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Planmeca Romexis 1
TABLE OF CONTENTS
Users Manual
Chapter A GENERAL
1 INTRODUCTION TO PLANMECA ROMEXIS ..................................... A-1
1.1 Introduction to digital imaging ............................................................................A-2
1.2 Securing the image data ....................................................................................A-2
1.3 Image acquisition ...............................................................................................A-3
1.4 Settings ..............................................................................................................A-3
1.5 Archiving ............................................................................................................A-3
1.6 Processing images ............................................................................................A-4
1.7 Measuring images .............................................................................................A-4
1.8 Annotating images .............................................................................................A-5
1.9 Printing ...............................................................................................................A-5
1.10 DICOM support ..................................................................................................A-5
1.11 Disclaimer ..........................................................................................................A-6
2 STARTING THE ROMEXIS APPLICATION ........................................ A-7
3 ROMEXIS MODULES .......................................................................... A-8
Chapter B PATIENTS AND FILES MODULES
1 ALL PATIENTS (SEARCHING ALL PATIENTS) ................................ B-1
1.1 Sorting patients ..................................................................................................B-1
1.2 Opening patient record ......................................................................................B-2
1.3 Patient files ........................................................................................................B-2
1.4 Adding and editing patients ...............................................................................B-3
1.5 Editing patients ..................................................................................................B-3
1.6 Assigning patients ..............................................................................................B-3
1.7 Finding assigned patients ..................................................................................B-4
1.8 Adding template patients ...................................................................................B-4
1.9 Adding virtual patients .......................................................................................B-4
1.10 Inactivating patients ...........................................................................................B-5
1.11 Searching patients by image .............................................................................B-5
2 DICOM WORKLIST SEARCH .............................................................. B-5
3 DICOM QUERY / RETRIEVE (OPTIONAL) ......................................... B-6
4 FIND BY IMAGE ................................................................................... B-6
TABLE OF CONTENTS
2 Planmeca Romexis Users Manual
Chapter C 2D IMAGING MODULE
1 IMAGE BROWSER .............................................................................. C-2
1.1 Imaging modalities ............................................................................................ C-2
1.2 Browsing images in different display modes .................................................... C-2
1.3 Image browser settings ..................................................................................... C-6
1.4 Toggling from one image type category to another .......................................... C-6
1.5 Using image thumbnails ................................................................................... C-6
2 MANAGING IMAGE STUDIES ............................................................. C-9
2.1 Opening images in the study ............................................................................ C-9
2.2 Opening a study ................................................................................................ C-9
2.3 Creating a new study ........................................................................................ C-9
2.4 Closing all open images .................................................................................. C-10
2.5 Arranging Images in study .............................................................................. C-10
2.6 Removing images from study ......................................................................... C-11
2.7 Adding an image to a study ............................................................................ C-11
2.8 Setting the layout ............................................................................................ C-11
3 IMAGE ACQUISITION ........................................................................ C-12
3.1 Capturing single intraoral images ................................................................... C-12
3.2 Capturing intraoral images into a template ..................................................... C-12
3.3 Capturing panoramic images .......................................................................... C-14
3.4 Capturing SmartPan layer panoramic images ................................................ C-14
3.5 Capturing cephalometric images .................................................................... C-14
3.6 Opening SmartPan images ............................................................................. C-15
3.7 Processing SmartPan stack images ............................................................... C-16
3.8 Moving and inactivating SmartPan images ..................................................... C-17
3.9 Adding SmartPan images to studies ............................................................... C-17
3.10 Importing and exporting SmartPan images .................................................... C-17
3.11 Printing SmartPan images .............................................................................. C-18
3.12 Using SmartPan images in Romexis Viewer .................................................. C-18
3.13 Using TWAIN capture ..................................................................................... C-18
4 IMPORTING IMAGES ........................................................................ C-21
4.1 Importing images using DICOM Import .......................................................... C-22
5 EXPORTING IMAGES ........................................................................ C-23
5.1 Exporting images using DICOM Export .......................................................... C-24
5.2 DICOM Media Storage (DICOMDIR) .............................................................. C-24
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5.3 DICOMDIR Import .......................................................................................... C-25
5.4 DICOMDIR Export .......................................................................................... C-26
6 PRINTING IMAGES / PRINT EDITOR ............................................... C-28
6.1 Vertical Toolbar ............................................................................................... C-32
7 DICOM PRINT (OPTIONAL) .............................................................. C-35
8 VIEW ADJUSTMENT TOOLS ........................................................... C-36
9 MEASURING IMAGES ....................................................................... C-38
10 DRAWING TOOLS ............................................................................. C-40
11 2D IMPLANT LIBRARY (OPTIONAL) ............................................... C-42
11.1 Adding and managing implants in the plan ..................................................... C-43
11.2 Image specific tools ........................................................................................ C-45
11.3 Image processing tools ................................................................................... C-46
12 IMAGE PROPERTIES ........................................................................ C-48
12.1 General Image Properties ............................................................................... C-48
12.2 Image Diagnosis ............................................................................................. C-49
12.3 All Parameters ................................................................................................ C-49
12.4 Image Alignments ........................................................................................... C-49
12.5 Copy image to Clipboard ................................................................................ C-49
12.6 Moving Image to Another Patient ................................................................... C-49
12.7 Assign as Face Photo .................................................................................... C-49
12.8 Inactivating an Image ...................................................................................... C-49
13 DICOM STORAGE & STORAGE COMMITMENT (OPTIONAL) ....... C-50
Chapter D 3D IMAGING MODULE
1 VOLUMES ........................................................................................... D-2
1.1 Opening a 3D volume ....................................................................................... D-2
1.2 Moving volume to other patient ......................................................................... D-2
2 EXPLORER .......................................................................................... D-3
2.1 3D master toolbar ............................................................................................. D-4
2.2 3D volume acquisition ....................................................................................... D-6
2.3 3D Volume Viewing .......................................................................................... D-8
2.4 Artefact removal ................................................................................................ D-9
2.5 Stitching multiple volumes .............................................................................. D-12
2.6 Recovering 3D volumes .................................................................................. D-18
TABLE OF CONTENTS
2.7 Importing 3D Images ...................................................................................... D-19
2.8 Importing intraoral scans in STL format .......................................................... D-19
2.9 Exporting 3D Images ...................................................................................... D-24
2.10 Saving 2D views ............................................................................................. D-29
2.11 Windows printing / Print Editor ........................................................................ D-31
2.12 DICOM Printing /Print Editor ........................................................................... D-34
2.13 DICOM Storage .............................................................................................. D-34
2.14 Creating virtual cephalometric images ............................................................ D-35
2.15 Launching external applications ..................................................................... D-36
2.16 Adjusting levels (contrast & brightness) .......................................................... D-36
2.17 Measuring angles in images ........................................................................... D-37
2.18 Measuring length ............................................................................................ D-37
2.19 Saving the current view .................................................................................. D-37
2.20 Opening a saved view .................................................................................... D-37
2.21 Deleting a view from the saved views ............................................................. D-37
2.22 Resetting a view to default orientation ............................................................ D-38
2.23 Using the Zoom Mode .................................................................................... D-38
2.24 3D Image Properties ....................................................................................... D-38
2.25 Deleting a 3D Volume ..................................................................................... D-38
3 SLICE SPECIFIC TOOLS .................................................................. D-39
3.1 Layer Slide Bar and Maximize button ............................................................. D-39
3.2 Layer and Curve Slide Bar .............................................................................. D-39
3.3 Snap shot tool ................................................................................................. D-39
3.4 Volume mirroring ............................................................................................ D-39
3.5 Adjusting Explorer Layer Settings ................................................................... D-40
4 VOLUME ADJUSTMENTS ................................................................ D-41
4.1 Adjusting thickness ......................................................................................... D-41
4.2 Adjusting contrast, brightness and sharpness ................................................ D-41
4.3 Exporting Views To Other Tabs ...................................................................... D-41
4.4 Cropping Volumes for 3D Rendering .............................................................. D-42
4.5 Showing / Hiding settings ............................................................................... D-42
4.6 Using the Volume Reslicer Tool ..................................................................... D-43
4.7 Moving and rotating volumes .......................................................................... D-43
4.8 Converting dental impressions into actual dentures
(Digital cast conversion tool) D-44
5 3D ANNOTATIONS ............................................................................ D-46
5.1 Using the region growing tool ......................................................................... D-47
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6 3D RENDERING ................................................................................. D-50
6.1 Setting 3D Rendering Cutoff Threshold .......................................................... D-50
6.2 Adjusting 3D Rendering Transparency ........................................................... D-51
6.3 Rendering Orientation Tools .......................................................................... D-51
7 3D PANORAMIC MODULE (OPTIONAL) .......................................... D-54
7.1 Using panoramic tools ................................................................................... D-55
7.2 Moving and rotating volumes .......................................................................... D-57
7.3 Show/hide renderer ........................................................................................ D-57
8 3D CROSS SECTIONS MODULE (OPTIONAL) ................................ D-58
8.1 Adjusting slices in cross sections views ......................................................... D-59
8.2 Full Arc Mode .................................................................................................. D-60
8.3 Adjusting axial slices ....................................................................................... D-61
8.4 Adjusting panoramic slices ............................................................................. D-61
8.5 Cross sectional scroll bar ................................................................................ D-61
8.6 Nerve tools ...................................................................................................... D-62
9 IMPLANT MODULE ........................................................................... D-64
9.1 Placing implants .............................................................................................. D-64
9.2 Implant placement tools ................................................................................. D-65
9.3 Managing implants using the Implant library .................................................. D-67
9.4 3D Implant Verification Tool ............................................................................ D-70
10 VIEWING AND DIAGNOSING TMJ IMAGES .................................... D-72
10.1 Temporomandibular joints ............................................................................. D-72
10.2 Using TMJ Tools ............................................................................................ D-74
11 PROFACE IMAGES ........................................................................... D-74
Chapter E RADIOLOGICAL FINDINGS MODULE (OPTIONAL)
1 USING THE 2D RADIOLOGICAL FINDINGS MODULE ..................... E-1
1.1 Using the Radiological Findings field .................................................................E-2
1.2 Using the Odontogram .......................................................................................E-3
1.3 Using the findings list .........................................................................................E-4
1.4 Exporting radiological interpretation ..................................................................E-6
1.5 Creating and printing a radiological interpretation .............................................E-7
2 USING THE 3D RADIOLOGICAL FINDINGS MODULE ..................... E-8
TABLE OF CONTENTS
Chapter F CLINIC MANAGEMENT MODULE
1 CLINIC MONITORING .......................................................................... F-1
1.1 Operatories ........................................................................................................ F-2
1.2 Searching dental units, operatories and users .................................................. F-3
1.3 Configuring clinic layout .....................................................................................F-4
1.4 Update firmware (centralized update of Planmeca dental unit software) .......... F-4
2 UNIT MONITORING / REMOTE CONTROL ........................................ F-5
2.1 Monitoring unit operations ................................................................................. F-6
2.2 Storing and restoring dental unit settings .......................................................... F-7
4.1 Configuring dental unit service mode ................................................................F-7
4.1 Using activity shortcuts ......................................................................................F-8
5 DIAGNOSTIC LOG ............................................................................... F-9
5.1 Filtering dental unit events ................................................................................. F-9
6 DEVICE SUMMARY ........................................................................... F-10
6.1 Unit ................................................................................................................. F-10
6.2 Instruments ...................................................................................................... F-11
6.3 Latest cleaning operations ............................................................................... F-11
6.4 Service history .................................................................................................F-12
7 INFO ................................................................................................... F-14
7.1 Using the quick reference cards and quick guides ..........................................F-14
Chapter G ADMIN MODULE 1
1 RESOURCE ..........................................................................................G-1
1.1 Permissions tab sheet ...................................................................................... G-1
1.2 Toolbars ........................................................................................................... G-2
1.3 Users tab sheet ................................................................................................. G-3
1.4 Device Alerts ..................................................................................................... G-5
2 IMAGING AND DICOM ........................................................................G-8
2.1 Templates ......................................................................................................... G-8
2.2 DICOM Configuration ..................................................................................... G-10
3 LOCAL SETTINGS .............................................................................G-19
3.1 3D ................................................................................................................... G-20
3.2 Reconstruction Server .................................................................................... G-20
3.3 2D ................................................................................................................... G-21
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3.4 External applications ....................................................................................... G-22
3.5 Dental Unit interface ....................................................................................... G-23
3.6 Intraoral video camera Serial Connection (CamComm) ................................. G-23
3.7 Practice management software interface (PMBRIDGE) ................................. G-23
3.8 CD-recording device ....................................................................................... G-24
3.9 DICOM ............................................................................................................ G-24
Chapter H REPORT MODULE
1 REPORT GENERATION ...................................................................... H-2
1.1 Image Link ........................................................................................................ H-2
1.2 Patient Link ....................................................................................................... H-2
1.3 Refresh ............................................................................................................. H-2
1.4 Print .................................................................................................................. H-2
2 IMAGE VIEW ........................................................................................ H-3
2.1 Previous/Next Image ........................................................................................ H-3
2.2 Open Copy ........................................................................................................ H-3
2.3 Set Layout ......................................................................................................... H-4
Chapter I PLANMECA ROMEXIS CONFIGURATION APPLICATION
1 ACCESSING PLANMECA ROMEXIS CLINIC MANAGEMENT
CONFIGURATION APPLICATION ........................................................I-1
2 GENERAL SETTINGS ...........................................................................I-2
2.1 General ............................................................................................................... I-2
2.2 Person ................................................................................................................ I-3
2.3 Security ............................................................................................................... I-5
2.4 Regional .............................................................................................................. I-8
3 IMAGING ..............................................................................................I-10
3.1 Panoramic ......................................................................................................... I-10
3.2 Cephalometric ................................................................................................... I-12
3.3 Intraoral ............................................................................................................. I-14
3.4 CBVT ................................................................................................................ I-17
3.5 Display .............................................................................................................. I-18
3.6 Dental Record ................................................................................................... I-19
3.7 PlanLink & Diagnostics ..................................................................................... I-21
3.8 Print .................................................................................................................. I-23
TABLE OF CONTENTS
4 IMAGE & DATA MANAGEMENT ........................................................I-24
4.1 Data folders ...................................................................................................... I-24
4.2 Trash ................................................................................................................. I-25
4.3 Long Term Archive ........................................................................................... I-26
5 START-UP ............................................................................................I-27
5.1 Client Parameters ............................................................................................. I-27
5.2 Planmeca Romexis Service .............................................................................. I-29
6 SERVER PARAMETERS .....................................................................I-32
6.1 Server ............................................................................................................... I-32
6.2 Database .......................................................................................................... I-34
6.3 External communication ................................................................................... I-35
APPENDIX A: PLANMECA PROMODEL ................................APPENDIX A-1
1 QUICK GUIDE FOR PLACING PLANMECA PROMODEL
ORDERS ............................................................................APPENDIX A-1
1.1 Overview of ProModel service ...........................................................Appendix A-1
2 PLACING PLANMECA PROMODEL ORDERS ...............APPENDIX A-2
2.1 3D Master Menu Toolbar with Planmeca ProModel Order ...............Appendix A-2
2.2 Overview of Planmeca ProModel Order Form ..................................Appendix A-4
APPENDIX B: ROMEXIS VIEWER ..........................................APPENDIX B-1
1 GENERAL .........................................................................APPENDIX B-1
2 OPENING IMAGES ...........................................................APPENDIX B-1
3 VIEWING 3D IMAGES .......................................................APPENDIX B-2
4 OPENING ADDITIONAL IMAGES ....................................APPENDIX B-2
APPENDIX C: ORDERING SURGIGUIDE DRILL GUIDES
WITH PLANMECA ROMEXIS ...................................................APPENDIX C-1
Planmeca Romexis 9
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Users Manual
10 Planmeca Romexis
TABLE OF CONTENTS
Users Manual
Planmeca pursues a policy of continual product development. Although every
effort is made to produce up-to-date product documentation this publication
should not be regarded as an infallible guide to current specifications. We
reserve the right to make changes without prior notice.
COPYRIGHT PLANMECA
Publication number 10014593 Revision 13
Released 17 January 2012
The manufacturer, assembler, and importer are responsible for the safety,
reliability and performance of the unit only if:
- installation, calibration, modification and repairs are carried out by qualified
authorized personnel
- electrical installations are carried out according to the appropriate
requirements such as IEC 60364
- equipment is used according to the operating instructions
Planmeca Romexis A-1
Chapter
Users Manual
A GENERAL
1 INTRODUCTION TO PLANMECA ROMEXIS
This manual describes how to use the Planmeca Romexis
TM
imaging software, which is
developed to be used with the Planmeca digital X-ray units and Planmeca intraoral video
cameras. Read this manual carefully before using the system.
NOTE The ProMax 3D X-ray units, other digital X-ray units and intraoral video camera have
separate manuals, which should be used in conjunction with this manual.
NOTE This manual is valid for the following software versions:
Planmeca Romexis 2.9.R.
Please see device manuals for availability of specific features.
NOTE Romexis can be used with Microsoft Windows XP, Windows 7, Windows Vista
Business, Windows 2003 and 2008 Server operating systems. Romexis conforms to
Windows user interface standards. Mac OS operating systems are supported with
certain limitations.
NOTE User organization must take care of protecting the computer and the network by using
up-to-date virus and malware protection software and fire wall.
Planmeca Romexis is a registered trademark of Planmeca company. Romexis imaging
software fulfills the requirements of Directive 93/42/EEC.
Planmeca Romexis is intended for viewing, enhancing and archiving images, and it can also
be used to take images with all the present and future Planmeca digital imaging devices.
The operation of the Romexis system is made as simple as possible. However, no computer
system can be operated continuously and successfully without competent software and
hardware. Especially in mission critical applications, such as archiving of patient images, care
must be taken to ensure continuous operation of the system. This includes, but is not limited
to, ensuring that hardware and software support is available, phone help and user training as
well as backing up of patient data has been arranged. It is recommended to engage a
competent system integrator service for this purpose.
INTRODUCTION TO PLANMECA ROMEXIS
A-2 Planmeca Romexis Users Manual
1.1 Introduction to digital imaging
Digital images are composed of small dots called pixels. 3D images on the other hand are
composed of voxels, which are pixels with three dimensions together forming a small cube.
The size of each pixel sets an absolute upper limit on what can be observed. Please refer to
documentation of the specific X-ray device for detailed information about maximum
resolution, image dimensions and exposure times.
Image dynamics
Each pixel in an image is represented by a numerical value in the computer memory.
Because of the numerical (nonphysical) nature of the image, the brightness and contrast of
the image can be altered and various image enhancements can be performed, which is not
possible with film images.
As one of the main advantages of digital imaging, it is also necessary to understand and keep
it in mind when using manipulated images for diagnosis. The numerical nature of the image
also sets an upper limit to the detectability of contrast differences (differences in radio
translucency) in digital images. This contrast resolution is expressed in terms of number of
bits used in capturing and storing the image or in number of gray levels that the system can
record. See below for values of Planmeca equipment:
Device Number of bits Gray levels
DIMAX (all modes) 12 4096
Promax 3D (all modes) 12 (15 bit raw processing) 4096
Note that although most computer screens can display only 256 (8 bit) gray levels or less and
although it has been shown that the human eye can barely differentiate contrast differences in
the order of 1/32 - 1/64 (5/6 bits), the eye automatically adapts to the lightning conditions, and
this together with proper use of the light box makes it possible to detect smaller variations in
film contrast. Therefore it is necessary to capture and record images at higher contrast
resolution than 256 grey levels (8 bits). More contrast latitude also allows more variations in
exposure factors (kV/mA).
IMPORTANT SAFETY NOTICE!
Image processing can significantly alter the visibility of both large and small structures (i.e.
bone loss and caries), which may result in either too many false positive or false negative
findings, if care is not taken.
1.2 Securing the image data
Romexis uses database system for storing patient data and image meta information. Image
data is stored into the file system as individual files. Both the database and the image data in
the file systems need to be backuped and stored in a safe place.
NOTE Planmeca claims no responsibility for the end users data security or for any
malfunction in the computer system that may lead to data loss.
Planmeca Romexis A-3 Users Manual
1.3 Image acquisition
The system is designed to automate the acquisition of images with minimum intervention from
the user. Provided that the user has selected the correct patient in Romexis software, the
acquisition (taking an exposure) and archiving of the image is almost exactly the same as with
conventional film based imaging systems, except that archiving is fully automated and no film
processing is required. The employed exposure technique is automatically stored with each
image.
1.4 Settings
Romexis provides various settings for the user to choose from. A range of parameters and
other options can be set to permit control over the main procedures. The default settings have
been chosen for a typical Romexis environment. If required, they can easily be changed in the
Romexis Configuration application.
1.5 Archiving
The archiving of images in Romexis is organized under patient names. The image data is
stored in the file system. The exposure values and basic patient data is stored in a database.
Multiple users can store and retrieve (different) images to and from the system
simultaneously.
Long term archive
Long Term Archive (LTA) allows old images to be moved to a more permanent storage based
on their age. For more information on Romexis Long Term Archive feature please see Image
Management under Romexis Configuration application. Please note that Long Term Archive
is not a backup system but appropriate backups should be maintained in addition to LTA
media.
Disk space requirements for 2D images
The following gives approximate disk space requirements for different image formats:
Format Without compression With JPEG
1

DIMAX2/3 normal resolution, panoramic 5.0 MB 0.8 MB
DIMAX2/3 normal resolution, cephalometric 7.0 MB 0.95 MB
DIMAX2/3 enhanced resolution
2
, panoramic 8.9 MB 1.1 MB
DIMAX2/3 enhanced resolution
2
, cephalometric 12.5 MB 1.9 MB
DIMAX2/3 high resolution
2
, panoramic 20 MB 2.2 MB
Dixi2/3 B0 normal resolution 560 kB 180 kB
Dixi2/3 B1 normal resolution 940 kB 310 kB
Dixi2/3 B2 normal resolution 1.3 MB 430 kB
Dixi2 B0 high resolution
2
2.2 MB 720 kB
Dixi2/3 B1 high resolution
2
3.8 MB 1.2 MB
Dixi2/3 B2 high resolution
2
5.2 MB 1.7 MB
1. The actual achievable values depend on the individual image.
2. Because of the extensive disk space requirements and the additional X-ray radiation needed to achieve the
same (low) level of noise (quantum mottle), the user should carefully evaluate the advantages of using the
enhanced/high resolution mode.
ProSensor S0 normal resolution 1,0 MB
IMPORTANT SAFETY NOTICE!
JPEG conversion is a so called lossy compression, the use of which can lead to loss of image
detail and it cannot be guaranteed that the diagnostic value of the compressed image is
equivalent to the original image. While several studies (see e.g. IADMFR/CMI97 Advances in
Maxillofacial Imaging: The loss of image quality in panoramic radiography using image
compression, C.G.H Sanderink et al.) indicate that the loss of data may be insignificant,
Planmeca cannot guarantee that it is safe to use compressed image data for diagnostic
purposes.
Disk Space Requirements for 3D Images
1.6 Processing images
Note that some of the image processing operations radically alter the appearance and
possibly the diagnostic value of the image. However, it is always possible to restore the image
to its original state or undo modifications one by one.
1.7 Measuring images
The measurement tools allow both geometric and relative intensity (i.e. radiotranslucency or
brightness/contrast) measurements to be made.
When performing geometric measurements it should be noted that image processing
operations (even just adjusting the brightness/contrast) can alter the apparent geometry of
the objects in the image. Also because of the normal distortions (most notably varying
magnification) associated with normal projection X-ray imaging the measurements must be
based on known reference objects in the image. For this purpose a calibration tool is provided
in the Romexis software.
When performing intensity measurements it should be noted that after certain image
processing operations the relative intensities of the objects may be affected by their
neighboring objects, which may affect the reliability of e.g. bone density measurements with
the help of a calibration step wedge. The only image processing operations guaranteed NOT
TO CHANGE the relative intensities so that measurements are independent of the
measurement position, are the brightness/contrast and level adjustment operations. No
guarantee can be given between the intensity measurements of two different images.
