Importing intraoral X-rays

You can import image files (.bmp, .png, .jpg, and .tiff files) of intraoral X-rays to attach to a patient's record in Dentrix Ascend Imaging, such as in the following scenarios:

Importing images from another office or provider (most common).
Importing images acquired in your office with non-integrated third-party imaging software.

To import intraoral X-rays

If the correct patient is not already selected, use the Patient Search box to access the patient's record.
On the Patient menu, under Clinical, select Chart, Progress Notes, Quick Exam, Perio, Tx Planner, or Imaging.

The patient's clinical record opens with the Chart, Progress Notes, Quick Exam, Perio, Tx Planner, or Imaging tab selected.
On the Imaging tab's menu, select Acquire Images.
Notes:
- Alternatively, you can press Alt+X to start the acquisition process (instead of using the Acquire Images option on the Imaging tab's menu). To use this keyboard shortcut, you must be viewing the patient's clinical record (on the Chart, Progress Notes, Quick Exam, Perio, Tx Planner, or Imaging tab).
- If the acquisition agent is not installed, the Acquisition Activation dialog box appears. Click (or tap) the Click here link to download the acquisition agent installer. Then, click (or tap) Done. After you install the acquisition agent and the drivers for your acquisition devices, you can begin acquiring images.
- If you have not already accepted the diagnostic use policy, the Diagnostic Use Warning dialog box appears. To begin using the imaging features of Dentrix Ascend, you must select the I accept the above-mentioned policy checkbox, and then click (or tap) Accept & Go to Imaging.
The options for acquiring images become available.
On the navigation panel, select one of the following tabs:
- Favorites - This tab contains the imaging procedures for the current location that have been marked as favorites. This tab is available only if there are favorite imaging procedures for the current location. If there are favorite imaging procedures for the current location, this tab is selected by default.
- Standard - This tab contains the standard imaging procedures that come with Dentrix Ascend Imaging. This tab is available for all locations. If there are not any favorite imaging procedures for the current location, this tab is selected by default.
- Custom - This tab contains custom imaging procedures. This tab is available only if custom imaging procedures exist.
  On the Custom tab, you can filter procedures according to the following options:
  - Organization - Displays all custom procedures that were created in your organization.
  - Location - Displays only the custom procedures that were created in the location that you are currently viewing.
  - User - Displays only the custom procedures that were created by the user whose account you are currently logged in with.
  Note: By default, Location is selected the first time you access Imaging. Whichever option you select after that is saved for the next time you view the custom procedures list.
Select an imaging procedure that corresponds to the acquisition type for intraoral X-rays (such as 1 Bitewing or Full Mouth Series).

The options for the selected procedure become available.
Under Billing Options, set up the following options:
- Without interpretation/analysis:
  - If you are importing an intraoral X-ray using a standard imaging procedure, and if no interpretation or analysis of the acquired image will be done in your office, to use an alternative procedure code, do one of the following:
    - For a single periapical image, select the Without interpretation/analysis using code D0707 checkbox.
    - For a single occlusal image, select the Without interpretation/analysis using code D0706 checkbox.
    - For a single bitewing image, select the Without interpretation/analysis using code D0708 checkbox.
  - If you are importing a full-mouth, 2-bitewing, or 4-bitewing series using a standard imaging procedure, and if no interpretation or analysis of the acquired images will be done in your office, to use the alternative procedure code for the selected imaging procedure, do one of the following:
    - For a full-mouth series, select the Without interpretation/analysis using code D0709 checkbox.
    - For a 2-bitewing or 4-bitewing series, select the Without interpretation/analysis using code D0708 checkbox.
- Apply charges - Do one of the following:
  - If you are importing images from another office or provider - Ignore this setting because it will become unavailable when you select the Existing procedure option in a later step.
  - If you are importing images acquired in your office with non-integrated third-party imaging software - Either select the checkbox to post the fee for the selected procedure (such as D0210 for a full mouth series), or clear the checkbox to post a zero amount for the procedure.
- Bill to insurance - Do one of the following:
  - If you are importing images from another office or provider - Ignore this setting because it will become unavailable when you select the Existing procedure option in a later step.
  - If you are importing images acquired in your office with non-integrated third-party imaging software - Either select the checkbox to bill the patient's insurance carrier for the procedure, or clear the checkbox to not bill the patient's insurance carrier for the procedure.
- Select provider - From the list, select the provider who you want to associate with the procedure.
  
