined in the Ax CEPH library Image 90 Window with predefined elements Ax CEPH AxCEPH docx Copyright 2010 Page 81 of 98 The window is divided into three sections In the middle section you can find predefined elements There three panels from which you can select Measurement Points and Planes Use the filter to narrow down your search Or click 21 100 display predefined elements in panels see above or in rows See the left hand side to view a specific element s details You can change them but take care since the actions cannot be undone See the right hand side to view elements included in the analysis type They are di
34. ferent characteristics different colors By default point on a line is cream colored its label and outline are olive green Existence of such point depends on the existence of the line it is on If the line which is in that case a parent is deleted the point is also deleted because itis the line s child If he line is moved the point on it is moved also 3 2 7 3 Point at the Intersection of Lines Ping Point Image 11 A point at the intersection of two lines A point that is on a line is distinguished by its color By default a point at the intersection of lines is cream colored its label and outline are dark grey Existence of such a point depends on the existence of two intersecting lines If the intersecting lines which are in that case parents are Ax CEPH AxCEPH docx Copyright 2010 Page 17 of 98 deleted the point is also deleted because it is the lines child Moving any of the lines moves the point to the new intersection Note Lines are infinite in length in both directions But they are displayed as line segments with small extensions at both endpoints The intersection of two lines can therefore be outside the displayed line segments pane Point Image 12 A point at the implied intersection of two lines Plane 1 and Plane 2 3 2 8 Moving a Line Plane Moving a line behaves differently according to the relation of a point to other geometric elements 3 2 8 1 Single Line
35. he Superimposition window 9 3 Using Display Tools You can set specific settings for each analysis individually To do this use the Settings section of the dashboard Image 100 Moving the First and Second point Here you can set color transparency levels and check whether the analysis will shown or not 9 4 Tools for Setting Points Manually The analysis or photo image can be positioned manually This way you can match them with more precision Users Guide Copyright 2010 Page 90 of 98 Image 101 Moving analysis or photo image 9 4 1 Translation First select the analysis or photo image on the canvas and move it anywhere on the screen holding down the left mouse button 9 4 2 Rotation Or move it by clicking the green crosshairs by the First point all the time holding down the left mouse key The analysis or image will be rotated around the First point Reset reset values of the analysis or image click the Reset button which can be found in the Link box in the dashboard AxCEPH docx Copyright 2010 Page 91 of 98 9 5 Export Picture Export mere Prnt You can export the superimposed image by clicking the Export picture button 9 6 Analysis and Superimposition Relation Any changes made to the analysis can be observed in the corresponding superimposed image This means were you to move the linking points the interrelated p
36. heet Do the same to copy for example names of measurements measurement values etc At this point it is wise to save the template That is why you should delete all data in Measurements Images and Patient worksheets Leave the Analysis worksheet as is Proceed by saving the template Click a button to select template and save analysis type as lt Note You need to save a template as template file format xit Leave Excel and load the saved excel template using Choose template button Note In order to make the template file smaller and faster to load you should delete both images from Image worksheet before saving Note We recommend to choose Analysis worksheet before saving so that it will open on export Ax CEPH AxCEPH docx Copyright 2010 Page 77 of 98 Wes Mes c E Box zara taw FANDIST S3 120514311 RETRUSION FANDI ASP GI PROTRUSION AN stb POTEN RENO Image 88 A part of a final Excel template Ax CEPH Users Guide Copyright 2010 Page 78 of 98 6 13 Saving analysis types Saveas Sve Analysis type Click Save type button to save the analysis type under the name you specified before creating iL Of course you can click Save as button to change name at will Clicking Save as opens window wher
