Dentrix Ascend Imaging

USER'S GUIDE

www.DentrixAscend.com

Publication Information

Publication date

October 2018

Copyright

2018 Henry Schein One. All rights reserved. No part of this publication may be reproduced, transmitted, transcribed, stored in a retrieval system, or translated into any language in any form or by any means without the prior written permission of Henry Schein One.

2018 RealCloud Imaging, Inc. All rights reserved. No part of this publication may be reproduced, transmitted, transcribed, stored in a retrieval system, or translated into any language in any form or by any means without the prior written permission of RealCloud Imaging, Inc.

Software license notice

Your license agreement with Henry Schein One, which is included with the product, specifies the permitted and prohibited uses of the product. Any unauthorized duplication or use of Dentrix Ascend, in whole or in part, in print or in any other storage and retrieval system is forbidden.

Licenses and trademarks

Dentrix Ascend and the Dentrix Ascend logo are registered trademarks of Henry Schein One. Henry Schein One and its logo are trademarks of Henry Schein One. The Dexis imaging software, product names, and logo are either trademarks or registered trademarks of Dexis, LLC. The Planmeca imaging software and product names are either trademarks or registered trademarks of Planmeca USA, Inc.

Version

You can find which version of Dentrix Ascend Imaging that you are using by doing the following: on the Developer Tools panel (in Chrome) or on the Web Inspector panel (in Safari), select the Console tab, and then open the imaging software. A line of text similar to "Ascend Imaging version: 1.0.6004.30092 6/9/2016 4:43 PM" appears.


Real Cloud Imaging, Inc.
2625 North Loop Drive
Suite 2130
Ames, IA 50010

Contents

Introduction

Dentrix Ascend's digital imaging solution is a cloud-based 2D and 3D dental imaging software module that interacts seamlessly with the Dentrix Ascend practice management program to provide efficient and versatile image management. Dentrix Ascend Imaging manages intraoral and extraoral X-rays/volumes as well as intraoral and extraoral color images produced by intraoral video and/or consumer digital cameras.

Because Dentrix Ascend Imaging is a web-based imaging software application, you can use it with Windows, Mac OS, iOS (iPad), and other operating systems in a supported, HTML5-compatible internet browser.

Important Note: You can use the iPad non-diagnostic purposes only.

You can acquire, import, export, view, and edit 2D images and 3D volumes of dental anatomy. Dentrix Ascend Imaging supports the acquisition of images from many brands of intraoral and extraoral imaging devices, which allows you to mix and match imaging devices and brands of equipment as needed.

All images that you acquire or import are uploaded immediately to the cloud, so you can access them from multiple locations for any number of users in near real time. Dentrix Ascend Imaging uses world-class storage providers, and images are automatically replicated to multiple servers for disaster recovery.

Dentrix Ascend Imaging has many image processing tools (such as filters and enhancements) that you can use on images to help determine the necessary treatments for patients. Also, you can attach images that you acquire and import to dental e-claims.

Dentrix Ascend Imaging is available as an add-on and must be purchased separately from the Dentrix Ascend practice management program.

Dentrix Ascend Imaging is used for diagnostic purposes in the field of dentistry.

Dentrix Ascend Imaging utilizes lossless compression for all intraoral and extraoral x-ray images and which is 100% reversible and does not result in loss of data. Dentrix Ascend Imaging utilizes lossy compression (JPEG) for all intraoral and extraoral color images.

Contact Customer/Technical Support should you have any questions, difficulties using, experience any anomalies, or have comments regarding the Dentrix Ascend Imaging program. See the "Customer/Technical Support" section of this user's guide for contact information.

Indications for use

Dentrix Ascend Imaging is a web-based Dental Picture Archiving and Communications Systems (PACS), i.e. dental imaging software, that enables dental care facilities to acquire, process, edit, and enhance dental images.

Dentrix Ascend Imaging provides a web-based interface for image acquisition and management of images which are used in the field of Dentistry and when operated by dental professionals who are responsible for providing dental care.

Images can be acquired from dental image acquisition devices and/or consumer imaging devices such as color digital cameras. Previously acquired images or volumes can be selected for upload directly from the user's computer.

Supported images include intraoral and extraoral dental X-rays/volumes and intraoral and extraoral color images produced by intraoral video or consumer digital cameras.

Dentrix Ascend Imaging is used for diagnostic purposes in the field of dentistry.

Dentrix Ascend Imaging is not intended for diagnostic use on a mobile display.

Images can be edited/enhanced (e.g. zoomed, contrast adjusted, inverted, annotated, rotated, filtered, etc...) as well as exported to standard image file formats.

Contraindications

None known

Precautions

Federal law restricts this device to sale by or on the order of a dentist.

To effectively use the Dentrix Ascend Imaging program, it is Strongly Recommended that all users obtain dedicated training on the use of this software prior to use on any live patients.

Read and understand the User's Guide in its entirety before using the Dentrix Ascend Imaging program upon live patients.

Use of this software as a diagnostic aid must be used in combination with other diagnostic aids and clinical experience to form a diagnosis and should not be solely relied upon for diagnosis.

Distance and Angle measurements require calibration by measuring length of a known object in image.

It is the operator's (user) responsibility to properly calibrate prior to clinical measurements and to determine if the accuracy achieved is within the error range required.

Do not operate this software upon live patients if you are feeling ill, fatigued, or if you are experiencing lack of concentration.

Do not leave any computer/device which is operating Dentrix Ascend Imaging unattended as this can create a security risk to patient or practice data. Always close the Dentrix Ascend Imaging program when leaving a computer or device unattended.

System requirements

Browser

Note: iPad cannot be used for acquiring images. iPad can be used only for viewing images for non-diagnostic purposes.

Operating System

Anti-Virus Software

Display

Supported acquisition devices

Legend

Windows
Compatible

Mac
Compatible

Supported Intraoral X-ray Acquisition Devices

Supported Phosphor Plate Devices

Supported Extraoral X-ray Acquisition Devices (Pan and Ceph)

Supported Intraoral/Extraoral Color Acquisition Devices

Important: If you want to use a device other than a DEXIS device, additional costs may be required, such as the purchase of drivers, to integrate that device with Dentrix Ascend Imaging. Before you purchase the Dentrix Ascend Imaging add-on or a particular device that you want to use with Dentrix Ascend Imaging, consult the manufacturer of that device to verify if there will be costs to get that device working with Dentrix Ascend Imaging.

Note: Some, but not all, devices have been testing using a TWAIN driver. Using a TWAIN driver with certain devices might have different results than expected.

Customer/Technical support

Setting up imaging devices

Setting up imaging devices

Because Dentrix Ascend Imaging is a web-based application, it is available immediately for use once you have purchased it and it is enabled by Henry Schein. However, for each computer that you want to acquire images from, you must install the following on that computer:

Note: If you do not perform the necessary setup on a computer that you want to acquire images from before attempting to acquire images, when you attempt to begin acquiring images (see step 2 of "Acquiring Images"), you will be asked to perform the necessary setup and will not be allowed to proceed with the acquisition until the setup is complete.

To install and configure the acquisition agent (Windows only)

Mac users: To install the acquisition agent, please contact our support team at 1-855-232-9493.

Important: Prior to installing the acquisition agent, verify that the Microsoft .NET 4.0 framework is installed. If .NET 4.0 is not installed, you must install it before you attempt to install the acquisition agent.

  1. Run Acquisition Agent Installer.exe.

  2. On the welcome screen, click (or tap) Next.

  3. On the Choose Components screen, leave Acquisition Agent selected, and then click (or tap) Next.

  4. On the Choose Install Location screen, leave the default Destination Folder selected, or click (or tap) Browse to select a different location. Then, click (or tap) Install.