3D X-ray Unit
File Format Maximum File Size
ProMax 3D s DICOM 3.0
(multi frame)
270 MB
Promax 3D DICOM 3.0
(multi frame)
250 MB
ProMax 3D Max DICOM 3.0
(multi frame)
430 MB
ProMax 3D Mid DICOM 3.0
(multi frame
977 MB
Note! For stitched volumes the disk space requirement is
double the maximum file size as the original volumes are
stored in addition to the stitched final volume
1.8 Annotating images
Images can be annotated with markers and text. These annotations appear as an overlay on
the image and can thus be turned on and off at will, they do not affect the actual image.
1.9 Printing
Romexis supports DICOM compatible printers and Windows compatible printers.
1.10 DICOM support
Romexis supports following DICOM (Digital Imaging and Communications in Medicine)
services:
DICOM Storage SCU (optional)
DICOM Storage Commitment SCU (optional)
DICOM Query Retrieve SCU (optional)
DICOM Worklist SCU (optional)
DICOM Modality performed procedure step MPPS SCU (optional)
DICOM Print SCU (optional)
DICOM Import, single and multi frame
DICOM Export, single and multi frame
DICOMDIR Media Storage
DICOM usage is described in chapters PATIENTS AND FILES MODULES, 2D IMAGING
MODULE and 3D IMAGING MODULE. DICOM configuration is described in section 2.2
DICOM Configuration on page 10 in chapter ADMIN MODULE.
1.11 Disclaimer
NOTE IMPORTANT SAFETY NOTICE!
Note that Planmeca claims no responsibility for the end users data security or for any
malfunction in the computer system that may lead to data loss.
Since image processing and digital subtraction radiography can significantly alter the
visibility of both large and small structures (i.e. bone loss and caries), which may
result in either too many false positive or false negative findings, Planmeca claims no
responsibility for the software use, actions or diagnoses made by the end-user.
The qualities of the monitor can strongly affect the image quality. The monitor qualities
change when it gets older.
Never try first to correct under/overexposure by taking a new image with new exposure
values. This should be done by adjusting the gamma and/or contrast/brightness to the
right level. If these adjustments do not help, only then take a new image.
Cone beam computed tomography (CBVT) imaging is based on complex mathematical
algorithms that produce high fidelity images, however various sources may cause
imaging artefacts that may lead to incorrect diagnoses if not properly interpreted.
Image interpretation should only be done by a competent person who is familiar with
the CBVT imaging capabilities, limitations and artefacts of the ProMax 3D.
NOTE Please note that as a generic viewing application Planmeca iRomexis Mobile
application is not approved for diagnostic work and shall not be used for such work.
STARTING THE ROMEXIS APPLICATION
2 STARTING THE ROMEXIS APPLICATION
1. To start Romexis application click this icon on your desktop.
2. A login window opens (if so defined in the Romexis Configuration application, see chapter
PLANMECA ROMEXIS CONFIGURATION APPLICATION).
The appearance of the Login window may differ from the above depending on the settings
configured by your administrator.
3. Type your username and password and click OK.
4. The Romexis application opens in Patient management module.
The name of the current user is shown in the title bar.
To login as different user click this button.
To logout click this button. All currently opened files will be closed.
NOTE If a new Login is performed while another user is currently logged in, all patient
records are closed but the current views will be remembered and will be shown when a
patient is next accessed by a user. This function allows multiple authorized personnel
to conveniently view and modify a patient's status using their own credentials. If the
Logout feature is used no views will be remembered and the patient data will be
opened with default view when next time accessed.
ROMEXIS MODULES
3 ROMEXIS MODULES
The Romexis software is built around different software modules. Each of them is designed to
perform special tasks. These modules can be accessed through the navigator buttons located
in the vertical toolbar on the left edge of the screen.
1. Patient module providing patient selection and management
2. Files module holding demographics
3. Dental record module (optional)
4. 2D Imaging module for X-ray and other imaging needs
5. 3D imaging module for ProMax 3D images (optional)
6. Clinic management (optional)
7. Report module
8. Admin module
The navigator toolbar is always visible and it can be used for navigating between the modules
at any time during the work process.
NOTE The visibility of the Romexis modules and functions are controlled by license and user
rights. Depending on the installed licence and user rights the functionality described in
this manual can vary.
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B PATIENTS AND FILES MODULES
In this section you can manage patients including seaching, editing, assigning patient to a
specific user (group), assign and inactivate patients
1 ALL PATIENTS (SEARCHING ALL PATIENTS)
Patients can be searched by ID or by name.
To search a patient by ID, enter the patient ID in the text field and click the Find button.
To search patients by their name choose the option Find by name from the drop-down menu
on the left of the search field. Enter the patients name in Last name, First name format into
the search field and touch the Enter key or click Find to make matching patients appear in the
patient list.
To view all patients saved in the database use the * sign as the search term.
NOTE If a partial name is entered Romexis will return all patients whose last name begins
with that partial string. In case you want to search patients by their first name replace
the last name with the wild card *.
Examples:
Doe, John all patients with the last name Doe and first name John
S all patients whose last name starts with the letter S
Smi all patients whose last name starts with Smi, e.g. Smith
and Smiley
Van Cogh all patients with the last name Van Cogh
*, Paul all patients whose first name is Paul
Patients can also be searched by a captured image, see section 1.11 Searching patients by
image on page B-5.
1.1 Sorting patients
Patients in the patient list can be sorted by ID, name, birth date, age, gender, phone number,
the number of assigned providers and type (for virtual and template patients) by clicking the
respective column title.
ALL PATIENTS (SEARCHING ALL PATIENTS)
B-2 Planmeca Romexis Users Manual
1.2 Opening patient record
After the patient search click the patient name in the patient list and click the Select button (or
double-click the patient name). You are presented with a dialogue where you are required to
define a reason for opening the patient record. This dialogue can be set optional in the
Romexis Configuration application.
Select the appropriate reason and click OK. Romexis automatically opens the Files module.
The reason for opening a patient record is saved and displayed in the dental record under the
patient case history.
The name of the active patient record is always visible in the upper right corner of the screen.
Several patient records can be open at a time but only one of the open records is active at a
time. To close the active patient record click the Close Patient button next to the patient
name. The open patient records can be viewed using the drop-down menu (click the name),
and the active patient record can be modified by selecting another patient from the drop-down
list.
1.3 Patient files
The Demographics tab sheet in Files module contains all patient demographic information
and is automatically selected when creating a new patient or editing an existing one. Click the
Edit patient button to edit demographic information and the Save patient button to save
changes.
Please note that the changes are not saved automatically. Click the Save patient button to
save your changes.
Planmeca Romexis B-3 Users Manual
1.4 Adding and editing patients
To create a new patient record click the Add Patient button which will take you to the Files
module. In the Files module you can enter the patients Demographic information and add
face photo to patient. The compulsory fields are Person ID, First name and Last name. Click
the Save Patient button to save the patient record into the database. Please note that the
changes are not automatically saved but the Save Patient button must be used. A new patient
search has to be made to view the newly created patient on the patient list.
NOTE All patient information is managed in the Files module. Romexis automatically opens
the Files module when the Add patient button is clicked. Existing patients are also
modified using this module.
1.5 Editing patients
To edit patients click the Edit Patient button to enter the patient demographics view.
Edit the information as required and click Save.
1.6 Assigning patients
Patients can be assigned to providers with the Assign patient button. Select the patient you
want to assign from the list and click the Assign patient button to open a list of providers, then
choose the provider you want to assign the patient to. Patients can have one primary provider
and several secondary providers. In case a patient already has one provider and the Assign
patient button is clicked again the following dialogue appears.
This allows the user to reassign the patient to a new Primary provider or assign new
Secondary provider(s) for the patient.
To see the provider assigned to the patient click the button.
The number of the providers assigned to the patient is shown in the patient list.
1.7 Finding assigned patients
To retrieve all patients that are assigned to the current user the Find assigned button can be
used to list these patients from the database.
1.8 Adding template patients
For educational purposes Planmeca Romexis offers a combination of template and virtual
patients.
The idea of template patients is that supervisors can create virtual patient cases for students
to practice on in simulation laboratory. Thus template patients are not real patients but
represent possible patient cases that can then be cloned into virtual patients for the students
to actually work on. The supervisor can define a template patients oral status, medical/dental
history and import images to the template patients.
To create template click the Add template button. Before students can actually start working
on a template patient, it needs to be cloned into a virtual patient that can then be assigned to
individual students.
NOTE Template patients can be differentiated from other patients by a Template entry in the
Type column.
1.9 Adding virtual patients
After the supervisor has created a template patient, virtual patients for students can be
created. The idea is that each student has their own virtual patient(s) to work with, but all
students start from the same template patient, that is, with the same clinical problem set.
To create a virtual patient select the template patient from the patient list and click the Add
virtual button. It may be a good idea to name each virtual patient so that the name also
indicates the student name, i.e. Janes Child Patient.
Planmeca Romexis B-5 Users Manual
DICOM WORKLIST SEARCH
NOTE Virtual patients can be differentiated from other patients by entering Virtual in the
Type column.
1.10 Inactivating patients
To remove a patient form the patient list click the Inactivate button. All patient information with
images is preserved. To reactivate or permanently delete patient records see chapter I
PLANMECA ROMEXIS CONFIGURATION APPLICATION.
1.11 Searching patients by image
On the Find by Image tab Patients can also be searched by the image type, date and image
comments.
To search patients by image define the search criteria and click the Find button. The patients
that match the search criteria appear in the list.
To open the patient by selectthe patient from the list and click the Select button.
2 DICOM WORKLIST SEARCH
Dicom Worklist search can be used to search and retrieve patients from a central patient
archive.
Searches can be filtered by patient, information, DICOM parameters such as accession
number or modality or by date ranges.
When selected, a patient is automatically added to the Romexis database if it is not already
registered. If a near match exists in the database the user will be asked on how to proceed.
DICOM QUERY / RETRIEVE (OPTIONAL)
3 DICOM QUERY / RETRIEVE (OPTIONAL)
The DICOM Query Retrieve SCU (Q/R) service is used for retrieving images from DICOM
PACS servers. Images can first be queried and then selected for retrieval to the local storage.
Once retrieved the images can be processed independent of the remote server.
To send processed images back to the DICOM PACS server Use DICOM Storage function.
To list images for a patient at the Patient Root Level, use Query Retrieve button.
To retrieve the selected images, use the Study button to list images at the Study Root Level..
4 FIND BY IMAGE
In this section you can search images according to the image type, added comments or by
date. Select the appropriate image type and/or date and add comments and click Find.
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C 2D IMAGING MODULE
The 2D Imaging module is intended for capturing, processing, and storing of X-ray images
and photographs.
NOTE To access the 2D imaging module a patient must be selected.
The 2D imaging module consists of the following parts:
1. Image browser: Displays thumbnails of all images of the currently sected patient
2. Master toolbar at the top contains tools for capturing, layouting as well as for exporting/
importing images.
3. Image processing toolbar at the far right contains tools for processing, measuring and
annotating images
4. Image specific toolbar above each image contains tool for adjusting the specific image.
Master toolbar
Image browser
Image specific
toolbar
Processing
toolbar
IMAGE BROWSER
C-2 Planmeca Romexis Users Manual
1 IMAGE BROWSER
The Image browser is intended for browsing 2D images of different imaging modalities.
The browser shows all images of the patient grouped according to the image type.
The Image Browser opens by default at the bottom of the screen when the Imaging module
is opened.
To open and close the image browser click this button on the top toolbar.
1.1 Imaging modalities
The images are grouped in following image type categories:
Panoramic: Panoramic and SmartPan exposures and scans.
CBVT: 2D snapshots generated in the Romexis 3D Module.
Cephalometric: Cephalometric exposures and scans, including images generated using the
Virtual Cephalometric tool in the Romexis 3D Module, see section 2.14 Creating virtual ceph-
alometric images on page D-35
Photo: Intraoral video camera images, scans and imported photos from handheld cameras.
Intraoral: Bitewing and periapical exposures and scans with tooth sites specified. Intraoral
images with no tooth sites specified are placed into the Other subcategory.
1.2 Browsing images in different display modes
The following display modes are available:
All image types
Displays a general outline of all patients images in one glance
To show a preview of all images in the category place your mouse over the image thumbnail.
The previews are displayed in selected sort order from left to right edge of the thumbnail.
To open the image currently shown in the thumbnail double-click the thumbnail
To open the selected category in Category grid display mode click on the icon
Planmeca Romexis C-3 Users Manual
IMAGE BROWSER
Category title, range of exposure dates and number of images in the category are shown
under the category icon
Image list
Displays a list of all patient images.
To select multiple images click and drag the images, or use Shift or Ctrl keys.
To open the pop-up menu right click on the image.
To delete or move multiple images for another patient, right click on the image.
To export all images:
Select all images by pressing Ctrl + A on your keyboard. Right-click on any of the selected
images and select Export selected images.
All Images
Shows an overview of all patient images divided into collapsible categories.
Category title, range of exposure dates and number of images in the category are shown next
to the category icon
Collapse/expand categories by clicking on the small category icon next to the category title
IMAGE BROWSER
Scrolling with the mouse wheel moves to the next row of images in the same category or to
the next category title
Category grid
Shows images in selected category in grid format to the maximize number of images shown
at one time. If the Image Browser is set to be hidden automatically when an image is opened
into the Image Viewer, the browser will automaticall reappear when all images have been
closed in the Image Viewer.
To reopen the Image Browser click the Image Browser button in the top toolbar.
Hovering over an image thumbnail in the All Images, Category Grid/Filmstrip/Carousel
browser modes will automatically show the image properties in a separate window. This
window can be dragged freely anywhere inthe window.
IMAGE BROWSER
In Category display modes the category title, range of exposure dates and number of images
in the category are displayed in the image browser title bar. Use the Previous and Next
category arrow buttons to move from one category to the next.
Category grid for intraoral images
Intraoral images are optionally further divided into three sub-categories: Periapicals,
Bitewings and Other based on selected tooth sites. Optionally displayed intraoral navigator
can be used to further filter images based on tooth sites. It can also be used to open images
directly into the Image Viewer by double clicking on thumbnails displayed in the navigator.
Optional subdivision and the visibility of the navigator are controlled from the Image Browser
Settings and Defaults menu.
Filmstrip browsing mode
Shows images in selected category in filmstrip format
Images are displayed from left to right in the selected sort order. Use the mouse wheel to
browse images one-by-one or use the scroll bar at the bottom to view the full range of images.
IMAGE BROWSER
Carousel browsing mode
Shows images in selected category in a 3D carousel
Images are displayed from left to right in the selected sort order. Use the mouse wheel to
scroll images one-by-one or use the scroll at the bottom to within the full range of images.
In carousel mode only the middle image (largest image front and center) can be selected,
highlighted or opened.
1.3 Image browser settings
Use this menu to define the image browser default view, what options to show on the
browser, how to sort images according to date, as well as restore default settings.
1.4 Toggling from one image type category to another
To select another image type click these buttons .
The categories containing no images show in grey.
1.5 Using image thumbnails
Use the image thumbnails to open a category or when in the category double click on the
thumbnail to open the image. Single clicking will select images to allow opening of multiple
images into the Image Viewer using the View Selected button. Select a suitable navigation
mode using the Display Mode buttons.
To toggle between images click on image thumbnail.
To open an image double-click the image thumbnail.
Hovering the mouse cursor over the image so that it is highlighted with a light gray border
displays the image properties in a separate window. Clicking on the image comment field
enables editing or adding a comment to the image. If the image thumbnail is too small while
The border of the selected image
shows in light blue
Image evaluation
Specified
The border of the currently
highlighted image shows in
light grey
tooth sites
Exposure date Image comment Last updated
IMAGE BROWSER
both exposure date and update date are configured to be shown only exposure date will be
shown.
Image thumbnails may also have image information symbols shown on top of them that
indicate the following things:
SmartPan stack image with multiple layers.
Image has been stored into Long Time Archive and full size image is not available for
viewing before it is restored from Long Time Archive.
Image belongs to a study.
Image with attached diagnosis that is viewable through the image properties dialogue.
Adjusting thumbnail size
Use this slider to change image thumbnail size. Setting is remembered separately for each
display mode. The approximate viewing position inside a category is preserved when
changing thumbnail sizes.
Adjusting image browser window size
To expand / collapse the image browser click the arrow to view browser in full screen or in
default height.
To freely resize the browser window drag the top edge of the Image Browser.
Clicking on the Collapse Browser arrow will revert the browser to its default height if it has
been resized by dragging.
Selecting Images
View/open selected images in full size
Clear current image selection
Show number of images selected
When Image Browser option Close Browser On Double Click is selected and you want to
open multiple images first select all of the images to open and then click on View Selected.
Filtering and selecting images by date
Filter images by exposure date: images with exposure dates that are checked are shown in
the browser. Click All Dates to toggle checkmarks for all dates. Click on a year to toggle all
images from the selected year.
Image date filter affects all Image Browser display modes. To reset the filter to show all avail-
able images first deselect All Dates and then reselect it.
IMAGE BROWSER
Refreshing the image browser
Patient images can be reloaded and updated from the server, when for example new
exposures have been taken at another workstation to the same patient file and the exposures
do not yet show up on the current workstation.
Settings and defaults
The Settings and Defaults can be used to adjust the following features among others:
The default display mode in which the browser opens when opening a patient file
What information to display on screen with image thumbnail
To hide image browser when double-clicking image thumbnail click the Image browser set-
tings icon select Options -> and Close browser on double-click. See also sectionsee chap-
ter Image browser settings on page C-6
How images are sorted
Reset browser to defaults
Use the settings icon or right-click in the browser window to access the settings and defaults
menus. The settings are user specific so that Romexis will remember the last settings for
each user.
MANAGING IMAGE STUDIES
2 MANAGING IMAGE STUDIES
An image study is a collection of related images of one patient. It is always based on a study
template where tooth numbers and exposure order can be predefined. See section G
Templates in chapter G ADMIN MODULE for information on how to create image
templates and section 3 IMAGE ACQUISITION on page C-12 for information on how to
capture images to a study.
2.1 Opening images in the study
Images can be opened directly by double-clicking on them in the image browser, or by
selecting them in the image browser and then clicking the View Selected button. Images can
be closed by clicking the icon in the images horizontal toolbar.
2.2 Opening a study
A study is a collection of related images of one patient. Studies can be viewed with the Study
tab. A list of existing studies appears, and by clicking the name of a study it is previewed in
the image navigator. To open an image from the study (for adjustment etc.) select the desired
image in the preview and click the View Selected button. To view all images in the study click
the View Study button. See section 12 IMAGE PROPERTIES on page C-48 for more
information on how to work with studies in Romexis.
2.3 Creating a new study
An empty study can be created using this button.
Select the template you want to use to create a new study.
For information on how to add images to an empty study see section 2.7 Adding an image to
a study on page C-11. Please note that to capture X-rays directly into a template you should
follow the instructions in section Intraoral images can be captured either as single images or
into study templates containing a predefined set of multiple images. on page C-12 in this
chapter.
2.4 Closing all open images
All open images can be closed by clicking the button.
2.5 Arranging Images in study
To view an overview list of populated studies, enter the Imaging module and click the Study
button in the Image Navigator. To open the selected study, click the View Study button. To
rearrange the images in the study drag an image from one slot to another using mouse. In
case you are dragging the image to an empty slot click Yes in the opening dialogue.
In case there is already an image in the target slot the system will ask whether you want to
move the image to the top of the old image or whether you want to swap the images.
In case there is more than one image in a study slot a scroll bar is shown for navigating
between images.
2.6 Removing images from study
To remove an image from the study drag the image outside the study window. (Note that the
image will not be deleted but it will remain in Romexis as a single image). Click Yes in the
opening dialogue.
2.7 Adding an image to a study
Open a study. Select the image that you want to add to the study from the Image Navigator
and add it to the first empty slot by double-clicking the image. (You may need to click the
Overview button to hide the study list and reveal the images underneath in the Image
Navigator.) In case you want to add a new image to a slot that already contains an image,
detach the old image first. In case you want to move an image to another slot just drag it with
the mouse.
2.8 Setting the layout
The opened and captured images automatically appear in the screen in their maximum size
their viewable size.
Images open in the viewer can be arranged into a temporary layout with the button.
These layouts are also used to position multiple images for printing. If the same layout is used
frequently, it is advisable to define and use a study template instead. See the previous
sections for using studies and chapter G ADMIN MODULE (section 2.1 Templates on
page G-8) for how to define templates.
IMAGE ACQUISITION
3 IMAGE ACQUISITION
NOTE The ability to capture X-ray images is defined in the user rights (see chapterG ADMIN
MODULE). In case a user does not have the right to capture images without approval
the image acquisition buttons are disabled until an Image acquisition request for that
current user/active patient/image type combination has been approved.
Intraoral images can be captured either as single images or into study templates containing a
predefined set of multiple images.
3.1 Capturing single intraoral images
To capture single images click the button to initiate image capture mode. The
Intraoral Exposure Window appears. When the X-ray unit is in ready state a message Waiting
for exposure appears on top of the window. Prepare the patient for exposure and select
exposure parameters. See Planmeca Intra X-ray manual for more information. You can now
expose X-rays in the normal way.
After the exposure a message stating Saving the image appears and the image is
automatically stored into the database. Define the tooth numbers and sensor orientation and
capture the next exposure, or click Done to return to the Imaging module when all exposures
have been captured.
3.2 Capturing intraoral images into a template
To capture intraoral images into a study template click the button.
IMAGE ACQUISITION
Select the desired study template from the list. At the beginning of the list there are empty
templates and at the bottom of the list there are studies with dates that already include
images captured earlier.
While capturing images using a study Romexis walks through the template in a predefined
order, denoting the current image to be captured by a blue border around the slot. Follow the
tooth numbering and sensor orientation as shown on the top, also predefined in the template.
You can cancel the process with the Cancel button in which case the captured images are
saved and the incomplete study is preserved for later use.
After all the images have been captured click Done.
IMAGE ACQUISITION
3.3 Capturing panoramic images
To capture a panoramic image click the button to initiate panoramic image capture
mode. The Panoramic Exposure window appears. When the X-ray unit is in ready state a
message Waiting for Ready appears on top of the window. Prepare the patient for exposure
and select the exposure parameters and drive the X-ray to the ready position. Refer to your
Planmeca panoramic X-ray units users manual if uncertain.
When the panoramic unit is in ready position a message stating Waiting for Exposure
appears on top of the window. You can now expose the X-ray as normal. After the exposure a
message stating Saving the image appears and the image is automatically stored into the
database.
Click Done when the exposure has been taken to return to the Imaging module.
NOTE The L sign denotes the left side of the patient.
3.4 Capturing SmartPan layer panoramic images
Certain Planmeca Promax 3D X-ray untis can take both 3D and 2D images using the same
sensor. Available 2D imaging modes are panoramic, bite-wing and sinus exposure modes.
SmartPan image will be stored as an image stack in Romexis consisting of one autofocus
panoramic image and 9 panoramic images each with a different panoramic focal layer. The 9
layers allow the user to view different focal layers in the image at a later time but they can be
optionally rejected in preference of the autofocus image. The SmartPan Autofocus image is
automatically produced using the sharpest layer in each segment of the exposure. The
Autofocus image combines the layers into one optimum image.
For the 2D images acquired with SmartPan, only the pixel size 127m is available.
To capture a SmartPan panoramic image click this button to initiate panoramic image
capture mode. The Panoramic Exposure window appears. When the X-ray unit is in ready
state a message Waiting for Ready appears on top of the window. Prepare the patient for
exposure and select the exposure parameters and drive the X-ray to the ready position. Refer
to your Planmeca panoramic X-ray units users manual if uncertain.
3.5 Capturing cephalometric images
To capture a cephalometric image click the button to initiate the cephalometric image capture
mode. The Cephalometric Exposure window appears. When the X-ray unit is in ready state a
message Waiting for Ready appears on top of the window. Prepare the patient for exposure
and select exposure parameters and drive the X-ray to ready position. Refer to your
Planmeca cephalometric X-ray units users manual if uncertain.