37. i add a tooth outline into an analysis type select it from the Teeth dropdown There are four predefined teeth outlines available that is upper and lower incisor and upper first and lower first molar In contrast to other features these outlines are predefined and are set in the default position Plus a tooth outline consists of three components that is two points and outline The outline is in child relation to the two points thus deleting a point deletes the outline as well OBS Image 61 of tooth outline tooth in default position in analysis interactive points of tooth outline Change the position of a tooth outline by moving point 1 and point 2 the top and bottom arrows in image 64 image on the right Change the width by moving the blue squares which are displayed after you click the outline Change the name label description color and layers of visibility of a tooth as for all the other elements Ax CEPH AxCEPH docx Copyright 2010 Page 53 of 98 You cannot connect a tooth outline to any other element But you can connect all other elements to the points in the outline Image 62 Line is connected to the apical point and incision inferius line 1 with analysis type MF UNI LJ 6 3 Measurements Use the application to measure distances and angles between geometric features included in the analysis Inserting measurements in an analysis type creates predefined sels of analysis types The measureme
38. lt by clicking Image 73 Tree and analysis type for determining angles SNA SNB and ANB 6 5 An example of how to measure WITS appraisal For example let us add WITS APPRAISAL to the previously created analysis type Image 74 Wits appraisal AX CEPH Users Guide Copyright 2010 Page 62 of 98 Wits appraisal is the distance between two planes perpendicular to the occlusal plane One of the perpendicular planes goes through a given point A the other through point B The appraisal be assigned positive or negative value In case that can be observed above the value is negative Should the plane going through point A go through point B which is to the right the value would be positive Follow steps The analysis includes points A and B 2 Click Plane and set itin direction of the occlusal plane as shown the image Image 74 Wits appraisal Enter the name Ocp 3 Click Point and set it on the occlusal plane 4 Enter the name PntWits 5 Set planes perpendicular to the plane Ocp through given points A and B 6 Enter names A PIn Wits and B Pin Wits 7 Then create two distance measurements Ax CEPH AxCEPH docx Copyright 2010 Page 63 of 98 b from point PntWits to plane A Pin Wits and enter the name from point PntWils to plane B Pin Wits and enter the name wb 9 Proceed by entering a name label unit of measurement and equation as stated below
39. nalysis When creating analyses the group is visible but all the other elements are hidden By default no component in the analysis type is included in the analysis layer Hence it is recommended to add all elements that must be visible during the analysis to the analysis layer 6 9 2 Print Layer The print layer enables you to join all elements required for printing an analysis To subsequently print the element it has to be included in the print layer To make elements visible add them on the print layer when creating the analysis type Outlines are by default included on the print layer Ax CEPH AxCEPH docx Copyright 2010 Page 69 of 98 6 10 Printout customization Frint export Click Print customize button to open the Print customisation window On the left you can view all the measurements included in Ihe analysis type and on the right there is a box for editing groups In the bottom section there is a box with data which will be grouped together Image 80 Print customisation and groups windows The Groups box is empty when creating the analysis type Clicking 4 opens a window for editing groups Add new group by clicking F and delete a group by clicking Change the existing group with Before printing do the following First click to add a group Then add measurements to the group Proceed by entering a new group and add measurements Users Guide Copyright 2010 Page 70 of 98
40. nd the computer can display 256 shades of gray 8 bits 28256 In addition you can print them onto transparencies The medical image is comprised of 12 bit pieces of information Hence the image contains 4096 shades of grey 21224096 The computer displays batches of 16 bit grayscale data as one Internally the image is still 12 bit That is why you can retrieve the quality of the original image by additional transformation of the derived image Image 39 Preview window for gray level correction Ax CEPH AxCEPH docx Copyright 2010 Page 35 of 98 Clicking Gray level or pressing lt F6 gt displays a window where you can change parameters accordingly The bottom section displays two charts The left hand side chart represents the gray level of the input image The right hand one represents the output image Move the slider under the input image chart to set the desired gray level Image 40 Parameters for correcting gray levels Move the red handle to the left to make the image brighter and move it to the right to make it darker Move the green handle to expand or shrink the range Only the range between the green and blue handle will be used Note Moving these handles to the middle range results in the loss of information however it will result in changing contrast and brightness of an image Image 41 Example of setting contrast Note Gray level correction is o