  5. On the completion screen, click (or tap) Finish.

  6. If you need to change the default settings of the acquisition agent (even though the defaults should suffice), after you complete the installation, right-click (or tap and hold) the Acquisition Agent icon in the notification area of the Windows task bar, and then click (or tap) Preferences.

    The Preferences dialog box appears.

  7. Set up any of the following options as needed:

    • Correction File Path - For Dexis sensors, this is the default location of the calibration files (C:\Dexis\Flashdir). If the calibration files are located elsewhere, click (or tap) Browse to locate and select the correct folder.

    • Use Binned Acquisition - In the Dexis imaging software (versions 9 and 10), "binned" is the default operating mode for Dexis sensors, so this check box is selected by default for Dentrix Ascend Imaging.

    • Use Buffered TWAIN Transfer - This option is for TWAIN drivers and is selected by default. If there are issues with TWAIN sources delivering images properly to the acquisition agent, clear this check box to use the native transfer mode, which some TWAIN sources require or recommend.

    • IAM Settings - Click (or tap) to configure Optime or OP30 settings.

    • Joy Number and Use Joystick with Generic Camera - If you use a "Generic" intraoral camera with a joystick button interface instead of proprietary buttons, select the Use Joystick with Generic Camera check box. The camera button will use a specific joystick number. This is typically zero if no other joysticks are installed on the computer. Enter a number from 0 - 10 for Joy Number.

      If you use a Digital Doc camera, and it has been installed to use a port other than zero, you must specify the appropriate joystick number.

    • Intraoral and Extraoral TWAIN rotation - The Acquisition Agent uses settings in an .ini file to rotate and/or flip an image from TWAIN intraoral or extraoral imaging device prior to being delivered to Dentrix Ascend Imaging. You can modify these settings to correct the rotation/orientation of images from TWAIN devices. The .ini file is located in the Acquisition Agent's folder on the computer. The .ini file lists all the TWAIN devices that have been used by Ascend's imaging. A device will be listed under the category that corresponds to the type of device that it is: PanoramicTwain (for panoramic images) or DigitalSensorTwain (for intraoral images). Refer to the examples below.

      [PanoramicTwain]
      RVG Twain=RotateNoneFlipNone

      [DigitalSensorTwain]
      Planmeca Twain Source=RotateNoneFlipNone

      Next to the device name, you can change the value after the equals sign (=) to one of the following values:

      1. RotateNoneFlipNone

      2. Rotate90FlipNone

      3. Rotate180FlipNone

      4. Rotate270FlipNone

      5. RotateNoneFlipX

      6. Rotate90FlipX

      7. Rotate180FlipX

      8. Rotate270FlipX

    Note: The acquisition agent logs actions that it performs for debugging, troubleshooting, and performance monitoring. To view the log, click (or tap) Show Log Files.

  8. Click (or tap) Done.

Acquiring images

You can acquire or import a single image or a set of images. You can also quickly acquire images for selected teeth.

Acquiring images

You can acquire images with a device (such as an X-ray sensor or an intraoral camera) or by importing image files (such as .png or .jpg files). The images will be attached to a patient's record upon acquisition. When you acquire images, you can customize the acquisition settings, and there are options for posting the associated procedure and billing the procedure to insurance.

For the complete list of acquisition devices that are supported by Dentrix Ascend Imaging, see the "Supported Acquisition Devices" section.

To acquire images

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

  2. On the Patient menu, under Clinical, click (or tap) Chart, Progress Notes, Quick Exam, Treatment Planner, Perio, or Imaging.

  3. On the Chart, Progress Notes, Treatment Planner, Perio, or Imaging tab of a patient's clinical record, on the Imaging tab's menu, click (or tap) Acquire images.

    Notes:

    • If this computer is not set up to acquire images, a message appears and asks you to perform the necessary setup before you can proceed with an acquisition. Click (or tap) Done. After you complete the instructions to install the acquisition agent and the drivers for the selected acquisition devices, you can begin acquiring images.

    • If you have not already accepted the diagnostic use policy, a dialog box appears. To begin using the imaging features of Dentrix Ascend, you must select the I accept the above-mentioned policy check box, and then click (or tap) Accept & Go to Imaging.

    The options for acquiring images become available.

  4. Under Imaging Procedures, select the procedure that you want to perform (each corresponds to a particular acquisition type: individual intraoral X-ray, intraoral X-ray series, extraoral X-ray, or intraoral photo, or extraoral photo).

    The options for the selected procedure become available.

  5. Under Billing Options, set up the following options:

    • Apply charges - To post the fee for the selected procedure (such as D0210 for a full mouth series), select the check box. To post a zero amount for the procedure, clear the check box.

    • Bill to insurance - Specify whether you want to bill or not bill the patient's insurance carrier for the procedure by selecting or clearing the check box, respectively.

    • Provider - Select the provider who you want to associate with the procedure.

  6. Set up the Acquisition Options that apply to the corresponding acquisition type.

    Intraoral X-ray

    Do the following:

    1. On the Tooth chart, select the teeth that apply to the current acquisition session.

      Note: To deselect all selected teeth, click (or tap) the Clear selected link.

    2. To allow for the automatic retaking of the radiograph (without having to click, or tap, Recapture) until a satisfactory image is acquired, select the Enable auto-repeat check box. Only the last image you acquire will be saved.

    3. Under Task to Perform, on the Acquire Images tab, select the desired device in the Available Devices button pop-up list if it is not already selected.

      Note: For the complete list of acquisition devices that are supported by Dentrix Ascend Imaging, see the "Supported Acquisition Devices" section.

    Intraoral X-ray series

    Do the following:

    1. If you are acquiring a full-mouth series, under Acquisition sequence, select FMX 18 or FMX 21; otherwise, skip this step.

    2. Under Acquisition sequence, select "Default sequence" or a custom order (if any).

    3. To change the order of the acquisition sequence, on the graphic with the numbered boxes, click (or tap) each box in the order that you will acquire the images.

      Tips:

      • To undo the previous selection, click (or tap) Undo as needed. To undo all selections, click (or tap) Reset.

      • When you finish specifying the order, to save the custom sequence for future use, type a name for the sequence, and then click (or tap) Save as ([sequence name]).

      • To delete a custom sequence, with that sequence selected, click (or tap) the white Delete button , which then turns red, and then click (or tap) the button again.

    4. Under Task to Perform, on the Acquire Images tab, select the desired device in the Available Devices button pop-up list if it is not already selected.

      Note: For the complete list of acquisition devices that are supported by Dentrix Ascend Imaging, see the "Supported Acquisition Devices" section.

    Extraoral X-ray

    Do the following:

    1. Under Task to Perform, on the Acquire Images tab, select the desired device in the Available Devices button pop-up list if it is not already selected.

      Note: For the complete list of acquisition devices that are supported by Dentrix Ascend Imaging, see the "Supported Acquisition Devices" section.

    Intraoral/extraoral photo

    Do the following:

    1. Under Task to Perform, on the Acquire Images tab, select the desired device in the Available Devices button pop-up list if it is not already selected.

      Notes:

      • For the complete list of acquisition devices that are supported by Dentrix Ascend Imaging, see the "Supported Acquisition Devices" section.

      • The first time you attempt to use an intraoral camera with Dentrix Ascend Imaging on any computer, when a message from the browser appears and asks if you want to allow the browser to have access to the camera, allow it.