When the cephalostat unit is in the ready position a message stating Waiting for Exposure
appears on top of the window. You can now expose the X-ray as normal. After the exposure a
message stating Saving the image appears and the image is automatically stored into the
database.
Click Done when the exposure has been taken to return to the Imaging module.
IMAGE ACQUISITION
When the panoramic unit is in ready position a message stating Waiting for Exposure
appears on top of the window. You can now expose the X-ray as normal.
SmartPan capture window will show the middle layer as preview and automatically store all
layers into Romexis for later viewing and processing.
3.6 Opening SmartPan images
SmartPan image can be opened and modified as a single stack image that allows moving
between panoramic focal layer, or it can be opened as 10 separate panoramic images if
necessary. When a SmartPan image is opened from the Image Browser by double clicking on
it the user will be presented with an option to open the image as a stack or separate single
images. Normally the 10/10 layer is an Autofocus layer where the sharpest vertical segments
in each layer have been combined into one overall sharp image.
NOTE After exposure SmartPan image is automatically opened as a stack image.
When the image is opened as a stack a scrollbar will be shown on the right edge of the image
that allows the user to browse between panoramic focal layers. Moving the scrollbox down
moves the changes the focal layer towards anterior while moving it up will change the focal
layer towards posterior. The mouse scroll wheel can also be used to navigate between layers.
The image title bar will read SmartPan with indication which stack layer image is currently
being shown (e.g. 5/9).
IMAGE ACQUISITION
NOTE If any of the individual panoramic images in a SmartPan stack are open the SmartPan
stack image will be opened as read only.
3.7 Processing SmartPan stack images
SmarPan panoramic images are stored in Romexis as a stack of 10 panoramic images that
show as a single item with a stack symbol in 2D Module Image Browser.
In general the processings and view tools will be applied to all images in the stack uniformly.
For example zooming in and out will uniformly zoom all images in SmartPan stack being
viewed even if they are not currently shown. There are some exceptions that are listed below.
NOTE If a SmartPan image is opened individually as a separate image(s) all processings will
be applied to those images only.
Exceptions to Viewing, Measurement and Drawing tools operation on SmartPan image when
opened as a SmarPan stack image:
Region of Interest: It is not possible to set a Region of Interest (ROI) on SmartPan images.
Calibration: Calibration is not universal to the stack but each image in the stack must be cali-
brated individually.
Measurements and annotations: Measurements and annotations are specific to each image.
Line Profile: Line Profile shows the profile for currently showing in the stack.
Histogram: Displays the histogram of the currently showing in the stack.
IMAGE ACQUISITION
Exceptions to Image Specific tools on the vertical image processing toolbar :
SmartPan layer cannot be changed while the toolbar is shown. Close the toolbar to change
layer.
Image Operations history shows the history of the image currently shown, not that of the
whole stack.
Image Properties: comments and diagnosis are uniformly applied to whole stack while rotat-
ing and mirroring are not possible.
3.8 Moving and inactivating SmartPan images
Move To Other Patient will prompt user to choose whether to move whole SmartPan stack or
only the visible/current stack image.
Inactivating stack image prompts user to choose whether to inactivate single image in the
stack or the whole stack.
3.9 Adding SmartPan images to studies
It is possible to add SmartPan stack images to studies that have free Panorama slot(s). When
SmartPan images are added to studies, it is possible to move individual stack images to
different slots like with any other study images. Also single images can be removed from
layout. Dragging and deleting, however, is limited to the topmost images in the stack.
3.10 Importing and exporting SmartPan images
DICOM / DICOMDIR Import: It is possible to import SmartPan images as stack using DICOM-
DIR import of a SmartPan stack that has been exported using DICOMDIR. It is also possible
Table 1: Summary of operations applied to whole image stack or per image
Operations that apply to whole stack Operations that affect only one image
Zoom-operations ROI
Pan Calibration
Magnifier Measurements
Overview Line Profile
Flashlight Histogram
Contrast/Brightness Annotations
Show Annotations Select Annotation
Delete Annotation
IMAGE ACQUISITION
to import multiple SmartPan stack images using DICOM Import which will automatically add
them to a stack if they originally belong to the same SmartPan exposure.
DICOM / DICOMDIR Export: When using DICOM export, only the currently shown stack
image is exported. In case of DICOMDIR, by default all stack images are added to the
DICOMDIR fileset.
Bitmap Export: When basic export is used only the currently shown stack image will be
exported to a bitmap file.
3.11 Printing SmartPan images
By default the currently shown stack image will be automatically added into the layout in print
editor. If all layers need to be printed the stack can first be opened as individual images, or
the can be added in print editor using the Image Browser shown at the bottom of the Print
Editor.
3.12 Using SmartPan images in Romexis Viewer
SmartPan images can be opened as a stack in Romexis Viewer if they have been exported
using DICOMDIR export.
3.13 Using TWAIN capture
TWAIN is a cross-platform interface for acquiring images captured by scanners, digital
cameras or frame grabbers. The manufacturer of the TWAIN device must provide a Source
Manager and TWAIN Data source for your device to work with Romexis.
Romexis supports the current TWAIN_32 standard. Refer to your device manufacturers
documentation for information on the availability of TWAIN_32 source modules.
If you are using the TWAIN device for the first time, check that you have the correct TWAIN
source device selected by clicking the TWAIN Setup icon to bring up the TWAIN Settings
dialogue. Then click the Select TWAIN Source button and choose the correct device from the
list.
IMAGE ACQUISITION
To acquire an image from the TWAIN device click the Acquire image using TWAIN button to
start the TWAIN interface. Refer to the scanner/camera users manual for information on how
to proceed with the device you are using.
3.13.1 TWAIN Source Settings
Wait for TWAIN driver Close: Specifies whether a Close command is expected from the
TWAIN driver to signal the end of scanning session. If disabled, only single scan is expected
to be received. When enabled, multiple scans can be made in one session which are all
returned in one batch when the scanning dialogue is closed. If the scannersoftware is capable
of scanning multiple images in one session this setting should be enabled.
Prefer Memory Transfer: Enables Memory Transfer instead of Native Transfer mode. Refer to
your scanner documentation for more information on supported and/or preferred mode. For
scanning color images Prefer Memory Transfer should be enabled.
Show TWAIN Launch dialogue: If enabled, a dialogue is shown when the scanner software
has been launched via TWAIN. On some lower end systems bringing up the TWAIN interface
can take some moments during which it may be useful to notify the user of the process. Some
virus scanning software is also known to slow down the TWAIN launch.
Show Import dialogue: Specify whether the Romexis image import dialogue should be shown
for each imported image. The image import dialogue allows the users to choose image
modality, specify tooth numbers, and crop or reorient the image. If disabled each scan is
imported with default settings and modality is defined by the Default Image Type setting
below. Default Image Type: Specifies the default modality for scanned images.
IMAGE ACQUISITION
3.13.2 TWAIN image preprocessing
TWAIN scans can be preprocessed using respective auto enhancement settings in Romexis
configuration application see section 3 IMAGING on page I-10
3.13.3 TWAIN auto import settings
In some cases you need to configure TWAIN Auto Import Settings to allow you to have
images automatically imported as part of the TWAIN capture. However, generally this is not
required and you can safely ignore these settings.
3.13.4 TWAIN Auto Recovery
NOTE If the scanned images cannot be correctly imported to Romexis due to technical or
user error during the process, Romexis will try to recover the images in the beginning
of the next scanning session. If scanned images are available in the temporary folder
(usually %temp% on Windows machines) Romexis will match them with the patient
that they were originally scanned to and ask the user how to proceed as shown below.
If the patient currently open is the same as the patient to whom the images were scanned the
following prompt will be shown and Romexis will proceed with importing the scans to the
patient.
If a different patient is open Romexis informs the user that there are some unprocessed
TWAIN scans and indicates to which patient ID the scans belong to. Work can proceed as
normal with the current patient. The prompt will stop appearing after the correct patient has
been opened and all scans have been successfully imported to the patient.
IMPORTING IMAGES
4 IMPORTING IMAGES
Click this button and browse to the image file to be imported. Several images can be imported
at the same time by holding down the Shift or Ctrl key while selecting files.
After selecting the file(s) and clicking Open a window for setting image parameters appears.
Select the image type, and, for intraoral images, also define the tooth numbers. For multiple
images you are prompted separately for each image.
If you click Cancel to skip a single image when importing multiple images, Romexis will ask:
Continue importing images?. Click Yes if you want to continue importing the rest of the
images.
It is also possible to crop the image when importing. Click the Crop button, click and drag the
mouse on the top of the image to specify the area of interest. A green rectangle will appear to
denote a selection in process. When the mouse button is released the rectangle will turn red
to denote a successful selection.
IMPORTING IMAGES
4.1 Importing images using DICOM Import
DICOM 3.0 format images can be imported using the DICOM Import function similar to other
images. See section 3.13.4 TWAIN Auto Recovery on page C-20 for more information on
the import process.
4.1.1 DICOM Import with Patient Data
To import a DICOM image and to create a new patient from the information included in the
DICOM file, use the DICOM with Patient option available in the File menu.
EXPORTING IMAGES
5 EXPORTING IMAGES
Open the image(s) or study that needs to be exported. Click the Export button.
NOTE By default the Filename field is empty. To change the default setting to patient name
see section 2.2 Person on page I-3.
NOTE To export all images select the view All images in table in the Image Browser see
section 1 IMAGE BROWSER on page C-2 or use DICOMDIR Export.
Select the Processed images option to export the image(s) in 8 bit with all enhancements
applied, or select the Original images option to export original image(s) (8 or 16 bits,
depending on the original capturing mode).
If you are exporting multiple open images or a study, you can either export the images as
multiple files or as one single image (all images merged into a single file) by selecting the All
images in one file option. When exporting as multiple files, a sequence number and file
extension will be automatically added to the file name specified.
If you want to create a text file that includes image related information enable the option:
Create patient and image information file.
If you want to embed the image information directly on the exported image enable the option:
Burn patient information to the exported file.
Click OK to export the file(s) as specified.
Export image(s) and Romexis Viewer to ISO image will create an CD ISO image file that can
be written to a CD using any 3rd party CD writer utility. Normally double clicking on the
exported ISO image file will start the 3rd party CD writing utility if correctly installed. Use this
option in case that the Burn image(s) and Romexis Viewer to CD does not work on your
computer for example.
Burn image(s) and Romexis Viewer to CD will write the image to a CD with Romexis Viewer
using the CD writing feature included in Romexis.
EXPORTING IMAGES
5.1 Exporting images using DICOM Export
Open the images or study that needs to be exported. Click the DICOM Export button to
open the export dialogue below.
Select the Processed images option to export the image(s) with all enhancements applied, or
select the Original images option to export original image(s) as they were captured. To enable
regenerating of 2D DICOM headers, tick the corresponding box. By ticking this box Romexis
will rewrite the DICOM headers containing the most recent information in the database. In
DICOM Export the original bit value is always preserved.
Anonymize File(s) removes all patient information from the exported DICOM image(s).
If you want to create a text file that includes image related information enable the option:
Create patient and image information file.
Click OK to export the DICOM file(s) with relevant patient information included.
Export image(s) and Romexis Viewer to ISO image will create an CD ISO image file that can
be written to a CD using any 3rd party CD writer utility. Normally double clicking on the
Burn image(s) and Romexis Viewer to CD will write the image to a CD with Romexis Viewer
using the CD writing feature included in Romexis.
5.2 DICOM Media Storage (DICOMDIR)
The DICOMDIR file format specifies a standard way to organize storage and retrieval of
DICOM format file sets to and from offline storage such as a CD. A compatible DICOMDIR
CD, for example, contains description and access information for all the studies on that CD.
Planmeca Romexis supports both DICOMDIR import and export functions.
Before you start using DICOMDIR import or export, make sure that the user has appropriate
import and export images permissions granted in the Romexis Administration module. (See
1.1 Permissions tab sheet on page G-1 in chapter G ADMIN MODULE for more
information on permissions.)
EXPORTING IMAGES
5.3 DICOMDIR Import
DICOMDIR Import allows you to import a set of multiple patients with their patient information
and images from DICOMDIR into Romexis.
To start importing images from a DICOMDIR, click on the DICOMDIR Import button
or use the File DICOMDIR Import menu option:
First browse to and select the DICOMDIR file to be imported using the Browse button. When
an appropriate DICOMDIR file is selected, a tree list with images and thumbnails is
populated. The tree list on the top left shows each patient in the DICOMDIR and their images
in a hierarchical list. When an image entry is selected in the tree list, its DICOM tags will be
displayed at the bottom and its thumbnail will be highlighted on the right.
To import images, tick them in the tree list and deselect any unwanted patients and images.
After you have selected all desired images, click Import to have new patients created when
necessary, based on the selection and the selected images imported to them. If a patient with
a same name as the one being imported is already found in the database, Romexis will ask if
you are sure you want to import the images to that patient instead of creating a new one.
Verify that the correct patient is in question before continuing.
EXPORTING IMAGES
All images that have an image UID (Unique Identifier) already in the database will be rejected,
unless you have enabled the Allow duplicate UIDs option at the bottom of the dialogue.
To import SmartPan images as stacks instead of separate images check the option Stack
single frame CT images.
5.4 DICOMDIR Export
DICOMDIR Export allows you to export a set of multiple patients with their patient information
and images into a DICOMDIR file structure. A DICOMDIR Directory information file is saved
as specified in the Export To dialogue and all exported DICOM image files are stored into its
adjacent subfolder titled \images.
To start exporting patient information and images from a DICOMDIR, open the Import
dialogue by clicking the DICOMDIR Export button or, if no patient is selected, use the
File DICOMDIR Export menu option:
First define the DICOMDIR file to be created and exported into using the Export To button. In
the opening Export To dialogue you can browse to the correct folder and define a filename for
the new DICOMDIR file.
EXPORTING IMAGES
After you have defined the DICOMDIR file, add patients into the tree list at the top left by
using the Add Patient button. In the dialogue that opens you can search and select a patient
to be added into the DICOMDIR. Select a patient in the list and click OK to add it to the tree
list. You can repeat the Add Patient task to add multiple patients.
When patients are added into the DICOMDIR they will show in the tree list with all their
studies and images in a hierarchical list. You can browse the item DICOM tags and
thumbnails by highlighting an item and referring to the bottom and right edges of the dialogue.
Use the tick marks next to each item to include or exclude them from the final DICOMDIR file.
The Save Processed Image option at the bottom of the dialogue allows you to export images
with all image processing operations merged into the image as they have been defined in
Romexis.
Save Annotations applies any annotations made in Romexis into the exported images.
5.4.1 Additional DICOMDIR Export Options
Regenerate 2D DICOM Headers Enables Romexis to rewrite the DICOM headers using the
newest information in database.
Anonymize File(s) removes all patient information from the exported DICOM image(s).
Export with Romexis Viewer option places a copy of Romexis viewer into the same folder with
the DICOMDIR file-set. The contents of the export folder can then be written onto a CD using
any 3rd party tools and handed to a customer or referrer. Please note that it is possible to
open DICOMDIR file-sets in Romexis Viewer 2.0 version and later.
When forwarding the DICOMDIR file-set, make sure you include the DICOMDIR Directory
information file specified in the Export To dialogue and the adjacent \images subfolder.
Export DICOMDIR and Romexis Viewer as ISO image will create an CD ISO image file that
can be written to a CD using any 3rd party CD writer utility. Normally double clicking on the
Burn DICOMDIR and Romexis Viewer to CD option allows you to write the DICOMDIR and a
copy of the Romexis Viewer directly onto a CD. Make sure you have an empty writable media
in the drive before attempting to use this option.
PRINTING IMAGES / PRINT EDITOR
6 PRINTING IMAGES / PRINT EDITOR
Romexis Print Editor is a comprehensive tool for printing 2D and 3D, regular and DICOM
images. The Print Editor allows for adding multiple images of different type on the same print
layout. These images can be scaled in size and cropped and labels of the image properties
can be added to the layout, among other things.
The Print Editor consists of the main toolbar located on the top and the vertical toolbar located
on the right. The main toolbar consists of buttons related to printing and viewing, whereas the
vertical toolbar consists of image specific adjustments related to the image size, position and
labels. The vertical toolbar is image specific and is only showing when an image is selected.
To create Print pages drag and drop the desired images on Print Editor.
To browse the print pages move the slider on the right or click on the page browser
thumbnails.
Page Setup
In the Page Setup window, the header and footer settings can be set visible and editable, the
page margins can be set and page size and orientation can be defined, see section Editing
header and footer on page C-34 for more information.
Printing Images
When you have defined the print settings in Print Setup, click the Print button to start the
printing.
Save Print
Saves current print pages as non-editable snapshots into patients 2D module under photo
category. Prints can be recreated by adding snapshots to a new print page in 100% scale.
Exporting Images
The print editor layout can be exported as a regular image to the hard disk. Click the Export
button to open the dialogue window where the export resolution, image format, export folder
and filename can be defined.
Browsing Images
To add more images to the layout click the Image Browser button. The image browser opens
to the lower part of the screen and lets you add images of the current patient to the print
layout by double-clicking on the desired image. The image will be inserted into an image
template slot for the respective image type if existing in the layout.
Adding Text Box
Add Text Box button allows adding different free or itemized text lists into printouts. The
following options are available:
Add Free Text Box to Layout Add freely editable text box.
Add Image Implant List to Layout Add an itemized list of implants (only for 3D print).
Add Image Diagnosis to Layout Add a copy of the image diagnosis if entered in the Image
Properties (only for 2D images or snapshots).
Add New Page
Adds new page to print layout with two options:
Empty page: A new, empty page is added with no specified image slots
Copy of current page: A copy of the currently shown page and its predefined image slots. This
option is useful for creating multiples pages with same layout.
Previous and Next Page
Moves to previous or to the next page in a multipage layout.
Page Thumbnails
Shows/hides the page browser on the screen on the left.
Adjusting Print Crop
To adjust the area of each image that will be included in the prints, select the desired image
and use the Adjust Print Crop tool. Draw the crop region with mouse and apply crop from the
right-click menu. The crop can also be cancelled from the right-click menu by choosing Reset
crop Region.
Showing / Hiding Annotations
Image annotations can be shown or left out of the print by clicking the button Show
Annotations.
Saving Print Templates
Print layouts can be saved as print templates for future use. Click the Save Layout As
Template button to save the current layout as a Named Layout or as a Default Layout.
The default layout will open always when the Print Editor is used whereas the named layout
can be restored from the layout list. The image will be inserted into an image template slot for
the respective image type if existing in the layout.
Selecting Print Templates
A saved template can be opened by clicking the Select A Saved Template button and
selecting the saved template name from the template list. To add images to template double-
click the images from image browser.
Deleting Print Templates
Delete a saved print template by clicking the Delete Saved Template button and choosing the
template to be deleted from the template list.
Zooming Print Layout
The print layout can be zoomed in and out by using the Zoom In & Zoom Out buttons. The
layout can also be fitted to view by clicking the Zoom to Fit button.
Adjusting images / Right-Click Menu
Clicking the right mouse button on top of an image opens a list of shortcuts to different layout
related functions. The image can be moved around the layout by dragging, and resized from
the image corners. To remove the image from layout select Remove from layout on the right-
click menu.
6.1 Vertical Toolbar
The vertical toolbar is divided into two sections. The upper section shows the name of the
selected image and contains adjustments for image scale, position, size, image borders as
well as image behaviour when moved around the layout.
Image Size / Image Position
Image size can be changed by selecting different scale for the selected image. Alternatively
the size can be changed by typing / browsing the desired image width (W) and height (H) from
the Position and Size controls.
Image position on the layout can be changed by dragging the image around the layout.
Alternatively this can be done by typing / browsing the desired location (X, Y) from the
Position and Size controls.
Image Borders
Print Editor lets the user add borders to each image in the print layout.
The borders size can be changed typing / browsing the desired border width (W) and height
(H) from the Image Border controls.
The Image Border Fill Color can be changed by clicking BG color field and choosing the
desired color. The Image Border Edge Color can be changed by clicking the FG color field.
The borders can be rounded by typing / browsing the desired radius (R) from the Image
Border controls.
Moving Images in the Layout
The dragging of the images around the print layout can be eased by ticking the checkboxes
Snap To Area Edges and Snap To Object Edges. This way when the image is dragged
around the print area, it sticks to nearest edges and objects.
Scale Image With Slot function will automatically scale the image to the slot when a new
image is added.
Editing Image Labels
The lower part of the vertical toolbar contains adjustments for image labels. The labels can be
hidden by unchecking the Show Labels checkbox.
Image labels can be added, edited and deleted from the Contents table. By clicking the Add
button a new label row is created. The label type can be selected from a collection of image
properties labels. The text field includes text that is added to the layout after the image
property data of the selected label. I.e the text field of the label Img Exp mA adds the string
mA after the image exposure mAs, e.g. 10 mAs. Click the LB field of the label row to add a
line brake after the label row. They can be handy if many labels are added to the same area
of the layout.
By selecting a row and clicking Del button the row can be deleted. By selecting a label row
and clicking the buttons Up and Down the label row can be moved in the table.
When the image label is selected from the Contents table, its characteristics such as opacity,
background (BG) and foreground color (FG) (text color), text font as well as relative position in
the layout can be defined. The relative position in the layout is chosen by clicking on the grey
fields of the small image layout preview located in the vertical toolbar. The changes in the
label characteristics can be seen on the print editor layout.
Editing header and footer
Header and footer can be set editable from Page Setup. By clicking the header or footer on
the layout the respective labels become editable in the contents table of the vertical toolbar.
DICOM PRINT (OPTIONAL)
7 DICOM PRINT (OPTIONAL)
In case a DICOM Print license is purchased and installed, images can be printed with DICOM
compatible printers. DICOM Print needs to be configured in the Admin module before the
DICOM printer can be used, see chapter G ADMIN MODULE.
VIEW ADJUSTMENT TOOLS
8 VIEW ADJUSTMENT TOOLS
Zoom in
Zoom out
Fits images to viewing window
Shows images in their actual size.
Scales all images in same size
Magnifies the image twice it size (2X).
Shows an overview of an image when the image is zoomed in.
Enables a movable square Flashlight overlay that allows regional filter for Gamma, Contrast &
Brightness, Invert, Equalize, Sharpen, and Emboss. Use the mouse scroll wheel to adjust the
size of the filter area and right-click to switch between different filters.
Flashlight setup
Similar to Flashlight function above but allows setting of Gamma, Contrast & Brightness
values. The settings are image specific. Use the mouse scroll wheel to adjust the size of the
filter area, and the radio buttons or the right click to switch between different filters.
Pan Moves image on the screen
VIEW ADJUSTMENT TOOLS
Adjust contrast and brightness
Invokes contrast and brightness control to all open images. You can adjust the brightness and
contrast by dragging the sliders or by moving the mouse on the image while pressing the left
mouse button. Horizontal movement changes the brightness and vertical the contrast.
Region of interest
Use the Region of Interest tool to specify and select the area of effect for image processing
tools and certain measurements. Use this tool together with for example image Histogram
tool to view grayscale values of a region.
Note that it is possible to specify multiple regions and to switch between them by using the
Reqion of Interest tool. Active region is denoted in green and inactive regions in blue color.
Use Delete Measurements tool or Delete key to delete the selected region.
MEASURING IMAGES
9 MEASURING IMAGES
Calibrate for measurement
Click the icon, draw the calibration line by holding the left mouse button down, end the line
with a right-click and the calibration window appears.
Enter the length and click OK.
NOTE! You should not use the calibration tool on CBVT snapshots as they are automatically
calibrated.
Measure angle
Click the icon, draw the angle by pressing the left mouse button down.
Measure length
Measure length over single or multiple points. Measure Length is a dual mode button: hold
down mouse button to call up mode selection between Single measurement and polyline
measurement.
Single measurement use to measure length between 2 points (default). Hold down left
mouse button to define measurement, release mouse button to finish.
Polyline measurement use to measure length over multiple points. Draw the line by
pressing the left mouse button down. Release mouse button to finish.
