the virtual plastic surgery software user`s manual PDF file
Contents
1. HA IIS DS ae NaF User s Manual NAUTILUS Sottware RUSSIA St Peterburg tel 7 812 973 3716 Email nau nausoft net http www nausoft net NAUTILUS PLASTIC DESIGNER Introduction During the last years the computer became a usual phenomenon at the numerous cosmetic centres clinics and can provide the experts in any area of medicine with a wide range of opportunities The computer technologies are already at such level of development that they can be useful to man in spheres where creative thinking is required and it is necessary to operate with categories other than mathematical For example modelling of plastic surgery results and hardware cosmetology procedures diagnostics of hair and skin condition The most complex but extraordinary interesting subject is the application of the computer in the field of plastic aesthetic and reconstructive surgery The main task that is carried out with the help of specialised software is to let the patient and the doctor see the probable results of the operation even before it is performed The program allows to consider separate details and the received image as a whole to compare various variants If the doctor wishes he can simulate with the help of the program the patient s status during the postoperative period He can prepare the patient beforehand that during the recovery period the patient s status and the impression from the patient s own appearance can be not so ple2. NAUTILUS PLASTIC DESIGNER X N 227 Activates the mode of image editing activates the editing toolbar A Ne28s Prints the current photo with the help the left mouse button choice of the printing device right mouse button Exit No29 Exit to the mode Card file 20 21 22 23 24 p i ers 4 he operation may differ 7 2 Ways of photos loading At transition to the Modelling mode the basic photos are automatically loaded from the card file according to projections Anterior Lateral Basilar In case any of the projections should be loaded not from the card file but from a file it is necessary to choose the necessary projection by button Ne21 Then simultaneously by 12 NAUTILUS PLASTIC DESIGNER buttons Ctril L on the keyboard activate the window of choice of a file The photo chosen from a file will appear in the current window Besides there will be a change of a basic photo in the patient s card A photo for modelling can also be received through TWAIN from a camera or another source For this purpose use button Ne22 Image format for input into the patient s card of the section Card file JPG for input into the section Modelling BMP SEA B S SRBX 7 3 Warning In the modelling mode you can always see on the screen a window warning that the result of computer modelling can differ from the result of the operation Besides the warning is printed out together with the res
3. The resulting tracker shown with bright red colour is constructed by transfer of points of the initial tracker to a new place Function of the resulting tracker is to specify the zones of changes of the nose As a result of construction of the resulting tracker there will be a recalculation of values in the information table The following step is the selection of boundary areas participating in modelling For transition press button Ne20 By the cursor set the points for selection of the area adjacent to the nose that participates in the operation In the table on the right there are data on deviation of points of the initial tracker from the resulting In the first column the names of parameters in the second actual values of deviation in the third values of deviation on axis O and in the fourth values of deviation on axis O Press button Ne20 for recalculation and construction of the result of modelling The further work with the received image is described in paragraph 8 5 24 NAUTILUS PLASTIC DESIGNER 12 1 2 Work with a tracker in the Lateral projection fig 11 Key points G glabella N nasion s supratip breakpoint T tip c columella breakpoint Sn subnosale Ls upper lip border S stomion Me menton Ac alar crease N root of the upper eyelashes R free point of rounding of the nose tip set between points O and C Basic lines Horizontal line FHP connecting the top edge of tragus and edge of t
4. 8 1 Modelling algorithm The sequence of actions of the modelling stage is shown in fig 8 Tracker is the system of points connected by lines with the of which the zone of change is designated Tracker represents a closed area or a broken line The initial tracker is exposed on the initial image on the border of the zone of changes The resulting tracker is constructed by transferring the points of the initial tracker The process of modelling consists in moving the changed zone from the initial position to the resulting place NAUTILUS PLASTIC DESIGNER Choosing of boundary areas participating in modelling is carried out with the help of a closed broken line The program offers two types trackers Free Point Track that can be applied to any kind of operations Standard Line Track prepared specially for modelling in rhinoplasty To change trackers press the inscription by the left or right mouse button Standard tracker will be described below in chapter 12 1 8 2 Installation of the initial free tracker The inscription Point Track in the top part of the screen means that you work with a free tracker Place the cursor on the working area by pressing the left mouse button make a point Release the left mouse button and move the cursor further trying to track precisely the border of change Then set the second point in the same way and so on If you are not satisfied with the constructed tracker and you want to begin an
5. bottom of a result sheet on the printer see 7 3 NAUTILUS PLASTIC DESIGNER 5 Working with the program 5 1 Program installation and running 1 Insert a CD with the program in the CD ROM Double click My computer icon Choose Plastic icon by double clicking Double click Disk 1 Run Setup exe Respond to questions Program is being installed 2 Insert the electronic key in LPT1 port 3 Install the key driver Press Start Run Specify the path to the program C Program Files Nautilus Surger Novex instdrv exe Click OK 5 2 External devices of images input The fundamentals of photographing The input of photos into the program can be carried out from any input device and also from a file from any carrier The simplest way to input the images is through TWAIN a special program allowing to work directly with the external device of image input If your external device is not Supported by TWAIN then input the image from a file The detailed step by step instructions you will find in the appropriate sections of the manual The format of the image used for input into the patient s card of the section Card file is JPG for input into the section Modelling BMP into section Preparation of presentation any graphic format Pay attention that in the current version of the program has the following restriction the photo should contain the colour 24 bit image and the size of the photo should not exceed 16