  7. Click (or tap) Proceed with Acquisition to start acquiring images for the corresponding acquisition type.

    Intraoral X-ray

    The selected acquisition device begins initializing.

    Then, the X-ray sensor begins arming.

    Then, the X-ray sensor becomes ready for exposure.

    Do the following:

    Note: A phantom, test target, and/or another non-human object should be X-rayed when installing or using any image acquisition device for the first time in Dentrix Ascend Imaging to verify proper operation prior to use on live patients.

    1. To change the acquisition device, select a device in the Available Devices for Procedure button pop-up list.

    2. In the Automatically Apply Enhancement list, select the type of enhancement that you want to have applied automatically to the image that will be acquired (Entire Image, For Perio, For Endo), or select Not Enhanced to not apply any enhancement.

      Note: When viewing an image after it has been acquired, you can turn the enhancement off and on. The original, raw image is preserved. For more information about enhancements and turning them on and off, see the "Processing images" section.

    3. Position the sensor in the patient's mouth, and align your X-ray source cone to point at the sensor, utilizing the paralleling or bisecting angle techniques. Set the appropriate exposure time on your X-ray source's control panel for the specific imaging device in use, and then trigger the radiation emission, which initiates the capture of the X-ray image. (Refer to the documentation provided by the manufacturer of your X-ray source for details about changing settings and usage.)

      Note: Radiation from an X-ray source initiates the imaging device (sensor) to capture an image, and this is controlled by someone triggering the X-ray source. The Dentrix Ascend Imaging program does not directly control the X-ray source or exposure settings.

      The resulting image is saved to the patient's record, and a preview of the image appears.

      Notes:

      • If you are acquiring in endo mode, the Recapture button is not available. The sensor is re-armed automatically and becomes ready for another exposure. Continue retaking the radiograph until you have acquired a satisfactory image to replace the previous image.

      • If you are not acquiring in endo mode, the Recapture button is available. To replace the image that you just acquired, click (or tap) Recapture. Reacquire the image. In the Select Image dialog box that appears, click (or tap) either Keep Existing to keep the original image or Keep Recaptured to replace the original image with the new image.

    Intraoral X-ray (using a phosphor plate)

    Do the following:

    Note: A phantom, test target, and/or another non-human object should be X-rayed when installing or using any image acquisition device for the first time in Dentrix Ascend Imaging to verify proper operation prior to use on live patients.

    1. Position a phosphor plate in the patient's mouth, and align your X-ray source cone to point at the sensor, utilizing the paralleling or bisecting angle techniques. Make sure that the edge of the phosphor plate with the dot or letter is pointing upward for all vertical placements or pointing toward the back of the mouth for all horizontal placements. Set the appropriate exposure time on your X-ray source's control panel for the specific imaging device in use, and then trigger the radiation emission, which causes the phosphor plate to capture the X-ray image. (Refer to the documentation provided by the manufacturer of your X-ray source for details about changing settings and usage.)

      Note: Radiation from an X-ray source causes the phosphor plate to capture the image, and this is controlled by someone triggering the X-ray source. The Dentrix Ascend Imaging program does not directly control the X-ray source or exposure settings.

    2. To change the acquisition device, select a device in the Available Devices for Procedure button pop-up list.

    3. From the Automatically Apply Enhancement list, select the type of enhancement that you want to have applied automatically to the image (Entire Image, For Perio, For Endo), or select Not Enhanced to not apply any enhancement.

      Note: When viewing an image after it has been acquired, you can turn the enhancement off and on. The original, raw image is preserved. For more information about enhancements and turning them on and off, see the "Processing images" section.

    4. Click (or tap) Start Acquisition.

    5. When the scanner is ready, put the phosphor plate, with the edge with the dot or letter pointing up, in the scanner according to the manufacturer's instructions.

      When the scanner finishes scanning the plate, the resulting image is saved to the patient's record, and a preview of the image appears.

      Note: To replace the image that you just acquired, click (or tap) Recapture. Reacquire the image. In the Select Image dialog box that appears, click (or tap) either Keep Existing to keep the original image or Keep Recaptured to replace the original image with the new image.

    Intraoral X-ray (using a software device)

    If you have selected one of the software devices (bridges) as your acquisition device, the corresponding third-party imaging program opens. Do the following:

    1. Acquire the image in the third-party imaging program.

    2. Close the third-party imaging program.

      The resulting image appears in the Dentrix Ascend Imaging program automatically.

      Note: To replace the image that you just acquired, click (or tap) Recapture. Reacquire the image. In the Select Image dialog box that appears, click (or tap) either Keep Existing to keep the original image or Keep Recaptured to replace the original image with the new image.

    Intraoral X-ray series

    The selected acquisition device begins initializing.

    Then, the X-ray sensor begins arming.

    Then, the X-ray sensor becomes ready for exposure.

    Do the following:

    Note: A phantom, test target, and/or another non-human object should be X-rayed when installing or using any image acquisition device for the first time in Dentrix Ascend Imaging to verify proper operation prior to use on live patients.

    1. To pause acquisition and change the acquisition device, click (or tap) Pause, and then select a device from the Available Devices for Procedure button menu. Click (or tap) Continue to resume acquisition.

    2. To skip ahead in the acquisition sequence, click (or tap) Skip Forward. This button is available only if the current step in the sequence is not the last step.

    3. To go backward in the acquisition sequence, click (or tap) Skip Backward. This button is available only if the current step in the sequence is not the first step, and if the previous step in the sequence does not have an image.

    4. In the Automatically Apply Enhancement list, select the type of enhancement that you want to have applied automatically to the image that will be acquired (Entire Image, For Perio, For Endo), or select Not Enhanced to not apply any enhancement.

      Note: When viewing an image after it has been acquired, you can turn the enhancement off and on. The original, raw image is preserved. For more information about enhancements and turning them on and off, see the "Processing images" section.

    5. Position the sensor in the patient's mouth, and align your X-ray source cone to point at the sensor, utilizing the paralleling or bisecting angle techniques. Set the appropriate exposure time on your X-ray source's control panel for the specific imaging device in use, and then trigger the radiation emission, which initiates the capture of the X-ray image. (Refer to the documentation provided by the manufacturer of your X-ray source for details about changing settings and usage.)

      Note: Radiation from an X-ray source initiates the imaging device (sensor) to capture an image, and this is controlled by someone triggering the X-ray source. The Dentrix Ascend Imaging program does not directly control the X-ray source or exposure settings.

      Radiation triggers the X-ray sensor.

      The resulting image is saved to the patient's record, and a preview of the image appears.

    6. Wait until the timer counts down to zero to proceed to the next step in the acquisition sequence.

      The current step in the acquisition sequence and the applicable teeth are selected for your reference.

      Notes:

      • To stop the acquisition session before completing the series, click (or tap) Finish Acquisition. You can resume the incomplete exam later on if necessary.

      • To replace the image that you just acquired, click (or tap) Recapture. Reacquire the image. In the Select Image dialog box that appears, click (or tap) either Keep Existing to keep the original image or Keep Recaptured to replace the original image with the new image.

    7. Repeat steps a - f until you finish acquiring the series.

    Intraoral X-ray series (using phosphor plates)

    Do the following:

    Note: A phantom, test target, and/or another non-human object should be X-rayed when installing or using any image acquisition device for the first time in Dentrix Ascend Imaging to verify proper operation prior to use on live patients.

    1. For each image you want to acquire, position a phosphor plate in the patient's mouth, and align your X-ray source cone to point at the sensor, utilizing the paralleling or bisecting angle techniques. Make sure that the edge of the phosphor plate with the dot or letter is pointing upward for all vertical placements or pointing toward the back of the mouth for all horizontal placements. Set the appropriate exposure time on your X-ray source's control panel for the specific imaging device in use, and then trigger the radiation emission, which causes the phosphor plate to capture the X-ray image. (Refer to the documentation provided by the manufacturer of your X-ray source for details about changing settings and usage.)

