NNT User Manual Rev 08 June 2018

User Manual

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NNT – User Manual

97050191 Rev. 06 01-08-2016

ENGLISH............................................................. 3

USER LICENSE The software, whose Author is and remains the owner for any purpose, is granted to the User as non-exclusive, royalty-free license of indefinite duration. The user license does not include the right to get the software in source code form, or to get the relevant project and logic documentation. Therefore the User acknowledges that the Author is and remains unique, exclusive and legitimate holder of all rights: property, copyright and economic use of software and relevant documentation. The User is aware and expressly acknowledges that software products, in general, cannot be developed in order to operate without errors as regards all possible applications and uses, and that updated versions of the Software may introduce new errors not present in the previous version. Therefore the User expressly agrees that the Software may contain errors. For this purpose, the User agrees, in his/her interest, to always carry out with due diligence backup copies of files (data and images), to overcome any malfunctions of the Software, as well as of the systems on which it is installed. Therefore we recommend to regularly make backup copies of all acquired images. The acceptance of the possibility that the Software may contain errors is a necessary condition for the Author to grant the User the license to use the Software Product. This license gives the sole right to use the Software as End User, in accordance with the rules set out below and according to the additional conditions and warnings contained in this documentation. NOTES This document is provided as means of consultation for the user of the program described therein. QR S.r.l. reserves the right to change the contents of this manual without prior notice. No part of this document may be changed, copied, reproduced, distributed, saved on magnetic or optical media, published on websites and other online services without prior written permission of QR S.r.l. The original version of this manual was written in Italian. All the other products and trade names mentioned in this document are registered trademarks of the respective manufacturers. The program is manufactured by QR S.r.l., a company of Cefla s.c. Via Selice Provinciale 23/A 40026 Imola (BO) Italy All rights reserved.

USER MANUAL

Contents ENGLISH 1. INTRODUCTION TO THE MANUAL ......................................................................................................................... 6 1.1. CONTENTS .......................................................................................................................................................... 6 1.2. DEFINITIONS ....................................................................................................................................................... 6 1.3. STYLISTIC CONVENTIONS ................................................................................................................................ 6 2. STARTING PROCEDURES ...................................................................................................................................... 7 2.1. SOFTWARE INSTALLATION............................................................................................................................... 7 2.2. SOFTWARE CONFIGURATION .......................................................................................................................... 7 2.3. MINIMUM PREREQUISITES ............................................................................................................................... 8 2.3.1. LIST OF VALIDATED VIDEO CARDS .......................................................................................................... 9 2.4. OPENING OF EXAMS ....................................................................................................................................... 10 2.4.1. OPENING OF EXAMS BY PATIENT .......................................................................................................... 10 2.4.1.1. OPENING OF EXAMS BY VIEWER ................................................................................................. 12 2.4.2. OPENING OF EXAMS BY DOCUMENT TYPE .......................................................................................... 12 2.4.3. SELECTING A PATIENT ............................................................................................................................ 13 3. IMAGE MANAGEMENT .......................................................................................................................................... 15 3.1. CHANGING THE IMAGE PALETTE .................................................................................................................. 15 3.2. HIDING IMAGE OVERLAYS .............................................................................................................................. 17 3.3. SAVING IMAGES IN DIFFERENT FILE FORMATS .......................................................................................... 17 3.4. SAVING A SCREEN SHOT................................................................................................................................ 18 3.5. WORKING WITH TOOLBARS ........................................................................................................................... 19 3.5.1. IMAGE CREATION TOOLBAR ................................................................................................................... 19 3.5.2. ANGLE TOOLBAR ...................................................................................................................................... 20 3.5.3. DISTANCE TOOLBAR ................................................................................................................................ 21 3.5.4. LINE AND ARROW TOOLBAR ................................................................................................................... 22 3.5.5. MARKER TOOLBAR ................................................................................................................................... 23 3.5.6. TEXT TOOLBAR ......................................................................................................................................... 24 3.5.7. PROFILE TOOLBAR ................................................................................................................................... 25 3.5.8. IMPLANT TOOLBAR .................................................................................................................................. 26 3.5.9. REPORT TOOLBAR ................................................................................................................................... 29 3.5.10. TOOLBAR ENABLE BUTTONS AND TOOLS ...................................................................................... 30 3.6. MAGNIFYING GLASS TOOL ............................................................................................................................. 31 3.7. ENABLE/DISABLE DELETE CONFIRMATION MESSAGES ............................................................................ 32 3.8. ENLARGED AND FULL-SCREEN IMAGE MODE ............................................................................................ 32 3.9. RESTORING IMAGE FACTORY POSITION ..................................................................................................... 33 3.10. SENDING THE IMAGES VIA EMAIL ............................................................................................................. 33 4. DICOM IMAGES ...................................................................................................................................................... 34 4.1. EXPORTING IMAGES IN DICOM FORMAT ..................................................................................................... 34 4.1.1. SAVING "SINGLE AXIAL IMAGE" / "SEQUENCE OF AXIAL IMAGES" .................................................... 34 4.1.2. SAVING "ALL IMAGES" .............................................................................................................................. 35 4.1.3. SAVING FROM AXIAL AND MPR VIEW .................................................................................................... 35 4.2. IMPORTING IMAGES IN DICOM FORMAT ...................................................................................................... 36 4.2.1. LIMITATIONS TO IMAGE IMPORT IN DICOM FORMAT IN THE SOFTWARE........................................ 36 4.3. SAVING 2D IMAGES IN DICOM FORMAT ....................................................................................................... 37 4.4. IMAGE STORING ON PACS ............................................................................................................................. 37 4.5. DICOM SETTINGS ............................................................................................................................................. 37 5. REPORT TEMPLATES ........................................................................................................................................... 39 5.1. FOREWORD ...................................................................................................................................................... 39 5.2. CREATING A NEW SINGLE-PAGE TEMPLATE............................................................................................... 39 5.3. MODIFYING AN EXISTING SINGLE-PAGE TEMPLATE .................................................................................. 40 5.4. DELETING A SINGLE-PAGE TEMPLATE......................................................................................................... 40 5.5. CONVERTING A SINGLE-PAGE TEMPLATE................................................................................................... 40 5.6. COPYING A SINGLE-PAGE TEMPLATE .......................................................................................................... 40 5.7. MULTI-PAGE TEMPLATES ............................................................................................................................... 41 6. REPORT .................................................................................................................................................................. 42 6.1. CREATING A NEW REPORT ............................................................................................................................ 42 6.1.1. SELECTING THE TEMPLATE .................................................................................................................... 42 6.1.2. INSERTING IMAGES IN THE REPORT ..................................................................................................... 43

