Processing images

You can perform various processing tasks, such as enhancing and annotating, on images.

Note: Any processing that you perform on an image is permanent (except for colorize, grayscale, and emboss, which are temporary). However, you can view the image in its original state by turning off any processing filters that you have applied.

To process an image

1. If the correct patient is not already selected, use the Patient Search box to access the patient's record.

   Note: You can include inactive patients in the search results by setting the Include inactive patients switch to On.

2. Do one of the following:

   • View an image from the patient's image history list (Exam view).

     1. On the Patient menu, under Clinical, click (or tap) Chart, Progress Notes, Quick Exam, Perio, Tx Planner, or Imaging. Then, on the Imaging tab's menu, click (or tap) Show Image History.

        

     2. On the Images tab, select an image (intraoral or extraoral; X-ray or photo), a series (such as a full mouth series or bitewings), or a 3D volume.

        

     3. If you have selected a series, under Image Navigator, click (or tap) an image of that series.

        

   • View an image from the patient's image history list (Modality view).

     1. On the Patient menu, under Clinical, click (or tap) Chart, Progress Notes, Quick Exam, Perio, Tx Planner, or Imaging. Then, on the Imaging tab's menu, click (or tap) Show Image History.

        

        The patient's imaging page opens, and the Intraoral X-ray tab is selected by default.

        

     2. Select one of the modality tabs to view the corresponding images: Intraoral X-ray, Intraoral Color, Extraoral X-ray, Extraoral Color, or 3D Volumes/CBCT.

     3. To view an image (intraoral or extraoral; X-ray or photo) or 3D volume, select it (a yellow border appears around it to indicate that it is selected), and then click (or tap) the item again.

   • View one of the patient's most recent images.

     1. Do one of the following:

        • On the Patient menu, under Clinical, click (or tap) Imaging.

        • On the Patient menu, under Clinical, click (or tap) Chart, Progress Notes, Quick Exam, Perio, Tx Planner, or Imaging. Then, on the Imaging tab's menu, click (or tap) Show Most Recent Images.

          

     2. Click (or tap) any single image (intraoral or extraoral; X-ray or photo), an image within a series (such as a full mouth series or bitewings), or a 3D volume.

        

   The selected image appears in the viewing area.

   

3. If the current template slot (for an intraoral X-ray image or an intraoral photo in a custom set) has multiple images assigned, to view an image other than the top image of the stack, do any of the following as needed:

   • At the top of the viewing area, click (or tap) the Previous or Next button  as needed to view the desired image in the stack.

   • On the image stack panel (near the bottom of the viewing area), click (or tap) the desired thumbnail image to view that image in the viewing area.

     Note: If the panel is collapsed, click (or tap) the handle to expand the panel.

   

4. Click (or tap) the Tools tab if it is not already selected.

   

   Note: The Tools tab is not available if you are viewing a CAD/CAM scan.

5. Use any of the following tools as needed:

   One Click Tools

   

   • Enhance - (For an X-ray only) Select the filter that corresponds to the anatomical structures that you want to enhance in an X-ray:

     • Not Enhanced - The image is not enhanced.

     • Entire Image - Adds a balance of sharpening and contrast levels that affects the overall sharpness and contrast.

     • For Perio - Adds a lower level of sharpening and a gray level adjustment to accentuate the subtle differences in the grayscale values of periodontal conditions.

     • For Endo - Adds a higher level of sharpening and contrast and a gray level adjustment to accentuate endodontic conditions. You may want to use this filter, for example, to help you to see the position of a file in relation to the root of a tooth when doing a root canal.

     • Custom - Applies a sharpness filter that you can adjust dynamically.

       

       With this option selected, do any of the following:

       • To increase the sharpness level, drag the slider to the right.

       • To decrease the sharpness level (apply smoothing/noise reduction), drag the slider to the left.

       • To fine-tune the sharpness level, click - and + as needed.

       • To save the current sharpness level as the default for the Custom enhancement option, click Save Default. The default is stored only on this computer.

       Note: When you are acquiring an image, you can select the Custom option from the Apply Enhancement list to apply the default sharpness level, but the slider is not available.

     Note: To switch between viewing the image with or without an applied enhancement, click (or tap) the Enhancement button. If the enhancement is turned off, the button is gray . If the enhancement is turned on, the button is orange .

   • Workups - (For a 3D volume only) As you change the view, you can save the settings as a workup for future reference. Do any of the following as needed:

     • Add a workup - Click (or tap) Save. In the Save Volume Workup dialog box, enter a name to identify the workup, and then click (or tap) Done.

       

     • Select a workup - From the list, select the desired workup. The view of the 3D volume updates accordingly.

       

     • Delete a workup - From the list, select a custom workup (the "Default" workup cannot be deleted). Click (or tap) the blue Delete button , which then turns red, and then click (or tap) the button again.

       

   • Rotate - (For an X-ray or photo only) Click (or tap) the button that corresponds to how you want to rotate the image: 180 degrees (clockwise), 90 degrees (clockwise), or -90 degrees (counterclockwise).