      Note: Radiation from an X-ray source causes the phosphor plate to capture the image, and this is controlled by someone triggering the X-ray source. The Dentrix Ascend Imaging program does not directly control the X-ray source or exposure settings.

    2. To change the acquisition device, select a device in the Available Devices for Procedure button pop-up list.

    3. From the Automatically Apply Enhancement list, select the type of enhancement that you want to have applied automatically to the images (Entire Image, For Perio, For Endo), or select Not Enhanced to not apply any enhancement.

      Note: When viewing an image after it has been acquired, you can turn the enhancement off and on. The original, raw image is preserved. For more information about enhancements and turning them on and off, see the "Processing images" section.

    4. Click (or tap) Start Scanning.

    5. When the scanner is ready, put the phosphor plates, with the edges with the dot or letter pointing up, in the scanner according to the manufacturer's instructions.

      As the scanner finishes scanning a plate, the resulting image appears as a thumbnail image on the panel at the bottom of the Dentrix Ascend Imaging program.

    6. One at a time, drag the thumbnail images from the panel to the appropriate boxes of the template.

      Note: If the orientations the phosphor plates were correct when the radiographs were taken and when inserting them into the scanner, the images will have the correct orientation in the series. When you drop a thumbnail image into a box of the template, the image is rotated automatically as needed for that position in the series.

    7. As needed, do any of the following:

      • To change the orientation of an image in the template, select it 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 swap two images in the template, drag one of the images to the box with another image.

      • To remove an image from the template, drag it back to the panel at the bottom.

    Intraoral X-ray series (using a software device)

    If you have selected one of the software devices (bridges) as your acquisition device, the corresponding third-party imaging program opens. Do the following:

    1. Acquire the images in the third-party program.

    2. Close the third-party imaging program.

      The resulting images appear as thumbnail images on the panel at the bottom of the Dentrix Ascend Imaging program automatically.

    3. One at a time, drag the thumbnail images from the panel to the appropriate boxes of the template.

    4. As needed, do any of the following:

      • To change the orientation of an image in the template, select it 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 swap two images in the template, drag one of the images to the box with another image.

      • To remove an image from the template, drag it back to the panel at the bottom.

    Extraoral X-ray

    Do the following:

    Note: A phantom, test target, and/or another non-human object should be X-rayed when installing or using any image acquisition device for the first time in Dentrix Ascend Imaging to verify proper operation prior to use on live patients.

    1. To change the acquisition device, select a device in the Available Devices for Procedure button pop-up list.

    2. Click (or tap) Start Acquisition.

    3. In the Automatically Apply Enhancement list, select the type of enhancement that you want to have applied automatically to the image that will be acquired (Entire Image, For Perio, For Endo), or select Not Enhanced to not apply any enhancement.

      Note: When viewing an image after it has been acquired, you can turn the enhancement off and on. The original, raw image is preserved. For more information about enhancements and turning them on and off, see the "Processing images" section.

    4. Use the options on the TWAIN interface window that appears to get ready to use the X-ray device. Dentrix Ascend Imaging waits to obtain the image from the device.

    5. Position the patient properly for your extraoral X-ray imaging device (for example, place the patient in a stand-up panoramic imaging device). Set the appropriate exposure parameters on your X-ray source's control panel, and then trigger the radiation emission, which initiates the capture of the X-ray image. (Refer to the documentation provided by the manufacturer of your X-ray source for details about changing settings and usage.)

      Note: Radiation from an X-ray source initiates the imaging device to capture an image, and this is controlled by someone triggering the X-ray source. The Dentrix Ascend Imaging program does not directly control the X-ray source or exposure settings.

      The resulting image is saved to the patient's record, and a preview of the image appears.

    Extraoral X-ray (using a phosphor plate)

    Do the following:

    Note: A phantom, test target, and/or another non-human object should be X-rayed when installing or using any image acquisition device for the first time in Dentrix Ascend Imaging to verify proper operation prior to use on live patients.

    1. Put a phosphor plate in your extraoral X-ray imaging device. Position the patient properly for your extraoral X-ray imaging device (for example, place the patient in a stand-up panoramic imaging device). Set the appropriate exposure parameters on your X-ray source's control panel, and then trigger the radiation emission, which initiates the capture of the X-ray image on the phosphor plate. (Refer to the documentation provided by the manufacturer of your X-ray source for details about changing settings and usage.)

      Note: Radiation from an X-ray source causes the phosphor plate to capture the image, and this is controlled by someone triggering the X-ray source. The Dentrix Ascend Imaging program does not directly control the X-ray source or exposure settings.

    2. To change the acquisition device, select a device in the Available Devices for Procedure button pop-up list.

    3. From the Automatically Apply Enhancement list, select the type of enhancement that you want to have applied automatically to the image (Entire Image, For Perio, For Endo), or select Not Enhanced to not apply any enhancement.

      Note: When viewing an image after it has been acquired, you can turn the enhancement off and on. The original, raw image is preserved. For more information about enhancements and turning them on and off, see the "Processing images" section.

    4. Click (or tap) Start Acquisition.

    5. When the scanner is ready, put the phosphor plate in the scanner according to the manufacturer's instructions.

      When the scanner finishes scanning the plate, the resulting image is saved to the patient's record, and a preview of the image appears.

    Extraoral X-ray (using a software device)

    If you have selected one of the software devices (bridges) as your acquisition device, the corresponding third-party imaging program opens. Do the following:

    1. Acquire the image in the third-party imaging program.

    2. Close the third-party imaging program.

      The resulting image appears in the Dentrix Ascend Imaging program automatically.

    Intraoral/extraoral photo

    Do the following:

    1. To change the acquisition device, select a device in the Available Devices for Procedure button pop-up list.

    2. Click (or tap) Start Acquisition.

      The live video stream from your camera appears.

      Note: To tune your camera's settings, you can click (or tap) the Tune Camera button .

    3. With the camera properly positioned, use the button on your camera to pause or freeze the live video stream (or click, or tap, Pause Streaming).

    4. Use the button on your camera to capture the current video frame (or click, or tap, Take a snapshot).

      The resulting image is added to the snapshot panel, and the video stream automatically becomes live again.

    5. Repeat steps c - d as needed to acquire additional snapshots.

    6. On the snapshot panel, clear the check box of the snapshots that you do not want to save.

    7. Click (or tap) Assign Images.

    8. Do any of the following:

      • To save one or more snapshots as intraoral images and assign tooth numbers, select the snapshots that pertain to the same teeth (deselect snapshots that do not pertain to the same teeth), and then drag them to the Select Teeth, UR/UL/LR/LL, Upper Jaw, or Lower Jaw box.

        If you drag snapshots to the Select Teeth box, select the applicable teeth, and then click (or tap) Assign Teeth.

      • To save one or more snapshots as extraoral images, select the snapshots that are extraoral images (deselect snapshots that are not extraoral images), and then drag them to the Extraoral Photos box.

      • To save the snapshots on the snapshot panel as intraoral images but not assign tooth numbers at this time, leave those snapshots on the snapshot panel.

      Assigned intraoral images appear on the left side of the preview area; extraoral, on the right.

      Note: If you have a mix of intraoral and extraoral images, they map to one procedure (D0350), which will appear in the progress notes with two icons. Also, you can delete or reassign the intraoral or extraoral exam as needed in the future.