USER MANUAL

6.1.3. INSERTING IMAGES IN AUTOMATED MODE ..........................................................................................44 6.1.4. REMOVING IMAGES FROM A REPORT ...................................................................................................44 6.1.5. INSERTING NOTES IN THE REPORT .......................................................................................................44 6.1.6. REMOVING NOTES FROM THE REPORT ................................................................................................45 6.1.7. REPORT TEXT DATABASE .......................................................................................................................45 6.1.8. ADDING PAGES TO A REPORT ................................................................................................................45 6.1.9. REMOVING PAGES FROM A REPORT ....................................................................................................45 6.2. REPORT ADVANCED FUNCTIONS ..................................................................................................................46 6.2.1. MODIFYING TEMPLATE OF REPORT PAGE ...........................................................................................46 6.2.2. MODIFYING VISUALIZATION OF REPORT IMAGES ...............................................................................46 6.2.3. USE OF “DRAW ONLY ON REFERENCE IMAGE” COMMAND ...............................................................46 6.2.4. USE OF “HIGHLIGHT CROSSES ON PANORAMICS” CONTROL ...........................................................47 6.2.5. PERFORMING MEASURES OF DISTANCES OR ANGLES .....................................................................47 6.2.6. INSERTING EXAM/PATIENT DATA IN THE REPORT ..............................................................................47 6.3. PRINTING A REPORT .......................................................................................................................................47 6.4. SAVING THE REPORT ......................................................................................................................................47 6.5. SAVING IN PDF FORMAT .................................................................................................................................48 6.6. SAVING IN DICOM FORMAT ............................................................................................................................48 6.7. OPENING A REPORT ........................................................................................................................................49 6.7.1. MODIFYING PATIENT DATA .....................................................................................................................49 7. MANAGING DOCUMENTS .................................................................................................................................... 50 7.1. IMPORT ..............................................................................................................................................................50 7.1.1. IMPORTING BY DOCUMENT.....................................................................................................................50 7.1.2. IMPORTING BY PATIENT ..........................................................................................................................50 7.2. EXPORT .............................................................................................................................................................51 7.2.1. EXPORTING BY PATIENT .........................................................................................................................51 7.2.2. EXPORTING BY DOCUMENT ....................................................................................................................51 7.3. DELETING DOCUMENTS ..................................................................................................................................52 7.4. USING SEVERAL ARCHIVES ...........................................................................................................................52 7.5. BURNING CDs AND DVDs ................................................................................................................................53 7.5.1. BURNING A DISC BY DOCUMENT ...........................................................................................................53 7.5.2. BURNING A DISC BY PATIENT .................................................................................................................53 7.5.3. CREATING A FREE VIEWER .....................................................................................................................53 7.5.4. BURNING SOFTWARE ...............................................................................................................................54 7.5.5. BURNING A VIEWER DISC WITH OR WITHOUT DICOM FILE ...............................................................55 7.6. TRANSFERRING DOCUMENTS OR PATIENTS BETWEEN ARCHIVES ........................................................56 8. OTHER FUNCTIONS ............................................................................................................................................. 57 8.1. CREATING REPORT HEADING ........................................................................................................................57 8.2. CHANGING THE PROGRAM THEMES .............................................................................................................58 8.3. CHANGING THE APPEARANCE OF THE GRAPHIC TOOLS..........................................................................58 8.3.1. USING THE GDI+ OPTION .........................................................................................................................58 8.3.2. SELECTING REPORT COLOURS .............................................................................................................58 8.3.3. SELECT THE INFORMATION TO BE INCLUDED IN THE REPORT ........................................................59 8.3.4. USING OVERLAY COLOUR CONVERSION OPTION (B/W PRINTERS ONLY) ......................................59 8.3.5. USING “PRINTER COLOUR USAGE AND COLOUR CONVERSION” OPTION .........................................60 8.3.6. PRINT OPTIMIZE ........................................................................................................................................60 8.3.7. APPLY A RULER ON THE IMAGES ...........................................................................................................60 8.4. 3M e DICOM PRINTERS ....................................................................................................................................61 8.5. SYSTEM FILES BACKUP ..................................................................................................................................61 8.6. PROGRAM INTEGRATION WITH THIRD-PARTY SOFTWARE (PARTNERING SOFTWARE) ......................61 8.7. SELECTING AND ACQUIRING FROM TWAIN SOURCES ..............................................................................62 8.8. COMPATIBILITY WITH VDDS PROTOCOL ......................................................................................................62 8.9. CONFIGURING AN EMAIL BOX ........................................................................................................................62 8.10. DOSE BOOK TOOL .......................................................................................................................................63 8.10.1. CONVERTING A DATABASE................................................................................................................63 8.10.2. STARTING THE DOSE BOOK TOOL ...................................................................................................63 8.10.3. REQUESTING ONE OR MORE PATIENTS ..........................................................................................64 8.10.4. REQUESTING ALL PATIENTS .............................................................................................................64 8.10.5. CONSULTING DATA .............................................................................................................................64 8.10.6. CREATING A REPORT .........................................................................................................................64

USER MANUAL

8.10.7. PRINTING A REPORT .......................................................................................................................... 65 8.10.8. FILTERING THE EXAMINATION LIST ................................................................................................. 65 8.10.9. SENDING THE REPORT VIA EMAIL ................................................................................................... 65 8.11. METAL ARTEFACT REDUCTION (MAR) ALGORITHM ............................................................................... 66 8.11.1. FOREWORD.......................................................................................................................................... 66 8.11.2. USAGE .................................................................................................................................................. 66 8.12. CONFIGURING INSTALLATION AND CLIENT DATA .................................................................................. 66 9. TROUBLESHOOTING ............................................................................................................................................ 68 9.1. WARNING TO RESTART PC ............................................................................................................................ 68 9.2. ERRORS GUIDE ................................................................................................................................................ 68 9.3. LOG ERROR ...................................................................................................................................................... 68 9.4. REMOTE SUPPORT .......................................................................................................................................... 69 10. IEC61223: ACCEPTANCE TEST ............................................................................................................................ 70 10.1. POSITIONING OF THE PATIENT SUPPORT [PARAGRAPH 5.1] ............................................................... 70 10.2. PATIENT POSITIONING ACCURACY [PARAGRAPH 5.2] .......................................................................... 71 10.2.1. AXIAL PATIENT POSITIONING ACCURACY [PARAGRAPH 5.2.1] .................................................... 71 10.2.2. SAGITTAL AND CORONAL PATIENT POSITIONING LIGHT [PARAGRAPH 5.2.2] .......................... 71 10.3. TOMOGRAPHIC SECTION THICKNESS [PARAGRAPH 5.3]...................................................................... 72 10.3.1. TOMOGRAPHIC SECTION THICKNESS FOR AXIAL SCANNING [PARAGRAPH 5.3.1] .................. 72 10.3.2. TOMOGRAPHIC SECTION THICKNESS FOR HELICAL SCANNING [PARAGRAPH 5.3.2] ............. 73 10.4. DOSE [PARAGRAPH 5.4] ............................................................................................................................. 74 10.5. NOISE, MEAN CT NUMBER AND UNIFORMITY [PARAGRAPH 5.5] ......................................................... 74 10.6. SPATIAL RESOLUTION [PARAGRAPH 5.6] ................................................................................................ 76

USER MANUAL

1. INTRODUCTION TO THE MANUAL 1.1. CONTENTS

This document has been designed as means of consultation to provide information and instructions on use of the software described therein, further in this document referred to as the “program”. The user shall fully read and understand this manual before using the equipment. It is highly recommended to keep this manual along with further documentation and to use it as an handbook in order to instruct new staff in using the equipment. 1.2. DEFINITIONS Definition CBCT or CB3D CBCT DEVICE 2D DATA ONLY CBCT DATA ONLY MAIN WORKSTATION USER MANUAL OF THE DEVICE

Meaning Cone Beam Computed Tomography Radiation-emitting device that uses CBCT technology Feature available only for data coming from 2D devices. Feature available only for CBCT data. Personal Computer directly connected to a CBCT DEVICE. Specific manual for the device that operates together with the program

1.3. STYLISTIC CONVENTIONS The following table illustrates the stylistic conventions adopted by this manual: Text format

Example

Bold Underlined <text> CAPITAL LETTER

Apply <Demonstration template> ENTER

Bold Italic Italic

File  Open Patient File

Meaning Menu or toolbar item Window Title Button Command Typed text Keyboard command

Important safety information and notes are highlighted in the manual as follows: DANGER: It alerts for a potential danger which may cause injury or fatality. WARNING: It signals the presence of a potential hazard, which may cause damage to the equipment. NOTE: It provides further information not connected to the safety of device, patient and operator. NOTE FOR VIEWER VERSION: It indicates that the functions described in the paragraph are not available when the program is distributed as Viewer, where Viewer is intended as a limited version of the program.