   • Flip - (For an X-ray or photo only) Click (or tap) the button that corresponds to how you want to flip the image: Horizontal or Vertical.

   • Invert - (For an X-ray or photo only) To invert the image's colors, select the Invert checkbox. To remove the filter, clear the checkbox.

   • Colorize - (For an X-ray only) To convert the image from grayscale to color, select the Colorize checkbox. To remove the filter, clear the checkbox. This option is available only for intraoral and extraoral X-rays.

   • Grayscale - (For a photo only) To convert the image from color to grayscale, select the Grayscale checkbox. To remove the filter, clear the checkbox. This option is available only for intraoral and extraoral photos.

   • Emboss - (For an X-ray or photo only) To emboss the image, select the Emboss checkbox. To remove the filter, clear the checkbox.

   • Straighten - (For an X-ray or photo only) If the image is not straight, to rotate it, do one of the following:

     • To rotate the image counter-clockwise, enter a negative value as a whole number or a decimal (such as "-0.3") in the o (degree) box, click (or tap) the - (minus) button as needed (the angle is reduced by 0.1 degree with each click, or tap), or drag the slider to the left.

     • To rotate the image clockwise, enter a positive value as a whole number or a decimal (such as "0.3") in the o (degree) box, click (or tap) the + (plus) button as needed (the angle is increased by 0.1 degree with each click, or tap), or drag the slider to the left.

   Annotations

   

   To add a shape, do the following:

   1. Under Drawing tools, select a shape option: arrow, rectangle, or circle.

   2. Select a line color and thickness:

      • Select a color from the Colors menu, or click (or tap) one of the Last used colors.

      • Select an Outline width: extra thin, thin, standard, wide, or extra wide. A preview of the selected line thickness that will be used for the shape appears.

   3. Click (or tap) and drag over a specific area of the image to create the shape.

   To add text, do the following:

   1. Under Drawing tools, select the text option.

      

   2. Select a font color and size:

      • Select a color from the Colors menu, or click (or tap) one of the Last used colors.

      • Select a Text size: small, normal, medium, large, or extra large. A preview of the selected font size that will be used for the text appears.

   3. Click (or tap) and drag to create a rectangle with dashed borders around the area of the image that you want to draw attention to.

      The Text Annotation dialog box appears.

      

   4. Enter the desired Text.

   5. Click (or tap) Create text.

      The text appears above the rectangle that you created in step c.

   To add a freehand drawing, do the following:

   1. Under Drawing tools, select the freehand drawing option.

      

   2. Select a line color and thickness:

      • Select a color from the Colors menu, or click (or tap) one of the Last used colors.

      • Select an Outline width: extra thin, thin, standard, wide, or extra wide. A preview of the selected line thickness that will be used for the shape appears.

   3. Click and drag over a specific area of the image to draw. When you release the mouse button, the drawing operation stops.

   Notes:

   • To remove the last annotation that you added to the image, click (or tap) Undo.

   • To remove all annotations from the image, click (or tap) Clear All.

   • When you select an item in the Annotation list, the corresponding annotation on the image is highlighted with white.

   • To switch between showing and hiding the annotations, click (or tap) the Select object(s) to Display button to open the Select Object(s) to Display dialog box, select or clear the Annotation checkbox, and then click (or tap) Confirm.

     

   • (For an X-ray, photo, or 3D volume only) To switch between showing and hiding all annotations and measurements for the image, click (or tap) the Show/hide annotations and measurements button . The button is available only if an annotation or a measurement has been applied to the image.

   • (For a 3D volume only) To view an annotation on a slice that is not currently being displayed, click (or tap) that annotation in the Annotation list.

   Measurements

   

   Important: Distance and Angle measurements are calculated from specified points after calibration from an object with a known length. Image resolution, displayed size, inherent image quality, and proper calibration all affect the accuracy of the measurement results. However, the factors that have the greatest effect on the overall precision of a measurement are the accuracy of the calibration and selection of the start and end points of the actual line or angle to be measured. Using the calibration results, you can decide as to whether the overall accuracy achieved is correct for the desired measurement.

   Precaution: It is your responsibility to properly calibrate prior to clinical measurements and to determine if the accuracy achieved is within the error range required.

   Note: Some digital sensors have a known pixel size for images, so no calibration is needed. Other digital sensors do not have a known pixel size for images, so calibration is needed prior to drawing measurements. For TWAIN sources that you have specified a known pixel size in the acquisition agent preferences, no calibration is needed.

   (For an X-ray, photo, or 3D volume only) To add measurements, do the following:

   1. (For an X-ray or photo) If calibration is required, to calibrate distance measurements using an object of known size in the image, do the following:

      1. Do one of the following:

         • If calibration has not been performed previously, Calibrate is selected by default. Ignore this step.

         • If calibration has been performed previously, Measurements is selected by default. Select Calibrate.

      2. Click (or tap) the first (starting) point of the known-length object on the image where you want to start measuring, and then drag to another point on the known-length object.