6. not subject to deletion in future The size of photos on the screen can be changed with the help of button Ne13 fig 1 Cancelling the display of photos in a card is made with the help of button Ne14 fig 1 It can be necessary for quick viewing of the textual information in a card file as the process of image loading on the screen requires certain time 6 1 2 Searchin the card file The search by the given categories is carried out with the help of the bottom bar that contains the table of codes medical histories as well as full names of the patients If the list of the patients is large spread the bottom bar upward by dragging split line Ne19 with the help of the mouse To make a search place the cursor on the necessary category patient code Neof medical history or first name patronymics last name and press F3 button on the keyboard In the top part of the list a free line will appear for entering the information for search Press the Enter button on the keyboard The required card of the given patient will appear on the screen 6 1 3 Printing from the card file To print photos and main data on the patient press button Ne10 Then you can mark the photos that should be printed out in the opened window Press the button Print You will enter the mode of automatic creation of the sheet type In the same mode you can set the printer parameters Then you can start printing fig 4 vy Picture Selector Iv Source photo 2 Source
7. sheet 6 3 Subsection Sheet of operational planning This subsection can be used for pre operational planning of rhinoplasty A ready Sheet of operational planning is offered You only have to select the necessary items with the cursor Other functions are carried out in the same way as the subsection Examination Sheet see 6 2 10 NAUTILUS PLASTIC DESIGNER f Preparation for modelling The preparation for modelling consists of the following stages Input of photos choice of a projection for work Calibration definition of basic distances and angles for the subsequent calculations Application of modelling mechanisms to the given area 7 1 Program interface The buttons of this section are shown in fig 5 gt Anterior Ne21 It has three values Anterior Lateral Basilar It loads the appropriate basic photos from the patient s card The switching of values is performed by pressing the right and left mouse buttons No20 Step forward back No22 Responsible for input of photos Has two values the right mouse button the choice of the device of image input the left mouse button the input No23 Rotates the photo 90 180 270 degrees on the screen No24 Help information about the program No925 Zooms the photo in and out with the help of the left and the right mouse button respectively No26 Activates the mode of measurement of distances and angles activates the toolbar of measurements
8. the button wait a little because if a large area is chosen for blurring the performance of function will require some time The degree of blurring is set by the slider of tool Ne41 With the help of tool Ne40 it is possible to make edges of the area blurred or precise Ne39 Dropper You can take any colour from the image by the Dropper make it the current colour and use it by painting tools For this purpose press the tool Dropper On the working area click the left mouse button The colour is defined as average value of colours of the given square The size of the square is set by tool Ne40 The current colour will be displayed in the window of indicator Ne42 COLOUR CORRECTION OF A PHOTO No43 Contrast No44 Brightness Noe45 Colour 6 Exit No49 Exit Transition to the section Card file If you do not like the result of editing press the buttons on the keyboard Ctrl Z to undo the last actions one by one 8 Modelling This chapter describes the procedure of modelling Transition to modelling is carried out with the help of button Ne20 You have already prepared the image in the necessary projection to work If you have forgotten to make calibration the program will remind to you of that In such case you should open a measurement toolbar see 7 4 and perform calibration For convenience of work it is possible to set the grid For this purpose also return to the measurements mode see 7 5 2
9. will be no necessity to compare the reality with the forecasts 14 Application of experience of a surgeon in work with the program The experience of each surgeon is unique it cannot be described it is impossible to enter it into a computer program as an algorithm Besides that the rules used by one surgeon can be absolutely inappropriate for another expert Our purpose was to make this computer program universal convenient for everyone who uses it and allowing to apply your own experience and knowledge during work We do not exclude the opportunity that in case of a creative approach to work with the program someone will manage to discover its additional opportunities that are not described in this manual Conclusion The program Nautilus Plastic is written in a modern programming language by remarkable programmers who have previewed an invaluable opportunity for it to develop and to be further improved If you have any remarks and offers in the process of the program use please contact us We plan to collect this information and use it for creation of the following versions of Nautilus Plastic All software that we offer on the market is regularly updated Therefore you can be sure that you are getting a developing product You have an opportunity to update it regularly and to be always ahead 30
10. 0001600 pixels Photographing is crucial since it influences the reliability of results The illumination should be natural and even without shadows and patches of light on the whole surface that will be subjected to modelling Pay attention to accuracy of camera angles In the beginning of work calibration of the images is performed While making a photo place a ten centimetre pattern for example a ruler next to the patient s face Later on this pattern is used for reduction of the images to the uniform size The rules of work with your input device digital camera scanner can be found in its manual 5 3 Printing outresults You can print from the sections Card file Modelling and Preparation of presentation You can set printer options from the program see 6 1 3 8 6 The information on your orinter properties can be found in its manual NAUTILUS 6 Card file of the patients The card file allows to enter change save and delete the information on your patients and also to carry out search by some attributes In case of accumulation of much information it is necessary to organise storage of this information on additional carriers see 11 1 123 45 6 7 8 9 10 19 gt Name 22 gumm Leonid History number T Surname 5 Female Phone Address fi 23 45 67 Big Morskaya 64 8 64 First visit Relatives info 1 2 01 1999 E wife Elena Mihailovna Kirdyk Last visit Next visit Doctor 20 021 9
11. 20 to the mode Source You can analyse the previous stages of modelling for example set a new area of changes or construct other initial and resulting trackers If you think that you should make changes to the received result it can become the starting image for the further modelling From the mode Result return the necessary number of steps back with the help of button Ne20 8 6 Saving the resultin the patient s card If you consider that the result received by you is final leave the section Modelling in the mode Result with the help of button Ne18 Exit The result of modelling is automatically saved in the patient s card You can enter the description of the received result that will be also printed out together with the photo see 6 1 Printing the result directly from the mode Modelling and the installation of the printer parameters is carried out by pressing button Ne28 Print by the left or right mouse button respectively 9 Comparison of results of modelling The comparison can be executed in two ways 1 Inthe section Modelling after the result is received at the top of the screen the inscription Result will appear Point by the cursor to the inscription Result and by pressing the left mouse button change the status to Source Thus you will see the initial image To return to the result press the right mouse button 2 In the section Card file choose item Ne17 Comparison fig 1 O