USER MANUAL

2. STARTING PROCEDURES 2.1. SOFTWARE INSTALLATION

NOT AVAILABLE FOR VIEWER VERSION In order to properly install and uninstall the program, the qualified user must refer to the documentation included in the installation disk. 2.2. SOFTWARE CONFIGURATION

NOT AVAILABLE FOR VIEWER VERSION This paragraph provides a description of the different software configurations available, some of which can be activated through a special USB hardware key. Hereafter a brief description of each software suite is provided: EXPERT: through this configuration the user may take advantage of all the potentials of the program, both in the 2D and the CBCT environments. In particular it is possible to perform scans (if the workstation is connected directly to the CBCT scanner), or otherwise perform anyway all the operations of primary, volumetric and secondary reconstruction, of 3D image generation, and of report creation and printing allowed by the software. PROFESSIONAL: the Professional configuration allows to create new studies, perform secondary reconstruction and create and print reports, starting from volumetric data (created by the primary reconstruction). ULTIMATE: if the workstation is directly connected to the CBCT scanner, this configuration behaves exactly like an EXPERT configuration. If, on the other hand, the workstation is not directly connected to the CBCT scanner, the functions are similar to a PROFESSIONAL configuration. BASIC: this suite allows to view, print, and save in a personal archive, previously created reports with the abovementioned configurations. The user will be also able to add distance and angle measurements and modify brightness and contrast of single images. Any information relating to the program installed and the characteristics of the workstation can be viewed by selecting the Help  About menu.

USER MANUAL

2.3. MINIMUM PREREQUISITES The table below indicates the minimum requirements for the workstations not directly connected to the CBCT device, and where the program will be installed or the corresponding Viewer version that will be used. Minimum requirements for NNT Station (2D and 3D) Operating system

Windows 7 Professional 32 / 64 bit Windows 8 Professional 32 / 64 bit Windows 8.1 Professional 32 / 64 bit Windows 10 Pro 64 bit

Processor

Intel Core 2 Duo / AMD Athlon X2 (4-core processor recommended)

Hard Disk

100 GB 7200RPM

System memory

4 GB (Windows 7 / 8 / 8.1 / 10)

Video card(1)

3D VideoCard 1 GB physical RAM OpenCL support v1.2 or higher(2)

Monitor(3) (minimum resolution)

4:3 monitor 1280 x 1024 pixel (or higher) Wide Monitor 1344 x 768 pixel (or higher)

Power supply(4)

≥ 400W

Additional devices

1 Network card 1Gbps(5) DVD-ROM (recommended)

NOTE: The software is optimised for keyboard and mouse use.

NOTE: The software is not optimised for installation and execution within a Virtual Machine.

_______________________________________________________________________________________________________________________________________

For the list of the validated video cards, refer to par. 2.3.1

Minimum requirement for proper operation of the metal artefact reduction procedure (MAR, refer to par. 8.10). For MAR proper operation, use one of the validated video cards listed in par. 2.3.1

Proper software display is ensured by using the 100% value (Small font or Smaller font 100%) as system font setting (Windows Control Panel)

Minimum requirement for proper operation of the validated cards; for the exact power value, refer to par. 2.3.1

Necessary requirement when using an archive shared in a network with other workstations. Use a wired LAN network. The use of LAN WiFi does not ensure image archives/program database consistency and could cause data corruption and/or loss.

USER MANUAL

2.3.1. LIST OF VALIDATED VIDEO CARDS The following video cards have been validated for use in the workstation dedicated to primary reconstruction of the CBCT data, for 3D Rendering Volume and for metal artefact reduction (MAR) function. NOTE: Use a discrete video card (no APU). In order to choose the appropriate card model, check the power of your PC power supply. Power supply ≤ 400W

Card (brand and model)

Sapphire Radeon R9 380 – NITRO – OC – 4GB GDDR5 Sapphire Radeon R9 270 – BOOST & OC – 2GB GDDR5 Sapphire Radeon R7 370 – DualX – OC – 2GB GDDR5 Sapphire Radeon R7 360 – NITRO – OC – 2GB GDDR5 Sapphire Radeon R7 360 – OC – 2GB GDDR5 Sapphire Radeon R7 265 – DualX – 2GB GDDR5 Sapphire Radeon R7 260X – OC – 2GB GDDR5 Sapphire Radeon R7 250X – VaporX – 1GB/2GB GDDR5 Sapphire Radeon R7 250 – 1GB/2GB GDDR5 ATI FirePro W7000 – 4GB GDDR5(6) Sapphire Radeon HD 7870 – 2GB GDDR5 Sapphire Radeon HD 7850 – 1GB/2GB GDDR5 Sapphire Radeon HD 7770 – GHZ Ed. – OC – VaporX – 1GB GDDR5 Sapphire Radeon HD 7750 – GHZ Ed. – OC – VaporX – 1GB GDDR5 Sapphire Radeon HD 6970 – VaporX – 2GB GDDR5 Sapphire Radeon HD 6950 – VaporX – 1GB GDDR5 Sapphire Radeon HD 6870 – VaporX – 1GB GDDR5 Sapphire Radeon HD 6850 – VaporX – 1GB GDDR5 Sapphire Radeon HD 6770 – VaporX – 1GB GDDR5 Sapphire Radeon HD 6750 – VaporX – 1GB GDDR5 ATI Radeon HD 5870 – 1GB ATI Radeon HD 5850 – 1GB ATI Radeon HD 5770 – 1GB ATI Radeon HD 4890 – 1GB(6) ATI Radeon HD 4870 – 1GB(6) ATI Radeon HD 4850 – 1GB(6)

Power supply between 400W and 500W

YES YES YES

YES

YES YES

YES

Power supply ≥ 500W

Validation

YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES YES

2016 2015 2016 2016 2016 2015 2015 2015 2015 2014 2014 2014 2014 2014 2013 2013 2013 2013 2013 2013 2012 2012 2012 2012 2012 2012

If a workstation is dedicated to primary reconstruction of the CBCT data, one of the cards indicated in the list must be used.

_______________________________________________________________________________________________________________________________________

Sheet not validated for MAR function

USER MANUAL

2.4. OPENING OF EXAMS 2.4.1. OPENING OF EXAMS BY PATIENT

NOT AVAILABLE FOR VIEWER VERSION It is possible to open the archived exams by filtering them by the patient with which they are associated. To do this: 1) From the main window, select File  Open by patient… or press the appropriate button (see figure) The patient selection window will be shown (called “Classic style”): 2) Press the “Update list” button to see the complete list of available patient personal data or type part of the surname to go directly to the patient desired. 3) Select the patient’s name and confirm with “OK”

A list of documents associated with the selected patient will be shown. 4) Select the required document and confirm with “OK”.

One may change the search query by performing an advanced search and filtering by different fields. To do this: 1) From the patient selection window, click on the settings modification button

2) Change the selection from "Classic style" to Advanced style" and confirm by clicking on "Apply".

3) A window will pop up asking you to confirm the change. Click on “Yes” to make the change effective.

USER MANUAL

At this point, by clicking on the “Advanced search” button, you can do a search by the fields shown in the image below. NOTE: Search fields are not exclusive, therefore, by selecting several parameters in the various fields, the filters will add up.

To view further details (columns) in the display window: 1) From the patient selection window, click on the column display button .

2) Add the desired columns and confirm by pressing “OK” .