41. ndicular Lines Image 17 Moving a perpendicular line perpendicular line is colored brown The perpendicular of a selected line turns purple Move it by clicking anywhere between the endpoints and drag it around In the special case when the position of a perpendicular is limited with a point you can move the perpendicular by moving the point Ax CEPH Users Guide Copyright 2010 Page 20 of 98 3 2 8 5 Parallel lines Image 18 Moving a parallel line parallel line is colored brown The parallel of a selected line turns purple Move it by clicking anywhere between the endpoints and drag it around In the special case when the position of a parallel line is defined with a point you can move the parallel by moving the point 3 2 8 6 Verticals and horizontals Verticals and horizontals are special lines that are always vertical or horizontal respectively matter how the image is rotated Move such lines by clicking anywhere between their endpoints drag them to the desired position 3 2 9 Image Calibration Image calibration is a procedure whereby the length of and distance between objects is determined based on the known length of any element An x ray image usually contains a ruler next to the forehead the Calibration element has a circle icon in the tree od LE Image 19 The Calibration element and the ruler Ax CEPH AxCEPH docx Copyright 2010 Page 21 of 98 Image calibration starts b
42. ne of the most important operations Users Guide Copyright 2010 Page 36 of 98 4 2 6 Soft Tissue Cephalometric images are usually quite bright due to transillumination of the head Use the Gray level filter to make them darker This way you lose the information on soft tissues which may be crucial in diagnostics planning etc Hence determine the area in the nose let us say it covers a fifth of the image on the right hand side where the soft tissue filter will be applied Then select Soft tissue to apply it in the selected area You can repeat the procedure until you get the right results normally repeating it twice should do it Step by step preparation of cephalometric image 1 Use Gray level for darker sections of the image to display hard tissue properly 2 Then mark the area see the next section to apply the filler 3 Select the Soft issue filler or press F7 Repeat the procedure until you get a suitable result Image 42 Using soft tissue filter in grayscale from black to white Set the ROI area to apply Soft tissue operation between the two lines see above Ax CEPH AxCEPH docx Copyright 2010 Page 37 of 98 4 3 Show The Show menu offers two functions Use them to specify the area where an operation will be used or for highlighting grays with a different color ROL seudo color Image 43 Show menu 4 3 1 ROI region of interest an area by clicking the to
43. ning Colors A red element is included in the structure and is completely undefined A yellow element is included in the structure it identifies a feature but it is in the initial position A green element is defined and moved to the designated position Icons point measurement length amp measurement angle i outline 2 measurement calculation grey icon background e g means that the element is currently hidden 3 2 7 Moving a Point Moving a point behaves differently according to the relation of a point to other geometric elements 3 2 7 1 Single point wee ye eee LAS ar d ur Image 8 Selecting a point A single point is one that is not bound to any other geometric element like a line It can be moved freely in any direction First select the point place the mouse pointer on it to highlight it then left click then drag it to the desired position Users Guide Copyright 2010 Page 16 of 98 Image 9 Moving a point to a new position Select point by clicking it directly see Error Reference source not found or alternatively nd often more practical click the points label see Image 9b then drag it to the desired position 3 2 7 2 Point on a Line pare aint Image 10 Moving a point on a line to a new position point that is on a line is distinguished by its color It is good practice to give elements of the same type but with dif
44. nstallation has completed successfully if Analysis type tab appears in the ribbon Note Please verify the product key when the installation falls It should end in Ax CEPH Users Guide Copyright 2010 Page 98 of 98
45. nt functions like a geometric feature that is you can change its label add a description and image Plus you can determine the layers of visibility and change colors On the other hand you can also hide measurement and only use it in calculation or printout Abiane Abode Messuenents Image 63 Entering a new measurement Every measurement that is distance or angle measurement can have two statuses Each measurement is undefined when newly added The measurement was inserted in the structure and has undefined status 5 Eid The measurement was inserted in the structure and has defined status AX CEPH Users Guide Copyright 2010 Page 54 of 98 6 3 1 Distance Distance measurement can be determined as existing between two points between a point and plane and between two planes 1 Distance between two points Click Distance and measure the distance between two points on the canvas 2 Distance between a point and a plane Click Distance and measure the distance between a plane and point on the canvas The order of selection does not matter You have obtained a perpendicular distance that is the shortest distance between the point and line 3 Distance between two planes Click Distance and measure the distance between two planes on the canvas 3 PET Ng n Point Image 64 Distance between point and plane distance between two points distance between parallel