12. 99 5 04 031 999 Ivanov AA Birthday Operation date Nurse 06 03 1975 06 03 1999 E Petrova CP Diagnosis Bi Operation pag Agent Insurance History Leonid Photo 2 Description Not Found 14 11 12 PLASTIC DESIGNER The section Card file contains the following buttons and inscriptions fig 1 gt Not Go to subsections of patients cards No2 First card in the card file Ne3 Previous card in the card file No4 Next card in the card file NAUTILUS 10 Ne10 Print Fy Clients Definition Width Position Rotation Projection X Level Depth Angles ORSUM Bony vault Height Base width Bony length Cartilage vault Height Lenath No5 Last card in the card file N26 Add a card to the card file No7 Delete the card from the card file Nos Save changes to the card 9 Cancel changes of the card 1 2 3 1 2 3 1 2 3 EZ LT Wes ft dhe ore Il EX i I t T 1 3 7 1 T 1 2 3 1 NFR z degrees 1 2 3 1 i 1 2 3 i a 1 L i a 1 2 3 1 PLASTIC DESIGNER NAUTILUS PLASTIC DESIGNER No11 Delete the photo from the patient s card No12 Add a photo to the patient s card No13 Change the size of the photo on the screen No914 Show photos in the card cancelled for scrolling through the card file Ne15 Modelling section No16 Section of creation of presentation materials No17 Section
13. AI to la 3 Measure distance from S to la 4 Estimate proportions of the nose The standard en en 31 9 mm X X 24 mm AI Al 32 mm 5 Estimate deviations of the median line of the nose width narrowness of the nose departments in respect to VFP and the median line define the asymmetry of these departments 6 Estimate the tip of the nose measurement T Al symmetry wide narrow curvature O O 7 The lines of edges of the back of the nose allow to define the asymmetry wide parts lf you require the lengths of segments and their projections on axis O and Y which are not included in the table but can be received in the given projection it is necessary to measure them manually For this purpose on the top and left part of the image the rulers are placed If not it is possible to receive values of the large accuracy increase the image with tool Ne25 Magnifying glass Each surgeon uses this or that technique of planning of operation and applies his own experience As there is no ready algorithm of actions of the surgeon the program offers the universal data which can be applied by you at your discretion The algorithm of actions of process of modelling is similar to the algorithm of work with a free tracker In the beginning you have established the initial tracker Shown by bright green colour on the border of the zone of changes nose After the initial tracker is constructed press button Ne20 for transition to the next step
14. age with tool Ne25 Magnifying glass The visual analysis 1 Measure the outstanding of the root of the nose CN radix projection 2 Measure NT dorsal bridge length of the nose 3 Measure AcT tip projection of the nose 4 Define the divided curve of the nose partition Ac Sn C T Then work on the algorithm of the modelling process that is similar to the algorithm of work with the free tracker In the beginning you have set the initial tracker Shown by bright green colour on the border of the zone of changes nose The modelling of the result can be carried out in different projections For the greater reliability it is necessary to observe proportions and distances between points for the connected parameters Such connected parameter for example is the projection of the segment N T on axis Y for the Anterior projection and projection of the same segment to axis Y for the Lateral projection The value of this parameter should coincide for both projections After the initial tracker is constructed press button Ne20 for transition to the next step The resulting tracker shown with bright red colour is constructed by transfer of points of the initial tracker to a new place Function of the resulting tracker is to specify the zones of changes of the nose As a result of construction of the resulting tracker there will be a recalculation of values in the information table The following step is the selection of boundary areas partici
15. area for Copying and moving to any place Colouring Blurring giving uniformity To select an area press and keep the left mouse button Move the cursor by the contour of the selected area Release the button of the mouse and necessary area will be rounded by a closed red line The degree transparency blurring of edges of the allocated area is set by tool Ne40 To move the area to another place of the image press and keep the Ctrl key of the keyboard Place the cursor on moved area Press the left mouse button and keeping it down move the cursor Release the mouse button and key Ctrl When the Scalpel tool is chosen the functions of work with area are activated No46 Copy area The copying and moving of the chosen area is carried out in the following order move the cursor on the area chosen by the Scalpel Press button Ne46 Vy Copy Then transfer by the cursor the copied area to another place Press again button Ne46 Copy The copied area will be fixed on the new place NAUTILUS PLASTIC DESIGNER Ne47 Paint The colouring of the chosen area is carried out by pressing button Ne47 The colour is set on indicator of the current colour Ne42 The degree of intensity transparency of colour is set by the slider of tool Ne41 The degree of blurring of edges is set by tool Ne40 No48 Blur Blurring giving of uniformity of colour of the chosen area is carried out by pressing button Ne48 After pressing
16. ary for more precise measurements of distances and angles Make the grid with the help of button Ne33 Scale of the grid can be changed with buttons Ne34 35 The crossing of red lines of the grid is the central point from which expansion narrowing of the gridlines is made To combine the gridlines with details of the face apply the function of photo zooming out and moving 7 5 1 14 NAUTILUS PLASTIC DESIGNER 7 6 Tools of photo 25 26 27 editing Editing of a photo allows not only to improve the quality of the entered photo but also enables to simulate the influence of some hardware cosmetology procedures and surgical intervention As to opportunities of editing with the help of the offered tools the largest 24 part of success of their application depends on your training y The editing tools and their 25 properties are shown in fig 7 36 43 44 TOOL PROPERTIES 37 45 22202 90 39 Ne40 Degree of influence To choose the degree of influence select one of five options by the Cursor Ne41 Intensity of influence scale The uppermost location of the slider means the minimal influence the lowest maximal 49 No42 Indicator of the current colour To choose a colour click the right mouse button on the indicator and on the screen a palette of 16 million colours will appear The colour can be chosen from a ready palette of 48 colours on the left For this purpose specify the necessary colo
17. asant What the patient will see can ensure his wish to make changes or on the contrary to refuse from the operation The program gives the doctor a number of arguments for Convincing the patient However if the patient comes to a conclusion that the operation is not worth making it means that the doctor has not allowed the patient to be disappointed and relieved himself from unpleasant explanations after the operation The computer equipment in combination with the software allows to make photos of the patient in place and to print them out together with the doctor s comments on peculiarities of prospective intervention Besides that it is possible to save the information on the patients data photos x ray to store it and at any time to retrieve from the computer medical database Besides the doctor has a wonderful opportunity to discuss the results of the future operation with the patient without the patient s presence Even if the patient lives in another country it is sufficient to receive his photos over the Internet and in the same way to send back the variants of results of the prospective operation and the offers We thank you for using our software If you will have any comments or remarks on the work of the program we are ready to take them into account in the next versions of Nautilus Plastic program NAUTILUS PLASTIC DESIGNER 1 Program users When we started writing the program we assumed that the users of the program will b