USER MANUAL

2.4.1.1. OPENING OF EXAMS BY VIEWER It is possible to open the archived exams by filtering them by the patient with which they are associated. To do this: 1) From the main window, select File  Open by patient… or press the appropriate button (see figure) The patient selection window will be shown (called “Classic style”): 2) Select the patient’s name and confirm with “OK”

2.4.2. OPENING OF EXAMS BY DOCUMENT TYPE

NOT AVAILABLE FOR VIEWER VERSION It is possible to open the archived exams by filtering them by type of document. To do this: 1) From the main window, select File  Open by document… or press the appropriate button (see figure)

It will be shown the document selection window: NOTE: Depending on the configuration of the software used, some buttons may not be available for selection. 2) Press the button corresponding to the type of required document 3) Select the patient’s name associated with the document and confirm with “OK” NOTE: It is possible to filter the patients list by typing part of the surname in the dedicated field, or by other search criteria by clicking on the "Advanced search" button (1). It is also possible to filter the list of patients based on the introduction date of the patient's personal data in the software (3). In particular, you can view: -

All the patients Today’s patients Patients in last 7 days Patients in last 30 days Patients in last 3 months Patients in last 6 months Patients in last year

USER MANUAL

2.4.3. SELECTING A PATIENT

NOT AVAILABLE FOR VIEWER VERSION It is possible to make the patient selection: this selection allows to centralize on the patient chosen those operations that relate to the association with a record (such as opening documents). To select a patient: 1) Click on the appropriate button (see figure) The patient selection window will be shown (called “Classic style”): 2) Press the “Update list” button to see the complete list of available patient records or type part of the surname to go directly to the patient desired. From this screen it is possible to: A) Select the patient’s name and confirm with “OK” B) Select the patient’s name and delete it from the software by using “Delete patient record” button. C) Add a new patient record in the software by using “Add new patient...” button D) Change the existing records by using the “Edit patient record…” button E) Delete patient records not associated with any document by using the “Unused records cleanup” button One may change the search query by performing an advanced search and filtering by different fields. To do this: 1) From the patient selection window, click on the settings modification button

2) Change the selection from "Classic style" to Advanced style" and confirm by clicking on "Apply"

3) A window will pop up asking you to confirm the change. Click on “Yes” to make the change effective.

USER MANUAL

To view further details (columns) in the display window: 1) From the patient selection window, click on the column display button

2) Add the desired columns and confirm by pressing “OK”

In case of patient confirmation (point A), you will see his name in the main window. At that point it will be possible to: 3A) View documents relating to the patient by selecting the required type using the command Open by document... or view all documents relating to the patient by using the command Open by patient 3B) Deselect the patient by clicking on the appropriate button (see figure)

USER MANUAL

3. IMAGE MANAGEMENT

3.1. CHANGING THE IMAGE PALETTE The visualisation window allows setting the image palette and any filters. 1) The visualisation window can be opened in two different ways: •

By double-clicking on the image you wish to modify.

•

(CBCT DATA ONLY) By selecting the Change the image palette button from the main toolbar.

2) (CBCT DATA ONLY) If the window has been opened using the toolbar button or the menu command, the “Select Image Group” dialog box will appear on screen. This window prompts to select the type of image that will be used as an example, during the adjustment process of tissue visualisation and the application of any filters. 3) (CBCT DATA ONLY) Select the type of image you wish to use.

4) The "Visualization Window" will appear. There is a preview image that instantly allows seeing how the modifications apply to the image. To the right of the preview image there is a scrollbar that allows moving inside the group of selected images. The scrollbar to the left allows applying a filter to the image. The type of filter to be applied can be selected by means of the Sharp and Sharp+ buttons above the scrollbar. NOTE: The Sharp filter cannot be used on the images of the documents created through artefact reduction procedure MAR, refer to par. 8.10.

USER MANUAL

A cursor within the window enables the modification of the image brightness and contrast: dragging the cursor to the right/left changes the contrast and to the top/bottom the brightness. (CBCT DATA ONLY) The options located to the right allow selecting the image tone. Available tones are: Grey, Sepia, Blue Film, Red, Flame and Spectrum. To modify the relationship between the greyscale and the image values, use the two arrows under the greyscale.

The button located between the greyscale and the options inverts the colours used The three scrollbars to the left of the greyscale are: -

Gamma: it modifies the curve trend by changing the ramp into an

BEnh (CBCT DATA ONLY) it gradually applies a filter that

STS (CBCT DATA ONLY) it applies a filter that gradually

upward-sloping and downward-sloping curve to improve the visualisation of soft and hard tissues. enhances hard tissues. smooths soft tissues.

It is possible to pre-set up to a maximum of three windows of greyscale and filters per image type, to load at a later stage. To do that: a) b) c) d) e)

(Optional) Select one of the three buttons "Wnd1", "Wnd2" or "Wnd3". Modify the greyscale settings. Click on the “Record” button. The “Select window” box will open. Select one of the three buttons "Wnd1", "Wnd2" or "Wnd3". The window will display the “Ok” button. Select the “Ok” button to save the settings in the selected window.

To load one of the levels saved, click on the corresponding “Wnd” button. NOTE: Before a new document is created, the Wnd1 is set as default. 5) After making all the adjustments (greyscale and filter), select “Apply”.

USER MANUAL

6) The “Apply To” window will be displayed. Select how you want to apply your changes: a) b) c)

Current Image: changes will be applied only to the selected image. Current Image Group: changes will be applied to the images belonging to the selected image group. (CBCT DATA ONLY) All images: (it may be disabled) changes will be applied to all the images of the study. (When selecting this option a message will appear, reminding you that the filter will not be applied to any image and the palette will not be applied to the 3D and scout images).

7) At the end click on the “OK” button.

8) Press the “Reset” button shown in the figure to reset the palette to the predefined settings.

3.2. HIDING IMAGE OVERLAYS The image overlays are all the graphic objects (lines, arrows, distances, angles, text, profiles, markers etc…) that can be manually added to the images. A command is provided in order to temporarily hide these objects, and show the images in their original status. From the main toolbar of the study select the “Show/hide image overlays” command. Deselect the command to restore the visualization of the overlay. 3.3. SAVING IMAGES IN DIFFERENT FILE FORMATS Each image can be saved in a JPEG or BMP format. To save an image in a different format, follow the steps below: From inside the study select File  Save Image As... The cursor will change its appearance to reflect the selected command. Left-click on the image you wish to save.

The “Save As” window will appear with a suggested file name. Browse for the directory where you want to save the file. From the “Save As Type” list select the file format in which you wish to save the image. Click on the “Save” button to save the file. After the file has been saved, the “ Save image as…” command is still active and it is possible to save other images. Right-click to deactivate it. NOTE: The “Save image as…” command for the images in different formats is available also in the RawData and Volumetric Data.

USER MANUAL

You can enable overlapped saving of the image data from the  “2D image option” menu. Such data will be visible in the lower part of the image.

3.4. SAVING A SCREEN SHOT The screen shot process consists in taking a picture of what is displayed at that moment on the screen and save it in a graphic format. 1) From the main toolbar select the Screen shot…. button.

2) The cursor will change to reflect the selected command. Select the screen you wish to capture and left click on it. 3) The “Save As” window will appear with a suggested file name. Browse for the directory where you want to save the file. From the “Save As Type” list select the file format in which you wish to save the image. Click on the “Save” button to save the file. After the file has been saved, the “Save image as…” command is still active and it is possible to save other images. To deactivate it right click.

USER MANUAL

3.5. WORKING WITH TOOLBARS Lines, angles, distances, remarks, profiles, markers, and implants can be added to each image (except 3D images). For the 3D images, only lines and text can be added. This paragraph will show how to apply these overlays to the images From the main toolbar select one of the buttons to open the corresponding toolbar.

3.5.1. IMAGE CREATION TOOLBAR By using this toolbar, you can create new images based on the type of document selected. Refer to the specific attachments of the desired application mode for the list of available functions. Example of image creation toolbar

Example of image creation toolbar

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3.5.2. ANGLE TOOLBAR

NEW ANGLE

(“New Angle”) MODIFY ANGLE

(“Drag Angle”)

DELETE ANGLE

(“Delete one angle”) DELETE ANGLES

(“Delete all angles”)

Select to trace a new angle.

Select to modify an existing angle.