46. ositions of the superimposed analysis will change as well You can make changes to the analysis in these two ways Change analysis in the Analysis panel save it to disk and then open the corresponding superimposition containing the analysis hange analysis You can also change analysis by clicking the Change analysis button in the Superimposition panel A window is opened where you can make according changes to the analysis x Save analysis Caneel andicum Analysis superimposition To accept the changes you made and return to the previous window click the Save analysis return button Otherwise click Cancel Having deleted the linking points by mistake the original analysis version will be kept Ax CEPH Users Guide Copyright 2010 Page 92 of 98 10 About panel In this panel you can set and view the following language application data and license data 10 1 Language Set language using a dropdown menu Set language and the menu and reports will be changed accordingly 10 2 Displaying Application Data CEPH is the copyright of AUDAX d o o the head office of which is located at Tehnolo ki park 18 SI 1000 Ljubljana Slovenia Audax d o o Tehnoloski park 18 Ljubljana SI 1000 Telephone 00 386 1 200 40 50 Fax 00 386 1 423 47 00 www axceph com 10 3 Entering a Product Key Use Ax CEPH to view the out of the box analyses or create new ones To create new analyses analysis
47. p left corner of the area and drag the pointer to the bottom right comer Then release the button Image 44 Area ROI Region Of Interest You can modify the area when black squares are displayed in corners and in the middle Drag and drop the squares to resize it at will 4 3 2 Pseudo color Use this function to display any grayscale image using red green and blue Users Guide Copyright 2010 Page 38 of 98 Image 45 Window for setting pseudo colors Changing the amount of red green and blue in turn changes the color scheme of the derived image on screen After finishing and closing the window the image is changed back to grayscale that is itis returned to the original version before having used Pseudo color function Images where pseudo colors have been applied cannot be stored as derived images 4 4 Annotations symbols You can insert annotations to the image That is graphical symbols text or their combination ek Line with annotation Line Suare Memo Image 46 Annotations and symbols 4 4 1 Annotation Ax CEPH AxCEPH docx Copyright 2010 Page 39 of 98 Select Annotation from the Annot symbols menu Hover over the image and left click thus selecting the area where you can enter text You can change the annotation at any time that is change the content font color positioning Having entered the text press Enter Image 47 Inserting annotation To chang
48. planes sud 6 3 2 Angle Angle measurement can be determined between three points or between two planes Ax CEPH AxCEPH docx Copyright 2010 Page 55 of 98 1 Angles are determined by three points Here the order of seleclion is important The first point determines the first ray the second point determines the apex and the third determines the second ray fou EC Image 65 Order of setting points must be observed On the left hand side we selected Kt Apex K2 and on the right hand side we selected K2 Apex K1 2 The angle can be determined by two planes p1 p2 That is first click plane 1 p1 and then the second one p2 Image 66 Setting adjacent angle The lines intersect each other so that two adjacent angles a and exist The following calculation 180 can be used You need not recalculate by simply selecting the corresponding adjacent angle holding down lt CTRL gt and clicking the adjacent angle Regardless of how you defined the angle it always consists of child elements that define it Deleting them results in deleting the measurement 6 3 3 Calculated values Clicking Calculated values opens a window for creating calculations AX CEPH Users Guide Copyright 2010 Page 56 of 98 ume arent aralas Mose n tes Prenas Ho etre n pud ge e fou ane pred Cretae Image 67 Calculation window
49. ransparency Image 30 Edit button Switch between displaying derived and original images at will To do so select them in the tree The Active image element shows the currenlly displayed image Bam sere ter ere Haman 15 ten ipo 18 41 p Ax CEPH AxCEPH docx Copyright 2010 Page 29 of 98 F mines e Image 32 Editor window for editing diagnostic values 4 1 Image manipulations and displaying The Editor provides tools for resizing flipping and rotating images DIEI emm de em ien Image 33 Display editing tools Users Guide Copyright 2010 Page 30 of 98 H Layout of the derived image Two mage layout The original image is displayed on top the derived image at the bottom This option is especially useful for digital panoramic dental x rays that is comparing the derived image with the original Two image layout The original image on the left the derived image on the right This option is useful for intra oral x ray images comparing the same area in the derived image and the original Resize image to fit window Show full sized image Flip image horizontally Flip image vertically Rotate image 90 degrees counterclockwise Rotate image 90 degrees clockwise Set custom zoom Preset values available are 50 70 100 200 and 500 You can type in any value