18. e is no universal algorithm of restoration It s hard to predict with accuracy how the tissues and the organism of each patient will act and how the external conditions will influence them Therefore not to make a mistake and not to deceive your patients we have decided not to introduce into the program the processes of restoration step by step But you can make photos of the patients who have already undergone the surgery and keep them in the card file see 6 1 1 having specified in the comments to the photo the necessary information on terms and status of recovery Then these photos can be shown to a new patient Thus he will see an unpleasant show of the post operative period not on himself but on another person The example of another person is not so frightening and the purpose will be achieved patient will be ready to the post operative period Besides the patient will also see final variant after the recovery of another patient which will create a psychologically positive mood Another approach is to make photos of the patient and to simulate with the help of the tools an approximate image basing on your experience unfortunately it cannot be incorporated into a computer program It would be better if having shown the images you would not keep them in the Card File for the patient The purpose will be achieved patient is ready for the operation Most likely that his recovery will be faster than that predicted by the computer and there
19. e is not so sure thena voluntary visit to an independent plastic surgeon in a beauty parlour is really a solution The only warning to the organisers of such a Service is that it should not be transformed into entertainment and a show discrediting the methods of plastic surgery Modelling of plastic surgery results and influences of hardware cosmetology procedures can be an integral part of work with clients Such an application of the program in itself brings success to the whole business makes the patients sure that they are in hands of professionals 3 NAUTILUS PLASTIC DESIGNER 3 Program as a tool of improvement of mutual understanding between the surgeon and the patient The experience of work of our program at the medical centres shows that the program allows to solve several important problems The patient can see the result that is either pleasant to him or not It will strengthen his desire to resort to an operation or will make him to reject this idea altogether The choice makes the patient trust the expert and the given medical establishment Even if the patient has not agreed for this operation for example rhinoplasty he can think about another operation for example blepharoplasty to improve his appearance In any case you will be surely recommended as a skilled expert who can be trusted The surgeon will save himself from unpleasant trials when the patient is not satisfied with the result of the operation caused by m
20. e the surgeons conducting reception of the patients and performing operations The program is a universal tool and the more skilled hand uses it the more valuable results are received Besides that the program contains a lot of appliances and tools that can be useful to the surgeon in his work during the preparation for an operation Basing on the already existing experience of use of our program in plastic surgery clinics we know that even a person who does not have direct relation to the operation can work with the program The main task of this person we ll call him the operator is to make a selection of problem patients and to satisfy the interest of the patients coming to visit mostly out of idle curiosity In this case the valuable time of a surgeon is saved If the patient is ready to continue a detailed conversation after the primary consultation the second advice with the use of the computer is carried out by the surgeon who has all preliminary data on the given patient Naturally the operator should be well prepared for the consultations to be competent in modelling of appearance and to work in close co operation with the performer of the operation In case of application of the program for changing of the results of influence of hardware cosmetology procedures it is the most reasonable if the expert who is carrying out these procedures works with the program The person working with the program should know how many procedures it is necessar
21. eived in JPG or BMP format Further through an intermediate file enter the images to the card of the potential client see 6 1 1 or directly to the section Modelling see 7 2 Carry out modelling in the usual way The results of modelling photo can be saved in an intermediate file also in JPG or BMP format and sent as an email attachment Probably you will need to accompany with results by the graphs inscriptions and comments In this case create the illustrations in section of Presentation see 10 After saving to an intermediate file in JPG or BMP format you can also send the information by email 21 NAUTILUS PLASTIC DESIGNER 12 Types of operations and ways of modelling of their results In virtual space of the computer the different types of operations can be executed with the help of tools and functions of the program 12 1 Rhinoplasty It is known that the operations on change of the form of a nose are most frequent plastic operations At the same time these are rather complex operations not only in reality but also at modelling them in virtual soace The reason in that change of one parameter leads to automatic change of others as there is an interrelation of these parameters There is also concept of an ideal nose when the ratio of distances and angles corresponds to the certain established values The ideal nose from the point of view of arrangement of the cartilages does not mean an ideal nose from the point of
22. erences can be an incorrectly made photo for example not an exact side view incorrect calibration of the image in the beginning of work as well as not exact installation of the initial tracker Some experience of work with the program is sufficient to learn not to make considerable mistakes The small divergence of values is not important and does not influence the result of modelling 12 2 Other types of operations The step by step creation of the final result of operation on the computer is not the exact imitation of actions that are carried out by the surgeon during the real operation You do not need to cut and to sew up The main task is to establish precisely the initial borders of the area of changes and then to select the points of desirable moving of this area The surgeon knows theoretically the result of the operation on the basis of his personal experience can imagine what deviations can be from the theory depending on various conditions Having initial variant it is required to create the final result applying tools and functions of the program The good knowledge of opportunities of the program allows to achieve the final result by different ways For example lift of the skin of the forehead and eyebrows on the computer is not attached to the lines of a seam within the hairy part of the head it is performed by moving of the area of eyebrows and top eyelid with the help of tool Ne38 Scalpel or through the free tracker Itis v