Select to delete an existing angle

Select to delete all the existing angles

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3.5.3. DISTANCE TOOLBAR

NEW DISTANCE

Select to trace a distance

(“New Distance”)

NEW DISTANCE WITH ARROWS

(“New Distance (arrow)”)

(NOT AVAILABLE FOR VIEWER VERSION) NEW DISTANCE WITH HYPHEN

(“New Distance(hyphen)”)

(NOT AVAILABLE FOR VIEWER VERSION) NEW DISTANCE WITH ARROW AND HYPHEN

(“New Distance arrow + hyphen)”)

(NOT AVAILABLE FOR VIEWER VERSION) MODIFY DISTANCE

Select to trace a distance with hyphen

Select to trace a distance with arrow and hyphen

Select to modify an existing distance

(“Drag”)

Select to trace a distance with arrows

DELETE DISTANCE (“Delete One Distance”)

Select to delete an existing distance

DELETE DISTANCES (“Delete All Distances”)

Select to remove all the existing distances

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3.5.4. LINE AND ARROW TOOLBAR

NEW LINE

(“New Line”) NEW LINE WITH TEXT

(“New Line + Text”)

NEW LINE WITH TEXT FROM DB

(“New Line + Text from DB”) NEW ARROW

(“New Arrow”)

NEW ARROW WITH TEXT

(“New Arrow + text”)

NEW ARROW WITH TEXT FROM DB

(“New Arrow + Text from DB”) MODIFY LINE OR ARROW

(“Drag”)

DELETE LINE OR ARROW

(“Delete One Line”)

REMOVE LINES OR ARROWS

(“Delete All Lines”)

Select to trace a line

Select to trace a new line with text

Select to trace a line with text from database.

Select to trace an arrow

Select to trace an arrow with text

Select to trace an arrow with text from database

Select to modify a line or an arrow

Select to delete a single line or arrow

Select to delete all the lines and arrows

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3.5.5. MARKER TOOLBAR

NEW SMALL MARKER

Select to trace a small marker

(“New Small Marker”)

NEW MEDIUM MARKER

Select to trace a medium marker

(“New Medium Marker”) NEW LARGE MARKER

Select to trace a large marker

(“New Large Marker”)

CHANGE MARKER COLOUR

Select to change the marker colour

(“Change Default Marker colour”) MARKER SET-UP

Select to open the marker set-up window. This command allows modifying marker thickness.

(“Marker setup”)

HIDE MARKERS

Select to hide the traced markers

(“Hide Markers”)

DELETE ONE MARKER

Select to remove an existing marker

(“Delete Marker”)

DELETE MARKERS

Select to delete the existing markers

(“Delete All Markers”)

The “Marker Setup” window allows modifying marker thickness.

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3.5.6. TEXT TOOLBAR

INSERT TEXT

(“Single line string”) INSERT MULTILINE TEXT

(“Multiline text”)

INSERT TEXT FROM DB

(“Database text”) EDIT TEXT

(“Edit text and size”) DRAG TEXT

(“Drag text”)

DELETE SINGLE TEXT

(“Delete text”)

DELETE ALL TEXT

(“Delete all text”)

Select to insert text

Select to insert multiline text

Select to insert database text

Select to edit a text

Select to drag a text

Select to delete an existing text

Select to delete all the existing text

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3.5.7. PROFILE TOOLBAR The profiles indicate the value in Hounsfield units NOTE: Accuracy of Hounsfield unit (HU) measurement has intrinsic limitations in CBCT technique, as broadly debated in scientific literature. Among others, see: "Deriving Hounsfield units using grey levels" - DMFR (2010) 39, p.323; "Influence of anatomical location on CT numbers" - OOOO Vol. 115 No. 4 April 2013 p.558; "Prospects and challenges of rendering tissue density in Hounsﬁeld units" - OOOO Vol. 116 No. 1 July 2013 p.105.

NEW PROFILE

Select to trace a profile

(“New Profile”)

INPUT REGION

Select to trace a focus area

(“Trace region”)

ZOOM IN PROFILE

Select to zoom in a profile

(“Zoom+”)

ZOOM OUT PROFILE

Select to zoom out a profile

(“Zoom-”)

DELETE PROFILE

Select to delete an existing profile

(“Delete Profile”)

DELETE REGION

Select to delete a focus area

(“Trace region”)

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3.5.8. IMPLANT TOOLBAR NOTE: DISCLAIMER OF LIABILITY CEFLA s.c. shall not be liable for any incidental or consequential loss, damage or expense, directly or indirectly arising from the use of the implant simulation feature, neither assumes nor authorises any other person to assume for it any other or additional liability or responsibility in connection with these features. Implant simulation should only be used by surgeons having received proper training. Implants are portrayed in a simplified shape, or template, faithfully replicating the outer dimension of the implants according to catalogues and datasheets of their respective manufacturers. As technical data is subject to change without notice, make sure that the dimensions of the implant template being used do reflect the actual implant size, according to current specifications from the chosen implant manufacturer. All company and/or product names may be trade names, trademarks and/or registered trademarks of the respective owners with which they are associated

NEW IMPLANT

(“New implant”)

SUBSTITUTE IMPLANT

(“Substitute implant”) EDIT IMPLANT

(“Edit implant”)

EDIT IMPLANTS DATABASE

("Edit implants database") DRAG IMPLANT

(“Drag implant”)

HIDE IMPLANT AXIS

(“Hide implant axis”) HIDE IMPLANTS

(“Hide implants”)

DELETE IMPLANT

(“Delete implant”)

DELETE ALL IMPLANTS

(“Delete all implants”)

Select to insert a new implant

Select to substitute a previously inserted implant

Select to edit the previously inserted implant

Select to add new implant models to the database

Select to move/tilt the implants present

Select to hide the visualisation of implant axis

Select to hide the implants present

Select to delete an implant inserted

Select to delete all the implants inserted

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Selecting “New implant”, the implant selection window will be shown:

The functions of the window are described below: Red Tabs List of the manufacturers and the relative models contained in the database. “Used implant(s)” tab It displays the implants currently used in the document (the implants are displayed after selecting the implant with the “Select implant” button. "Select implant" button It allows selecting the desired implant so that it can subsequently be inserted in the document. After clicking this button, the selected implant will be shown in the green “Used implant(s)” tab. "Exit" button It allows closing the window and returning to the original document. After selecting the implant, the insert/edit window will be displayed:

The functions of the window are described below: Implant display window: In this window you can edit the size and shape of the implant by: 1)

Changing the red nodes in the image, dragging them both vertically and horizontally to the desired position with the mouse.

Adding new points (diameters) by double-clicking the desired point or right-clicking and selecting “Add diameter” / “Remove diameter”.

Colours window: It allows changing the implant display colour.

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Steps window: It allows dragging the red nodes in steps of 0.05mm, 0.1mm or 0.5mm. “Vertical position” and “Diameter” fields: They indicate the measurements of the various parts of the implant. You can edit the measurement by inserting a new value from the keyboard. "Add" / "Remove" buttons Add/remove a diameter in position 0mm. "Insert implant" button It allows inserting the previously selected implant in the document. "Unselect implant" button It allows deselecting the previously selected implant and returning to the previous window. "Exit" button It allows closing the window and returning to the original document. Once the implant has been positioned, you can obtain information on HU values by double-clicking on the implant. A window will open, as shown in the figure, indicating the HU and Misch scale values. The red diagram indicates the values of volume densities occupied by the implant, the blue diagram indicates the values of volume density outside the implant (up to 1mm distance).

Right-click to select “Apply implant description” button. It allows to position the implant description on the image.

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3.5.9. REPORT TOOLBAR

PATIENT DATA (“Report patient data”)

Select to view/edit the patient data pertaining to the report

ADD PAGE (“Add page”)

Select to add a new page to the report

EDIT TEMPLATE (“Edit template”)

Select to edit a page of the report template

EDIT NOTE (“Edit note”)

Select to insert or edit a note

INSERT TEXT NOTE IN DATABASE (“Report notes texts database”)

Select to insert a text note in the database

EMPTY REPORT NOTES (“Empty report notes”)

Select to clear the notes present

REPORT WIZARD (“Report wizard”)

Select to start the guided report creation

REMOVE PAGE (“Remove page”)

Select to remove a page from the report

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3.5.10. TOOLBAR ENABLE BUTTONS AND TOOLS The “Enable toolbar” buttons to the right include most of the commands present in the toolbars. Initially only the buttons of the above-mentioned toolbars are present. Press one of these to activate the buttons concerning the selected toolbar.