  Note: Only providers who have access to the current location and who are flagged as charting providers are available for selection. Also, the provider who is selected by default is determined by the current location's Default procedure provider setting.
Do one of the following:
- For an individual image - Do the following:
  1. If applicable for the selected procedure, on the Tooth chart, select the correct teeth:
    - For an individual bitewing image, at least one tooth of the maxillary arch and at least one tooth of the mandibular arch must be selected.
      
      Note: The BW checkboxes are available for quickly selecting the most common teeth for bitewings.
    - For an individual periapical or occlusal image, at least one tooth of the maxillary or mandibular arch must be selected.
      
      Note: The brackets are available for quickly selecting posterior teeth on both arches.
    Note: To deselect all selected teeth, click (or tap) the Clear selected link.
  2. If you want to allow for the automatic importing of additional images (endo mode), select the Enable auto-repeat checkbox.
- For a series of images - Specify the acquisition sequence:
  - For a full-mouth series, from the sequence list, select Default sequence or a custom order (if available).
  - For a 2-bitewing series, select the 2BW Center, 2BW Left, or 2BW Right option. Then, from the sequence list, select Default sequence or a custom order (if available).
    
    Note: Tooth numbers (using default sequence):
    - Center - (1) 3, 4, 5, 28, 29, 30; and (2) 12, 13, 14, 19, 20, 21.
    - Left - (1) 12, 13, 14, 19, 20, 21; and (2) 14, 15, 16, 17, 18, 19.
    - Right - (1) 1, 2, 3, 30, 31, 32; and (2) 3, 4, 5, 28, 29, 30.
  - For a 3-periapical series, select the Maxillary or Mandibular option. Then, from the sequence list, select Default sequence or a custom order (if available).
  - For a 4-bitewing + 3-periapical series, select the Maxillary or Mandibular option. Then, from the sequence list, select Default sequence or a custom order (if available).
  - For a 4-bitewing + 4-periapical series, select the 4BW + 4PA or 4BW + 4PA Alt option. Then, from the sequence list, select Default sequence or a custom order (if available).
  - For a 7-bitewing + 3-periapical series, select the Maxillary or Mandibular option. Then, from the sequence list, select Default sequence or a custom order (if available).
  - For other series (such as 4-bitewing, 7-bitewing, 2-bitewing + 2-occlusal, 2-bitewing + 2-periapical, 4-bitewing + 2-periapical, and 4-bitewing + 6-periapical), from the sequence list, select Default sequence or a custom order (if available).
  Note: To manage the acquisition sequences for the selected imaging procedure, do the following:
  1. Next to the sequence list, click (or tap) Edit.
    
    The Edit Acquisition Sequence dialog box appears.
  2. Do any of the following:
    - To add a sequence, do the following:
      1. Click (or tap) each placeholder of the sequence diagram in the order that you will acquire the images.
        
        To undo previous order selections, click (or tap) Undo as needed. To undo all order selections, click (or tap) Reset.
      2. When you finish specifying the order for all placeholders, to save the custom sequence for future use, enter a name for the sequence in the Start typing a new name box, and then click (or tap) Save as ([sequence name]).
    - To delete a custom sequence, with that sequence selected in the sequence list, click (or tap) the blue Delete button , which then turns red, and then click (or tap) the button again.
  3. Click (or tap) Finish.
Do one of the following:
- If you are importing images from another office or provider - On the Import tab, select the Existing Procedure option, and then specify the date that the procedure was performed.
  
  Note: With this option selected, the Apply charges and Bill to insurance checkboxes under Billing Options become unavailable because the procedure will be posted with a zero dollar fee and will not be billed to insurance. The procedure (which will have an "Existing" status) will appear in the patient's clinical record but not on the patient's ledger.
- If you are importing images acquired in your office with non-integrated third-party imaging software - Do one of the following:
  - On the Input tab, select the Import From File device on the Available Devices menu if it is not already selected.
  - On the Import tab, select one of the following options:
    - Existing Procedure - Use this for a procedure that was performed prior to today (and may already have been billed to the patient's insurance carrier). Specify the date that the procedure was performed.
      
      Note: With this option selected, the Apply charges and Bill to insurance checkboxes under Billing Options become unavailable because the procedure will be posted with a zero dollar fee and will not be billed to insurance. The procedure (which will have an "Existing" status) will appear in the patient's clinical record but not on the patient's ledger.
    - Completed Procedure - Use this for a procedure that you performed today. Today's date and time will be associated with the procedure.
      