Line profile
By clicking the Line Profile icon and drawing a line to the 2D image, the user can view the
gray scale profile of the respective line. Min, Max, Average and Standard Deviation of the line
MEASURING IMAGES
profile are also available. If the line profile gray scale values are very near to each other, by
ticking the Relative values checkbox the variations between these values are emhazised.
Show histogram
By clicking the Show Histogram icon the histogram of the open image/selected region of
interest is shown. A histogram is a graphical representation of the gray scale distribution in
the image/area. By default the histogram is drawn in square root scale. Linear scale can be
enabled by ticking the Linear scale checkbox. Max, Average and Standard Deviation of the
histogram data is also available.
Show measurements, Show/hide values
DRAWING TOOLS
10 DRAWING TOOLS
Draw Line
Draw line over single or multiple points. Draw Line is a dual mode button, hold down mouse
button to call up mode selection between single line and polyline drawing.
Draw single line - use to draw line between 2 points (default). Hold down left mouse button
to define line, release the button to finish.
Draw polyline - use to draw line over multiple points. Draw the line by pressing the left
mouse button down and release the button to finish.
Draw a horizontal line
Draw a vertical line
Draw an arrow
Draw curve
Draw rectangle
Draw an ellipse
Add text
Click the icon and point with the mouse where you want to add the text. Type the text to the
opening window and click OK.
To edit the text later select the text with the Select annotations button (see below) and then
double-click the text. Edit the text and click OK.
Select/move/edit annotations
Click the icon and and take the mouse (cross inside the arrow) to the top of the graphics. To
move a graphic, select and drag it to a new position. This tool can also be used to edit
annotations by moving their control points.
DRAWING TOOLS
Delete selected annotations or measurements
Show annotations
Shows and hides annotations. Even if the annotations are hidden they are still stored with the
image.
Select annotations
When an annotation (line, arrow, circle, rectangle, curve) is selected, its color and line width
can be adjusted. Use the Select Annotation tool to activate the annotation you want to edit.
When an annotation is active you can modify it using the Color and Width settings shown in
the Image Toolbar.
Sketch a free line
Sketch a free line for demonstration purposes.
NOTE Sketch lines are not saved or stored and are lost when image is closed.
2D IMPLANT LIBRARY (OPTIONAL)
11 2D IMPLANT LIBRARY (OPTIONAL)
2D Implant Library allows visualization of realistic implant models on 2D images. 2D Implant
Library is an optional feature and can be purchased separately. It will be available in
Planmeca Romexis when appropriate Romexis licence is installed.
NOTE When using panoramic imaging mode, magnification of object may appear uneven
depending on its position and angle in relation to the focal plane. Use panoramic or
other 2D images for treatment planning prudently.
11.1 Adding and managing implants in the plan
I
To add an implant to the plan click this button.
Select the appropriate implant and properties from the from library and click Add to Plan.
Square box corresponding to implant insertion depth appears next to cursor. To add an
implant to the image place the box in the implant site and click the left mouse button.
To rotate or move the implant activate it by clicking it with the left mouse button.
To rotate the implant drag the implant from its control points.
To move the implant drag the implant with the mouse. When the implant library is open and
the n implant is activated the corresponding implant type is displayed in the library.
To replace an implant, select another implant from the library and click Replace. To delete an
implant from image select the implant and click Delete Annotation or Delete key
on your keyboard.
NOTE Modifications performed in the 2D Implant Library, such as adding or deleting implants
will also affect the 3D Implant Library.
To edit the name and color of the selected implant click this tool .
The following window opens To save your settings when finished click OK.
11.2 Image specific tools
These tools affect the selected image only.
Scales the image 1:1.
Zoom in
Zoom out
Show image properties
Opens the General tab under Image properties window where the tooth numbers (for intraoral
images) can be defined, the image can be rotated/flipped and the image file info and
exposure parameters can be viewed.
Show image diagnosis
Opens the image Diagnosis tab under Image Properties. Shows and allows editing image
diagnosis. Diagnosis up to 2500 characters is supported.
Opens image processing toolbar
Maximize the image
When an image is maximized use Next and Previous buttons to browse other open images in
the layout or study.
Close the image
11.3 Image processing tools
Adjust levels
Gamma curve can be adjusted by moving the green line in the histogram. The histogram can
be cut from the ends by moving the red lines. The levels can also be adjusted by moving the
mouse vertically and horizontally on the image.
Use the small double arrow shown in the bottom left corner of the above screenshot to reveal
the advanced options.

Use the up/down arrows and the 1:1 button to scale the histogram to bring out details. Enable
Overlay result histogram to highlight the resulting histogram and Linear scale to draw the
histogram in linear scale instead of the default logarithmic scale.
The Min, Max, Avg (Average), and StdDev (standard deviation) values show the
corresponding grayscale values in the image or in the Region of Interest when one is active.
When pseudocolours are enabled, this dialogue is also used to select colours and to alter
their balance. To do so, use the handles on the top of the dialogue to adjust the colour
balance. Double-click on a handle to change the colour for its range.
Click the small down arrow to apply preset colours.
Adjust brightness and contrast of the image
Adjust sharpness of the image
Adjusting can be done by using the sliders or by moving the mouse on top of the image.
Sharpen the image
Sharpens the image according to the settings in the tool above.
Soften the image
Noise removal
Invert the image
Apply Ceph filter to bring up more facial soft tissue.
Adjust the vertical green lines to specify the area of effect. Use the Gain slider to adjust the
strength of the filter, higher values will bring out more tissue. To apply filter on the left edge of
the image enable the Left option.
Apply pseudocolours
Use the Adjust levels dialogue to modify the colours.
Image operations
Shows history of image operations. Click on an operation in the history to to revert image to
that point.
To apply the enhancement shown in the Image Operations list to all new exposures of the
same type from the File menu select Capture > Save image enhancements as default
enhancements option. For more information on how to review and adjust default
enhancements for new exposures see chapter 3 IMAGING on page I-10.
Save modifications
Romexis saves image modifications automatically when the image is closed. In case you
want to save the image while working with it use the Save button.
Revert to original
Removes filters and grayscale adjustment from the image and shows it without preprocessing
as it was when received from the X-Ray unit.
Undo
Redo
IMAGE PROPERTIES
12 IMAGE PROPERTIES
12.1 General Image Properties
Shows general properties for selected image including exposure information. Allows definition
of image type, sensor orientation, exposure date, tooth numbers, and image comments.
When image has been mirrored or flipped horizontally a small dual arrow is shown in image
status bar indicating that the images has been mirrored.
Comments when available will be shown in the image title bar and can be used as search
criteria in the Find by Image tab.
IMAGE PROPERTIES
12.2 Image Diagnosis
Opens the image Diagnosis tab under Image Properties. Shows and allows editing image
diagnosis. Diagnosis up to 2500 characters is supported.
12.3 All Parameters
Displays image parameters in detail.
12.4 Image Alignments
Define the alignment of the image inside the layout slot. Affects image placement on screen
and in Export / All images in one file operation.
12.5 Copy image to Clipboard
The image can be copied to the Windows clipboard by right-clicking the image and selecting
Copy to clipboard from the pop-up menu.
12.6 Moving Image to Another Patient
An image can be moved to another patient by right-clicking it and selecting Move from the
pop-up menu. Define the patient to receive the image using the Search dialogue.
12.7 Assign as Face Photo
Assigns the selected image as patient photo shown for patient in Demographics screen under
Files module.
12.8 Inactivating an Image
An image can be inactivated by right-clicking the image and selecting Inactivate from the pop-
up menu. When the image is inactivated it will disappear from Romexis, but will remain in the
image folder on the hard drive. The image can be permanently deleted in the Romexis
configuration, see chapter 9 I PLANMECA ROMEXIS CONFIGURATION APPLICATION.
DICOM STORAGE & STORAGE COMMITMENT (OPTIONAL)
13 DICOM STORAGE & STORAGE COMMITMENT
(OPTIONAL)
In case a DICOM Full license is purchased and installed, images can be sent to a remote
DICOM application, i.e. DICOM image archive PACS. DICOM Storage needs to be
configured in the Admin module before the DICOM storage can be used, see chapter G
ADMIN MODULE.
Open the image you want to store and click the button. Click OK in the opening
dialogue.
To check the status of storage transaction, use the Image Properties dialogue. DICOM
Storage Commitment is also shown in the Image Properties next to the storage status. When
DICOM Auto Storage is enabled, the storage of a single image can be canceled in the Image
Properties dialogue.
NOTE Images can also be automatically stored after capturing, see section G DICOM
Configuration in chapter G ADMIN MODULE and section 6.3 External
communication on page I-35 in chapter I PLANMECA ROMEXIS CONFIGURATION
APPLICATION.
Planmeca Romexis D-1
Chapter
Users Manual
D 3D IMAGING MODULE
The Planmeca ProMax 3D generated images are captured, processed and stored in the
Planmeca Romexis 3D Imaging Module.
The three-dimensional data of the maxillofacial area is called an X-ray volume. The
dimensions of the 3D volume varies depending on the source
The 3D module is divided in five tab views which are the following:
1. Volumes
2. Explorer
3. Panoramic (OPTIONAL)
4. Cross sections (OPTIONAL) or Implant (OPTIONAL) in case implant license is installed.
5. TMJ (OPTIONAL)
6. ProFace (OPTIONAL)
NOTE A patient needs to be selected before the 3D module can be accessed. See chapter B
PATIENTS AND FILES MODULES.
NOTE A volume must be opened in the Volumes tab to be activated in the Explorer,
Panoramic, Cross sections, TMJ or ProFace tab.
VOLUMES
D-2 Planmeca Romexis Users Manual
1 VOLUMES
1.1 Opening a 3D volume
In the Volumes tab the patients 3D volumes are listed and axial-view thumbnail is displayed.
Thumbnails axial slices can be scrolled with arrow or mouse wheel.
To move or inactivate a volume or to view its properties use the right-click context menu.
To open a 3D volume double-click the volume line or select the volume and click the View
button
1.2 Moving volume to other patient
Right click on a volume in the Volumes list and choose Move to Other Patient, then choose
patient to move the volume to.
Planmeca Romexis D-3 Users Manual
EXPLORER
2 EXPLORER
The Planmeca Romexis 3D Explorer is intended for capturing, viewing and adjusting 3D
volumes in three different directions (coronal, sagittal, axial). The images can be printed,
exported and sent to the DICOM archive in case the DICOM license is in use. The Explorer
tab sheet is divided into three different parts:
1. Menu toolbar: Toolbar on top, including the common tools.
The following tools are available for all viewports:
2. 3D Volume Viewing: Main area of the Explorer with 3D volume viewports.
3. Volume Adjustments: Located on the right, containing image processing tools specific to the
Explorer module.
4. Slice specific tools
Maximize - Adjusts the viewport to full screen
Mirror -Reverses data viewing direction as follows
Axial view: From above / below
Coronal view: From front / back
Sagittal view: From left / right
Snap shot - Saves a 2D CBVT snapshot of the viewport with default settings. For more
information see section 2.10 Saving 2D views on page D-29
Show vieport settings - Define number of slices, slice distance and thickness.
EXPLORER
2.1 3D master toolbar
The 3D master toolbar contains buttons common to all 3D modules. Functions available on
this toolbar include 3D volume capture, import, printing, measurement, view management
and others. In the following the functions are explained in brief and references to sections
providing more information are listed.
NOTE Buttons for Export, saving a 2D view, DICOM print and storage, launch function and
image properties are inactive out until a volume is opened.
3D Volume Acquisition: Starts 3D exposure. Only available in the Explorer module. Refer to
2.2 3D volume acquisition on page D-6 for more information.
Artefact Removal:
Opens the Artefact Removal dialogueue for the currently open volume. Only available in the
Explorer module. Refer to 2.4 Artefact removal on page D-9.
Volume Stitching:
Opens the dialogue for stitching together multiple adjacent 3D volumes. Only available in the
Explorer module. Refer to section 2.5 Stitching multiple volumes on page D-12.
Import:
Planmeca Romexis native REC file, DICOM multi frame and DICOM single file frame set
respectively. Refer to 2.7 Importing 3D Images on page D-19.
Export:
Opens the Export dialogueue that allows selecting the export format and other options before
exporting. Refer to 2.9 Exporting 3D Images on page D-24.
DICOM Print:
Windows print and DICOM print respectively. Opens the Print Editor dialogueue that allows
the selection of views to be printed and other print options. Refer to D Windows printing /
Print Editor and 2.12 DICOM Printing /Print Editor on page D-34.
DICOM Storage:
Send open volume to DICOM storage (requires full DICOM license). Refer to 2.13 DICOM
Storage on page D-34.
Launch external application:
Executes a user-definable third party software with the currently open 3D volume. Refer to
2.15 Launching external applications on page D-36.
EXPLORER
Send to iPhone
Sends images currently open to specified iPhone. Enter the IP address of the iRomexis
device where you want to send the image to.
ProModel Order button
Opens the integrated order form for ProModel. For more information see APPENDIX A:
PLANMECA PROMODEL on page A-1.
Save 2D View
Save a copy of the selected view into the 2D Imaging module. Refer to 2.10 Saving 2D
views on page D-29.
Virtual Ceph
Opens a dialogue where virtual 2D cephalometric image can be generated from 3D volume
data.
Order guide (Materialise Dental Surgiguide)
Opens an ordering form which can be used for placing an order for SurgiGuide of an implant
plan.
Please see APPENDIX C: ORDERING SURGIGUIDE DRILL GUIDES WITH PLANMECA
ROMEXISfor more information on how to order Materialise Dental SurgiGuide with
Planmeca Romexis.
Adjust Levels
Opens the viewport histogram adjustment dialogue. Refer to 2.19 Saving the current view
on page D-37.
Measure length and angle
respectively. Refer to 2.19 Saving the current view on page D-37.
View Operations
Click this button to save, delete or reset views. Refer to 2.19 Saving the current view on
page D-37.
Click this button to select a view from list
Click this button to delete view
EXPLORER
Click this button reset view.
Show/hide Orientation Lines:
Toggles the visibility of orientation lines in the view as specified in Volume Adjustments. Refer
to section 4.5 Showing / Hiding settings on page D-42.
Zoom Mode:
Toggles zoom operation of the mouse wheel on/off. Refer to 2.19 Saving the current view on
page D-37.
3D Image Properties:
View and edit image properties. Refer to 2.16 Adjusting levels (contrast & brightness) on
page D-36
Inactivate:
Inactivates the currently open 3D volume. Refer to D Adjusting levels (contrast & brightness)
View 3D Volume: Use this drop-down menu and the View button to select and view 3D
volumes of the current patient. Refer to 2.7 Importing 3D Images on page D-19.
2.2 3D volume acquisition
To start image capturing click this icon. The image acquisition window appears.
NOTE See also Planmeca ProMax 3D/Dimax3 users manual.
NOTE Do not perform any other operations during the 3D exposure.
EXPLORER
Two test images can be taken before the 3D volume exposure (On how to activate/deactivate
the test exposure, refer to ProMax 3D users manual). With this function two images, one
coronal and one sagittal image, in an angle of 90 to each other will be captured. This means
that patient positioning can be verified before the final exposure, and additional radiation
caused by a possible retake can be avoided.
Artefact Removal
None / Low / Med / High allows selection of level of artefact removal processing applied to the
image that is to be exposed. Higher settings should be used with patient who have more high
density materials in the exposed area such as amalgam fillings. Artefact removal can be re-
applied using the 2.4 Artefact Removal tool with different settings if the result is not
satisfactory.
When all exposures have been taken and the reconstruction calculation is completed, the 3D
study is automatically saved into the database under the patient file and displayed on the
screen, see the figure above for an example.
If ProMax 3D stitching mode is used, the stitching window is automatically presented in
Planmeca Romexis. For more information see 2.5 Stitching multiple volumes on page D-12.
HU-correction enabled
When enabled provides more uniform HU-values on the edges of the volume.
EXPLORER
2.3 3D Volume Viewing
The 3D volume is displayed simultaneously in four different views: Sagittal (red), Coronal
(green), Axial (blue) and 3D rendered view. The red, blue and green lines across the views
indicate the slicing planes in the views.
NOTE It is recommended that the 3D rendered view is disabled in image capturing
workstations (see chapter G ADMIN MODULE).
The position in the volume can be freely adjusted by holding down the left mouse button and
moving the mouse in the view. All views are connected to each other, which means that
moving one view will affect the other views as well, except for the rendered volume. While
moving the mouse in one view, the two other views automatically move to the corresponding
position. The viewing angle can be rotated freely by holding down the right mouse button
while moving the mouse.
When orienting the image, you can recognize anterior, posterior, left, and right anatomies by
the A/P/L/R letters respectively on the edges of the views. These will automatically update to
denote the nearest anatomy to the edge.
When moving the mouse cursor on top of the image, a Hounsfield Unit (HU) value will be
shown at the bottom right of the current view. The value shown is an average value of 3 x 3
pixel area under the mouse cursor.
All views have orientation lines to provide a comprehensive view and the relation to each
other. This means that the view of the coronal plane, e.g., is indicated with a green line in the
sagittal plane, axial plane and with a green auxiliary plane in the perspective view. Likewise
the sagittal and axial planes are indicated. With the buttons of the Rendered Volume
Auxiliaries it is possible to switch the auxiliary lines in the rendered volume on or off.
EXPLORER
2.4 Artefact removal
Objects of high density, such as amalgam or other metallic bodies, can cause artefacts on X-
ray images because the radiation cannot penetrate them. Artefact Removal is not
automatically applied when the volume is reconstructed, but if disturbing artefacts are present
after a successful capture, you may want to recalculate the volume, using the Artefact
Removal.
Follow these steps to perform the removal:
1. Use the sagittal (or coronal) view to align the axial view so that the whole teeth arch can be
seen and the amount of amalgam visible is maximized in the axial view.
2. Click the Remove Artefacts button. In the window that appears select the Artefact threshold
by moving the slider. The threshold can be set between 0 for pure black and 4096 for pure
white (amalgam, for example, ranges near value 4000). A decrease in the threshold value will
remove more possible artefacts (darker shades of grey) and an increase will remove less. In
other words, a decrease in threshold makes suspect areas more likely to be considered for
removal. Therefore, decrease in value may also increase the processing time as more areas
will need to be processed.
3. Use the Artefact Threshold slider to set the grey level (defines the threshold value above
which the voxels are considered as artefacts). While you adjust the slider from right to left,
pay attention to the axial view you aligned in step 1 above. Areas of amalgam, which are
normally bright white, turn into red. Keep moving the slider to the left until all presumed areas
of amalgam have barely turned red and the dentin remains white or light grey.
EXPLORER
4. To start the artefact removal click the button. Keep in mind that the more voxels are
being eliminated, the more time it will take to process the 3D volume. The reconstruction PC
will start a recalculation of the 3D volume, ignoring all areas (voxels) above a certain grey
level, which have been flagged as undesired in step 3 by colouring them red. Leaving the
problematic areas out of the calculation will remove artefacts caused by amalgam or other
metallic bodies from the recalculated volume. The bodies that caused artefacts will, however,
still be visible. To finish the removal, click Done.
NOTE Move the threshold to the left until the amalgam or other metallic bodies appear red,
not further. Too aggressive settings may affect dentin.
NOTE Multiple separate red areas will increase the calculation time. Too many red areas can
escalate the recalculation time and produce unwanted results. Therefore the threshold
must be defined individually for each volume.
NOTE If the volume was taken with a Planmeca Romexis version older than 1.4 you need to
manually select the right frameset ID from the dialogue. Planmeca Romexis asks the
originally captured frame sets from the reconstruction PC. If the correct frameset is not
on the reconstruction PC anymore, it is not possible to proceed with the Artefact
Removal.
EXPLORER
Automatic artefact removal during exposure
In the 3D Exposure window automatic artefact removal can be applied to all new exposures.
This eliminates the need to remove artefacts separately from each volume. The following
preset artefact removal options are available:
None Apply no artefact removal and return the volume as is.
Low Apply artefact removal with a low threshold to reduce some artefacts and minimize the
effects on real anatomy.
Mid Allows a medium level threshold to compromise between artefact reduction and effect
on anatomy.
High Apply a high threshold to maximise artefact reduction but with the risk of hard tissue
anatomy being affected.
The default level for automatic artefact removal is a site wide setting that is configured in
Planmeca Romexis Configuration application. The site wide default can be overridden per
exposure using the buttons as described above.
For more detailed information see 2.4 Artefact removal on page D-9
EXPLORER
2.5 Stitching multiple volumes
You can produce larger volumes in Planmeca Romexis than the native maximum of 8 x 8 cm
allowed by ProMax 3D. This process is called stitching and it involves joining together 2 or
more volumes captured from neighbouring anatomy. When positioning the patient for stitched
imaging it is important to consider the barrel-like shape of the volume and to allow adequate
overlap between each volume. See also the latest ProMax manuals for information on
automatic stitching modes available at X-ray exposure time.
If ProMax 3D is set to the stitching exposure mode, the Stitching dialogueue is automatically
presented at the exposure time. The volumes are automatically added and aligned so that the
user only needs to check the correctness of the alignment and click Stitch to finish. For
vertical stitching the volumes must first be prealigned by hand in Planmeca Romexis, using
the stitching mode Auto with Tilt.
Volumes can also be re-stitched, or volumes captured not using ProMax 3D stitching mode
can be stitched manually. The following applies to re-stitching and manual stitching.
NOTE All volumes are converted to 300 m voxel size for stitching. This resolution
corresponds to that normally achieved using ProMax 3D Low Dose exposure mode.
To start stitching volumes together make sure that the patient has at least two appropriate
volumes and click the Stitch Multiple Volumes Into One button. The general process
for stitching is as follows:
1. Add volumes to be stitched into the work area.
2. Align matching anatomy in the volumes. Planmeca Romexis places the volumes in the correct
position according to exposure geometry information from ProMax 3D, but you may
occasionally need to adjust the alignment for better results. Drag the volumes so that they
align as closely as possible.
3. Select horizontal or vertical stitching mode according to the nature of the case at hand.
EXPLORER
4. Click Stitch and Planmeca Romexis will take care of fine-tuning the volumes for perfect match
and stitches them together.
The Volume Stitching dialogueue is divided roughly into three parts, see the figure above for
an example. On the top of the dialogueue view is a drop-down list of volumes available for the
current patient, and buttons to add volumes to the work area, or remove the most recently
added volume.
In the middle of the dialogueue view is a work area where the volumes to be stitched are
displayed, where they can be aligned, and where the results can be previewed.
On the bottom there are three drop-down lists, and the estimated size of the final stitched
volume is displayed. Additional sliders to adjust the slice shown will appear when the volumes
are added into the work area, see Fig. 1 and Fig. for examples. The following options are
available:
Mode: Select Horizontal or Vertical, depending on whether the volumes are to be stitched
horizontally side by side, or vertically on top of one another.
Background: Select Black or White as the background colour for the work area. In some
cases it is easier to work against a white background, but this option is for user convenience
only and will not affect the stitching result.
Stitching Mode:
Auto In the Auto mode Planmeca Romexis will search for the best horizontal alignment for
stitching after the user has provided a rough alignment in the work area. This mode is most
suitable for horizontal stitching and it is the default when the horizontal stitching mode is used
in ProMax 3D.
Auto with Tilt This mode is similar to Auto mode above, but Planmeca Romexis will
additionally consider different rotations for the volumes in case the patient has tilted their
EXPLORER
head between the exposures. Tilt recognition is most suitable for vertical stitching and this
mode is the default when vertical stitching mode is used in ProMax 3D.
Manual The Manual mode allows the user to manually perform a final alignment for the
volumes in case the two automatic modes explained above do not produce the expected
results.
NOTE Both Auto modes provide a snap-to feature that recognizes matching anatomy and
pulls the volumes into the correct position during the alignment as if they were
magnetic.
Adjust Slices: These sliders (see Fig. 1 for an example) allow selecting the slice shown for
each volume. If the volumes do not share anatomy in the same slice, the sliders can be used
to adjust the slice shown so that a common anatomy can be seen in all volumes. This is
especially necessary when doing vertical stitching, as the anatomy shown by the default
center slice (125) of the top and bottom volume will be 2-4 cm apart. The tick box on the left of
each slider controls the visibility of each volume.