23. ery easy to receive the results of dermoimage correction skin scars hair transplantation with the help of the editing tools see 7 6 The operations including any kinds of skin lifts are carried out through free trackers or the tool for working with an area Scalpel and can be slightly adjusted to the final result with the editing tools For example blepharoplasty facelift and lifts of other parts of the body as well as correction of body contours liposuction and other 13 Modelling result of the post operative period The plastic operation no matter how magnificent its final result is has the post operative period of restoration to which not each patient is ready During the restoration period the woman observes an awful picture in a mirror It seems to her that now she will look this way she begins to regret that she has decided to make an operation Not only does it spoils the mood but also frightens and causes stress The stress in turn leads to slow recuperation of the body Our program allows to simulate the images of results of operation during post operative period in different terms for example in one week in one month Some experts say that it is not necessary to do that that the patient can be frightened and reject the operation in general Others consider that very important 29 NAUTILUS PLASTIC DESIGNER In any case the program allows to do that and you should decide for yourself whether to use it or not Ther
24. ew click the mouse outside of the tracker and the tracker will disappear Double click the mouse when you are through and the tracker will be considered constructed it will be shown by a bright red colour The transition to the following step is carried out with the help of button Ne20 8 3 Construction of the resulting free tracker The inscription at the top of the screen Set Track means that you are in the mode of construction of the resulting tracker At first the initial and the resulting trackers coincide Select any point of the tracker by the cursor and move it to the necessary place In the same way go on moving other points Pay attention to the table of results on the right The columns of the table contain 1 Number of the point in the tracker in the order of construction 2 The shortest distance between the initial and the resulting location of a given point 3 Value of change of distance between the initial and the resulting point on axis O 4 Value of change of distance between the initial and the resulting point on axis O The line containing the information on the current point is shown with red colour If you are not satisfied with the constructed resulting tracker and you want to begin anew click the mouse outside of the tracker and the previous work will disappear Upon termination of construction double click the mouse and the tracker will be considered constructed it will be shown by bright green colour Transi
25. f an ideal nose is stipulated for the side view The recalculation of ideal parameters occurs by pressing the button At the stage of reception of the resulting tracker The following order of actions is similar to the general algorithm of modelling Since we are trying to describe the medical laws mathematically from the point of view of mathematics there are some contradictions when the performance of some ideal parameters leads to displacement of other ideal parameters Therefore we have entered the term theoretically ideal nose and practically allowable ideal nose The values of a theoretically ideal nose are given in the information table in the third column at the stage of installation of the initial and resulting trackers The values of the 28 NAUTILUS PLASTIC DESIGNER practically allowable ideal nose can be received in the mode of construction of an ideal nose also in the information table third column Thus the information table of the construction mode of an ideal nose contains In the first column names of parameters In the second column values of the practically allowable ideal nose in the third column theoretically ideal nose in the fourth difference of values Probably you will observe difference of values of a theoretically ideal nose in the mode Construction of the resulting tracker and in the mode Construction of an ideal nose The reason for these diff
26. f presentation by pressing the cross in the top right corner 20 NAUTILUS PLASTIC DESIGNER 11 Additional opportunities 11 1 Saving results Results of work and the information on the clients can be saved on various carriers for example floppy disk CD The choice of the carrier depends on the size of the information and purpose Let s assume that the result of modelling photo should be transferred to a floppy disk At first it is necessary to save the photo to a file For this purpose you can directly from the section Card file get the menu by clicking the right mouse button on the image Choose item of the menu Save to file Write the filename After that by standard ways transfer the file to the carrier Probably you will want to save from time to time the card file of the patients database in archive as a backup In this case it is recommended to save the folder with the database on another carrier or in another catalogue on the hard disk we shall name it archive The path to the folder with the database can be found as follows through my computer choose the drive on which Windows is installed Most likely at you it will be a drive C Then start the program Bdeadmin exe located at C Program Files Borland Common Files Bde Bdeadmin exe The window will appear choose at the left inscription Surger by clicking on the inscription The full path will appear on the right for example Path C Program Files Nauti
27. file by pressing button No7 fig 1 Let s assume that you need to change or to add the information to en existing card For this purpose use button Nes Button Ne9 cancels last changes Moving through the card file is carried out by buttons Ne2 3 4 5 6 1 1 Working with photos in the patient s card The input of photos of the patient is carried out by pressing button Ne12 In the photo field a free cell form a new photo appears It is possible to replace a photo in a card file by a new image Click on the cell where the new photo will be inserted by the right mouse button The following menu will appear Acquire from file Acquire from TWAIN image received from a digital camera video Camera scanner Save to file Further import the photo in the way that is convenient for you The number of necessary photos stored in a card file is unlimited But first three photos are basis images and should 8 NAUTILUS PLASTIC DESIGNER correspond to projections Anterior Lateral Basilar Item Save to file see 11 1 allows to save the images on any carrier The comments to a photo are entered in the following order double click by the right mouse button the necessary photo You will see an active window with this photo to the bottom part of which you can enter the necessary textual information up to 130 signs Deleting photos from a card is carried out with the help of button Ne11 fig 1 The first 3 photos are basis images and are
28. gles For measurement of distances tool Ne30 Compasses is used Seize by the cursor the compasses pointer and place it on one of the points of the measured object Repeat the actions for the other point It is possible to move the tool completely For this purpose in addition press the button Ctrl For measurement of angles use tool Ne32 Seize by the cursor the beam of the angle and move it Similarly repeat actions for the other beam Move the angle by the cursor pressing simultaneously the button Ctrl In the right top line of the table the current value of distance or corner will be displayed If you want to save this value place the cursor in the second line of the table and enter the prospective designation or name Then press Enter The name of parameter and its value will be entered automatically into the information part of the table Thus you can make a list of measurements of distances and angles that can be useful for you in subsequent calculations These data will automatically be entered into the patient s card in the subsection Measurement and can be printed out from there 7 9 1 Zooming and moving a photo To zoom in out the image apply tool Ne25 Magnifying glass When you zoom out a photo the scale of the rulers is increased accordingly To moved the zoomed photo seize the image by the right mouse button and pull in the necessary direction 7 5 2 Application of auxiliary grid Auxiliary grid is necess