50. re about tooth positioning in the follow up in chapters about creating analysis types 3 2 10 2 Hard and soft tissue Other structures can be marked by manually creating outlines with the Outline F tool Image 24 Click to place the outline s nodes Ax CEPH AxCEPH docx Copyright 2010 Page 23 of 98 Right click where you want to start the outline then click around the structure you wish to outline Double click to finish the outline Image 25 Selected and deselected outline An outline can be edited 1 by clicking and dragging nodes or 2 by deleting nodes hold the Ctrl key and click a node Deleting any of the two end nodes will delete the whole outline All outlines are by default on the print layer and therefore appear on the printout Remove them by using the editing tools 3 2 11 Zoom Window The Zoom window can be opened or closed if it is open by pressing the F2 key It can be resized and moved around The program remembers the last used size and position of the Zoom window The Zoom window displays a magnified view around the mouse pointer No elements are displayed in the zoom view Users Guide Copyright 2010 Page 24 of 98 Image 26 The Zoom window when moving a point When moving a point the Zoom window displays a crosshairs marking the center of a point even if the label was selected Click the Negative button to display the vicinity of the crosshairs negati
51. s cephalometric measurements in comparison with standard values and a specific method of displaying results Examples are Downs Analysis Ricketts Analysis Steiner Analysis etc Users Guide Copyright 2010 Page 8 of 98 2 3 Program Window Layout The program screen is divided into a number of areas Image 1 Ax CEPH program window layout The Command Ribbon changes according to the type of task making analyses designing analysis types superposing images View Icons allow hiding or revealing single types of primitives in the image The Model Tree provides easy browsing of the primitives in the analysis The Splitter allows resizing the canvas at the expense of the tree and vice versa The Canvas contains the image and the analysis primitives The Dashboard contains information about and settings of the currently selected element Ax CEPH AxCEPH docx Copyright 2010 Page 9 of 98 3 Making Analyses Based on Predefined Analysis Type Making an analysis applies the knowledge that is contained in analysis type Most users will be using only this feature of Ax CEPH 3 1 Workflow xRay picture Patient data Choose analysis type Saved analysis types Raw analysis Locating landmarks Finished analysis uve analysis Image 2 Flowchart for making an analysis Users Guide Copyright 2
52. see Application Setup After installation you can observe the following tabs Analysis Superimposition and About license data Then select the About tab and License data A window is opened including the following two tabs 1 Personal data 2 License Users Guide Copyright 2010 Page 96 of 98 oy fet TE Ri pd Image 106 Generate unique key Open the Personal data panel and enter your name in the Name field e g Bernard Shield Doctor of Medical Dentistry That is here you supply name of license owner which can be company or individual Click the Generate unique key button to obtain computer specific data string in the Key field Then copy paste to e mail and send the license to Code department of Audax Based on the type of license you purchased you will receive a corresponding activation key Image 107 An email from Ax CEPH code department with the activation key Ax CEPH AxCEPH docx Copyright 2010 Page 97 of 98 and paste the returned key in the license dialog Unlock the application To activate ful functionality you have to click the Unlock the application button The top box in the window displays user and license validity information T ey sistere qp t Image 108 Entering product key for enabling full functionality Quit and reopen it The i