To stitch together three volumes follow these steps:
1. Add all three volumes into the work area by selecting them from the list of available volumes
and by clicking the Add button.
2. Align the volumes by dragging them to correct positions. See below for examples.
3. Click Stich and wait for Planmeca Romexis to iterate for the best alignment and save the
stitched image into the database.
Figure 1 Volume Stitching dialogue after the first volume is added
EXPLORER
Figure 2 Volume Stitching dialogue after all three volumes have been added to the work area and
perfectly aligned. Note that the volume size is 15.9 x 8.7 x 8 cm
Figure 3 Volume Stitching dialogue: Example of inadequate alignment
EXPLORER
2.5.1 Generating partial, high-resolution ROI reconstructions
When using Planmeca ProMax 3D units it is possible to generate higher resolution partial
reconstructions of original volumes using selected exposure modes. The following exposure
modes can be used to generate Partial Reconstructions:
Planmeca ProMax 3D Max Full Skull 400m (Normal)
The voxel size of the ROI reconstruction will be half of the original (double the resolution) so
that original volume of 400m will produce a ROI reconstruction of 200 m with approximately
half of the physical dimensions of the original.
To generate ROI Reconstruction in Planmeca Romexis:
1. In 3D Explorer module move the intersection of axial, sagittal and coronal slice reference
lines in the middle of the region of interest using your mouse. The intersection of the
reference lines will be the center of the new high-resolution volume.
2. From the File menu select Capture > ROI Reconstruction.
The Reconstruction PC will indicate if it is possible to generate a ROI reconstruction of the
selected volume.
NOTE ROI reconstruction is possible only if the original raw data is available on the
reconstruction PC. Therefore ROI reconstructions should be generated as soon as
possible after the exposure is taken.
3. The ROI reconstruction will be generated and opened for viewing automatically in Explorer
module.
EXPLORER
NOTE When generating a new ROI reconstruction from stitched volumes only the volume in
which the ROI is closest to the center will be included in the new volume.
EXPLORER
2.6 Recovering 3D volumes
In case the 3D volume is not correctly stored into Planmeca Romexis database after
exposure due to network disruption or other problems, in most cases it is possible to
download the original exposure from the ProMax 3D system using the 3D recovery feature.
To recover a 3D volume:
1. Start Planmeca Romexis on the 3D exposure workstation. This feature requires connection to
the ProMax 3D system that is usually not available on other workstations.
2. Make sure that the correct patient is open in Planmeca Romexis.
3. Go to 3D Volumes module.
4. From the File menu place your mouse over Capture and select Recover 3D Volume from the
list.
A list of recent exposures in the Promax 3D system will be shown.
5. Select whether to apply HU correction to the recovered 3D volume.
6. Choose the correct exposure and click OK. The 3D volume will be automatically downloaded
and added to the Volumes list.
NOTE If you accidentally downloaded the wrong volume you can inactivate it and try again. In
case the correct volume cannot be found please contact your local Planmeca
technician as the exposure may still be recoverable by other means.
EXPLORER
2.7 Importing 3D Images
Native Planmeca Romexis *.rec files:
3D images in *.rec format can be imported to Planmeca Romexis. Use the File menu to
import raw .rec volume feature and browse to the file you want to import. Only native
Planmeca Romexis 3D images that have been generated using Planmeca ProMax 3D and
Planmeca Romexis can be imported using this feature. The extension of the imported image
must therefore be *.rec.
DICOM Files
A 3D image in DICOM 3.0 format can be imported to Planmeca Romexis. Click the Import
button and browse the file to be imported. The extension of an imported image file is *.dcm.
DICOM 3D Multi Frame:
Imports a single DICOM standard file that contains the 3D Image Data in a set of Frames.
DICOM 3D Single Frame set:
Imports a set of multiple DICOM standard files that each contain a single Frame of the 3D
Image Data.
Importing ProFace images
Imports ProFace images
Importing intraoral scans
Imports intraoral images
2.8 Importing intraoral scans in STL format
Anatomical surface models can be imported in STL (stereolithography) format. STL files
describe only the surface geometry of a three dimensional object without any representation
of color, texture or other common CAD model attributes.
The surface models can be imported in any 3D module but can be adjusted (delete, change
color) in the 3D Implant Planning module using the Implant List. Surface model import
requires the optional Planmeca Romexis 3D Implant Planning license.
To import intraoral scan is STL format:
1. Open the 3D image you want to adjust.
2. Start STL import by clicking this button.
3. Select the STL model from the left.
4. Orient CBVT volume and surface scan to comparable positions:
To rotate the image, press and hold down the left mouse button while dragging the image
To pan/move surface scan and crop CBVT, press and hold down the right mouse button,
while dragging the image
EXPLORER
To pan/move CBVTvolume press and hold down the middle mouse button while dragging the
image
To zoom in/out the image use the mouse wheel
EXPLORER
5. Right-click on 3 common landmark points in the surface model and CBVT rendering.
6. Start by selecting a landmark in STL and then in CBVT and so forth.
Note that you can select landmarks on any side of the anatomy by rotating the models.
7. The current step text indicates the correct selection procedure.
Use the back button to undo and repeat the previous step in case of wrong selection. Ideally
the landmarks should be placed on corners of occlusal and buccal or distal and mesial or
distal surfaces. Landmarks are indicated as follows:
1st landmark: sphere
2nd landmark: cylinder
EXPLORER
3rd landmark: cube
8. To finish positioning click Done.
Planmeca Romexis will automatically match the surface scan to the CBVT volume.
9. The following options are available
Direction buttons to orient the CBVT rendering to default positions
Set Crop to limit the anatomy that is used for matching the surface scan to the CBVT
Threshold to adjust the CBVT rendering bone surface
The imported STL scans can be found in the Implant list where there colour can be modified,
(see section List implants in the plan on page D-66).
EXPLORER
Additionally the following options can be selected:
Allow Scaling When enabled, Planmeca Romexis will stretch the surface model to achieve
better fit with the CBVT volume. Note that this may alter proportions of the surface model.
Fine Tune Match
When enabled, Planmeca Romexis will analyze the anatomy around each control point and
uses the actual anatomy for best possible fit.
When disabled, Planmeca Romexis will minimise the deviation between the three control
points in each data to get the closest fit with no additional analysis.
10.To import crown(s) repeat the above process starting from step 1.
11.After the step 3. the following dialogueue opens.
12.To use the same match for crown placement as for the surface click Use Existing Match
button.
The crown will be automatically placed into the exact same area where it was placed in the
crown planning software.
EXPLORER
2.9 Exporting 3D Images
Export File Type
Planmeca Romexis can export 3D volumes in 3 different formats:
Single Multi Frame DICOM File
A single DICOM standard file that contains the 3D image data in a set of frames.
Export Viewer with Multiframe image
Enables export of volume frames together with an additional viewer program. Both the 3D
viewer program and the images will be saved to one folder. This allows you to burn the folder
on a CD and view it on a computer without Planmeca Romexis or the DICOM viewer program.
Create ISO image with Viewer & Multiframe
Creates an CD ISO image file that can be written to a CD using any 3rd party CD writer utility.
To start the start the 3rd party CD writing utility double-click the exported ISO image file. Use
this option in case that the Burn Viewer with Multiframe on CD does not work on your
computer.
Burn Viewer with Multiframe on CD
Allows direct writing of a Viewer CD with the currently open 3D volume onto a CD. Before
using this option make sure that there is a BLANK writeable CD-R or CD-RW disk in the CD
drive.
EXPLORER
Set of Single Frame DICOM Files
A set of multiple DICOM standard files each of which contains a single Frame of the 3D
Image data.
If images are to be exported as they were originally captured, tick the Export Original (not
rotated) selection. All rotations and translations done to the image afterwards will not be
exported with this function.
After inserting a blank writeable CD click OK to start the CD creation and writing process.
Resolution
The desired resolution to be used for exporting DICOM files can be set here.
Bit Depth
Select the volume bit depth, 12 or 15 bits.
Include Nerves and Implants
Export voxel representation of nerves and implants (as cylinders) present in the study. Nerves
and implants cannot be edited after export. Implants are exported as realistic models if a
suitable model is available in the Implant library. In case there is no corresponding model
available the implants will be exported as 3D cylinders.
Export Cropped
Export cropped volume if cropping has been applied.
Anonymize
Remove personal identification information from the export DICOM file.
EXPLORER
2.9.1 Exporting 3D images as STL surface models
Planmeca Romexis allows exporting a STL surface model of some 3D images such as CBVT
volumes of dental impressions created using the Digital Cast feature (for more information
see section Converting dental impressions into actual dentures (Digital cast conversion tool)
on page D-44.)
Exporting as STL surface models allows the re-use of such models in any 3rd party software
that supports the STL standard format.
To export a STL file:
1. Open the CBVT volume that you want to export.
2. Adjust the 3D Rendering threshold value so that the surface that you want to export shows
cleanly.
3. From the File menu select Export > Export Volume as STL
3D Rendering view to be exported as STL
EXPLORER
4. The following window opens.
The following settings can be adjusted:
Normal or Low resolution
The resolution selection affects the amount of detail in the exported STL file. Using Normal
resolution also results in a larger file size
Apply smoothing
The exported STL surface is smoothed resulting in a more pleasant look with a possible loss
of detail.
Export Cropped
Select this option to export the STL of the selected crop region only. You can adjust the crop
region by drawing a box around the area that you want to export.
EXPLORER
TIP! You can preview the crop result in real-time in the 3D Rendering view where it can also
be rotated while the STL Export dialogue is open.
Folder
Select the folder where to export
Filename
Name the file to be exported
5. When finished with adjusting click OK.
6. Planmeca Romexis will now export the STL file.
The STL file can now be used in 3rd party software for further processing or imported back to
Planmeca Romexis using the STL Import, see section 2.8 Importing intraoral scans in STL
format on page D-19 for more information.
Crop result preview in 3D rendering
Sample view of post-processing the STL model in 3rd party software.
EXPLORER
2.10 Saving 2D views
Clicking the Save 2D View button exports the current view from the screen and imports it
automatically to the Planmeca Romexis 2D Imaging Module (see chapter C 2D IMAGING
MODULE) where all the 2D image processing tools can be used.
In the appearing window you can select one or more viewports by clicking them. To reselect,
click on the empty space of the viewport. This selection enables you to choose specific
images to the 2D Imaging Module.
TIP! To include only one view panel in the snapshot eg Cross Sections, maximize that view
in Planmeca Romexis before opening the 2D Snapshot dialogue.
There are 4 options for generating 2D snapshots:
Color image; if this option is checked an 8 bit color image will be created. If the option is
unchecked a 12 bit gray scale image is created.
Create single image; if this option is checked one single image is created. If this option is not
checked single images from different views will be created.
High resolution; doubles the resolution of the image. This option is useful for low resolution
images on which the labels may appear grainy.
Large fonts; larger label font for improved readability.
EXPLORER
MultiPanel division
If a greater number of slices is to be created than what is shown in the preview, the
MultiPanel Division selection can be used to achieve this. By default Create Snapshots as
shown on screen option will be used. MultiPanel Division is most useful when a large number
of slices (usually over 30) are processed so that they would not conveniently fit in one
reasonably sized image. Such large number of slices are needed for example when
multipage printouts are to be created. MultiPanel Division is best used together with Full Arc
View that allows better visualization and navigation of large number of cross sectional slices.
Please see section 4.2 Full Arc Mode for more information.
NOTE The 2D Snapshot dialogue is a shared feature with 3D Printing and all of the below
applies to defining views for printing as well.
To specify a customized view panel division enable the Specify panel division option and
continue as follows:
1. Select the panels that you want to modify by checking the tick box next its label. If you leave a
panel deselected its default snapshot as shown in the preview will still be generated unless
you also deselect that by clicking on the preview.
2. For each selected panel specify the range of slices that you want to generate. For Axial and
Panoramic views a maximum of 8 slices can be generated at constant distances through the
volume. The Range maximum is defined as follows:
a. Axial and Panoramic: The size of the volume divided by the distance between slices. For
example for 80 mm high volume with 1mm axial slice distance a maximum of 80 axial slices
can be generated.
b. Cross Sectional: The length of the panoramic curve divided by the distance between cross
sectional slices. For a full jaw panoramic curve totalling 180 mm in length and with 1 mm
cross section distance a maximum of 180 cross sectional slices can be generated.
3. Use Divide Into drop down to create a desired number of images of each panel. Further use
Cols and Rows values to set how slices are distributed on the final image. The Image Size
allows the user to estimate snapshot dimensions and fit on a portrait or landscape media.
4. Click OK to generate snapshots as specified.
EXPLORER
2.11 Windows printing / Print Editor
Click the Print button to start printing to a Windows printer. Select view ports to print from the
Select Print Views dialogue and how to divide them in PrintEditor. To open images in Print
Editor click OK. For more detailed information see paragraph 13 DICOM STORAGE &
STORAGE COMMITMENT (OPTIONAL) on page C-50. for instructions on how to use the
multipane division please see paragraph 2.10 Saving 2D views on page D-29.
EXPLORER
Example case for creating a multi-page printout.
Original data: Planmeca ProMax 3D volume with general anatomy.
End result:
7 page printout
3 panoramic images on one page
12 axial slices on one page
120 cross sections at 1mm distance between slices, spanning 5 pages. This example
assumes that the panoramic curve is exactly 120 mm long but any length can be used
although division may need to be adjusted. Slice distance is set to 1 mm, slice thickness to
1mm and slice width to 25mm.
No rendering included
7 page Print Template that will allow easy generation of similar prints easily.
Steps:
1. Using Cross Section or Implant module turn on Full Arch Mode and see section 4.2. for typical
workflow suggested.
2. Set Axial viewport to show 12 slices using the viewport settings. Set desired slice distance,
thickness and position for good coverage.
3. Set Panoramic viewport to show 3 panoramic images with desired distance and layer
thickness.
4. Turn Show every fifth section on and Panorama referenced off in Show/Hide Settings for
better clarity if desired.
5. Start Print Editor.
6. In Select Print Views dialogue click on 3D rendering to exclude it.
7. Enable Specify panel division under MultiPanel Division and:
Disable Axial division by deselecting the Axial check box. Axials will be generated as shown
in the preview.
Disable Panoramic division by deselecting the Panoramic check box. panoramic images will
be generated as shown in the preview.
Leave Sectional division enabled and:
Leave full range specified (1-120 in this example)
Set Divide Into = 5
Set Cols = 6 and Rows = 4. These setting will produce cross sectional images that are 149
x 220 mm in dimensions and will nicely fit on A4 paper.
EXPLORER
8. Set other Snapshot Options as desired. See for example below.
9. Click OK to create print images.
10.In Print Editor set page to portrait in Page Setup.
11.Use Add New Page to add 6 New Empty Pages. Use Add copy of current page if you want
to copy the image slots and their settings as well.
12.Select the axial slice image, right click on it and choose Move to Page > 2. You may need to
adjust the image scale to make it fit on the page.
13.Repeat the above for each cross section slice image and move them to pages 3 through 7.
Align each image to its page. Use Labels to add slice thickness, distance and other
information if required.
14.You can call up the Image Browser to add 2D Exposures or 2D Snapshots into the printout if
desired.
15.Use Labels to add page numbers and other information. See below for finished page layout.
16.The finished layout can be saved as a Print Template using the Save Layout button. Next
time a similar print is created you only need to create the corresponding images and use
Select Layout and choose the template that has been created. Planmeca Romexis will
automatically place all images onto correct pages and slots.
EXPLORER
2.12 DICOM Printing /Print Editor
Click the DICOM Print button to start printing with DICOM compatible printers. See
paragraph 2.11 Windows printing / Print Editor above.
NOTE For help on configuring DICOM print, see section G DICOM Configuration in chapter
G ADMIN MODULE.
2.13 DICOM Storage
In case a full DICOM license is purchased, images can be sent to a remote DICOM
application, i.e. DICOM image archive (PACS). DICOM Storage needs to be configured in the
Admin module before the DICOM Storage service can be used, see chapter G ADMIN
MODULE.
Open the image you want to store and click the button. Click OK in the opening dialogue.
NOTE Images can also be automatically stored to the DICOM archive after capturing, see
section G DICOM Configuration in chapterG ADMIN MODULE.
EXPLORER
2.14 Creating virtual cephalometric images
Virtual Cephalometric can be used to generate 2D cephalometric images from 3D volume
data and save them into patients 2D images. Different projections and composition algorithms
can be used and the volume orientation can be freely adjusted for best results.
To orientate the volume press:
To rotate and align the volume Left mouse button. Note that the projection is perspective free
so the close and far anatomy can be aligned perfectly.
To rotate the volume sagittally (nodding) Ctrl + right mouse button.
To adjust contrast and brightness Ctrl + left mouse button.
Use the Direction buttons to choose from which direction the cephalometric image should be
generated from. These can be used together with crop options so that the far side of anatomy
is removed from the cephalometric image creating an image where duplicate anatomy does
not need to be considered. Enable Rulers check box to have a ruler shown on the image.
EXPLORER
To use different algorithms for the calculation of the cephalometric image use the Calculation
Method drop down:
Default: Produces the most film like quality in the image.
Flat: Flattens the image by reducing contrast differences between areas in the image.
Log: Uses logarithmic mapping to add contrast in the image.
2.15 Launching external applications
A 3D image with patient information can be automatically transferred to a 3rd party
application with the Launch button. The 3rd party application path is defined in chapter G
ADMIN MODULE, see section G LOCAL SETTINGS. Open the 3D image that you want to
transfer and click the Launch button.
3D volume Brightness/Contrast and settings, thickness and the position of the volume are
automatically saved when the image is closed. In addition the 3D Views tools can be applied
to save the currently displayed views.
2.16 Adjusting levels (contrast & brightness)
NOTE If the adjustment of the 3D volume rendering is not satisfactory, the adjustments can be done
manually in the Input Values window. A histogram is a graphic representation of the
intensity distribution in the volume.
To adjust the gamma curve move the green line in the histogram. The value is displayed in
under the histogram in the middle field.
To adjust contrast and brightness the histogram can be cut from both ends by moving the red
lines (see The Adjust tools can be applied on the slice views, meaning the coronal, sagittal
and axial view, and they enable the enhancement, examination and measurement of the
views. on page D-41).
Scale histogram
By pressing the arrows in the middle, the histogram can be scaled up or down. The button
restores the original scale of the histogram.
EXPLORER
Threshold
The black line increases or decreases the threshold and consequently has the same function
than the slider Set 3D Rendering Cutoff Threshold.
Pseudo Colour modification
The buttons left and right of the gamma value, named F and R, modify the pseudo colours.
Pressing the button alters and allocates the colour selection for different tissues
automatically, based on the curve of the histogram. To modify the Pseudo Colours manually,
drag the rectangles above the histogram left or right. With this, the position and range of the
specific colour can be altered. By double clicking the rectangle, the colours can be changed
for an individual selection. The button resets the settings of the Pseudo Colours. From
the arrow button ready made color maps can be selected.
2.17 Measuring angles in images
Click the icon to draw an angle into a slice view by pressing the left mouse button down. Drag
to draw the first line and then click and drag to draw the second line.
2.18 Measuring length
Measure length over single or multiple points. Measure Length is a dual mode button: hold
down mouse button to call up mode selection between Single measurement and polyline
measurement.
Single measurement use to measure length between 2 points (default). Hold down left
mouse button to define measurement, release mouse button to finish.
Polyline measurement use to measure length over multiple points. Draw the line by
pressing the left mouse button down, release mouse button to finish.
NOTE All measurements are automatically stored as saved views, use the Open Saved View
button to call them back to view. For information on editing measurements see 4
VOLUME ADJUSTMENTS on page D-41.
2.19 Saving the current view
Saves the current displayed view. Enter a name to the opening dialogue.
2.20 Opening a saved view
Opens a previously saved view.
2.21 Deleting a view from the saved views
Delete one of the saved views from a list.
EXPLORER
2.22 Resetting a view to default orientation
Restores the original orientation and settings of the views.
2.23 Using the Zoom Mode
When the Zoom Mode button is activated the sliced views can be scaled up and down. Move
the mouse pointer over the desired view and turn the mouse wheel into the appropriate
direction (up to zoom in, down to zoom out).
NOTE When the Zoom Mode button is deactivated, turning the mouse wheel over a view will
scroll through the image layers as the Layer Slide Bars do (see 3.1 Layer Slide Bar
and Maximize button on page D-39).
NOTE The rendered volume can be zoomed with and without the Zoom Mode button
activated.
2.24 3D Image Properties
Click the Properties button to view Image properties or add an image comment.
2.25 Deleting a 3D Volume
A 3D volume can be deleted with the Inactivate button. The volume moves to trash and can
be deleted permanently or reactivated in the Planmeca Romexis Configuration Application
(see chapter I PLANMECA ROMEXIS CONFIGURATION APPLICATION).
NOTE Deleting can be restricted with user rights. See section G Permissions tab sheet in
chapter G ADMIN MODULE.
SLICE SPECIFIC TOOLS
3 SLICE SPECIFIC TOOLS
The slice specific tools are located vertically next to each slice viewport (axial, sagittal,
coronal).
3.1 Layer Slide Bar and Maximize button
Pressing the Maximize button at the top right corner of a viewport opens the
corresponding view into a full size window.
A Layer Slide Bar is located at the right border of the coronal, sagittal and axial view.
In each case the slide bar can be moved to scroll through the image layers of the
corresponding view. For example, scrolling the slide bar of the coronal view up and down
moves the view inside the layers forward and backwards. The corresponding orientation lines
in the two other views as well as the auxiliary plane in the 3D rendered view automatically
move to the appropriate position, to reflect the change.
NOTE It is also possible to scroll through the image layers using the mouse wheel, when the
Zoom Mode is deactivated (see The Adjust tools can be applied on the slice views,
meaning the coronal, sagittal and axial view, and they enable the enhancement,
examination and measurement of the views. on page D-41).
3.2 Layer and Curve Slide Bar
A slide bar is located at the right border of each view, sagittal, axial and panoramic. In the
sagittal and axial view the slide bar can be moved to scroll through the image layers. This
means that scrolling the slide bar of the axial view up and down moves the view inside the
layers forward or backwards. The corresponding orientation lines in the sagittal and
panoramic view automatically move to reflect the changes.
Moving the slide bar of the panoramic view modifies the radius of the panoramic curve and
the change is immediately reflected in the axial view by the panoramic curve moving in or out
in relation to the patients anatomy. When the slider is released, the panoramic view is
automatically updated with the new curve.
3.3 Snap shot tool
With snap shot tool a 2D snapshot can be quickly created out of a 2D image for single
view.
3.4 Volume mirroring
Reorients volume in the viewport as follows:
Coronal: Anterior vs Posterior
Sagittal: Lateral vs Contralateral
Axial Upper vs Exterior
SLICE SPECIFIC TOOLS
3.5 Adjusting Explorer Layer Settings
Explorer layer settings dialogue can be opened by clicking on the button in the top right
corner of each 2D viewport. The number of images, layer thickness and distance between
layers can be set individually for each viewport (coronal, sagittal, axial).
VOLUME ADJUSTMENTS
4 VOLUME ADJUSTMENTS
Volume Adjustments at the far right contain Explorer-specific image processing tools.
The Adjust tools can be applied on the slice views, meaning the coronal, sagittal and axial
view, and they enable the enhancement, examination and measurement of the views.
4.1 Adjusting thickness
Defines the displayed slice thickness of the slice views.
The resampling/thickness can be adjusted from the drop-down menu. The option Bilinear
applies a bilinear interpolation filter on the thinnest slice data, resulting in a smoother but less
detailed image.
NOTE This setting will override viewport specific layer thickness settings.
4.2 Adjusting contrast, brightness and sharpness
Adjusts contrast, brightness and sharpness of the coronal, sagittal and axial view. By
dragging the sliders the brightness and the contrast can be adjusted. These settings are
alternatively called Window and Level. The settings are saved automatically when the image
is closed
Sharpening can be done using the rightmost slider. Best results are achieved using thicker
layer settings (2-5 mm).