29. he point Ma Horizontal line through the point Sn Using a standard track set the points on the image of the patient You receive an arrangement of basic lines which allow to perform the visual analysis Information table contains the following data G Al Al Me S Me En En X X Al Al VFP X X VFP En VFP VFP en VFP AI Al VFP T AI Al T projection of the segment G AI on axis Y projection of the segment Al Me on axis Y length of the segment S Me length of the segment en en length of the segment O O length of the segment Al Al distance from the line VFP to the right point O distance from the left point O to the line VFP distance from the left point en to the line VFP distance from the line VFP to the right point en distance from the line VFP to the right point Al distance from the left point Al to the line VFP distance from the point O to the right point Al distance from the left point Al to the point O T IN VFP deviation of the median line IN T from the line VFP 23 NAUTILUS PLASTIC DESIGNER The first column name of parameter second column real value of parameter third column ideal value of parameter fourth column deviation of the real value from the ideal value And if the deviation is more than 5 10 it is shown with bright red colour The visual analysis 1 Measure the height of the median part of the face from G to Al Al 2 Measure the height of the bottom part of the face from AI
30. he sub eye 5 crest EL par nnm PREKL Vertical line VHP i com g oOo i N g perpendicularly to FHP through the point AC Angles NFR nasofrontal NFA nasofacial TA tip CLA columella ladial YLA Using a standard tracker set the points on the image of the patient You will receive the location of the basic lines and values of angles that allow to perform the visual analysis The information table contains values of parameters N T actual distance between points Ac T actual distance between points Ny Cy projection of the segment to axis O 25 NAUTILUS PLASTIC DESIGNER Gx Nx projection of the segment to axis O Cx Nx projection of the segment to axis O Ny C y projection of the segment to axis O Sy C y projection of the segment to axis O C y SNy projection of the segment to axis O The first column name of parameter the second column real value of parameter the third column ideal value of parameter the fourth column deviation of the real value from the ideal value And if the deviation is more than 5 10 it is shown with bright red colour lf you require the lengths of segments and their projections on axis O and Y which are not included in the table but can be received in the given projection it is necessary to measure them manually For this purpose on the top and left part of the image the rulers are placed If not it is possible to receive values of the large accuracy increase the im
31. is located in the left part the working sheet of presentation fig 9 The sheet of presentations is formed as a DIY of such sei ana objects as a textual window window of images arrows indexes All these objects can be moved their form colour and size can be changed they can be deleted you can create new objects and fill them in with text While working with text there is a possibility to change fonts colour to change the location and other options which are described in the menu of functions All these functions can be applied to an active object 12 x Remark 1 Remark 2 To activate an object it is enough to point the cursor at it and to click the left mouse button The active object is shaded with a red frame To place photos and other images in a window of the images activate it Then press the button Image and from the opened menu choose the necessary file For creation of new object press the button New choose from the menu the name of the object necessary to you It will appear in the top left corner of the sheet Seize it by the cursor and move to the necessary place Dragging any of the corners extend it to the size necessary to you Upon termination of formation of a sheet of presentations save the result to a file with the help of the button To keep The printing of a file with the presentation material is carried out by standard methods of the computer Close the mode Preparations o
32. lar from the left bottom point of the nostril to the straight line D D NarisR perpendicular from the right bottom point of the nostril to the straight line D D TSnG angle of deviation of the nose tip O from of the median line AcIT length of projection of the segment from the left point An to the point O on the straight line O Sn AcrT length of projection of the segment from the right point An to the point O on the straight line O Sn AcID length of projection of the segment from the left point An up to the point of crossing the straight line D D from the straight line O Sn on the straight line O Sn 27 NAUTILUS PLASTIC DESIGNER AcrD length of projection of the segment from the right point An to the point of crossing the straight line D D from the straight line O Sn on the straight line O Sn DD actual distance between points AlAl actual distance between points AITI length of projection of the segment from the left point Al up to the point T on the Straight line O Sn AlTr length of projection of the segment from the right point Al up to the point T on the Straight line O Sn DI TSn distance from the point D left to the straight line O Sn Dr TSn distance from the point D right to the straight line O Sn All TSn distance from the point Al left to the straight line O Sn Alr TSn distance from the point Al right to the straight line O Sn Acl TSn_ distance from the point An left to the straight line O Sn Acr TSn distance from the
33. lus Plastic Designer Base Remember this way for the further fast copying of the database Knowing the path to the database through my computer find the folder Database and copy by it to the archive In case of failure in the computer and the losses of the information remove current Database from the program and copy the archived Database in its place The frequency of backup depends on how frequently it replenishes You can it do it for example once a week 11 2 Input of x ray snapshots The x ray snapshots can be placed in the patient s card from an intermediate file the same way as any other images Scan an x ray snapshot Place the received image in an intermediate file with JPG format Further place the image from the file to the patient s card see 6 1 1 If necessary the snapshot can be placed in the section Modelling from the card For input of a snapshot directly to the Modelling section work according to 7 2 11 3 Transfer of the information via the Internet Let s assume that your potential patient lives in the another city or even another country but he would like to receive consultation from you In this case offer to the patient to send his photos via email to your computer or if you do not have email on the address your friends Describe to the patient what three projections of photos you need Explain that in each photo should be a 10 centimetre standard for the further scaling The photos should be rec