    Intraoral/extraoral photo (using a software device)

    If you have selected one of the software devices (bridges) as your acquisition device, the corresponding third-party imaging program opens. Do the following:

    1. Acquire the images in the third-party program.

    2. Close the third-party imaging program.

      The resulting images appear as thumbnail images on the panel at the bottom of the Dentrix Ascend Imaging program automatically.

    3. Do any of the following:

      • To save one or more snapshots as intraoral images and assign tooth numbers, select the snapshots that pertain to the same teeth (deselect snapshots that do not pertain to the same teeth), and then drag them to the Select Teeth, UR/UL/LR/LL, Upper Jaw, or Lower Jaw box.

        If you drag snapshots to the Select Teeth box, select the applicable teeth, and then click (or tap) Assign Teeth.

      • To save one or more snapshots as extraoral images, select the snapshots that are extraoral images (deselect snapshots that are not extraoral images), and then drag them to the Extraoral Photos box.

      • To save the snapshots on the snapshot panel as intraoral images but not assign tooth numbers at this time, leave those snapshots on the snapshot panel.

      Assigned intraoral images appear on the left side of the preview area; extraoral, on the right.

      Note: If you have a mix of intraoral and extraoral images, they map to one procedure (D0350), which will appear in the progress notes with two icons. Also, you can delete or reassign the intraoral or extraoral exam as needed in the future.

  8. Click (or tap) Finish Acquisition or Begin Uploading (only for an intraoral X-ray series using phosphor plates or a software device or for intraoral/extraoral photos).

    Note: For an intraoral X-ray series using phosphor plates or a software device, if not all thumbnail images have been mounted into the template when you click (or tap) Begin Uploading, a confirmation message appears. If you choose to continue, only the mounted images will be saved.

  9. For an intraoral X-ray series using phosphor plates or a software device or for intraoral/extraoral photos, when the images are finished being saved to the patient's record, click (or tap) Continue.

  10. For a set of intraoral photos (or an individual intraoral photo or X-ray), you can assign tooth numbers to a selected snapshot by clicking (or tapping) the Edit button .

    For each snapshot that needs tooth numbers assigned to it, do the following:

    1. Under Image Navigator, click (or tap) an image thumbnail. You can skip this step if there is only one image thumbnail.

      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. Select the applicable tooth numbers.

    4. Click (or tap) Assign Teeth.

Acquiring an image for selected teeth

You can quickly acquire an image for the teeth that are selected on a patient's clinical chart.

To acquire an image

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

  2. On the Patient menu, under Clinical, click (or tap) Chart.

    The patient's clinical record opens with the Chart tab selected.

  3. Select one or more teeth.

  4. Do one of the following:

    • If you have selected teeth for a periapical image, on the Imaging tab's menu, click (or tap) PA Quick acquire.

      The options to acquire an image become available. Skip steps 5 - 8.

    • On the Imaging tab's menu, click (or tap) Acquire images.

      The options for acquiring images become available. Proceed to step 5.

  5. Under Imaging Procedures, select the procedure that you want to perform (an intraoral periapical or bitewing X-ray image).

    The options for the selected procedure become available.

  6. Under Billing Options, set up the following options:

    • Apply charges - To post the fee for the selected procedure (such as D0220 for a periapical image), select the check box. To post a zero amount for the procedure, clear the check box.

    • Bill to insurance - Specify whether you want to bill or not bill the patient's insurance carrier for the procedure by selecting or clearing the check box, respectively.

    • Provider - Select the provider who you want to associate with the procedure.

  7. Under Task to Perform, on the Acquire Images tab, select the desired device in the Available Devices button pop-up list if it is not already selected.

    Notes:

    • For the complete list of acquisition devices that are supported by Dentrix Ascend Imaging, see the "Supported Acquisition Devices" section.

    • The first time you attempt to use an intraoral camera with Dentrix Ascend Imaging on any computer, when a message from the browser appears and asks if you want to allow the browser to have access to the camera, allow it.

  8. Click (or tap) Proceed with Acquisition to start acquiring an image for the corresponding acquisition type.

    Note: A phantom, test target, and/or another non-human object should be X-rayed when installing or using any image acquisition device for the first time in Dentrix Ascend Imaging to verify proper operation prior to use on live patients.

    The selected acquisition device begins initializing.

    Then, the X-ray sensor begins arming.

    Then, the X-ray sensor becomes ready for exposure.

  9. If you need to change the selected acquisition device, select the correct device on the Available Devices for Procedure list.

  10. In the Automatically Apply Enhancement list, select the type of enhancement that you want to have applied automatically to the image that will be acquired (Entire Image, For Perio, For Endo), or select Not Enhanced to not apply any enhancement.

    Note: When viewing an image after it has been acquired, you can turn the enhancement off and on. The original, raw image is preserved. For more information about enhancements and turning them on and off, see the "Processing images" section.

  11. Position the sensor in the patient's mouth, and align your X-ray source cone to point at the sensor, utilizing the paralleling or bisecting angle techniques. Set the appropriate exposure time on your X-ray source's control panel for the specific imaging device in use, and then trigger the radiation emission, which initiates the capture of the X-ray image. (Refer to the documentation provided by the manufacturer of your X-ray source for details about changing settings and usage.)

    Note: Radiation from an X-ray source initiates the imaging device (sensor) to capture an image, and this is controlled by someone triggering the X-ray source. The Dentrix Ascend Imaging program does not directly control the X-ray source or exposure settings.

    Then, the resulting image is saved to the patient's record.

    Then, a preview of the image appears.

    Note: To replace the image that you just acquired, click (or tap) Recapture. Reacquire the image. In the Select Image dialog box that appears, click (or tap) either Keep Existing to keep the original image or Keep Recaptured to replace the original image with the new image.

  12. Click (or tap) Finish Acquisition.

Importing images

You can import image files (.bmp, .png, .jpg, and .tiff files) to attach to a patient's record.

To import images

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

  2. On the Patient menu, under Clinical, click (or tap) Chart, Progress Notes, Quick Exam, Treatment Planner, Perio, or Imaging.

  3. On the Chart, Progress Notes, Treatment Planner, Perio, or Imaging tab of a patient's clinical record, on the Imaging tab's menu, click (or tap) Acquire images.

    The options for acquiring images become available.

  4. Under Imaging Procedures, select the procedure that you want to perform (each corresponds to a particular acquisition type: individual intraoral X-ray, intraoral X-ray series, extraoral X-ray, or intraoral photo, or extraoral photo).

    The options for the selected procedure become available.

  5. Under Billing Options, set up the following options:

    • Apply charges - To post the fee for the selected procedure (such as D0210 for a full mouth series), select the check box. To post a zero amount for the procedure, clear the check box.

    • Bill to insurance - Specify whether you want to bill or not bill the patient's insurance carrier for the procedure by selecting or clearing the check box, respectively.

    • Provider - Select the provider who you want to associate with the procedure.

  6. If you are importing images for an individual intraoral X-ray, on the Tooth chart, select the teeth that apply to the current importing session; otherwise, skip this step.

    Note: To deselect all selected teeth, click (or tap) the Clear selected link.

  7. If you are importing images for a full-mouth series, under Acquisition sequence, select FMX 18 or FMX 21; otherwise, skip this step.

  8. Under Task to Perform, click (or tap) the Import Images tab.

  9. Select one of the following options:

    • Completed Procedure - Use this for a procedure that you are performing. Today's date and time will be associated with the procedure.

    • 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 check boxes under Billing Options become unavailable because the procedure will be posted with a zero dollar fee and will not be billed to insurance.