4.3 Exporting Views To Other Tabs
Exports the current displayed view of the slices to the Panoramic and Cross Sections tabs.
The processed slices are shown in the other tabs like in the Explorer.
VOLUME ADJUSTMENTS
4.4 Cropping Volumes for 3D Rendering
Crop Volume for 3D Rendering crops the rendered volume. It is applied over the sliced views
but affects only the 3D rendered volume view.
After pressing the Crop button, move the mouse pointer over one sliced view. Press the left
mouse button and a white framed rectangle appears. By dragging the mouse on the view the
cropped area can be defined. The rectangle also appears in the two other sliced views, as
reference to define an exact area for the cropping. In case volume has not been rotated a
preview of the cropped volume is shown instantly. The cropping operation is finalised with
mouse right-click. The cropped rendering is automatically centered when right mouse button
is clicked. The cropping can be adjusted by turning on the cropping feature and moving the
crop box or adjusting the cropping boundary by dragging its corner points.
4.5 Showing / Hiding settings
To set up the display of the orientation overlays, press the Show / Hide Settings button. In the
Show/Hide Settings window you can select the overlays to be shown.
NOTE Cross sectional slice numbering can be changed between ordinal and panorama
referenced.
VOLUME ADJUSTMENTS
4.6 Using the Volume Reslicer Tool
The Volume Reslicer allows to create a new set of projections that can be sent to Dicom
storage as a 3D volume stack. Thus the 3D volume can be more conveniently viewed in some
3rd party DICOM viewers that do not allow free reorientation of the data in axial, sagittal and
coronal views. The Reslicer allows a stack of slices perpendicular to the mandible to be
stored into PACS instead of the standard stack of axial slices for example.
To use the Volume Reslicer open the 3D volume that you want to reslice before queuing it for
DICOM Storage to a PACS server and click on the Volume Reslicer button under the Adjust
menu.
Defining Source Data
Use the Source drop-down menu to choose the projection that you want to use as a basis for
the new stack. The new stack slices will be perpendicular to the source projection so that the
Axial source allows generation of coronal and sagittal like slices.
Use the Draw Arc and Edit Arc tools to define a line or arc that is used as the direction of the
resliced stack. The new slices will be perpendicular to this line and the source projection. The
new stack of slices is generated immediately after the arc has been drawn and a preview is
available on the right. The preview allows adjusting the stack slice settings of distance, width
and thickness, as well as mirroring of the slices.
To send the result to DICOM Storage queue use the Send to Storage button and use Include
Source view in stack option to include the source view in the final stack if preferred. Note that
the resulting stack will not be available in Planmeca Romexis after the Volume Reslicer
Window is closed.
4.7 Moving and rotating volumes
Toggles editing mode to move/rotate volume and annotation and measurement editing. Use
the left mouse button to move and right button to rotate the volume. Select an annotation or
measurement to activate handles for editing the control points.
To change the position of the slice views (axial, coronal and sagittal) disable the tool to allow
grabbing and draggoing the slice rulers around.
VOLUME ADJUSTMENTS
4.8 Converting dental impressions into actual dentures
(Digital cast conversion tool)
With Digital Cast conversion tool the dental impressions (negative) generated in Planmeca
ProMax 3D Impression Mode can be converted into digital models representing an actual
denture (positive). The tool can be used to replace plaster casts (in certain cases).
The digital casts can be used for electronic archiving of the impressions or they can be turned
into STL surface models for further use in Planmeca Romexis or other treatment planning
software.
For more information on how to work with STL models see section 2.9.1 Exporting 3D
images as STL surface models on page D-26 and section 2.8 Importing intraoral scans in
STL format on page D-19.
To produce digital casts
1. Acquire a CBVT scan of dental impression using Planmeca ProMax 3D Impression Scan
mode.
2. Make sure that the scan is approximately centred in Planmeca Romexis as indicated in the
Digital Cast dialogue.
3. Open the Digital Cast dialogue by clicking this button.
The positioning of the volume can be adjusted while the dialogue is open.
4. When finished click OK.
Planmeca Romexis now produces a Digital Cast CBVT model. Please wait while the data is
being processed. This may take a few minutes.
VOLUME ADJUSTMENTS
5. The Digital Cast (positive) model opens in the 3D Explorer.
If the model doesnt show correctly in the rendered view, adjust the threshold setting slider
under 3D Rendering Adjustments until the surface is shown cleanly.
NOTE Due to large file size digital casts are not automatically saved.
To store the Digital Cast model for later use, export the model into a small STL surface
model. For more information see section 2.9.1 Exporting 3D images as STL surface
models on page D-26.
NOTE The Digital Cast operation is highly memory intensive. If you receive a low memory
warning during Digital Cast operation increase your Planmeca Romexis memory
reservation. For more information see section 5.1.2 Java VM Parameters on page I-28
3D ANNOTATIONS
5 3D ANNOTATIONS
The 3D Annotations tools can be used to place text annotations on 3D slices. The location of
text and point of interest can be moved after placement. All 3D annotations including region
growing results are stored as saved views.
Add text
Click the icon and point with the mouse where you want to add the text. Type the text to the
opening window and click OK.
To edit the text later select the text with the Select annotations button (see below) and then
double-click the text. Edit the text and click OK.
Add arrow
Place text annotation with dot point of interest indicator. Click on a location to start placement
and indicate point of interest, enter text to finish and adjust location of text label. Place text
annotation with arrow point of interest indicator. Click on a location to start placement and
indicate point of interest, enter text to finish and adjust location of text label.
Draw rectangle
Use this tool to draw a rectangle
Draw an ellipse
Use this tool to draw an ellipse.
Measure cube
Use this tool to measure a cubic area in the image.
Measure ellipsoid
Use this tool to draw and measure an elliptic area in the image.
Region growing tool
Use this tool to accurately determine the required amount of biomaterial in the target. The
Planmeca Romexis calculates the area using the gray scale. If this tool is inactive click the
Reset view button on the master toolbar on top of the screen.
NOTE Due to the technology used in CBVT imaging the calculated HU-values are
approximates and may vary between patients depending on individual anatomy,
volume size and other factors. Therefore the calculated HU-values should be
considered as relative reference values only and they must not be depended on as
absolute values.
3D ANNOTATIONS
5.1 Using the region growing tool
Presets
There are four presets for using the region growing tool:
Bone for determining the amount of bone in the area in question
Soft Tissue for measuring the amount of soft tissue
Air cavity for measuring the dimensions in the air cavity
Root cavity for measuring the dimensions in the root cavity
Threshold
Voxels with values differing (either higher or lower) from the seed point less than the
Threshold setting are included in the region
Advanced options
Pre-Smooth Data
Use this option to filter voxel data before region growing for less noisy result.
NOTE This setting may cause very small features to be lost.
Always include lower
Include voxels with values lower than the seed value in the region regardless of the threshold
setting. Use this setting for segmenting air cavities.
Always include higher
Include voxels with values higher than the seed value in the region regardless of the threshold
setting. Use this setting for segmenting bone.
3D ANNOTATIONS
Post-Smooth Region Grow Result
Use this tool to remove noisy voxels from the region grow result. This setting may cause very
small features to be lost.
NOTE The settings Always include lower / higher should not be used together since this
selection would always include whole volume in the result.
Use Local Threshold / Local Threshold slide bar
This setting is useful for segmenting areas with slow gradients, if the current voxel value is
outside of the Threshold range but very similar to the previous neighbouring voxel included in
the region (difference is less than the Local Threshold setting).
This setting prevents false contours in the segmentation result caused by slow gradients.
Color
Click the colour map to select the colour for region growing marking and click Redo.
3D ANNOTATIONS
3D RENDERING
6 3D RENDERING
There are two different 3D rendering styles available in Planmeca Romexis; Surface style and
X-ray style. 3D rendering style is selected from Planmeca Romexis Admin module. The
default rendering style is Surcafe Style.
The 3D Rendering tools can be applied to manipulate the rendered volume.
You can pan the rendered volume around by dragging it while pressing the middle mouse
button (or alternatively holding down left and right mouse buttons while dragging). To re-
center the rendering right click on the new center point (only available on Surface rendering
style).
6.1 Setting 3D Rendering Cutoff Threshold
Moving the slider determines the threshold for which gray scale values are shown in the 3D
rendered view.
Surface style rendering X-ray style rendering
3D RENDERING
6.2 Adjusting 3D Rendering Transparency
Moving the slider to the top increases the transparency of the 3D rendered view.
Show Pseudo Colours in 3D Rendering
Available only in X-ray Style rendering. In Surface rendering Pseudo colouring is always on.
Clicking this icon changes the greyscale to colours. In the Adjust Levels window of the 3D
Rendering, the colours for the different tissues can be modified.
Rotate Light Direction
Available only in Surface Style rendering.
6.3 Rendering Orientation Tools
The rendered volume view has three coloured planes indicating the coronal, sagittal, and
axial planes. These planes help you in orienting the three slice views in relation to the 3D
rendering and actual anatomy. The planes can be shown/hidden by pressing the
corresponding buttons at the right side of the rendered volume views as follows:
Show coronal plane (green).
Show sagittal plane (red).
Show axial plane (blue).
Show / Hide all planes.
The following options are also available:
Show/Hide Volume Boundaries:
The 3D volume is by default surrounded by a volume boundary box that may in some cases
help properly orienting the 3D volume. Use this button to turn the boundaries on/off.
Show Perspective in 3D Rendering:
This button will turn on linear perspective that provides a more natural view of the anatomy.
By default the rendering is shown in an isometric style that has no perspective effect.
When in the default non perspective mode, hold down the right mouse button and move the
mouse up and down to produce a slicing effect in which the anatomy is sliced out as you
move the mouse up. This effect can be used to slice of thin layer of the anatomy or to clear
obstructing anatomy from the view for example.
3D RENDERING
Show/Hide Orientation Lines:
Toggles visibility of orientation lines and measurements in rendered view only.
Rendering overlay
3D Rendering overlay allows volumetric coloring of the 3D volumes based on the gray scale
values in the image. It allows coloring of soft tissue and airways for example enhancing the
informative value of the 3D rendering. Use the Show Overlay to turn the overlay on/off and
the Overlay Properties to specify the qualities of the overlay present in the image.
Show Overlay Turn the overlay on/off. If no overlay is defined then the Overlay Properties
dialogue is automatically presented (see below). On large volumes please be patient as the
display of the overlay may take a while at each time the volume is first opened.
Overlay Properties The following properties can be defined for the overlay.
Color Specify the color that the chosen gray values should appear in.
Threshold Specify the grayscale value to be colorised (between 0-4095).
Transparency Specify the level of transparency of the overlay against the rendering. 0%
for fully opaque and 100% for fully transparent.
Smoothing - Applies a smoothing filter on the 3D rendereing
3D RENDERING
6.3.1 3D Rendering Options
Set Rendering Options
The following options are available for Surface style rendering.
To set current rendering setting as the custom preset click the Add button. The currently
selected option will be shown in the thumbnail circled with white line. To delete the current
custom preset click the Del button.
NOTE 3D rendered view quality can be changed in Planmeca Romexis Admin module, see
chapter
G ADMIN MODULE.
Table 2: Rendering presets
Rendering presets
1. Maximum Intensity Projection MIP
2. X-ray
3. X-ray shaded (default)
4. Shaded
5. Shiny
6. Surface
7. Black & White X-ray
8. Soft tissue
3D PANORAMIC MODULE (OPTIONAL)
7 3D PANORAMIC MODULE (OPTIONAL)
In the 3D Panoramic Module panoramic views can be generated from the 3D data. The
panoramic image generated can be adjusted and processed in multiple ways. The image
range and thickness can be defined as well as the selection of the appropriate curve for the
construction of the panoramic view. Also an export of the displayed view (with Save 2D View)
to theC 2D IMAGING MODULE can be done. The image can also be printed from
Panoramic Module.
The Panoramic tab contains four views:
Sagittal view, where the sagittal orientation of the 3D volume can be rotated.
Axial view, where the axial orientation of the volume can be rotated and where the
panoramic curve is defined and shown.
Panoramic view, where the generated panoramic image is shown.
3D Rendered view
By turning the mouse wheel on top of the sagittal or axial view, the view can be zoomed in or
out.
Holding down the left mouse button while dragging the Axial or Saggital view will move the 3D
volume, and holding down the right button will rotate it. Refreshing the views may take a
moment.
7.1 Using panoramic tools
With the Panoramic imaging tools, the panoramic view can be defined and adjusted by
drawing a curve to the axial view and choosing a range to be displayed.
Drawing panoramic curve
Planmeca Romexis automatically places the panoramic curve. To define a new curve, click
the Draw Panoramic Curve icon. Use the left mouse button to place points for the curve on
the axial view. When you are done, click the right mouse button and the new panoramic view
will be calculated.
NOTE All created panoramic curves will be saved and listed in the Select Panoramic Curve
option.
Editing panoramic curve
To edit the curve, click the button and move single points in the curve or even the whole curve
by grabbing the green line of the curve. Change the position by dragging the points or the
entire curve with the left mouse button. To finish editing, click the icon again.
Selecting Panoramic Curve
Pressing this button shows a list of all saved panoramic curves. All curves you draw are
saved and named with the date and time they were created. Click on an entry to recall and
apply that curve.
Deleting Current Panoramic Curve
Clicking the Delete Current Panoramic Curve icon deletes the panoramic curve currently
displayed. The standard curves are not deleted.
Adjusting panoramic images
From panoramic view upper right corner adjustment dialogue can be opened by clicking the
button.
The number of panoramic images, the layer thickness and the distance between panoramic
images can be defined in the opening dialogue.
Adjusting 3D rendered view
See paragraph 6 3D RENDERING on page D-50.
Defining data range
By pressing the Define Data Range button the area of interest for the panoramic image can
be defined. You can select from which part, lower or upper jaw, the panoramic image is
created. In the appearing window move the sliders up or down to adust. The left slider
restricts the upper jaw and the right slider the lower jaw.
7.2 Moving and rotating volumes
Toggles editing mode to move/rotate volume and annotation and meassurement editing. Use
the left mouse button to move and right button to rotate the volume. Select an annotation or
measurement to activate handles for editing the control points.
7.3 Show/hide renderer
Allows showing and hiding of the 3D rendered view.
3D CROSS SECTIONS MODULE (OPTIONAL)
8 3D CROSS SECTIONS MODULE (OPTIONAL)
NOTE In case you have purchased Planmeca Romexis Implant license the Cross Sections tab
will be replaced by an Implant tab. All features described below for Cross Sections will
be available under the Implant tab. See 9 IMPLANT MODULE on page D-64.
In the 3D Cross Sections Module cross sectional slices, axia slices and panoramic images
can be created from the 3D data.
The Cross Sections tab contains four views:
Axial views
Panoramic view
Cross sectional slices view
3D rendered view
The views can be expanded by clicking the small dual arrows in the end of the view dividers
or maximized by clicking the Maximize button.
Axial view
Panoramic
view
Cross-sectional
sices view
3D rendered
view
8.1 Adjusting slices in cross sections views
Clicking this button in the upper right corner mirrors the cross sections.
Clicking theis button in the upper right corner of the cross sections view opens a dialogue
where the number of cross sectional slices, the distance between them, and the width and the
thickness of the slices can be defined.
NOTE The 3D Panoramic Module and 3D Cross Section Module share the same panoramic
curve and data range definition. Therefore when one is changed in either of the tabs,
the changes will be reflected in the other tab as well. Sagittal or axial rotation of the 3D
volume is defined in the Panoramic Module and also affects the Cross Section Module.
8.1.1 Edit Cross Sectional Slice Interval
To edit the cross sectional slice interval, move the slider up or down. If the section lines are
activated in the Edit Orientation Lines (see 8.6 Nerve tools on page D-62) the adjustment is
visible in the axial view, indicated by the yellow lines. After moving the slider the cross
sectional view gets updated accordingly.
8.1.2 Edit Cross Sectional Slice Width
To edit the cross sectional slice width, move the slider up or down. If the section lines are
activated in the Edit Orientation Lines (see 8.6 Nerve tools on page D-62) the adjustment is
visible in the axial view, indicated by the yellow lines. After moving the slider the cross
sectional view gets updated accordingly.
8.2 Full Arc Mode
Full Arc Mode allows the whole arc specified by the panoramic curve to be processed as
individual cross sections. This mode is most useful when the user wants to produce a print
out of cross sections covering the whole jaw anatomy. Differences between the normal
editing and Full Arc Mode are listed in the following table.
Table 3: Normal mode and Full Arc mode comparison table
Normal Mode Full Arc Mode
Moving Cross
Sections
Free Limited to intra slice increments
Printing and 2D
Snapshots
Maximum number of cross
section reference lines shown in
Axial and Panoramic view is
what is currently shown in the
Cross Section browser.
All cross sections reference
lines can be shown. Maximum
number is defined by length of
panoramic curve and distance
between slices.
Cross Section
numbering
Previous setting is remembered Ordinal numbering is used by
default
Typical use case
3D image diagnosticsc done in
Planmeca Romexis only
Complex printouts where
measurements must be
available on all or most cross
sections.
Typical workflow
1. Browse and rotate volume
freely to make findings
2. Use views and
measurements to indicate
findings.
3. Use saved views to return to
findings and measurements
when necessary
1. Align volume optimally for
best compromise between
Panoramic coverage and Cross
Sectional alignment. No volume
re-alignment should be done
after this point to prevent
existing measurements from
not being shown on Cross
Sections.
2. Turn on Full Arc Mode to limit
movement of Cross Sections.
This ensures that
measurements made on Cross
Section always remain visible in
them.
3. Save View is used so that the
selected volume alignment can
be restored if volume needs to
be re-aligned between
measurements.
4. All Cross Sections are
processed and measurements
made on them where required.
5. When all Cross Sections
have been processed they are
all printed out in a multi-page
printout.
8.3 Adjusting axial slices
Clicking the button in the upper right corner of the axial view opens a dialogue where
the number of axial slices, the distance between them and the thickness of the slices can be
defined.
8.4 Adjusting panoramic slices
Clicking the button in the upper right corner of the panoramic view opens a dialogue
where the number of panoramic slices, the distance between them and the thickness of the
slices can be defined.
8.5 Cross sectional scroll bar
At the top of the Cross Sectional View is a scroll bar for to move the cross sections. Moving
the scroll bar right or left shifts the visible slices to the corresponding direction along the
panoramic curve. If the Cross section lines option is activated in the Edit Orientation Lines
(see 8.6 Nerve tools on page D-62), they also get shifted in the axial and panoramic view.
The middle section is indicated by a bright red line and by a bright red ruler in the cross
sections view.
Using the Cross sectional scroll bar
1. Click on the end arrows to move cross sections voxel by voxel.
2. Drag the scroll box to freely move cross sections around.
3. Click between the scroll box and end arrows to move cross sections in increments of the
distance between the slices.
NOTE Full Arc mode will modify the behaviour of the cross sectional scroll bar.
8.6 Nerve tools
The Nerve tools at the bottom right enable to add and modify nerve channels to the views.
Drawing nerves
To draw a new nerve channel click the Draw Nerve icon. Use the left mouse button to place
points either on the panoramic or on the cross sectional view for a curve depicting the nerve
channel of the patient. When you are done, click the right mouse button and the nerve
channel will be displayed as a coloured line in the panoramic view and as dots of the same
colour in the cross sectional views.
Deleting nerves
This option deletes the currently selected nerve channel. To select an existing nerve channel,
point the mouse on it and press the left mouse button or open the List of Nerves. If no nerve
channel is selected, the action has no effect.
Managing nerve properties
By clicking this icon the properties of a nerve channel can be adjusted. A window opens
where you can name the nerve and modify the colour and diameter. To change the properties
a nerve needs to be selected. To select an existing nerve channel, point the mouse on it and
press the left mouse button or open the List of Nerves and select the nerve from the list.
Listing nerves
The option List of Nerves shows a listing of all nerves visible in the Cross Sectional tab. In the
opening window nerves can be selected and deleted and their properties can be changed. To
delete a nerve (deletes the nerve from both the list and the cross sectional tab), select a nerve
and click the Delete button. To change the properties of a nerve, select a nerve and click the
Properties button. The Nerve Properties window will appear (for further information see D
Managing nerve properties).
IMPLANT MODULE
9 IMPLANT MODULE
Planmeca Romexis Implant module provides tools for planning an implant placement inside a
3D volume. The Implant module extends the Cross Sections module and shares all features
that it provides. For information on common tools with Cross Sections module such as cross
section, panoramic, and nerve adjustments, refer to 8 3D CROSS SECTIONS MODULE
(OPTIONAL) on page D-58.
Selected implant are available in accurate silhouettes in 2D slices allowing more acurate
panning of implant sites. Planmeca Romexis Implant module is designed to allow quick and
effortless placement of implant models into the 3D volume with minimum number of mouse
clicks.
9.1 Placing implants
1. Add implant to the plan by using a default choice, drawing to size, or a specific model from
library.
2. Place the implant to the correct location and use control handles to orient it to match the
patients anatomy. You can use all available views (panoramic, axial, cross-sections and
rendering) for placement and orienting. To reorient the implant in the rendered view hold
down the CTRL+SHIFT keys while grabbing the implant from its control points.
3. You can change the size of the implant model from the Properties window, or in the Implant
Library.
IMPLANT MODULE
4. Verify margins and orientation by using the Impant Verification tool and place next implant.
For more information on how to use the tool see section 9.4 3D Implant Verification Tool on
page D-70.
9.2 Implant placement tools
Add default implant
Use Add default implant tool to place a pre-selected default implant into the plan. The default
implant can be defined in the Implant library.
Free draw placement
Use the Free draw tool to draw an approximation of the implants width and height, using the
patients anatomy as a reference for sizing. Then use Implant Library to search and select the
nearest matching real implants from your library. With this method you will get the correct
length and diameter without first having to guess which size would provide the best fit.
Open implant library
Use the Open Library to place implants directly from the Implant Library. This allows you to
first browse your selection of available implants and decide on the type before placing an
implant into the plan. After selecting the implant type, press the Add button to add the
selected implant into the plan. You can then align the implant to match the patients anatomy.
You can also use the Implant Library to add new implants into the library and modify existing
designs. See below for more information on the Implant Library.
Delete selected implant
Use the Delete selected implant to remove the selected implant from the plan.
Properties for selected implant
IMPLANT MODULE
Use the Properties button to call up the Properties dialogue shown below. This dialogue can
also be shown by double-clicking on any implant.
Use the Implant Properties dialogue to change the name, colour, length, and diameter of the
selected implant. The dialogue allows setting the length and diameter of the implant
accurately in tenths of a millimeter. Use the Library button to move to the Implant Library.
NOTE If the implant has been added or replaced from the Library, the length and diameter
cannot be changed as they are fixed to the values that were set in the library. To
change the measurement of such an implant, use the Replace feature in the Library.
List implants in the plan
The Implant list dialogue shows all implants that are present in the current plan. Use it to
change the name, colour, length, and diameter of the listed implants. The dialogue allows
setting the length and diameter of the implant accurately in tenths of a millimeter by using a
keyboard entry.
IMPLANT MODULE
9.3 Managing implants using the Implant library
Create new implants, modify, add implants to plan, replace, and search for implants. Implants
that are commonly used can be freely added and will be automatically grouped by
manufacturer and product lines. If available a realistic preview of the currently selected
implant model will be shown on the screen.
A general principle is that implants that have been placed into the plan are not affected by any
changes made in the library. To modify implants that are already placed, modify the
properties of an individual implant with the Properties button, use the Replace function, or the
implant list.
New
Create a new implant in the Implant Library by specifying the required information. Note that
you can use the drop-down lists to select existing manufacturers or product lines. When
entering numerous implant models, the Copy function explained below may be more suitable.
Copy
Copy the selected implant to a new one and change one or more properties. This option is
useful when creating groups of implants that share some properties.
Properties
Modify the properties of the selected implant.
NOTE Changing the properties in the library does not affect implants that have already been
placed into the plan.
IMPLANT MODULE
Delete
Delete the selected model from the library.
NOTE Deleting an implant from the library does not affect implants that have already been
placed into the plan.
Set Default
Set the selected model as the default implant. This default selection is used by the Add
default implant feature.