34. n the screen the additional panel will appear on which 2 photos are placed You can place on the panel of comparison the images necessary for you from the patient s card For this purpose click the left mouse button having pointed to the right area of the panel of comparison and also ona photo from the card file The necessary photo will be placed on the panel of comparison Now in the same way enter the second photo to the left area of the panel of comparison TO zoom out the image on the screen press the icon Maximise in the top right corner of the panel of comparison To return the images in the initial view press the same icon You can change the arrangement and size of a photo within the panel of comparison Seize by the cursor a dividing line between photos and move it to the necessary side 19 NAUTILUS PLASTIC DESIGNER 10 Preparation of presentation materials The given section allows to create the illustrations with indices and comments These materials can be used for discussion of forthcoming operations with the colleagues for the dialogue with the patients in case of preparation of the documents publications demonstrations etc The created sheet of presentation can contain text figures graphs photos accompanied by inscriptions comments and indices in the form of arrows The section Preparation of presentation opens by pressing index Ne16 Presentations fig 1 In the right part of the screen the menu of functions
35. pating in modelling For transition press button Ne20 By the cursor set the points for selection of the area adjacent to the nose that participates in the operation In the table on the right there are data on deviation of points of the initial tracker from the resulting In the first column the names of parameters in the second actual values of deviation in the third values of deviation on axis O and in the fourth values of deviation on axis O Press button Ne20 for recalculation and construction of the result of modelling The further work with the received image is described in paragraph 8 5 26 NAUTILUS PLASTIC DESIGNER 12 1 3 Work with the tracker in the Basilar projection fig 12 Key points G glabella C columella breakpoint T tip Al alar flare Ac alar crease Sn subnosale D lateral point of the nostril wall Basic lines Vertical line through points Al Vertical line through points An Vertical median line through the point Sn Vertical line through points D Horizontal line through the point O Horizontal line through points Ac An Horizontal line through points Al Al Horizontal line through the point With Horizontal line through the bottom points of the nostrils Using a standard track set the points on the image of the patient You receive the location of the basic lines that allow to perform the visual analysis Information table contains the following data NarisL perpendicu
36. photo 3 NAUTILUS PLASTIC DESIGNER 6 2 Subsection Examination Sheet This subsection can be used in case of rhinoplasty The ready Sheet of pre operational examination is offered You only have to select the necessary items of the text with the Cursor You can enter comments to figures schemes For this purpose double click the image in the card An additional toolbar with the image and a window at the bottom of it will open PROACH Closed Incision Exposure Lateral crura Dome definiftion width Position Rotation Projection Radix Bony hump Cartilaginous hump OSTEOTOMIES Yes No Type L ANGLE Septum Nasal spine AT AD DAQT Increaseidecredse sizes of the previews where you can enter the text of the comment If you want to edit graphs and figures from the examination sheet double click the left mouse button on the image An additional toolbar will appear double click it and you will enter the editing mode Now using editing tools make necessary changes colour areas etc see 7 6 Then leave the editing mode with the help of button Ne49 Exit You will return to the mode Card File Examination sheet Close the additional toolbar and the corrected image will be automatically placed in the initial place in the card Printing of the examination sheet is performed by button Ne10 You can see the print preview and also change the printer properties If everything satisfies you start printing the
37. point An right to the straight line O Sn The first column name of parameter the second column real value of parameter the third column ideal value of parameter the fourth column deviation of the real value from the ideal value And if the deviation is more than 5 10 it is shown with bright red colour The visual analysis 1 Symmetry and deviations from the vertical axis 2 Distance from O to An An and distance from A to C correspond as 1 to 2 3 Distance from O to Al Al and distance from O to C correspond as 2 to 3 4 Width of the over narial part constitutes 3 4 of the width An An 5 The nose should form a right triangle with the top O Further work on the algorithm of modelling process described for other projections 12 1 4 Construction of an ideal nose In rhinoplasty there is a concept of the ideal nose The certain points are established unequivocally for each patient but the changes of some distances and angles are possible and if their ratio corresponds to some ideal values we receive the most correct nose The functions of calculation of an ideal nose by Bird Daniel and others are known The received ideal noses not always are the best from the aesthetic point of view for the particular patient Evidently these theories were checked up by us with the help of the program But still we offer an automatic calculation of an ideal nose Probably it will help someone The calculation o
38. s of comparison of modelling results No18 Exit from the program No19 Split allows to extend reduce the field of the card The patient s card consists of four subsections The card with the data on the patient photo Examination sheet information graphs figures Operation planning sheet data graphs figures Measurements results of measurements of distances angles made and calculated before the beginning of modelling The change of subsections of a card is carried out by pressing button Ne1 figure 1 6 1 Subsection Client s card lf your card file is still empty it is necessary to begin filling it You can make a card for a new patient by pressing button Ne6 The patient s code is assigned automatically and later allows to identify the given patient The items requiring entering date can be filled directly or through a choice of date in the calendar The calendar is activated by clicking the mouse arrow key on the right part of the information cell Before filling in the medical history press F3 button on the keyboard It allows to enter the current date automatically Then enter the information Moving through the text is carried out with the help of up and down arrow keys on the keyboard If the cell Medical History is covered by the bottom bar lower the bottom bar by dragging split Ne19 by the mouse fig 1 After filling the card save it by pressing button Nog You can delete the card from the card
39. tion to the following step with the help of button Ne20 8 4 Selection of the zone of modelling The inscription at the top of the screen Set Area means that you are in the mode of installation of the area of tissues around the zone of change which will be also involved in modelling Setting points by the left mouse button designate the area of changes lf the constructed area does not satisfy you and you want to begin anew click the mouse outside the area and the previous work will disappear Upon termination of construction double click the mouse and the area will be considered constructed it will be shown by bright blue colour Transition to the following step with the help of button Ne20 18 NAUTILUS PLASTIC DESIGNER 8 5 Getting the result lf the area of changes is large you should wait several seconds before the result is received The inscription at the top of the screen Result means that you see the result of modelling For comparison of the result of modelling with the initial variant click the left mouse button on the inscription Result It will allow to go to the mode of the initial image Source You can consider the result final and exit with the help of button Exit to the mode Card file You can continue modelling further having accepted for the initial the very first variant or the received result If you wish to return to the initial image and to begin modelling anew return with the help of button Ne