  10. Click (or tap) Proceed with Acquisition.

  11. Do one of the following:

    • If you are importing an individual intraoral or extraoral X-ray image, click (or tap) Start Acquistion.

    • If you are importing images for an intraoral X-ray series, click (or tap) Start Importing.

    • If you are importing images for intraoral/extraoral photos, click (or tap) Start Importing.

    The Import File dialog box appears.

  12. Select the desired image files, and then click (or tap) Open.

    If you are importing images for an intraoral X-ray series or intraoral/extraoral photos, the selected image files appear as thumbnail images on the panel at the bottom of the Dentrix Ascend Imaging program.

  13. For an intraoral X-ray series or intraoral/extraoral photos, repeat steps 10 - 11 as needed to import additional images.

  14. For X-ray images, from the Automatically Apply Enhancement list, select the type of enhancement that you want to have applied automatically to the images (Entire Image, For Perio, For Endo), or select Not Enhanced to not apply any enhancement.

    Note: When viewing an image after it has been imported, you can turn the enhancement off and on. The original, raw image is preserved. For more information about enhancements and turning them on and off, see the "Processing images" section.

  15. For an intraoral X-ray series, do the following:

    1. One at a time, drag the thumbnail images from the panel to the appropriate boxes of the template.

    2. Do any of the following:

      • To change the orientation of an image in the template, select it 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 swap two images in the template, drag one of the images to the box with another image.

      • To remove an image from the template, drag it back to the panel at the bottom.

  16. For intraoral/extraoral photos, do the following:

    1. Clear the check box of any thumbnail image on the panel that you do not want to save to the patient's record.

    2. Click (or tap) Assign Images.

    3. Do any of the following:

      • To save one or more snapshots as intraoral images and assign tooth numbers, select the snapshots that pertain to the same teeth (deselect snapshots that do not pertain to the same teeth), and then drag them to the Select Teeth, UR/UL/LR/LL, Upper Jaw, or Lower Jaw box.

        If you drag snapshots to the Select Teeth box, select the applicable teeth, and then click (or tap) Assign Teeth.

      • To save one or more snapshots as extraoral images, select the snapshots that are extraoral images (deselect snapshots that are not extraoral images), and then drag them to the Extraoral Photos box.

      • To save the snapshots on the snapshot panel as intraoral images but not assign tooth numbers at this time, leave those snapshots on the snapshot panel.

      Assigned intraoral images appear on the left side of the preview area; extraoral, on the right.

  17. Click (or tap) Finish Acquisition (only for an individual intraoral/extraoral X-ray image) or Begin Uploading (only for an intraoral X-ray series or intraoral/extraoral photos).

    Note: For an intraoral X-ray series, if not all thumbnail images have been mounted into the template when you click (or tap) Begin Uploading, a confirmation message appears. If you choose to continue, only the mounted images will be saved.

  18. For an intraoral X-ray series or intraoral/extraoral photos, when the images are finished being saved to the patient's record, click (or tap) Continue.

  19. For a set of intraoral photos (or an individual intraoral photo or X-ray), you can assign tooth numbers to a selected snapshot by clicking (or tapping) the Edit button .

    For each snapshot that needs tooth numbers assigned to it, do the following:

    1. Under Image Navigator, click (or tap) an image thumbnail. You can skip this step if there is only one image thumbnail.

      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. Select the applicable tooth numbers.

    4. Click (or tap) Assign Teeth.

Modifying exams

You can resume incomplete exams and recover missing images. You can also rearrange images in a set of images.

Resuming incomplete exams

If you skipped the acquisition of any images in an exam that uses a set of images or canceled an exam before acquiring all the images, you can return to that exam and complete the image acquisitions as needed.

To resume an incomplete exam

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

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

    The patient's imaging page opens to the history view, and the most recent image or series (such as a full mouth series or bitewings) is selected by default on the Images tab.

  3. Select a series (such as a full mouth series or bitewings).

  4. On the corresponding options menu, click (or tap) Resume exam. This option is available only if the exam is a series and has missing images (the image count is less than the number of spaces in the template).

    The Acquisition Options dialog box appears.

  5. Under Acquisition sequence, select "Default sequence" or a custom order (if any).

  6. Click (or tap) Proceed with Acquisition.

    The options for acquiring images in the series appear.

  7. Finish acquiring images for the exam.

Recovering images

If an individual image or any images in a set did not get uploaded to the server, you can recover those images from the computer where those images were acquired.

To recover images

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

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

    The patient's imaging page opens to the history view, and the most recent image or series (such as a full mouth series or bitewings) is selected by default on the Images tab.

  3. Select an image or a series (such as a full mouth series or bitewings).

  4. On the corresponding options menu, click (or tap) Recover images.

    The options for recovering images appear.

  5. In the Recover Images From list, select either The past two days to search for images from the past two days or All time to search for images from any time in the past.

  6. Click (or tap) Start Recovery.

    The images that can be recovered appear in the panel at the bottom of the page.

  7. One at a time, drag the correct thumbnail images from the panel to the appropriate boxes of the template. For intraoral/extraoral photos, you can select multiple thumbnail images on the panel and then drag them together.

  8. Click (or tap) Begin Uploading.

Rearranging images in exams

You can rearrange images within an exam that uses a set of images.

To rearrange images in an exam

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

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

    The patient's imaging page opens to the history view, and the most recent image or series (such as a full mouth series or bitewings) is selected by default on the Images tab.

  3. Select a series (such as a full mouth series or bitewings).

  4. On the corresponding options menu, click (or tap) Re-arrange exam.

    The Re-arrange Image dialog box appears.

  5. Do any of the following as needed:

    • To swap two images in the template, drag one of the images to the box with another image.

    • To move an image to an empty box in the template, drag the image to the desired box.

    • To change the orientation of an image in the template, select it 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).

    When you have moved, or changed the orientation of, at least one image, the Confirm button becomes available.

  6. When you have finished rearranging the images, click (or tap) Confirm.

Viewing images

You can view the recent images and the image history for a patient. You can also quickly determine which teeth have images and view images for selected teeth.

Viewing recent images

You can view a patient's most recent images by category. This is the default view when you select the Imaging tab of the patient's clinical record.

To view a patient's recent images

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

  2. 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, Treatment Planner, or Perio. Then, on the Imaging tab's menu, click (or tap) Show Most Recent Images.

    The patient's recent images appear.

  3. In any of the boxes, which correspond to categories (intraoral X-rays, intraoral photos, extraoral photos, and extraoral X-rays), do any of the following:

    • Click (or tap) the Previous button to view an image that was acquired prior to the image being displayed currently. This button is available only if there is an older image.

    • If you have navigated to an older image, click (or tap) the Next button to view a more recent image.

    • Click (or tap) the image being displayed currently to view that image larger. The image will open in the image history view. For information about using the image history view, see the "Viewing history" section.

      Note: If you click (or tap) a specific image of a series (such as a full mouth series or bitewings), that image appears by itself, and you can easily navigate through the other images in that series in the patient's image history view.

Viewing image history

You can view a patient's entire image history chronologically and quickly navigate between each image. Also, in the history view, you can view individual images larger than you can in the recent images view, and you can process (such as enhance or annotate) an image. For information about using the recent images view, see the "Viewing recent images" section. For information about processing images, see the "Processing images" section.

To view a patient's image history

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

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

    The patient's imaging page opens to the history view, and the most recent image or series (such as a full mouth series or bitewings) is selected by default on the Images tab.

  3. If needed, filter the list of images on the Images tab to display only the images that match the filter criteria that you specify.