53. splayed in separate panels insert a new feature into the analysis type first select it in the predefined elements window click to add it On the other hand click to remove it from the analysis type Adding more complex features or measurements adds its constituent elements as well That is why when for example adding Wits appraisal three points an occlusal plane and two auxiliary planes get added as well f Acd elements Click Add elements button to add all selected elements into the analysis type These elements be applied in the same way as the ones added manually The only difference is that their values are preset name label picture description You can repeat the procedure of adding as many times you need 8 1 2 How to store elements to the Predefined database Hl Seve weis Each newly created element can be stored into the Predefined database by using Save to predefined button which is placed on the Details box in the elements dashboard Ax CEPH Users Guide Copyright 2010 Page 82 of 98 Click Save to predefined after manually specifying the element that is after placing itin the image entering description name label and image Should you choose to save a more complex element or measurement also all its constituent elements that have not been saved predefined will be saved After saving Save to predefined button changes into Update predefined element button It
54. sting type and changing iL Chapter 8 Creating analysis type from previously stored type explains how to shorten a new analysis type development by using predefined measurements from the database Chapter 9 Superimosition explains how to place analysis over analysis or photography over analysis Chapter 10 About panel explains additional features for software setup Chapter 11 Ax CEPH setup explains how to install the Ax CEPH software and enter Ihe key to unlock additional functionalities Ax CEPH AxCEPH docx Copyright 2010 Page 5 of 98 1 1 Who Should Use It This guide is intended for users of different degrees of knowledge and experience with the software Users The users who will use Ax CEPH as a routine tool Advanced users The users who will develop their own analysis types Researches The developers who will use Ax CEPH as a research tool This guide assumes that you have some knowledge of the Windows operating 1 2 Typographical Conventions This document uses the following typographical conventions Command and option names appear in bold type in definitions and examples The names of directories files machines partitions and volumes also appear in bold Variable information appears in italic type This includes user supplied information command lines In addition the following symbols appear in command syntax definitions Square brackets surroun
55. the template taking care to set the template type that is format format is not supported Quit MS Excel Now you can use all the available options the template offers Let us take a closer look at the following example 6 12 1 Example 1 6124 1 Starting a new template Open an analysis in the selected type and export data into the template The open Excel fle has three worksheets containing exported data 1 Measurements where all measurements are exported according to the print customization Image where the X ray image and analysis image are exported Patient where the patient data is exported Ax CEPH Users Guide Copyright 2010 Page 74 of 98 6 1212 Adding a new worksheet Add new worksheet Shift F11 and rename it to Analysis You may use the Insert Worksheet button to insere a new worksheet Patient S insert Worksheet Move or Copy code Protec sheet eb Color Hide Select ll Sheets Image 84 Inserting a new list when creating template renaming worksheet to Analysis optional Rightclick on a new sheet tab and rename it to Analysis Drag the Analysis worksheet to the first position you may leave it where it is as well 6 1213 Image To display the patient s radiograph and print layer in the Analysis worksheet do the following Select cells of the image in the Image worksheet or delete the image to make selecting easier The radiograph
56. type 6 4 1 Choose phantom picture a Las Image 69 Choose phantom picture display a lateral view of the phantom image click Choose phantom picture 6 4 2 Position landmarks First set four single points Ax CEPH AxCEPH docx Copyright 2010 Page 59 of 98 Image 70 Setting points S N A and B Then rename them to 5 A and B do so use the Dashboard Sella Turcica Nasion Point A Point B 5 N A B 6 4 3 Create planes Connect points SN NA and NB to create planes Image 71 Setting angles SNA and SNB Users Guide Copyright 2010 Page 60 of 98 6 4 4 Create dimensions Set two angles between the created planes that is between SN and NAM and between SN and NB To select adjacent angles use Ctrl and click the corresponding adjacent angle Enter names for measurements SNA and ZSNB 6 4 5 Calculated dimensions Enter a mathematical expression to calculate a new measurement which equals the difference between angle measurements ANB SNA SNB Image 72 Angle measurement ANB First enter a name and label plus the unit of measurement Calculate in the following way Ax CEPH AxCEPH docx Copyright 2010 Page 61 of 98 Select SNA Double click it or click gt to move it to the right hand side box Click the operator minus Select SNB Double click it or click gt to move it to the right hand side box Confirm the resu