      3. Change the length of the Standard for calibration as needed to the correct number of millimeters for the known length. Also, the Pixel Size in micron appears for your reference.

      

      Note: Perform the calibration only if you are comfortable that you can measure the calibration object accurately and that the displayed results have the accuracy needed. Now that you have defined the length of the segment, all measurements you add will be calculated respective to that calibration.

   2. Do one of the following:

      • (For an X-ray or photo) Do one of the following:

        • If calibration is not required, Measurements is selected by default. Ignore this step.

        • If calibration is required and has been performed previously, Measurements selected by default. Ignore this step

        • If calibration is required and Calibrate is selected, select Measurements.

        

      • (For a 3D volume) Calibration is not required, Ignore this step.

        

   3. Do the following:

      1. If Add New Measurement is not already selected in the Measurement list, select it.

      2. Click and drag on the image to create a line (a yellow line with start and end points).

      3. Click elsewhere on the image to create another line that is connected to the previous line's end point, and then continue clicking various areas on the image to create other connected lines as needed.

      4. For each additional measurement that you want to add, select Add New Measurement in the Measurement list (the lines of the previous measurement turn red), and then repeat steps ii-iii.

   Notes:

   • To show the calculated length of each line segment, select the Show segment length (SL) checkbox.

   • To show the calculated angle where two line segments meet, select the Show angle (A) checkbox.

   • With a measurement selected in the Measurement list (the corresponding lines become yellow), you can add connected lines by clicking various areas on the image.

   • With a measurement selected in the Measurement list (the corresponding lines become yellow), you can remove connected lines in reverse order by clicking (or tapping) Undo.

   • To remove all measurements from the image, click (or tap) Clear All.

   • To switch between showing and hiding the lines and their calculated lengths and angles, click (or tap) the Select object(s) to Display button to open the Select Object(s) to Display dialog box, select or clear the Measurement checkbox, and then click (or tap) Confirm.

     

   • To switch between showing and hiding all annotations and measurements, click (or tap) the Show/hide annotations and measurements button . The button is available only if an annotation or a measurement has been applied to the image.

   • (For a 3D volume only) To view a measurement on a slice that is not currently being displayed, click (or tap) that measurement in the Measurement list.

   • Any warning text for known pixel size measurements appears below the Measurement list.

   Density (Line)

   

   Important: Density measurements are calculated from specified points on the image and are reported from the actual pixel values selected. Image resolution, displayed size, and inherent image quality can all affect the accuracy of the Density measurement. However, the factor which has the greatest effect on the overall precision of a density measurement is the accuracy of the selected point or points to be measured.

   (For an X-ray only) To get the density (gray level) from one point to another on the image, do the following:

   1. Click (or tap) Line.

   2. Click (or tap) a point on the image, and then click (or tap) another point to create a line.

      A graph of the gray levels along the specified line appears, and the average Gray level is indicated.

   Note: To remove the density line, click (or tap) Clear.

   Density (Rectangle)

   

   (For an X-ray only) To get the density (gray level) of a rectangular area on the image, do the following:

   1. Click (or tap) Rectangle.

   2. Click a point on the image, and then drag to another point to create a rectangle.

      The Average gray level is indicated.

   Spotlight

   

   (For an X-ray or photo only) To add spotlights, do the following:

   1. Select an Effect: Invert, Colorize (for an X-ray only), Zoom x2, Sharpen, or Contrast.

   2. Move the Spot size slider to specify the size of the spotlight.

   3. Click (or tap) a specific area of the image to place the spotlight. A spotlight with a red border appears.

      Invert

      

      Colorize

      

      Zoom x2

      

      Sharpen

      

      Contrast

      

   4. To move the spotlight, click (or tap) another area of the image.

   5. To suspend the spotlight on the image so that you can add other spotlights, click (or tap) Suspend. The border of the spotlight turns blue.

      

   6. Repeat steps a-e as needed to continue adding spotlights.

      

      Note: To remove all spotlights, click (or tap) Clear Suspended, or select another processing tool.

6. Adjust the brightness, contrast, black level, white level, and/or window settings (for a 3D volume only) as needed.

   Do the following:

   1. Click (or tap) the Adjust brightness, contrast, and black/white levels button.

      

   2. Do any of the following:

      • Move the Brightness slider to decrease or increase the brightness.

      • Click and drag up or down in the viewing area to decrease or increase the brightness.

        

      • Move the Contrast slider to decrease or increase the contrast.

      • Click and drag left or right in the viewing area to decrease or increase the contrast.

        

      • Move the Black Level slider to decrease or increase the black level.

      • Move the White Level slider to decrease or increase the white level.

      • (For a 3D volume only) Move the Window Center slider to decrease or increase the value.

      • (For a 3D volume only) Move the Window Width slider to decrease or increase the value.

      • To reset all these settings to their default values, click (or tap) the Reset to default link.

      Note: If you change any of these settings from their default values, the Adjust brightness, contrast, and black/white levels button becomes orange .