    Do the following:

    1. Click (or tap) in the Narrow down the results field to view the available filters.

    2. Set up any of the following filters:

      • Date - To view the images according to a different date, select the desired date in the list under Show images taken on. To view all images that have been acquired on and after the selected date, select the All since that day check box. To view the images that were acquired only on the selected date, clear the All since that day check box.

      • Type - To view images in any category (intraoral X-rays, intraoral photos, intraoral photos without tooth numbers assigned, and extraoral X-rays, and/or extraoral photos), select the All types check box. To view images in only certain categories, make sure the check boxes of only those categories are selected; the other check boxes must be cleared.

      • Teeth - If the Intraoral X-ray and/or Intraoral photo check boxes are selected, to view those types of images for specific teeth, select the desired teeth on the Tooth Chart. The tooth filter does not apply to intraoral photos that do not have tooth numbers assigned to them and extraoral X-rays (which apply to all teeth), and extraoral photos (which apply to all teeth). To clear all tooth selections, click (or tap) the Clear selected link.

      • Show everything - To set the filter options to their default states and display all the patient's images, click (or tap) the Show everything link.

      The image list displays the images that match your filter criteria.

    3. Click (or tap) the X in the upper-right corner of or anywhere outside of the Narrowing Down the Results menu to close the menu.

  4. With an image or a series selected, do any of the following:

    • Navigate the series - If you have selected a series (such as a full mouth series or bitewings), to navigate between the images of that series, click (or tap) each image of the series under Image Navigator. A larger version of the current image (highlighted with a yellow box) in the series appears in the viewing area.

      Note: You can also click (or tap) the Previous and Next buttons to navigate between the images in the set.

    • Zoom in/out - To increase the zoom level (zoom in), move the Zoom slider to the right. To decrease the zoom level (zoom out), move the slider to the left. If you are using a mouse, you can also zoom in and out by positioning the pointer over the image (the pointer will change to cross hairs) and then rotating the scroll wheel of your mouse.

    • View full screen - To view the image full screen, click (or tap) the Full Screen button . To return to the normal view mode, click (or tap) the Normal Mode button .

    • View the entire series - If you have selected a series (such as a full mouth series or bitewings), to view all the images in the series at once in the viewing area, click (or tap) the Series Mode button . Then, to return to the single-image view mode, do one of the following:

      • Click (or tap) an image in the viewing area to view only that image.

      • Click (or tap) an image under Image Navigator (which is "Image Preview" in single-image view mode) to view only that image.

      • Click (or tap) the Single Mode button .

      Note: You can zoom in and out while viewing a series.

Determining which teeth have images

You can determine which teeth have images associated with them from a patient's clinical chart and progress notes.

To determine which teeth have images

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

  2. On the Patient menu, under Clinical, click (or tap) Chart.

    The patient's clinical record opens with the Chart tab selected.

  3. Do one of the following:

    • Look at a tooth's number. You can tell if a tooth has an image associated with it, and the age of that image, by the background color of the circle around that tooth number: black is 0 - 6 months, dark gray is 7 - 12 months, light gray is 13 - 24 months, and white is 25 or more months (or no image).

    • Select one or more or no teeth, and then click (or tap) the Progress Notes tab. On the Progress Notes tab, there is an imaging symbol next to any procedure that has images associated with it.

    • Select one or more or no teeth, and then click (or tap) the Quick Exam tab. On the Quick Exam tab, look at a tooth's number. You can tell if a tooth has an image associated with it, and the age of that image, by the background color of the circle around that tooth number: black is 0 - 6 months, dark gray is 7 - 12 months, light gray is 13 - 24 months, and white is 25 or more months (or no image).

Viewing images for selected teeth

You can view images for selected teeth from a patient's clinical chart and progress notes.

To view images for selected teeth

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

  2. On the Patient menu, under Clinical, click (or tap) Chart.

    The patient's clinical record opens with the Chart tab selected.

  3. Do one of the following:

    • Select one or more teeth with associated images, and then click (or tap) Image Peek. The button is available only if at least one tooth with an image is selected.

    • Select one or more teeth with associated images, and then click (or tap) the Progress Notes tab. On the Progress Notes tab, click (or tap) the imaging symbol next to a procedure.

    • Select one or more teeth with associated images, and then click (or tap) the Quick Exam tab. On the Quick Exam tab, click (or tap) Image Peek (the button appears as a white tooth on a blue background if there is not enough room to display the button with a text label). The button is available only if at least one tooth with an image is selected.

    The Image Peek dialog box appears.

    Tips:

    • If there are multiple images, use the Back and Forward buttons to navigate between the images.

    • To edit the image that is currently being viewed, click (or tap) Open for Edit.

  4. Click (or tap) Done.

Comparing images

Comparing images

You can compare two images side by side.

To compare images

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

    • 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.

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

      2. On the Images tab, select an image or a series (such as a full mouth series or bitewings).

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

    • 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, Treatment Planner, Perio, or Imaging. Then, on the Imaging tab's menu, click (or tap) Show Most Recent Images.

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

    The selected image appears in the viewing area.

  3. Click (or tap) Compare.

    The images that have tooth numbers in common with the selected image (the "Original") appear on the Images for tooth range panel.

  4. The first image on the Images for tooth range panel is selected by default, but you can select a different image to compare with the original.

  5. To modify how an image is being viewed, click (or tap) the Original or Compared image, and then do any of the following for the selected image:

    • Use the (yellow or blue) Brightness/Contrast button to change the brightness and/or contrast.

    • Use the (yellow or blue) Zoom slider to zoom in and out.

    • While zoomed in on an image, drag the blue square (on the comparison image on the Images for tooth range panel) or the yellow square (on the image under Image Navigator) to pan to another part of the image.

  6. Linking the images being compared allows the zooming and panning of one image to be synchronized with the other. To link images, do the following:

    1. Click (or tap) the Original or Compared image (zoomed and panned or not).

    2. Click (or tap) the (yellow or blue) Link button .

      The images are linked.

      Note: If you alter the zoom and/or pan of an image before linking it to the other, when you link them, the zoom factor and the position of the pan box (yellow or blue box) of the other image is synchronized to be the same as the first.

    Now, as you zoom in and out and pan, both images are affected.

    Note: To unlink the images, click (or tap) the Link button .

  7. Click (or tap) Finish Comparison.

Processing images

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. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

    • 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.

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

      2. On the Images tab, select an image or a series (such as a full mouth series or bitewings).

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

    • 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, Treatment Planner, Perio, or Imaging. Then, on the Imaging tab's menu, click (or tap) Show Most Recent Images.

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

    The selected image appears in the viewing area.

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

  4. Use any of the following tools as needed:

    One Click Tools

    • Enhance - 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.

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

    • Rotate - 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 - Click (or tap) the button that corresponds to how you want to flip the image: Horizontal or Vertical.

    • Invert - To invert the image's colors, select the Invert check box. To remove the filter, clear the check box.

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

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

    • Emboss - To emboss the image, select the Emboss check box. To remove the filter, clear the check box.

    Annotations

    To add a shape, do the following:

    1. Set up the Drawing tools.

      • Select a shape: arrow, rectangle, or circle.

      • 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.

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

    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.

    • To switch between showing and hiding the annotations, select and clear the Show check box.

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

    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.

    To add measurements, do the following:

    1. To calibrate distance measurements using an object of known size in the image, click (or tap) Calibrate. 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. Change the length of the Standard for calibration as needed to the correct number of millimeters for the known length.

      Perform the above calibration step until 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 dynamic measurements will be calculated respective to that calibration.