Add to Plan
Use Add to Plan to add the selected implant into the current plan and automatically close the
Implant Library dialogue. When you add implants from the library, you cannot adjust their size
with the Properties dialogue. To change the size, use the Implant Library and the Replace
selected button again.
Replace selected
Use Replace selected to have the currently selected implant in the plan replaced with the
implant model that is currently selected in the Implant Library. The dialogueue will
automatically close. When you replace an implant with another from the library, the
dimensions of the placed implant can no longer be adjusted with the Properties dialogue. To
change the size, use the Implant Library and the Replace selected button again.
IMPLANT MODULE
Implant Search
Use the Search function to browse through large libraries for implants with certain properties.
Use the Search options to specify properties of the implant models to search for. The Search
button executes the search while the Clear button clears the search results.
IMPLANT MODULE
9.4 3D Implant Verification Tool
The 3D Implant Verification tool can be used to evaluate the placement of implants. To
estimate the fit between implant and anatomy at the site the slice views and average HU-
values in the proximity of an implant can be used.
Contrary to the other Planmeca Romexis 3D views the Implant Verification views are always
centred on the current implant whereas the 3D volume revolves around the implants vertical
axis. This makes it easy to focus on the implant and its relation to the surrounding anatomy.
When the 3D Implant Verification dialogue is accessed the currently selected implant is
automatically shown. The implant under inspection can be selected and reoriented in
Planmeca Romexis Implant module while the 3D Implant Verification dialogue is being
shown. The slice orientations and measurement margins can be easily adjusted as described
in the following illustration.
1. Around 2. Green
3. Red
4. HU mean values
5. Axial slice
6. HU mean values
7. Choose
11. Adjust implant color or
8. Total mean 9. Adjust 10. Colors
implant slice cross section

around and inside implant
value and
standard
deviation
around and
inside implant
thickness of
measured layer
both inside
and outside

corresponding
to HU values
HU measurement layers

previous or
next implant
cross section
cross section
implant
and adjustment
around implant
dialogue
IMPLANT MODULE
Visual implant site evaluation
Axial, Cross Section and Envelope slice views
Use the axial slice to rotate the cross section views around the implants vertical axis by
clicking and dragging with mouse. This allows you to inspect the anatomy by viewing the
green and red cross sections (lines 1 and 2 respectively on the axial view) and compare them
with the overview on the implant Envelope view.
Also shown on the Axial slice are the implant envelope ring and anatomical orientation of the
data (Anterior, Posterior, Left, Right)
Use mouse wheel to move the axial slice plane (blue line) up and down on the implants
vertical axis. This allows you to view the axial slice at any level on the implants height.
Cross Section Views
The green and red cross sections (number 1. and 2. on the axial slice) are slices
perpendicular to each other and parallel to the axis of the implant. They allow the inspection
of the anatomy around the implant when rotated using the axial view. They also show the
silhouette of the implant, axial slice position and orientation (A,P,L,R).
Use mouse wheel on the cross section and envelope slice views to zoom in and out.
Implant Envelope View
The Implant Envelope view is a flattened cylinder view of anatomy on the implants outer
perimeter. It allows you to see with one glimpse if any of the implants outer wall would fall on
a weaker bone for example instead of having to do 360 degree rotation of the cross section
views. Shown on the Implant Envelope are the implant apex and insertion depths (cyan lines)
and intersections with the green and red cross section slices.
Density colors
Use the Density colors option to enable pseudocoloring of the data to enhance differentiation
between different anatomy densities. Using pseudocolors each grayscale value will be
mapped to different color so that the fine differences between different values can be more
easily perceived. Use the histogram dialogue to adjust the colors that are used and their
distribution over the grayscale histogram.
Statistical implant site evaluation
The HU mean values component displays the mean value of voxels inside or outside of the
implant in the margin specified using the Options - Measure range outside / inside sliders.
The values are shown in a line graph progressing from top of the implant towards the apex
with implant silhouette and margin thickness references on the right and HU value scale
reference at the bottom.
The mean value totals are shown with vertical lines that correspond to the values under the
Measurements value box. The Measurements box also displays the corresponding standard
deviation values. By default the outside values are violet and inside values are orange color
but the colors can be adjusted using the radio and palette buttons at the bottom of the Options
box.
The bulls-eye chart at the bottom right indicates the distribution of mean HU values in the
outside margin around the implant in the posterior/anterior, left/right directions.
VIEWING AND DIAGNOSING TMJ IMAGES
10 VIEWING AND DIAGNOSING TMJ IMAGES
Planmeca Romexis TMJ module allows convenient viewing and diagnosis of the
tempormandibular joint regions. After drawing posterior anterior line (PA line) for each side of
the anatomy, multiple dedicated lateral slices and PA slices are provided. These views
correspond to a double lateral-PA exposure but can be easily aligned, rotated and adjusted to
give a better understanding of the anatomy in the region. Planmeca Romexis TMJ module
therefore offers similar diagnostic value as TMJ programs available in some X-ray devices but
allowing multiple studies with single exposure to be generated.
10.1 Temporomandibular joints
1. Open the volume to be studied in Planmeca Romexis Explorer module. The volume can be a
full head exposure, a single TMJ or both TMJs stitched together with Planmeca Romexis
stitching feature. The only requirement is that the TMJ region must be visible in the volume
that is used. Orient the volume in anterior-posterior line so that the mandible is aligned
correctly (TMJ slices are perpendicular to the axial plane). Also orient the left-right line so that
both condyles (if visible) are on the same axial plane.
2. Use the Export View to Other Tabs button to apply the new orientation in other
modules.
3. Navigate to TMJ module.
4. Verify alignment of the volume using the Axial view. Use the slider on its right edge to bring
condyles into view.
VIEWING AND DIAGNOSING TMJ IMAGES
5. Draw right posterior anterior (PA) line using this tool . Start drawing by clicking on the
middle of the condyle and then hold down the left mouse button while dragging to define the
length and direction of the PA line. Planmeca Romexis will automatically introduce the
opposite half of the line and round its total length to nearest millimeter.
To finish the line, release the left button and Planmeca Romexis will automatically populate
the slice views.
6. Draw left PA line using this tool. Repeat the process described in step 5.
By default the Synchronise Sides toolis enabled so that the left PA line length is constrained
to match that of the right PA line. In this case only the direction of the left PA line needs to be
defined. To specify a left PA line of different length, disable the Synchronise Sides tool.
7. Use the view settings dialogues to adjust the number, width and spacing of the PA and lateral
slices similar to other 3D modules.
8. To adjust the position of the PA lines verify that the Move/ rotate volume tool is disabled and
then use left mouse button to move a PA line or right mouse button to rotate. To adjust the
width of the slices (length of the PA line) either use the slice specific settings menu or redraw
the line.
PROFACE IMAGES
10.2 Using TMJ Tools
Draw Right PA Line
Use to draw and define the posterior-anterior PA line for the right side slices.
Draw Left PA Line
Use to draw and define the posterior-anterior PA line for the left side slices.
Synchronise Sides
Enable / Disable synchronisation of left PA line with right PA line. When enabled the drawing
of PA line length will automatically constrained to match the length of existing lines. The
length can still be adjusted using the view settings dialogue which will then affect both PA
lines simultaneously. When disabled each PA line can be individually defined.
11 PROFACE IMAGES
For more information on ProFace image acquisition and processing see the appropriate
Planmeca ProMax X-ray unit Users manual and Planmeca Proface Users & Calibration
manual (publication number 10029835).
Planmeca Romexis E-1
Chapter
Users Manual
E RADIOLOGICAL FINDINGS
MODULE (OPTIONAL)
Planmeca Romexis Radiological Findings module allows creating structured interpretations of
dental findings in radiographs. It is designed to replace free text entries or paper checklists.
Both 2D and 3D images can be interpreted. An odontogram is used to indicate location of
findings while a categorised list of findings is used to enter findings into the radiological report.
Also free text entries are available.
1 USING THE 2D RADIOLOGICAL FINDINGS MODULE
2D Radiological Findings Module consist of three parts:
1. Radiological Findings field
2. Odontogram field
3. Findings list
Radiological findings field Odontogram field Findings list
USING THE 2D RADIOLOGICAL FINDINGS MODULE
E-2 Planmeca Romexis Users Manual
1.1 Using the Radiological Findings field
To select images in which you want to mark findings use the Image Browser or click the
image links in the Radiological Findings field.
To view the list of all images of the current patient click Show all images.
NOTE If Show all images is not pressed, only the findings of the currently open image will be
listed. SmartPan stack is shown as a single image.
When a tooth is selected, the tooth number will be shown in the note.
To expand / collapse the list of findings for the selected image, click the arrow on the right
edge of each image row.
To open the image in the main window click on the image link.
To display all information of the selected finding place your mouse over the finding in
question.
To create a free text note for a selected image click the Add free text button. The following
window opens. Enter the appropriate text in the field. When finished click OK.
Freely added text will be indicated with Note marking in the findings row.
Image and link
Expand / collapse
Tooth number
Tool-tip shows
information about
created finding
finding
and finding
information
Planmeca Romexis E-3 Users Manual
To delete a finding or to edit a tooth selection right-click the finding you want to modify.
From the opening pop-up window select Delete or Edit Tooth Selection. The modifications
will be automatically updated in the odontogram.
1.2 Using the Odontogram
The Odontogram is used to select the tooth to be interpreted or to mark a missing tooth.
To select a tooth click the tooth in the Odontogram. The edges of the selected tooth or tooth
parts are marked in bold.
Tooth number and selected tooth surfaces are shown in the text box with letters
(MODBLMDL).
1.3 Using the findings list
Open the image in which you want to add a finding.
NOTE If no image has been selected the screen with message Select single image from list
will appear. To use the findings list first select image.
The findings list shows all the possible findings grouped under different fields of dentistry.
To add a finding in the image select the appropriate finding from the list and click it with the
left mouse button.
NOTE If you are trying to select a finding from the list that is not applicable to the current
selection in the odontogram, a tool tip appears. Selection of tooth or part of a tooth
might be required.
The finding will now appear on the Radiological findings field under the image in which the
finding was recorded.
All findings are image specific which means that an interpretation can relate to one image
only. A study or SmartPan stack is considered as a single image.
Tool tip explaining why
the finding cannot be
selected
1.4 Exporting radiological interpretation
To open the Export window click the Export button on top of the screen.
The following window opens.
To export an image with radiological interpretation check the box Create patient and image
information file. Click OK.
Findings and other parameters are added to a .txt file.
1.5 Creating and printing a radiological interpretation
To add findings of a selected image to a printable layout select Add Text Box > Add
radiological findings to layout.
To insert the odontogram to a layout click the Odontogram button.
If Radiological findings module is selected in 2D module when print editor is opened, the
findings and the odontogram will be automatically added to layout.
2 USING THE 3D RADIOLOGICAL FINDINGS MODULE
To open the 3D Radiological Findings Module click the Findings button on the View toolbar
on top of the screen.
The following dialogue opens.
NOTE For more detailed information on how to use the 3D Radiological findings module see
section 1 USING THE 2D RADIOLOGICAL FINDINGS MODULE on page E-1.
In the 3D module the orientation of the volume in the views can be modified at any time
without closing the dialogue.
When a finding is created in 3D module, also the view orientation is saved with the finding.
To return to the view orientation in which the finding was registered click the view orientation
link on the finding on the right as illustrated in the above image.
View
orientation
links
Planmeca Romexis F-1
Chapter
Users Manual
F CLINIC MANAGEMENT MODULE
Planmeca Romexis Clinic management module is an application that allows time stamped
recording and real-time monitoring and control of most technical and operator activities in
Planmeca Compact i and Planmeca Sovereign dental units. The features available and the
data gathered can be used for remote assistance, service and maintenance support, and
preventive maintenance planning.
1 CLINIC MONITORING
Clinic monitoring view shows a graphical overview of all the devices in the clinic connected to
Planmeca Romexis. The user can monitor the dental unit usage in each section of the clinic,
and spot users requiring assistance.
The users that are currently logged in are marked with a square and the dental units with a
circle in the clinic layout.
The user-unit pairs are colour-coded based on their status. The tool tips show more
information on the status and the active provider. The providers, units or users can be located
in the clinic by using the Search feature.
A right-click menu shows shortcuts to other views for the selected device.
Additionally the administrator can configure the clinic layout of up to eight floors. The
operatories can be freely placed in the layout and dental unit software can be upgraded
remotely.
CLINIC MONITORING
F-2 Planmeca Romexis Users Manual
1.1 Operatories
Operatories represent rooms or work areas. An operatory consists of a chairside PC (shown
as squares in the layout) and dental units (shown as circles in the layout). The operatories are
colour coded according to their current operational status and connectivity
It is important to match each chairside PC with its respective dental unit in an operatory, as
this enables registration and logging of the dental units user activities.
By holding the mouse over an operatory the following information is shown in a tool tip:
Name of the operatory
Name of the dental unit and its current status
Name of the current provider logged in on the chairside PC
An alert or an error code message if present
To show a Right-clicking on an operatory calls up a context menu that allows quick access to
other views with the operatory automatically selected:
Planmeca Romexis F-3 Users Manual
CLINIC MONITORING
1.2 Searching dental units, operatories and users
The Search feature can be used to search a specific dental unit, operatory or user at the
clinic. To start a search click the Search button in the control panel at the bottom of the Clinic
view.
In the opening window select the appropriate search criterion from the Search by drop-down
menu. You can search by user, patient, operatory or dental unit.
Click OK.
To search by name type the name in the Name field or select Provider default form the drop-
down menuselect the appropriate criterion from the Name drop-down menu.
Click OK.
CLINIC MONITORING
1.3 Configuring clinic layout
To configure the clinic layout click this button at the bottom of the screen. The operatories are
shown as black rectangles consisting of a PC and dental unit.
A list of operatories, chairside PCs and dental units are shoe in the control panel. A PC or a
dental unit becomes available in the list once it has connected to the server. If a PC or a
dental unit is not available in the list, please verify that a connection can be established and
that it has been connected to Planmeca Romexis Server.
1.3.1 Creating new operatories and floorplans
To create new operatories drag and drop the operatories into the layout. The operatories can
be named for example to match the names of the actual operatories at the clinic. After adding
an operatory into the layout drag and drop the corresponding PC/dental unit pair into it.
Multiple floorplans can be used for multi-floor, multi-clinic or other complex layouts by creating
multiple floorplan files in PNG format on the server. For more information see the Planmeca
Romexis Clinic Management installation manual (publication number 10018645).
1.4 Update firmware (centralized update of Planmeca dental
unit software)
The Update Firmware can be used to check the current version of dental units software as
well as for uploading new firmware to the selected units.
To show the update options click the Update Firmware button. A list of all connected dental
units and their software version is shown at the bottom of the screen.
To select multiple units for update hold down the Ctrl key while selecting the units.
To choose the software you want to the selected selected units use the Find Files button.
Browse to the *.MOT file that contains the new software. To update the units click on Update
Selected Units.
UNIT MONITORING / REMOTE CONTROL
2 UNIT MONITORING / REMOTE CONTROL
In the Unit view the user activities in the selected dental can me monitored in real time. It can
also be used to review, store and resore the dental units settings. In case of maintenance
personnel, to access dental unit service modes with full descriptions of each setting.
2.1 Monitoring unit operations
The following activities can be monitored:
Chair position
Active instrument and power level
Instrument settings for all connected instruments. On how to change the instrument settings
refer to the dental unit Users manual.
Suction
Operating light usage
Error description
Short history of dental unit operation in line graphics:
Instrument type and power level.
Different instruments are denoted with different colours.
Seat height
Backrest angle
Operating light level
Syringe on/off
Suction on/off
2.2 Storing and restoring dental unit settings
1. Adjust the unit settings according to your preferences.
2. When satisfied, record the settings on the unit. On how to adjusta the instrument settings
refer to the dental unit users manual.
3. Click on the Save Settings button on the dental unit control panel.
4. To restore the previous settings click the Restore Settings button.
To overwrite the settings stored earlier in the database save the settings again. Currently one
set of stored instrument settings per user is available.
4.1 Configuring dental unit service mode
1. Click on the wrench icon to enter the service mode.
2. The current service mode is shown on the virtual unit control panel and the possible values
are listed and described on the bottom right of the screen.
3. To change settings, use the virtual control panel in the same way as when changing settings
at the actual unit.
4. To exit the service mode, either click on the wrench icon or the Program icon on the virtual
control panel.
NOTE Before accessing service mode on a unit remotely, make sure that nobody is currently
using the unit.
OR
4.1 Using activity shortcuts
The following shortcuts are available to perform routine activities on the dental unit.
Service mode
NOTE Before entering the service mode make sure that nobody is using the dental unit.
Save settings to user profile
Saves current dental unit settings to the current user profile in Planmeca Romexis database.
Load settings from user profile to the dental unit
Load stored settings from the current user profile into the dental unit.
Short instrument flushing
Long instrument flushing
Waterline Cleaning System cycle
Suction Tube Cleaning System
BienAir micromotor reverse operation mode
BienAir micromotor torque operation mode
DIAGNOSTIC LOG
5 DIAGNOSTIC LOG
In the Log view the daily unit events can be monitored and diagnosed (error and help
messages). Also the event history can be reviewed
Monitoring can be done remotely off-site or on-site when applicable.
The Log records and shows the dental unit status and events. The log displays detailed error
descriptions and error codes. See the example below
5.1 Filtering dental unit events
The events can be filtered by dental unit, type of events, or according to a certain time period.
Click on the appropriate drop-down menu and select the desired filter criterion.
By selecting <All> with current date, the log displays all dental unit events in real time.
To forward an event log via e-mail see section 3.7.6 E-mail Notification on page I-22
To see an error in its context of use, select an event and click the Show Event in Graph
button.
In front of the selected event a history graph of the unit is shown which can be used for
troubleshooting. The history graph shows the context of use at the time the error occurred.
DEVICE SUMMARY
6 DEVICE SUMMARY
The Device summary view provides information on the dental units usage and maintenance.
Select the unit for which you want to summary.
6.1 Unit
Total column
The Total column indicates the total usage time of the dental unit and operating light.
Current column
The Current column indicates the number of usage hours after the last reset (usually annual
maintenance or lamp change). Usage time is shown for
Dental unit
Operating light
Suction system use
Chair seat height
Chair backrest
Chair legrest
Total usage of a specific instrument or instrument type, cannot be monitored.
Limit column
The Limit column shows the time until a preset alert limit
DEVICE SUMMARY
6.2 Instruments
The instruments section shows the total usage hours for different dental unit instruments.
6.3 Latest cleaning operations
Based on the dental units events collected in real-time, a full history of the units cleaning
operations is recorded and can be reviewed. Entries of the last cleaning operations are
shown for the following:
Planmeca Waterline Cleaning System full cycle (disinfection)
Instrument flushing (water)
Suction line cleaning
Use the View All shortcut to see a full history of the cleaning operations listed above in the
Diagnostic Log.
DEVICE SUMMARY
6.4 Service history
The Service history field shows a list of recent maintenance operations and a form for
entering new maintenance records or for reviewing the previous records.
The following information is recorded from a service visit:
Entry ID for quick reference
Date when carried out
Entry type:
Service Visit:
A scheduled visit such as annual maintenance.
Unscheduled Service Visit:
A non-scheduled visit that may have caused unscheduled downtime for the dental unit.
Possibly caused by an unexpected lamp failure or similar.
User Guidance Visit:
For cases where there is no technical problem, but a visit is required to instruct the user in
proper use or maintenance of the dental unit.
Remote Service:
Recorded when a technical problem can be solved without visiting the clinic, for example by
adjusting service modes remotely.
DEVICE SUMMARY
Remote User Guidance:
Used for example when the user can be remotely instructed on the phone on the proper use
of the dental unit by referring to the recorded history information.
User Name:
The maintenance person who was logged in at the time of recording the entry.
Comment:
To provide more details and to assist in later maintenance visits.
The existing entries can be viewed by selecting them from the Service History list, which
automatically updates the recorded values onto the form. To record a new entry, click on New
Entry to start recording a new maintenance operation. To edit an existing record, click the
Edit button.
The following information can be recorded for maintenance visits:
Username of the person who provided the service (automatically records the user currently
logged in)
Entry date
Entry reason, selectable from the following:
Scheduled Service Visit
Service Visit
User Guidance Visit
Remote Service
Remote User Guidance
Error events that the service entry negates can be selected from the list of all errors. Click the
Add and Remove buttons to modify the list. Once negated the errors no longer show in
Diagnostic Log.
Elapsed Time:
For recording the time consumed on the service operation.
Spare Parts:
A list of components used. Part number, part name and quantity can be recorded as listed in
Planmecas spare part manuals, for example.
Free comment:
A field for explaining, for example, the steps taken during the maintenance.
INFO
Reset Values:
Set a service point to reset the units summary counter values. Use these options after
servicing a part or the dental unit. The options can be changed at a later point in case an
erroneous recording was made. These settings only affect the display of summary values and
they do not affect the data stored into the database, which remains fully available for
reporting.
Dental Unit:
Resets the dental unit counter when, for example, annual maintenance is done.
Operating light:
Resets the operating light counter when the lamp is changed.
7 INFO
The Info view provides instructions for common dental unit operations.
Quick reference card and maintenance and infection control quick guides are currently
available for Planmeca Sovereign, Planmeca Compact i Touch and Planmeca Compact i
dental units.
7.1 Using the quick reference cards and quick guides
1. Select the current dental unit from the drop-down menu.
2. Select the control or time period for which you want to view the instructions.
3. Scroll down the screen to read all instructions.
Planmeca Romexis G-1
Chapter
Users Manual
G ADMIN MODULE
The Admin module is divided into the following tab sheets:
1. Resource
2. Dental record
3. Imaging
4. Device alerts
5. Local settings
1 RESOURCE
Under the Resource tab you can create user groups and define user names, passwords and
clinic names.
1.1 Permissions tab sheet
The existing user groups are shown in the list. To define the new user group click the Add
button. In the opening dialogue type in a name and description of the new user group and
define permissions for the new group.
Use the Update button to alter the permissions of an existing group.
Use the Inactivate button to inactivate the user group.
RESOURCE
G-2 Planmeca Romexis Users Manual
1.2 Toolbars
The primary way of customising toolbars in Planmeca Romexis is via user groups. This allows
each specialist group at the clinic to see a customised set of tools suitable for their work on
any Planmeca Romexis workstation they may use. Personal customisations are possible if a
users group has the Edit Toolbars permission granted.
The Toolbars tab allows flexible toolbar customisation for each user group. By default all
toolbar buttons are visible and they should be selectively hidden by adding them to the
Hidden list on the right.
NOTE If a user belongs to a group that has the Edit Toolbars permission granted, he can
freely modify the toolbars directly without entering the Admin module as follows.
These personal customisations will be automatically applied to each user when they
login to Planmeca Romexis.
Planmeca Romexis G-3 Users Manual
RESOURCE
To open the toolbar specific customisation menu click on the arrow in the top right corner of
the toolbar (if Toolbar Borders are enabled) you want to customise or right click on any button
in the toolbar. The following options are available in the toolbar customisation menu.
Show Text Labels
Show the function of each button in a text label below the button.
Show Toolbar Borders
Show a title bar and border for each button group.
Customize Toolbar
Allows showing and hiding buttons in each button group.
Reset Toolbar to Defaults
Reset the currently selected toolbar to settings for the users group.
To show or hide complete toolbars or reset all toolbars to defaults at one, right click between
the toolbars or in any empty area next to the toolbars to call up the general customisation
menu as shown below.
1.3 Users tab sheet
The existing users are shown in the list. To add a new user click the Add button. In the
opening dialogue fill in or define:
Users personal information
Username and password
Address
RESOURCE
Contact information
Role, provider type (doctor, student, hygienist)
Group(s) that the user belongs to
Whether the user is also a patient
Whether the user should receive device alerts
User profile can have a photo added to it using the Photo tab. The photo will be shown in the
user interface where remote user identification is relevant.
Use the Update button to modify a users information.
Use the Inactivate button to inactivate the user in Planmeca Romexis.