57. types and superimpose images and analyses you need to have a licensed product key The latter is computer specific and cannot be transferred You can receive a time restrcted or no restricion key For detailed treatment of the setup process see the follow up chapter on how to install the application Ax CEPH AxCEPH docx Copyright 2010 Page 93 of 98 11 Ax CEPH Setup CEPH application setup can be done in two steps First you have to install the application on the computer from CD or by running a setup file that can be downloaded from the website Then you have to unlock the application to make it fully functional 11 1 Application Setup You can download the setup file from the website www axceph com There are two versions available the demo and full version Using the demo version you cannot create new documents However it includes some sample documents which you can view and study The full version offers all features First you have to unlock it by supplying the product key For more information on how to unlock the application see follow up 11 1 1 Start Setup BE Select an appropriate file version demo or full version and run it by double clicking it cene seka language use durne the p Image 102 Selecting setup language A window is opened where you can select setup language To continue click the Ok button AX CEPH Users Guide Copyright 2010 Page 94 of
58. ve or the Contrast button to improve the contrast 3 2 12 Info Window The Info window can be opened or closed if it is open by pressing the F3 key It can moved around and the program remembers the last used position The Info window displays information about the currently selected element name image and note Ax CEPH AxCEPH docx Copyright 2010 Page 25 of 98 Image 27 The Info window 3 2 13 Element Commands Elements offer a number of advanced options Select an element in the tree or on the canvas Right click to open the context menu with a number of options Show Hide Show text Rotate to Horizontai Add to pirt layer Remove from part layer Add te analysis layer Delete fron analysis layer Delete AX CEPH Users Guide Copyright 2010 Page 26 of 98 3 2 13 1 Hide Show Elements can be hidden and revealed as necessary The elements icon in the tree changes accordingly 32432 Show text All elements have labels that be visible or hidden on the canvas Use this command to toggle a label s visibility 3 2 13 3 Rotate to Horizontal The image can be arbitrarily rotated Select a line and right click Select Rotate to Horizontal from the context menu This makes the selected line horizontal and the whole image is rotated to match nado pre yr fom aver ada at larer pr Image 29 Image rotation Ax CEPH AxCEPH docx Copyright 2010 Page 27 of
59. y selecting the Calibration element in the tree The Dashboard changes peda masas Image 20 The Dashboard for image calibration Click two points on the radiograph ruler and enter their distance in millimeters you want to change the points press Delete or the Calibrate again button and repeat the procedure 3 240 Creating and Editing Outlines hard and soft tissue Outlines can be predefined teeth or created manually by placing points around an area 3240 1 Teeth zZdbee Liner tet a Selecting a predefined tooth adds three interdependent elements to the canvas and the tree two points and the outline of a tooth The points are the outline s parents if either point is deleted so is the whole outline Delete an element by selecting it and pressing the Delete key Tu iz Image 22 A tooth in the tree and on the canvas The newly added tooth has a blue dashed bounding box around it AX CEPH Users Guide Copyright 2010 Page 22 of 98 Prine 1 a Point 1 mi BN Tam Pom Image 23 Resizing and moving a tooth Width It can be changed by clicking tooth s outline it tums red from pink and the bounding box appears and dragging the resize handle on the bounding box to the desired position Position a tooth can be moved around by dragging its two points to the desired position Read mo
60. you wish to make the analysis Click the OK button Unplaced geometric elements that are used in the analysis appear on the image This state is called raw analysis 3 2 4 Correctly Placing Offered Landmark Points onto the Radiograph AX CEPH Users Guide Copyright 2010 Page 14 of 98 After identifying reference points and defining outlines the analysis is ready to be printed exported saved or sent by e mail 3 2 5 Selecting Elements Elements can be in one of three states a Set a set element is placed onto the canvas and designates a point plane etc b Highlighted an element is highlighted when the mouse pointer green crosshairs is placed on it the element turns light blue An element can be highlighted by moving the mouse pointer near it or its label E Selected an element is selected after left clicking on a highlighted element The element turns red Elements can also be selected in the tree This comes in particularly handy for elements that are hidden Image 7 The selected element is highlighted in the tree and colored red on the canvas If an element depends on other elements parent child relationship and is selected all parents of that elements purple see Image 10 Moving a point on a line to a new position 3 2 6 Element Icons in the Tree Ax CEPH AxCEPH docx Copyright 2010 Page 15 of 98 The icons of elements in the tree come different shapes and sizes each with ils own mea

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