      Note: For most sensors that integrate directly with Dentrix Ascend Imaging, it may not be necessary to calibrate images taken with those sensors.

    2. Click (or tap) Dynamic Measure.

    3. Click (or tap) a point on the image, then another point, and so on until you have created all the necessary lines.

    Notes:

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

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

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

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

    • To switch between showing and hiding the lines and their calculated lengths and angles, select and clear the Show check box.

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

    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.

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

    1. Click (or tap) Line.

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

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

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

    Density (Rectangle)

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

    1. Click (or tap) Rectangle.

    2. Click (or tap) and drag to create a rectangle.

      The Median gray level is indicated.

    Spotlight

    To add spotlights, do the following:

    1. Select an Effect: Invert, Colorize (for X-ray images 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.

  5. Adjust the brightness and/or contrast as needed.

    Do the following:

    1. Click (or tap) the Brightness/Contrast button.

    2. Do any of the following:

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

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

      • To reset the brightness and contrast levels to their default states, click (or tap) the Reset to default link.

      Note: If you change the brightness or contrast, the corresponding button becomes orange .

Deleting images

Deleting images

You can delete a single image or a series of images from a patient's record. You can delete images only if they are not associated with procedures that are attached to insurance claims.

Notes: The procedures that are associated with the images that you are deleting will also be deleted or voided (if older than 120 days).

To delete images

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

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

    The patient's imaging page opens to the history view, and the most recent image or series (such as a full mouth series or bitewings) is selected by default on the Images tab.

  3. Select an image or a series (such as a full mouth series or bitewings).

  4. On the corresponding options menu, click (or tap) Delete exam.

    The Delete Exam confirmation message appears.

  5. Click (or tap) Delete.

Reassigning images to a different patient

Reassigning images to a different patient

You can move a single image or a series of images from one patient's record to another's. You can move images only if they are not associated with procedures that are attached to insurance claims.

Note: The procedures that are associated with the images that you are moving will be deleted or voided (if older than 120 days) in the original patient's record and posted to the new patient's record.

To process an image

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

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

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

    The patient's imaging page opens to the history view, and the most recent image or series (such as a full mouth series or bitewings) is selected by default on the Images tab.

  3. Select an image or a series (such as a full mouth series or bitewings).

  4. On the corresponding options menu, click (or tap) Reassign exam.

    The Reassign Exam dialog box appears.

  5. Use the to the following patient search box to search for and select the name of the patient to whom you want to move the images.

  6. Click (or tap) Reassign Exam.

Sharing images

You can export and print images.

Exporting images

You can export an image, a specific image of a series, or an entire series (such as a full mouth series).

To export images

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

    • 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 or a series in the patient's image history list.

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

      2. On the Images tab, select an image or a series (such as a full mouth series or bitewings).

    • 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, Treatment Planner, Perio, or Imaging. Then, on the Imaging tab's menu, click (or tap) Show Most Recent Images.

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

    The selected image (or the first of the selected series) appears in the viewing area.

  3. If you are viewing a series (such as a full mouth series or bitewings), to view a differrent image of that series, under Image Preview, click (or tap) an image. Otherwise, skip this step.

  4. Do one of the following:

    • To export only the image currently being viewed, or to select and export multiple images in a series, click (or tap) Share.

    • To export the selected image or series of images, from the corresponding options menu, click (or tap) Share exam.

    The Image(s) to be shared dialog box appears if you used the Share button, or the Share Exam or Image dialog box appears if you used the Share exam menu option.

  5. Set up the following options:

    • Include image enhancements - Select this check box to apply an enhancement, which adds a balance of sharpening and contrast levels that affects the overall sharpness and contrast, to any of the images being exported that have enhancement applied to their originals. Any images being exported that do not have enhancement applied to their originals will not be exported with enhancement. Clear this check box to not enhance any of the images being exported even if enhancement has been applied to their originals.

    • Include annotations and measurements - Select this check box to include any annotations or measurements that were added to the images being exported. Clear this check box to export the images without the annotations and measurements.

    • Export as JPEG (Otherwise PNG) - Select this check box to export the selected images as .jpg files. Clear this check box to export the selected images as .png files. If you are exporting multiple images, they will be saved as individual images in one compressed folder.

    • Share exam as - These options are available only if you selected the Share exam option on the series' options menu in step 4. To export the images as one file that contains all the images, select Entire exam in one image. To export each image as an individual file, select Separate individual images.

  6. If you used the Share button in step 4, and if you are viewing a series of images, click (or tap) the desired images. Selected images have a yellow box around them. If necessary, you can click (or tap) a selected image to remove the yellow box unless only one image is selected.

  7. Click (or tap) Export.

    The images are downloaded.

Printing images

You can print an image, a specific image of a series, or an entire series (such as a full mouth series).

To print images

  1. Use the Patient Search box to access a patient's record.

    Notes:

    • If the last patient record you accessed since you last logged on is the correct patient's record, you do not need to re-enter the patient's name in the Patient Search box.

    • 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 or a series in the patient's image history list.

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

      2. On the Images tab, select an image or a series (such as a full mouth series or bitewings).

    • 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, Treatment Planner, Perio, or Imaging. Then, on the Imaging tab's menu, click (or tap) Show Most Recent Images.

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

    The selected image (or the first of the selected series) appears in the viewing area.

  3. If you are viewing a series (such as a full mouth series or bitewings), to view a differrent image of that series, under Image Preview, click (or tap) an image. Otherwise, skip this step.

  4. Do one of the following:

    • To print only the image currently being viewed, or to select and print multiple images in a series, click (or tap) Share.

    • To print the selected image or series of images, on the corresponding options menu, click (or tap) Share exam.

    The Image(s) to be shared dialog box appears if you used the Share button, or the Share Exam or Image dialog box appears if you used the Share exam menu option.

  5. Set up the following options:

    • Include image enhancements - Select this check box to apply an enhancement, which adds a balance of sharpening and contrast levels that affects the overall sharpness and contrast, to any of the images being printed that have enhancement applied to their originals. Any images being printed that do not have enhancement applied to their originals will not be printed with enhancement. Clear this check box to not enhance any of the images being printed even if enhancement has been applied to their originals.

    • Include annotations and measurements - Select this check box to include any annotations or measurements that were added to the images being printed. Clear this check box to export the images without the annotations and measurements.

    • Share exam as - These options are available only if you selected the Share exam option on the series' options menu in step 4. To print the images on a single page, select Entire exam in one image. To print each image on a separate page, select Separate individual images.

  6. If you used the Share button in step 4, and if you are viewing a series of images, click (or tap) the desired images. Selected images have a yellow box around them. If necessary, you can click (or tap) a selected image to remove the yellow box unless only one image is selected.

  7. Click (or tap) Print.

    A .pdf file of the images is created for you to print.

Attaching images to claims

Attaching images to claims

You can attach images that you have acquired using Dentrix Ascend Imaging to a claim.

To attach images to a claim

  1. Click (or tap) a claim on the Unsent Claims page, the Sent Claims page, a patient's Insurance Claims page, or a patient's ledger.

    The Claim Detail dialog box appears.

    Note: If the patient has images for the same date of service as a procedure on the claim, a warning symbol appears. You can click (or tap) the symbol to view the warning message and click (or tap) a link to go to the Attachments tab.

  2. Click (or tap) the Attachments tab.

  3. Add images from the patient's images:

    1. Click (or tap) Add Image.

      The Add from Imaging dialog box appears.

    2. Click (or tap) a procedure with the correct date of service to view the corresponding images. Select the check boxes of the images that you want to attach to the claim. Repeat this process as needed.

    3. Click (or tap) Add.