Example of angle toolbar selection and the relative tools

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3.6. MAGNIFYING GLASS TOOL Select the icon shown in the figure to use the magnifying glass tool. Once the option is selected the mouse cursor will take the shape of a magnifying glass. Move the cursor over the image to enlarge it. The enlargement automatically disables the default overlay display while displaying overlays entered by the operator. To close the tool right-click or select again the magnifying glass icon.

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3.7. ENABLE/DISABLE DELETE CONFIRMATION MESSAGES

NOT AVAILABLE FOR VIEWER VERSION: A confirmation message appears every time the user tries to:  delete an image;  (CBCT DATA ONLY) delete a single transaxial from the sequence;  delete all the angles of an image;  delete all the distances of an image;  delete all the lines and arrows of an image;  delete all the text of an image;  launch NNT Burner;  (CBCT DATA ONLY) use a Quick Curve, after the fifth point is inserted. When the following message is visualized it is possible to decide if the next time it will be shown or bypassed.

Checking the “Don’t show this message again” flag the software won’t show the confirmation message for the selected operation. Confirmation messages can always be restored inside the study, through File  Messages options menu, that will display “Message confirmation Setup” window. The entries of messages you are interested in can be selected or deselected. For enabling all the confirmation messages (including the ones that are not in the list) the Enable all confirmation Messages button has to be pressed. 3.8. ENLARGED AND FULL-SCREEN IMAGE MODE In order to manage image display in the best possible way, the images present in the various views can be maximised and displayed in full screen mode. In the first case, the image size will be adapted to the software display window. To perform such operation, move the cursor to the desired image, right-click and select Maximized from the menu. To restore the image size, go back to the previous view, move the cursor to the desired image, right-click and select Restore from the menu. NOTE: If the image is maximised, the zoom and change view commands cannot be used. However, you can enter measures, edit the image palette, etc. To display an image in full screen mode, move the cursor to the desired image, right-click and select Fullscreen image from the menu. A new window will open displaying the image in full screen mode: in every case, except for 3D rendering display, it is possible to zoom in/out by means of the mouse wheel and move the zoomed image by keeping the left button pressed. In case of 3D rendering, you can use the same commands used in the 3D box of the view to move, zoom in/out and turn the 3D model. NOTE: Except for the 3D rendering, if the image is in full screen mode, you cannot perform any editing.

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3.9. RESTORING IMAGE FACTORY POSITION Each view allows editing the image display area by means of the vertical or horizontal separators. Just move the cursor to one of them and keep the left button pressed while dragging. If you want to put the separators back to their factory position, just move the cursor to an image, right-click and select the Reset images layout item from the menu. 3.10. SENDING THE IMAGES VIA EMAIL If a personal email box has been set in the program to send emails (see par. 8.9), you can send the images as an email attachment. Move the cursor to the desired image, right-click and select Send image via email. A window will be displayed, which allows specifying a name and format for the image. Clicking on OK, a window will be displayed, where to enter the addressee email address, the subject and a message (optional). NOTE: Such function is available not only for Volumetric data, but also for 2D images. In the latter case, if many images are selected simultaneously, all of them will be attached to the email. NOTE: Forwarding times may extend in case of big files. WARNING: Check the right configuration of the email box. Make sure that the total size of the attachments does not exceed the maximum limit allowed by the provider/domain of the email address used. Moreover, you can send an image via email to the technical support service. Move the cursor to the desired image, right-click and select Send image via email to support. A window is displayed where you can enter a message (optional); the addressee and Subject fields are already filled out. NOTE: In case of 2D images, you can send all the selected images in TIFF format. WARNING: This option must be used if required by the technical service. Any image sent without the explicit request by the technical service does not trigger any support procedure.

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4. DICOM IMAGES The DICOM (Digital Image and Communication in Medicine) is the file format that aids the distribution and the viewing of medical images. The program allows exporting and subsequently importing the images in DICOM format. 2D DATA ONLY 2D images can be saved in DICOM format (as well as PNG, TIFF and JPEG) with the “ORIGINAL”, “DEFAULT” and “TREATED” options. The “ORIGINAL” option allows obtaining RAW images, the “DEFAULT” option allows obtaining an unchanged/not reprocessed version of the images, while the “TREATED” version contains all processing/postprocessing applied by the user. As the “TREATED” format is a reprocessed version, it is deliberately marked so that no other processing filter can be applied if it is reimported in the software. Information mentioned above applies to Export, Store, Send data to, etc.

CBCT DATA ONLY For both the Export and the Store functions, you can save the DICOM images in “DEFAULT” and in “TREATED” format; the “DEFAULT” format is the unchanged/not reprocessed version of the images, while the “TREATED” format contains all processing/post-processing applied by the user. As the “TREATED” format is a reprocessed version, it is deliberately marked so that it cannot be used by third-party software to generate new images or sections (e.g. in case of axial images), as any cut produced on the treated dataset may generate images with altered diagnostic content. WARNING: All the images saved in DICOM format with the “TREATED” option (by means of the Export, Store, Save, Send data to, etc. commands) CANNOT be reloaded (via Import, Retrieve, etc.) to the program. 4.1. EXPORTING IMAGES IN DICOM FORMAT

CBCT DATA ONLY WARNING: Only the axial images exported in DICOM format can be reimported (via Import, Retrieve, etc.) to the software. No other type of CBCT image can be reimported, except for scout images in case of Retrieve. 4.1.1. SAVING "SINGLE AXIAL IMAGE" / "SEQUENCE OF AXIAL IMAGES" After the CBCT document opening, select File → Save in DICOM format → Single Axial Image to save a single axial image in Dicom format (.dcm) To save a complete sequence of axial images, select File → Save in DICOM format → Sequence of Axial images In both cases, it is possible to select Free matrix option to export the images while maintaining the original dimensions (in pixel), or 512x512 Matrix option to force the size to 512x512 pixels, the latter is achieved by shrinking, if necessary, the original axial images. The “Browse for folder” window will appear. Browse for the folder in which you want to export the DICOM images, then select the “OK” button. The export process will start immediately. NOTE: During "Sequence of Axial images " saving in both Free matrix and 512x512 matrix export case, a further folder will be created in the selected one with file path: ..\Surname_Name_YYYYMMDD. Such folder will store the DICOMSET.

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4.1.2. SAVING "ALL IMAGES" After the CBCT document opening, select File  Save in DICOM format  All Images to save in Dicom format (.dcm) different types of secondary images, if available in the document (scout, axial, cross, multiplanar etc.). A windows will appear, where it is possible to select the image types available in the document and after confirming with the button “Send”, a second window called “Browse for folder” will appear, allowing to choose the folder in which you want to export images. Press the “OK” button to start the export.

4.1.3. SAVING FROM AXIAL AND MPR VIEW Right-click 2D images to open the menu that allows to choose to save images in DICOM format. “(current image group)” allows to save the whole series of images on which you clicked. “(current image view)” allows to save the whole series of images present on all the 2D views currently displayed. NOTE: Images exported in DICOM format using the mode described below may not be reimported in the Software

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4.2. IMPORTING IMAGES IN DICOM FORMAT

CBCT DATA ONLY

NOT AVAILABLE FOR VIEWER VERSION Select File  Import  Import DICOM dataset A window labelled “Load DICOM Dataset” appears, here the DICOM files to import have to be selected. To import a multi-file DICOMSET select one of the dataset files. Then, system asks whether the document must be imported as a Volumetric Data or a Study document. For Studies and relevant Reports, the possibility to store imported documents in the PACS is disabled ( File  DICOM Storage (Study) and File  DICOM Storage (Report)). 4.2.1. LIMITATIONS TO IMAGE IMPORT IN DICOM FORMAT IN THE SOFTWARE In order to allow the Software to recognise DICOM images they must have the features indicated in the table below. Dicom Tag

Tag Name

2D images

3Dimages

Standard Dicom 3

[0002; 0010]

Transfer Syntax UID

1.2.840.10008.1.2 Implicit VR – Little Endian

1.2.840.10008.1.2.1 Explicit VR – Little Endian

1.2.840.10008.1.2.4.70 Explicit VR – Little Endian – JPEG Lossless, Non-hierarchical, First-Order Prediction

[0008; 0005]

Specific Character Set

ISO IR_100 ISO IR_192

[0002; 0002]

Media Storage SOP Class UID

1.2.840.10008.5.1.4.1.1.1.1 DX Image Storage

1.2.840.10008.5.1.4.1.1.2 CT Image Storage

1.2.840.10008.5.1.4.1.1.1.3 IO Image Storage 1.2.840.10008.5.1.4.1.1.7 Secondary Capture Image Storage [0008; 0008]

Image Type

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original\primary\axial

4.3. SAVING 2D IMAGES IN DICOM FORMAT Each image can be saved in DICOM format. From inside the document select File  Save Image As... The cursor will change its appearance to reflect the selected command. Left click on the image you wish to save.