      Note: The procedure (which will have a "Completed" status) will appear in the patient's clinical record and on the patient's ledger.
Click (or tap) Start.
Import one or more images:
- For an individual image - Do the following:
  1. In the Import File dialog box that appears, select the correct image file.
  2. Click (or tap) Open.
    
    The image is saved to the patient's record.
    
    Then, if you are importing in endo mode, the Import File dialog box re-opens; otherwise, ignore steps c-d.
  3. While in endo mode, repeat steps a-b as needed to import additional images.
  4. When you are finished importing in endo mode, in the Import File dialog box, click (or tap) Cancel. Then, click (or tap) Finish Acquisition.
- For a series of images - Do one of the following:
  - If you selected the Import from File option on the Input tab in step 8, do the following:
    1. In the Import File dialog box that appears, select the correct image file.
    2. Click (or tap) Open.
      
      The image is saved to the patient's record, and a preview of the image appears. Also, the program advances to the next step in the acquisition sequence automatically, and the Import File dialog box re-opens.
      
      The current step in the acquisition sequence and the applicable teeth are selected for your reference.
    3. Repeat steps a-b until you finish importing images for the series.
      
      Note: To stop the acquisition session before you finish acquiring the entire series, in the Import File dialog box, click (or tap) Cancel to pause the acquisition, and then click (or tap) Finish Acquisition. You can resume the incomplete exam later if necessary.
  - If you selected an option on the Import tab in step 8, do the following:
    1. Click (or tap) Start Importing.
      
      The Import File dialog box appears.
    2. Select the correct image file, and then click (or tap) Open.
      
      The image that you imported appears as a thumbnail image on the panel at the bottom of the Dentrix Ascend Imaging program.
    3. Repeat steps a-b until you finish importing images for the series.
    4. After all the images have been imported. One at a time, drag the thumbnail images from the panel to the correct boxes of the template.
    5. Do any of the following as needed:
      - To stack multiple images in one template slot, drag either a thumbnail image from the panel at the bottom or an image from a template slot to a template slot that already has an image assigned. That image is put on the top of the image stack for that template slot (but you can choose a different image to be on top).
      - To choose the top image for a template slot with multiple images, navigate between the images in the stack by clicking (or tapping) the corresponding Next or Previous button as needed. The image that is visible in the stack when you click (or tap) Begin Uploading will be set as the top image of the stack.
      - To change the orientation of an image in the template, navigate to the desired image in the stack for a template slot (if multiple images are assigned to that template slot), select the image to view the toolbar, and then click (or tap) any of the available buttons as needed: Flip Horizontal, Flip Vertical, Rotate Counterclockwise (90 degrees), and/or Rotate Clockwise (90 degrees).
      - To remove an image from the template, navigate to the desired image in the stack for a template slot (if multiple images are assigned to that template slot), and then drag the image back to the panel at the bottom.
    6. Click (or tap) Begin Uploading to save the mounted images to the patient's record.
    7. If not all thumbnail images have been mounted to the template when you click (or tap) Begin Uploading or Cancel, a message appears, stating that unassigned images will not be saved to the patient's record.
      
      Click one of the following buttons:
      - Send to Recovery - To save the unassigned images. You can assign them to the patient later using the existing functionality for recovering images.
      - Discard Images - To delete the unassigned images permanently.
      - Stay on Page - To return to where you were so you can assign unassigned images or make other changes.
    8. If any images fail to upload, a message appears and provides the option for you to recover the images. Click (or tap) Recover Images to begin the recovery process.
For each image that needs tooth numbers assigned to it, do the following:
1. If there are multiple image thumbnails, under Image Navigator, click (or tap) an image thumbnail; otherwise, if there is only one image thumbnail, skip this step.
  
  A larger version of the current image appears in the viewing area.
2. Click the Edit button .
  
  The Assign Tooth Numbers dialog box appears.
3. To change dentition, click (or tap) the Toggle primary/permanent link to show a tooth chart and the dentition buttons, select the applicable teeth, and then click (or tap) the Permanent or Primary button. Repeat this process as needed to change the dentition of other teeth. Then, click (or tap) the Back to assignment link.
4. Select the correct tooth numbers.
5. Click (or tap) Assign Teeth.