40. ults of modelling The warning can be moved on the screen For this purpose move the cursor to the window and press the left mouse button Without releasing it move the window The text of the window of warning can be changed at your discretion For this purpose click on the working area with the left mouse button Then press simultaneously keys Ctrl T The option window will appear on the screen In the editing line you can change the text of the warning You can cancel the window of warning on the screen by unselecting the appropriate option 13 NAUTILUS PLASTIC DESIGNER To cancel start printing the warning line at the bottom of patient photos select unselect the appropriate line To cancel start printing the time and date at the bottom of patient photos select unselect the appropriate line After you have changed the options press the button OK to confirm the changes or Cancel to cancel the changes 7 4 Calibration of the images This stage of work is necessary for reduction of the relative sizes of the photo to real ones The patient should be photographed with 10 centimetre ruler see 5 3 Activate by button Ne26 the measurement toolbar fig 6 Choose the tool Compasses by button Ne30 Put it on the pattern and press button Ne32 Calibrate On the edges of the photo horizontal and vertical rulers will appear Do not forget to calibrate the images of all basic photos 7 5 Measurementtoolbar Distances and an
41. ur It will be displayed in the window Colour Solid Then press OK To choose a colour from a complete spectrum of colours place the cursor in the necessary place of a spectrum in addition by arrow specify a tint on the extreme right scale This colour will appear in the window Colour Solid Then press OK The chosen colour will be shown in window of the current colour Ne42 15 NAUTILUS PLASTIC DESIGNER TOOLS No34 Pencil Drawing lines with weight set by tool Ne40 with the colour set by tool Ne42 and degree of pressing determined by tool Ne41 Choose the tool In the working area move the cursor without releasing the left mouse button You will get a line or a closed area To draw a straight line press and keep the button Shift on the keyboard Click on the working area with the left mouse button Then pressing the button Shift move the cursor and make a new point by the left mouse button The points will be automatically joined by a line N2035 Brush Drawing of wide lines of the given thickness degree of pressing and given colour set with the help of tools Ne40 41 42 SN V Ne36 Finger Extends a point of the image where the cursor is placed With the help of tools Ne40 41 the intensity and width of influence is set N Ne37 Eraser Erases a part of the image The thickness is set by tool Ne40 For amplification of the influence rub the same place No3s Scalpel Cuts allocates
42. utual misunderstanding at the initial stage Besides that the preliminary modelling allows to eliminate the scandalous patients who by virtue of their character are always dissatisfied by something The future problems with such patients become visible at once at the stage of computer modelling 4 Concurrence of the results of the operation with the results of preliminary modelling Responsibility of the doctor Everybody knows that the result of any operation depends on a large number of circumstances Therefore it is difficult to imagine a universal algorithm of the operation and postoperative period To program such an algorithm we should enter thousands of variables into the formula even for the simplest operation The surgeon planning operation aims ata certain result and the more skilled he is the closer to the ideal the result will be Unfortunately the patient who is far from medicine is not ready at first to that approach Therefore surgeon even before the operation warns the patient about possible complications concludes a contract with him For the same reason it is impossible to consider the result of modelling a document Each surgeon understands that Therefore at the request of the users of our program we have made a warning window saying This image is received with the help of computer modelling The result of operation can differ from it You can change the text of the warning or it can be removed completely or printed at the
43. view of aesthetics for a particular patient Therefore it is very important to combine the possibilities of the surgeon and the wish of the patient The computer modelling can help them At the stage of consultations with the patient and preparation for the operation use the standard examination sheet see 6 2 and the sheet of operational planning see 6 3 At the stage of modelling the surgeon is offered built in standard trackers for three projections Anterior Lateral Basilar With the help of this trackers it is possible to established the presence of asymmetries of the face to change the distances angles to move points and to observe changes of proportions In the table on the right the real ideal values are shown and the difference between these values 12 1 1 Work with the tracker in the Anterior projection fig 10 Key points G glabella N nasion IN intercanthal T tip Al alar basis Pn middle of subnasal fold S stomion Ma menton O the basis of the nasal bone En internal edge of the eye Sn subnosale Basic lines Vertical line VFP through the points G and PC Vertical median line through IN on middle the nose back in the point O Vertical parallel lines through points en down to the level lip corners Horizontal line through the point G Horizontal line through the point N Horizontal line through points Al Al 22 NAUTILUS PLASTIC DESIGNER Horizontal line through the point S Horizontal line through t
44. y to perform to achieve a certain result Situations are possible when a patient prepared to undergo hardware influence understands in the course of a talk with an expert in hardware cosmetology that his problem can be solved only by surgical intervention Modelling of plastic surgery results can be offered in this case and the second consultation can take place already in the walls of a medical establishment 2 Organisation of service of plastic surgery results modelling Nautilus Plastic program can be applied as an independent commercial project That is it can be used as a separately paid service offered directly at the medical centre or for example in a high class beauty parlour Such beauty parlour can work together with the medical centre and provide primary consultations to the patients and also rehabilitation of those patients who have undergone operation and require hardware cosmetology procedures massage and so on The examples of such mutual co operation of medical centres with beauty parlours exist in Russia The service Plastic surgery results modelling or Consultation of a plastic surgeon can be popular since the clients of beauty parlour can decide right there whether in general they can expect that their problem can be solved by an operation For a potential patient to cross the threshold of a medical centre it is necessary step over a psychological barrier he should already be 50 sure that he wants to do it But if h
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