The “Save As” window will appear with a suggested file name. Browse for the directory where you want to save the file. Click on the “Save” button to save the file. After the file has been saved, the “Save image as…” command is still active and it is possible to save other images. Right-click to deactivate it. 4.4. IMAGE STORING ON PACS

NOT AVAILABLE FOR VIEWER VERSION If the “NNTDicom” function is enabled, you can send images in DICOM format to a PACS. To do this, after opening the program document containing the images to send, select the command File  Save in

DICOM format…

4.5. DICOM SETTINGS

NOT AVAILABLE FOR VIEWER VERSION Through the DICOM settings… command, you can set: 1)

EXPORT MODALITY: the type of dataset to create. Two different types of dataset are available:

• •

Multiple files DICOM dataset: DICOM multiple files (one for each axial image). Single-file DICOM dataset: DICOM single file containing all the axial images.

CHARACTER SET: The character set used during export. It is possible to select between:

• •

ISO_IR 192 (Unicode): "Unicode" character set ISO_IR 100 (Ascii): “Ascii” character set.

INSTITUTION NAME and STATION NAME: names used during file export.

“EXPORT AXIAL DATASET AS HORIZONTAL” option: it forces the axial images export, ignoring the inclination with respect to the patient system. It applies when exporting only axial images, not when exporting all images. When forwarding Dicom dataset to third-party software, this option is ignored if all image export is active.

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STORAGE: it displays the list of active storage paths.

FORCE STORAGE OF ALL 2D IMAGES: For every storage (Store) on PACS it forces the storage of all 2D images of the patient, not only the new images not sent to PACS yet.

DON’T SEND REFERENCE AXIAL: It does not send the axial image screenshot containing references of panoramic, cross, etc.

ENABLE IMAGE COMPRESSION: All DICOM format images are compressed in lossless mode before being sent or stored.

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5. REPORT TEMPLATES NOT AVAILABLE FOR VIEWER VERSION 5.1. FOREWORD Templates are required to create a report. This template represents the layout with which header, patient data, notes and images will be included in the report. Several templates can be created, customising them according to the type of printer, the type of paper used, or simply the type of report you want to create. There are two main types of templates: single-page templates and multi-page templates. Two single-page factory templates called F0 and F1 are pre-installed on the software. Such templates are required to print single 2D images in portrait (F1) or landscape (F0) format. 5.2. CREATING A NEW SINGLE-PAGE TEMPLATE Select File  Template Setup 

Single page layout 

New….

Select the printer from the list of printers, the paper type and orientation which will be used for the report, then click on the “OK” button. The template layout will appear inside a dialog box. It contains 5 predefined fields: Comments: it defines the comment associated with the template. Header: report header area. Patient: patient data area. Notes: report comments area. Logo: manufacturer and software logo area (cannot be changed by the user) Img1: area reserved to the first report image. Use the “Comment” field to describe the template being created (Example: Maxillary implant study) Left-click on the “Img1” box. The “Img1” box will be highlighted and the cursor will change depending on the area where it is. Each box can be adjusted in two different ways:

1) Using the mouse: click inside the box and drag the mouse to change the box position. Click on the edges of the box to resize it.

2) Using control buttons: click on the single buttons to modify the position, size and scale of the box.

NOTE: Changing the scale from 100% will cause the report images to lose the 1:1 scale.

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Click on the “Add” button to add a new image box. Continue adding new image boxes until the template is defined. Click on the “Remove” button to delete the highlighted box. At the end click on the “OK” button. You will be prompted to confirm before saving the new template. Select “OK”..

5.3. MODIFYING AN EXISTING SINGLE-PAGE TEMPLATE Select File  Template Setup 

Single page layout 

Open….

The “Open report page layout” window will appear on screen. Select the template to modify and click on the “OK” button. The selected template will open. After modifying the template, click on the “OK” button. 5.4. DELETING A SINGLE-PAGE TEMPLATE Select File  Template Setup 

Single page layout 

Delete….

The “Delete report page layout ” window will appear on screen. Select the template to delete and click on the “OK” button. You will be prompted to confirm before deleting the template. 5.5. CONVERTING A SINGLE-PAGE TEMPLATE Converting a template means adapting an existing template to a printer different from the one used during the template creation. After the conversion the original template will be overwritten by the new one. Select File  Template Setup 

Single page layout 

Convert….

The “Convert template” window will appear on screen. Select the template to be converted and click on the “OK” button. Select the type of printer you wish to use for the conversion (“ Windows Standard” or “Digital / DICOM”). From “Print Setup” select the printer to use for the conversion, then press “OK”. You will be prompted to choose if you want to keep a copy of the original template (select “No”) or if you want to overwrite it (select “Yes”). 5.6. COPYING A SINGLE-PAGE TEMPLATE Copying a template means creating a copy of a template. This command is useful if you want to create similar templates. After copying it, each template can be modified according to your needs. Select File  Template Setup 

Single page layout 

Copy….

The “Copy template” window will appear on screen. Select the template to be converted and click on the “OK” button. The selected template will open. Perform the modification you wish and click “OK”. You will be prompted to confirm before saving the template. Click on the “OK” button.

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5.7. MULTI-PAGE TEMPLATES Select File  Template Setup 

Multiple pages layout

The Edit template window will open, where various operations can be performed

Add: It creates a new template and adds it to the list of the multi-page templates. Delete: It creates an existing template and deletes it from the list of the multi-page templates. Add Page: It adds a page to the selected template. The pages that can be added are the previously created singlepage templates. To create a new page with a new layout, first create the single-page template with the desired layout. Delete Page: It deletes a page of the selected template. Move Up: It swaps the selected page with the previous one. Move Down: It swaps the selected page with the following one. Ok: It confirms and saves the editing just performed on the templates and closes the window. Cancel: It cancels the editing just performed on the templates and closes the window.

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6. REPORT

6.1. CREATING A NEW REPORT A document with images must be opened in order to create a report. 6.1.1. SELECTING THE TEMPLATE After opening a document with images, select Report  New… The “Open report page layout” window will appear on screen. For each template, ID comment, associated printer, rank showing how often the template has been used and a preview image are shown. Select the template to be converted and click on the “OK” button. The template will open. The new report based on the selected template appears on the screen near the document images. At the same time the “Open Report Page Layout” window is displayed again. Select a new template and click the “OK” button if you wish to add a new page to the report, otherwise press the “Cancel” button. Please find below a brief description of the report fields: 1) 2) 3) 4)

Report header Patient data Empty image fields Comment field

Note that the patient data and header are automatically introduced by the software.

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6.1.2. INSERTING IMAGES IN THE REPORT Left-click in the first box destined to contain an image. The green box will turn yellow. Left-click on the image to insert. If the image is too large to fit in the report, on the image is displayed the area of the image that may be inserted. The area that cannot be inserted is darkened. Adjust the frame location inside the image to delimit the area to be inserted. Right-click to copy the image inside the report. The image frame will be copied into the report. Repeat the previous steps to insert additional images in the report.

At the end the report is complete with all the images.

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6.1.3. INSERTING IMAGES IN AUTOMATED MODE The insertion of images in a report can be optimized using the automated modality. This modality allows selecting sequentially the images to insert in the report without highlighting the report boxes every time. Here below there is a brief description of this sequence. Open an empty report page (Report  New…). Holding down the F1 button, select an image that has to be inserted in the report, repeat this operation for all the images you want to insert. If the position of the images has to be known in advance, select “ Report  Report Wizard”. The boxes inside the report page will be identified by numbers. At the same time the first box will be automatically highlighted. Select the image you wish to insert in the first box. After the image has been inserted inside the report, the following box will be highlighted. Do the same until all the boxes have been filled.

6.1.4. REMOVING IMAGES FROM A REPORT To delete an image from a report, right click on the image. A pop-up menu will appear. Click on the “ Remove” menu item. A red cross will be drawn on the selected image. You will be prompted to confirm before deleting the image. Click on "Yes" to delete the image. 6.1.5. INSERTING NOTES IN THE REPORT Make sure a note field has been designated within the report. Left click on the report. Select Edit  Report New… The “Text editor” window will appear. Type the text you wish to insert. It is possible to change font size, style and colour. When you have finished select the “OK” button. The notes will appear inside the report.

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6.1.6. REMOVING NOTES FROM THE REPORT To remove notes from the report select Edit  Empty Report Notes… NOTE: In case the report comprises more than one page, you will be prompted to select the page from which you wish to remove the notes. 6.1.7. REPORT TEXT DATABASE

NOT AVAILABLE FOR VIEWER VERSION It is possible to create a database for the most common comments used on the report; this database can be opened by selecting Edit  Show report notes texts database… A window with the list of the existing comments will appear. Highlight the comment you wish to insert, press the “Select” button and then the “Apply” button to insert it in the report.

6.1.8. ADDING PAGES TO A REPORT To add new pages to the report select Edit  Add report page… The “Open Report Page Layout” window will appear, displaying the list of all the available templates. Select a template and click on the “OK” button. The template will open. At this time it is possible to modify the template layout before using it. At the end click on the “OK” button. A new empty page will appear below the first page of the report. In the “Open Report Page Layout” click the “Cancel” button to start inserting images into the new page, or select another template and press the “OK” button to add another page to the report. 6.1.9. REMOVING PAGES FROM A REPORT If the report has more than one page, it is possible to remove single pages. Select Edit  Remove Report Page… From the drop down list select the page you want to remove. You will be prompted to confirm before removing the page from the report. Click on the “Yes” button to remove the page.

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6.2. REPORT ADVANCED FUNCTIONS 6.2.1. MODIFYING TEMPLATE OF REPORT PAGE Select Edit  Report Page Layout… If the report contains more than one page, you will be prompted to choose the page layout you wish to modify. This is possible through the “Select the report page ” dialogue. The template corresponding to the selected page will e open. If images have already been inserted in the page, it is only possible to change the position of the images, without modifying their size and scale. Make the changes in the same manner as when creating a new template. After making the changes, click on the “OK” button. The report page will be automatically updated. 6.2.2. MODIFYING VISUALIZATION OF REPORT IMAGES It is possible to modify the visualization of an image already copied into a report. Right-click the image of the report you wish to modify. Select “ Change Palette…” from the menu displayed. The “Visualization Window” will appear, showing the selected image. For a detailed explanation of this window, please refer to paragraph 3.1 At the end press the “Apply” button to apply the modifications to the image. 6.2.3. USE OF “DRAW ONLY ON REFERENCE IMAGE” COMMAND

CBCT DATA ONLY The “Draw Only On Reference Image” flag appears in the pop-up menu after right clicking on an image in the report. If the flag is checked the selected image will display its reference lines only inside the axial image from which it has been created.

Otherwise, reference lines will be drawn on all of the axial images of the report.

Axial image without reference lines

Axial image with reference lines

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6.2.4. USE OF “HIGHLIGHT CROSSES ON PANORAMICS” CONTROL

CBCT DATA ONLY The “Highlight crosses on panorex” flag appears in the pop-up menu after right clicking on a single transaxial or sequence of transaxial images in a report. If the command is enabled, each transaxial view will draw a complete reference line on each panoramic image of the report. Otherwise, if the command is disabled, only a partial reference will be displayed on the panoramic images.

At the first command selection the reference

At the second command selection the

At the third command selection the reference

lines are complete.

reference lines are partially coloured.

lines are disabled and only minimum references are drawn.

6.2.5. PERFORMING MEASURES OF DISTANCES OR ANGLES On the images of the report it is possible to measure distances or angles as it is done on the images of the study (see chapter 3.5). Right-click on the image of the report you wish to modify. From the menu displayed move the mouse to “ Distances…” to open the distance measurement menu and to “Angles…” to open the angle measurement menu. 6.2.6. INSERTING EXAM/PATIENT DATA IN THE REPORT It is possible to include additional data related to the patient and to the exam in the Patient area. On this matter, please refer to paragraph 8.3.3. 6.3. PRINTING A REPORT To print a report select Report  Print… 6.4. SAVING THE REPORT To print a report select Report  Print…

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6.5. SAVING IN PDF FORMAT

NOT AVAILABLE FOR VIEWER VERSION Select File  Save report in PDF format… Choose the desired path and file name. Now set the PDF quality (150, 300 or 600 DPI) and, as for Printing, the interested page range. The PDF document is then generated and subsequently opened.

6.6. SAVING IN DICOM FORMAT Select File  Save report in DICOM format… Choose the desired path and file name.

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6.7. OPENING A REPORT Select File  Open… “Choose document” window will be displayed. Click the “Report” button. On the “Report List” window, select the patient and click “OK”. NOTE: If the patient does not appear on the upper part of the list, search it by entering the surname initials in the field on the top-left corner of the window (see image at the side, item1). Furthermore, it is possible to search by applying a filter by dates (see illustration at the side, item 2) located on the top-right corner of the window.

6.7.1. MODIFYING PATIENT DATA Select Edit  Report Patient Data… The software will open the “Patient File” dialogue. After you have finished click on the “OK” button.

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7. MANAGING DOCUMENTS NOT AVAILABLE FOR VIEWER VERSION 7.1. IMPORT Importing a document means copying it from an external medium (CD, network, etc.) to the current working directory. There are two different ways to import documents: by patient or by document. It is also possible to import DICOM datasets selecting the menu File  Import  Import DICOM dataset…, the description of this procedure is available in paragraph 4.2. 7.1.1. IMPORTING BY DOCUMENT Select File  Import  Import by Document… The “Choose Document” window will appear. Select the type of document you wish to import. The “Import/Export path setup” dialogue will appear. The “Current path” field displays the location from where the software will import the documents. Select the “Change path” button to change the directory. When completed select the “Browse” button to display the list of documents stored in the directory. Select the document(s) you want to import. Use the “Select all” button to select all the listed documents. Check the “Delete Source file” flag to delete the file from the original location after the import procedure is terminated (if the device allows that). Use the “Print” button to print the list of patients. Once the documents have been selected click on the “OK” button. At the end of the import process a dialogue box will appear. Click on the “OK” button. 7.1.2. IMPORTING BY PATIENT This function allows the recovery of a determined document using the LABEL typed during Export, (for example to know on which number of CD in your archive it is stored). Select File  Import  Import by Patient… The “Patient List” window will appear. To select a patient type the surname initials, part or the entire surname, then click on the “Update list” button. Highlight the desired patient and then press “OK” button. The list of not on-line documents of the selected patient will appear. In the column “ Notes “ will be shown the Label typed during Export. Highlight the desired document and click on the “OK” button The “Import/Export path setup” dialogue will appear. Insert the correct path of the document to import. Click on “BROWSE” button. If the path is correct it will begin the copy of the files. At the end of the import process a dialogue box will appear. Click on the “OK” button.

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Cone Beam Imaging Systems

NNT User Manual Rev 08 June 2018