RESOURCE
1.4 Device Alerts
1.4.1 Configuring device alerts
The Device Alerts tab allows configuration of error forwarding to user e-mails (Device Alerts)
and clinic-specific alerts for dental unit use (Usage Data Alerts). To enable the sending of e-
mails the user must have Work E-mail address entered and Listens to Device Alerts property
enabled in user settings.
RESOURCE
The Configure Device Alerts tab allows configuring of specific error and help events to be
forwarded to a selected users e-mail.
RESOURCE
1.4.2 Configuring usage data alerts
The Configure Usage Data Alerts tab is used to configure triggers that allow custom events
on:
Unit component mileage limits (hours) for preventive maintenance.
Unit instrument activation frequency to track inappropriate use.
IMAGING AND DICOM
2 IMAGING AND DICOM
2.1 Templates
Templates are used for capturing multiple images to a certain predefined layout. The template
can contain intraoral, panoramic and cephalometric X-ray images and photos. The template
also defines the print layout and alignment for the images attached to it.
The list of existing image templates is shown in the left side of the list. To edit an existing
template click Update. To prevent using a certain template for new studies click Inactivate.
However, inactivating does not affect existing studies based on the template.
To create a template click New and enter a name for the new template in the opening window.
Click the button and choose the desired layout in the opening window. You can
use predefined layouts or customize how many images you want per row or how many rows
of images you want in each column. The last option allows you to create complex templates
such as FMX 20. To enter the template edit view. Click the desired layout option.
IMAGING AND DICOM
In the Template Editor view double-click the image slot to define the image type, sensor
orientation, tooth numbers, exposure order and placement in relation to other slots.
NOTE The alignment X and Y are also used to position images into a print layout. Appropriate
alignment will allow images to be printed in larger scale with less whitespace in
between.
After you have defined all necessary information for all slots click OK and the new template is
saved into the database. Now the new template can be used in Planmeca Romexis X-ray
module and in radiology approval process in the Clinical Record module.
IMAGING AND DICOM
2.2 DICOM Configuration
In order to configure DICOM destinations the following information is needed from the local
network administrator:
Network configuration information for Planmeca Romexis workstation
Port numbers for DICOM configurations
IP addresses of DICOM services
AE titles, Port numbers and IP addresses for the needed DICOM services
Storage server
Printer
Worklist
Modality Performed Procedure Step (MPPS)
Query / Retrieve
AE title for workstation (default AE_title is ROMEXIS_1) and Planmeca Romexis server SCU
and SCP are needed for some of the services.
NOTE If there are several Planmeca Romexis workstations in the network configured under
local settings the workstations should have unique AE titles, for example ROMEXIS_2,
ROMEXIS_3 etc, unless the Communicate through server option is enabled. For more
information see section 2.2.1 DICOM Storage Setup on page G-12
In the DICOM tab sheet all the default destination applications are defined By clicking the
Select button the Default AE window opens.
IMAGING AND DICOM
To add a new Application Entity (AE) click the Add button and define the AE title, host name
and port number in the opening window
In addition to AE Title, Host Name and Port Number parameters, the Transfer Syntax to be
used can be set to No Restriction (automatically negotiated) or limited to a certain Transfer
Syntax for increased compatibility.
IMAGING AND DICOM
2.2.1 DICOM Storage Setup
In the opening Storage Setup window the DICOM Storage Settings can be changed or
checked.
DICOM Storage Setup options:
Communicate through server:
Enable this option to route all DICOM communication from Planmeca Romexis clients to
DICOM services via Planmeca Romexis Server. If enabled Planmeca Romexis server SCU
AE Title wil be used instead of Planmeca Romexis Client AE Title.
General
Reuse association for Singleframe CT images:
Specify whether a single storage association should be reused for all frames in a Singleframe
CT image set. If disabled a new association will be opened for each frame.
Supports Enhanced (Multiframe) CT images:
Enable this option if you prefer to have 3D volumes sent to DICOM Storage in multiframe
format. See your DICOM Storage server documentation for more information.
Send Images with processing applied:
Enable this option to have all image enhancements applied in Planmeca Romexis to be
merged into the image that is sent to DICOM storage.
Send Images with annotations applied:
Enable this option to have annotations made in Planmeca Romexis to be merged into the
image that is sent to DICOM storage.
Send grayscale images with LUT:
Include Values of Interest Lookup Table (LUT) with images on DICOM Storage. In Planmeca
Romexis the following applies to LUT values:
If a value unequal to 1.00 is set in Planmeca Romexis Configuration > Imaging >
Autoehancements > Gamma, only that specified gamma value will be used as LUT.
If a value equal to 1.00 is set in Planmeca Romexis Configuration > Imaging >
Autoehancements > Gamma, the first Adjust Levels operation gamma and min/max values
will be used as LUT
IMAGING AND DICOM
In general only the first Adjust Levels operation shown in the Image Operations will be used
as LUT while the following Adjust Levels operations will be ignored.
SOP Class
The Force SOP Classes option allows forcing of a specific SOP Class to be used for each
image category in Planmeca Romexis. By default Planmeca Romexis will dynamically choose
the correct SOP Class for each image. Forcing of SOP Class is usually not required but may
be useful in some cases to maximize compatibility with different PACS solutions. The first
item in each drop down list is the default value Planmeca Romexis would normally first
attempt to use.
Modality
The Force Modalities option allows forcing of specific modality to be used for each image
category. By default Planmeca Romexis will dynamically choose the best modality for each
image. Forcing of modality is usually not required but may be useful in some cases to
maximize compatibility with different PACS solutions, eg. if the solution doesnt support PX
dental modality for example.
IMAGING AND DICOM
Storage Commitment
Storage Commitment Enabled:
Enables storage commitments that will be shown in Image properties once received.
Use separate commitment threads:
Threads Storage Commitment into maximum 10 parallel processes improving Storage
throughput in cases where PACS Storage Commitment processing time is long.
Two association mode for commitment:
When two association mode is enabled, a dedicated association socket will be opened for
establishing Storage Commitment. Otherwise the original Storage association socket is
reused to establish Storage Commitment.
NOTE Two association mode for commitment cannot be used with server autostorage.
Listening port for commitment:
Specify port where Planmeca Romexis server listens to Storage Commitments when Two
Association mode is used
Timeout for commitment(s):
Specify Planmeca Romexis Server timeout for receiving Storage Commitment whenTwo
Association mode is used
IMAGING AND DICOM
2.2.2 DICOM Printer Setup
The DICOM Printer settings can be checked and changed in the opening DICOM Printer
Setup window.
Under Film Box the following settings can be made:
Orientation: Default / Portrait / Landscape
Default will let the printer choose the print orientation while Portrait or Landscape will force the
selected orientation.
Film Size: Several choices
This setting allows forcing the printer to use a certain film size.
Magnification Type: Default, Replicate, Bilinear, Cubic, None
Default will use the default magnification type of the printer while the others can be used to
overrule.
Smoothing Type: Please refer to your DICOM printer manual for more information on this
setting.
Magnification Factor: The multiplier to magnify prints.
Set this to a value larger than 0 to scale images up or down. 0.5 will yield 50% size, 1 yields
100% while 1.5 yields 150% scaling. Leave empty to let the printer fit the image on the film.
Header Text Height: Text height for text in header.
Values between 20-50 are usually good. Leaving this empty will cause no header to be
printed. Please note that if a magnification is applied in printing the text sizes will also be
scaled accordingly.
Footer Text Height: Text height for text in footer.
Values between 20-50 are usually good. Leaving this empty will cause no footer to be printed.
Annotation Text Height: Text height for annotation.
Values between 20-50 are usually good. Leaving this empty will cause no annotations to be
printed.
IMAGING AND DICOM
2.2.3 DICOM worklist setup
Communicate through server:
Enable this option to route all DICOM communication from Planmeca Romexis clients to
DICOM services via Planmeca Romexis Server. If enebled Planmeca Romexis server SCU
AE Title wil be used instead of Planmeca Romexis Client AE Title.
General
Enable Select and update closes matching patient automatically to have Planmeca Romexis
select and update closes matching patient automatically when a patient is opened from
DICOM Worklist and a patient with similar information already exists in Planmeca Romexis
database. Normally Planmeca Romexis will ask the user to make a selection between
updating or creating a new patient.
Default Modality Specifies the default value for the Modality selection in Patient module
DICOM Worklist screen.
2.2.4 DICOM Modality performed procedure step (MPPS)
DICOM MPPS SCU service is used together with DICOM Modality Worklist SCU service. If
Planmeca Romexis MPPS service is configured, the ID, status and dates of studies as well as
patient name will be sent to PACS when starting the exposure. Dates and compete list of
images including X-ray parameters will be sent to the HIS/RIS server after closing exposure
task.
To connect to HIS/RIS MPPS the provider service Default MPPS AE should be enabled.
IMAGING AND DICOM
For sending messages select Default MPPS AE and tick the box Allow sending messages in
Modality Performed Procedure field.
2.2.5 DICOM Query / Retrieve Setup
Use Planmeca Romexis Serve AE title:
Use Planmeca Romexis Server SCU title in Query mode as calling AE title instead of using
Planmeca Romexis Client AE title.
Allow only for current patient:
Limits DICOM Query Retrieve queries to the currently selected patient only.
Automatic for PMBRIDGE patient:
Automatically execute Query / Retrieve for current patient when new patient is selected using
PMBRIDGE.
IMAGING AND DICOM
2.2.6 DICOM Storage Settings
The following options require that DICOM polling has been enabled in Planmeca Romexis
Configuration application. For more information see section 6.3 External communication on
page I-35.
Store new Images automatically:
Specify whether newly captured images should be automatically processed by the server side
automatic DICOM Storage. Please note that if the server side automatic DICOM Storage is
disabled, this setting will have no effect. Even if this setting is enabled, automatic storage can
be canceled per image in the image properties dialogue.
Retry storage for failed commitment:
Enable this feature to retry Dicom Storage for image when its commitment fails.
Delete image with successful commitment after X number of days.
2.2.7 DICOM Query / Retrieve Settings
Listening port: Port number where DICOM Query / Retrieve results should be expected.
Default is port 104.
2.2.8 DICOM Default Specific Character Set
To support patient names and information in different languages and character sets, this
setting allows a specific character set to be defined for saving DICOM files. Set this option
according to your local requirements to allow any DICOM compatible application to correctly
read and display patient information as you have entered it.
LOCAL SETTINGS
3 LOCAL SETTINGS
Defining the default settings
To specify the settings made on the current workstation as global default values on all new
workstations that log in to the same Planmeca Romexis server click the Set as Global
Defaults button. The settings of those workstations that have already logged into Planmeca
Romexis server at some point are not affected. Only the settings modified by the user are
affected. This feature is especially useful for settings such as 3D Module Enabled or DIDAPI
Enabled for example.
LOCAL SETTINGS
3.1 3D
3D Module Enabled on This Workstation
This setting enables the organization to allow/disallow access to the 3D module on a per
workstation basis.
3D Rendering Enabled
Enabling this function generates 3D rendered view in 3D imaging module but consumes more
memory. This function should be disabled in image capturing workstations.
Surface Rendering
Enabling this feature uses an optimised proprietary ray tracing engine to produce a real
life solid object appearance to 3D volumes. The Surface Rendering mode allows 4
different rendering styles that can be selected in the volume Rendering Style menu.
When this feature is disabled, a more X-ray like rendering is generated that allows
see-through anatomy.
3D Rendering Texture Quality
The following settings affecting the quality of the 3D rendered view (but not 2D slices) can be
made:
Low - Low quality resolution with the lowest demand on hardware and low memory usage.
This setting is equal to Planmeca Romexis 1.6 and previous versions.
Normal - Average resolution mode with modest memory requirements. Dedicated graphics
card recommended as graphic chips integrated on motherboard may degrade performance.
High - High resolution mode that demands a high-end graphics card with a minimum of 256
memory on board.
Use Low Quality Preview
When enabled previews of 2D and 3D views are shown in low quality when the views are
manipulated.
3.2 Reconstruction Server
The 3D reconstruction PCs Host Name and Port Number is defined here.
LOCAL SETTINGS
3.3 2D
Image Capture (DIDAPI) Enabled
This setting requires Planmeca DIDAPI to be installed.
Image Reprocessing Enabled
This setting enables Reprocessing of exposures in certain modalities. Reprocessing allows
easy exploration of different DIDAPI pre-processing settings and is therefore well suited for
identifying optimal settings during initial configuration of a X-ray device. A single exposure
can be processed multiple times with different DIDAPI Configuration values applied and
returned to Planmeca Romexis each time as if it was a new exposure. Starting from
Planmeca Romexis 2.0.R only panoramic exposures (excluding tomographies and sinus
mode) can be reprocessed.
NOTE Only TIFF images can be reprocessed. Please set Image Type to TIFF in Planmeca
Romexis Configuration application before using Image Reprocessing, see paragraph 3
IMAGING on page I-10.
When Image Reprocessing is enabled and panoramic exposure is started, the above
dialogue is shown. The following choices are available:
ReProcess Latest Image: Returns the most recent real exposure as a new image with current
DIDAPI configuration applied.
Choose Image to ReProcess: Select an existing image in Planmeca Romexis for
Reprocessing, apply current DIDAPI configuration on it, and return the result as a new image.
Launch DIDAPI Config: Launches DIDAPI Configuration tool for changing DIDAPI
preprocessing settings.
Turn ReProcessing OFF: Turns OFF the Image Reprocessing Enabled setting in Admin /
Local Settings.
Reprocessing is usually used as follows:
1. Check DIDAPI Configuration that preprocessing settings are
2. Expose an image of a patient or a test target.
3. Enable Image Reprocessing in Admin / Local Settings
4. Evaluate image and use DIDAPI Configuration to adjust preprocessing to better match
customer's preferences.
5. Start new exposure and choose Reprocess Latest Image. The original image is returned with
new preprocessing settings and verify image quality. Repeat steps 4. and 5. until desired
image quality is achieved.
6. Turn Reprocessing off.
Rejecting exposures is allowed.
Allows user to cancel exposure during exposure time.
LOCAL SETTINGS
3.4 External applications
Some 3rd party applications can be launched directly from 2D Imaging and 3D Imaging
modules with the Launch button. Image and patient information is transferred to this software
simultaneously. Click the Select button to define the path.
To make the definition, e.g. Simplant Implant planning software, browse the Simplant-exe file.
Type the name of the Simplant and type the Command Line:-sf %0.
NOTE The launch feature requires that the receiving software is capable of receiving file and
patient information via command line. Please refer to the 3rd party documentation for
correct parameters.
3.4.1 Showing quick launch presets
The pre-defined 3D Quick Launch targets can be selected for the following software:
Straumann coDiagnostiX
Patterson Dolphin
N-Liten 3D
NobelClinician
Materialise Simplant
iPhone
The toolbar logo can be defined for each software and the launch command can be
customized when necessary using the 3D Imaging Application setting. Only one software can
be defined for Quick Launch at a time.
LOCAL SETTINGS
3D Binning
The 3D Binning option specifies a pre-scaling operation to be done on 3D images before they
are handed over to the launched application. The operation is called binning and it combines
two or more adjacent voxels into one, reducing the resolution of the resulting image. Binning
does not affect the geometry or dimensions of the image. Valid settings are:
Use original resolution and do not process the image. This is also the default value if left
blank.
Apply binning so that the volume shrinks to half of the original, so that for example a 0.16mm
resolution results in 0.32mm resolution.
Apply binning so that the volume shrinks to one third of the original, so that 0.16mm resolution
results in 0.48mm resolution.
A recommended output to use in 3rd party implant planning software is 0.32mm or 0.48mm
voxel size. When exposing in High resolution or Standard modes (0.16mm,) use binning
value 1 or 2 (resulting in 0.32mm or 0.48mm), and with the Low dose mode (0.32mm) use
binning value 1 or blank (resulting in 0.32mm).
3.5 Dental Unit interface
Use the PLANLINK Dental Unit interface to enable intraoral video camera activation and foot
pedal automation in Planmeca Romexis. This setting should be used instead of intraoral
video camera Serial Connection only in case the PLANLINK service is in use. In most cases,
however, this should be disabled and the intraoral video camera Serial Connection explained
below should be used instead. Please note that the PLANLINK operation requires a
PLANLINK enabled Planmeca Compact i unit.
3.6 Intraoral video camera Serial Connection (CamComm)
Enable this setting to enable intraoral video camera activation and foot pedal automation in
Planmeca Romexis using standard Serial Connection. The Comm port needs to be specified
correctly and is in most cases COM1. Please note that this requires the use of Planmeca
Compact unit.
3.7 Practice management software interface (PMBRIDGE)
Enables Practice Management (PMBridge) interface.
LOCAL SETTINGS
3.8 CD-recording device
Device Bus
Specify device bus where the CD Writer is located. Change this only if the AUTOMATIC
setting doesnt work.
Log CD-burn
Write a log of the CD-writing process for troubleshooting purposes.
3.9 DICOM
AE title for workstation and other workstation specific DICOM identifiers.
Planmeca Romexis H-1
Chapter
Users Manual
H REPORT MODULE
The Report Module enables to list several processes of Romexis as a report. These reports
contain direct links to images and patients as well as the possibility to print the report.
The Report Module offers three kinds of reports:
1. Images by Date and Type
2. Images by Capturer
3. X-ray log book
REPORT GENERATION
H-2 Planmeca Romexis Users Manual
1 REPORT GENERATION
Select one report mode from the drop down menu and press the -button.
Perform your selection and click OK. The selected report mode will be displayed.
1.1 Image Link
To view one of the listed images, double-click on the blue image name in the left column
(Image Link) or select the image or several images by holding down control, and
press the Open Link(s) button. The Image View tab opens and the selected
image(s) is shown.
1.2 Patient Link
By double-clicking on a red patient name, a patient file can be opened directly for further
processing.
1.3 Refresh
The Refresh button updates the current report on the screen.
1.4 Print
Reports can be printed with the button. Open the report you want to print and click
the Print button. The preview window appears and the report is printed according to the layout
on the screen.
Planmeca Romexis H-3 Users Manual
IMAGE VIEW
2 IMAGE VIEW
The Image View tab displays images opened from the report in the Report Generation tab.
Each open image has its own horizontal toolbar above the image. These viewing and
processing tools affect only that respective image (see chapter 4, section 1.7.2). As images
are viewed Read Only, no changes will be saved.
2.1 Previous/Next Image
By pressing the button, the next image according to the report list will be opened.
The button opens likewise the previous image in the report list.
2.2 Open Copy
The button opens an exact copy of the current image for further processing.
IMAGE VIEW
H-4 Planmeca Romexis Users Manual
2.3 Set Layout
The button allows to choose a new, temporary arrangement of the opened
images.
Planmeca Romexis I-1
Chapter
Users Manual
I PLANMECA ROMEXIS
CONFIGURATION APPLICATION
The Planmeca Romexis configuration application is a separate application for adjusting global
settings.
The Planmeca Romexis configuration application is accessible only for users with
Administrator rights.
Use the Show Help button to display an interactive help window that explains the options
under each item.
1 ACCESSING PLANMECA ROMEXIS CLINIC
MANAGEMENT CONFIGURATION APPLICATION
The Planmeca Romexis Clinic Management Configuration application is a password-
protected facility for changing various system-wide Planmeca Romexis Clinic Management
settings. Access to Planmeca Romexis Clinic Management Configuration is defined by user
group permissions.
To enter the Configuration application browse to the folder C:/Program files/Planmeca/
Romexis/admin
Double-click RomexisConfig file.
GENERAL SETTINGS
I-2 Planmeca Romexis Users Manual
2 GENERAL SETTINGS
2.1 General
2.1.1 Client instance
Defines the Planmeca Romexis Instance name that is shown in the Planmeca Romexis title
bar if the option Show Instance Name in Romexis title bar is selected. You can insert some
free text (for example clinic name) into the Romexis title bar. All Planmeca Romexis Clients
that are connected to the same server have the same Instance name.
Allow more than one client instance on one workstation
With this options selected multiple Planmeca Romexis Clients can be started on the same
computer.
Planmeca Romexis I-3 Users Manual
GENERAL SETTINGS
2.2 Person
2.2.1 Name Formatting
The Name Formatting selection affects the formatting of name display on the screen.
Dont Format
The names are displayed as they were entered into the database.
Capitalize First Letter
The first letter of each name is capitalized and the rest remain in lower case.
Capitalize ALL
Capitalizes all letters in a name.
Name Formatting affects the processing of searches for names so that when Don't Format is
used, searches are case sensitive, while Capitalize First Letter / Capitalize ALL make
searches case insensitive.
GENERAL SETTINGS
2.2.2 Name Display Order
In Name Display Order you can decide which name, family name or first name, is displayed
first in Planmeca Romexis
2.2.3 Patient identification
Patient Identification defines which Patient ID is used to refer to patients. The same ID is also
used in patient search. Planmeca Romexis can maintain three different Patient IDs at a time.
Custom ID
refers to an ID typed into Planmeca Romexis at patient creation, or an ID generated by e.g.
Axium.
Other ID
Refers to an ID imported from another software, where this usually administrative ID has
been assigned to patients manually (may e.g. refer to a patients old paper file).
Autonumber
Instructs Planmeca Romexis to automatically assign a Patient ID to the created patient and to
use this unique identifier. This is viable only in cases where Planmeca Romexis is used as the
master patient management software.
2.2.4 Patient ID Sorting
The following options are available when patient list is sorted by the Patient ID column.
Insertion order
Sorting in the order the patients were entered into the database.
Alphabetical
Alphabetical sorting: 001, 1111, 22, aaa, aab, aba
Numerical
Numerical sorting ignoring leading zeros: 001, 22, 1111, aaa, aab
Prefix alphabetically
Sorting first by leading alphabets and then numerically: A22, A1111, B01
GENERAL SETTINGS
2.2.5 Patient
Give warning for Selecting all patients
Warns the user when all patients are searched at the same time from the database in the
Patient Module.
Export files using patient name
Specifies the patients name to be used as the default filenmae for exports. The suggested
filename can still be changed. When disabled the filename field shows empty by default.
2.3 Security
The Login and Approval settings affect the information requested from users when logging
into Planmeca Romexis or when granting approvals. This allows for the facilities to adjust the
security measures in Planmeca Romexis according to their local policies.
2.3.1 Login Username and Password
Username and Password are required
When logging in to Planmeca Romexis both username and password are required .
Username required, Password is optional
Only username is required when logging in.
Login only with Swipe Card
When additionally selecting this option, the user can log in only with a swipe card.
GENERAL SETTINGS
2.3.2 Approval Username and Password
Username and Password are required
When granting approvals e.g. for image acquisition requests, Planmeca Romexis asks for
both username and password.
Username required, Password is optional
Only username is required.
Approval only with Swipe Card
When additionally selecting Approval only with Swipe Card the approval can only be made
with swipe card.
2.3.3 Password
Maximum password age in days
Set to 0 for password that never expires.
Minimum password length
Sets the required minimum length for the password.
Maximum number of wrong password
The number of wrong entries is set to 0 as default (wrong entries are not calculated)
At least one digit required
At minimum one number is required in the password. This setting is disabled as default
At least one special character required
At least one non-alphanumeric character (e.g. @,#,!,%,&,?) required in the password. This
setting is disabled as default.
GENERAL SETTINGS
2.3.4 Swipe Card User ID
When swiping the card, the card produces an output text string that contains the user ID and
password.
Track No (Number) in Swipe Card
Indicates the row in the text output from which the password string is read.
Assume e.g. the following typical Swipe Card output
: %testusera6yz8cat?
;0000948721?
;20060101=20070101?
The User ID test user is located on the first track (0), starting from the second column (1) and
ending in the eigth column (7).
Start Column in Swipe Card
Indicates the column in the text output where the password string starts.
End Column in Swipe Card
Indicates the column in the text output where the password string ends.
2.3.5 Swipe Card Password
See Swipe Card User ID above for more information.
GENERAL SETTINGS
2.4 Regional
2.4.1 Tooth Identification System
FDI/ISO
This option refers to the two-digit FDI World Dental Notation.
ADA
Universal Numbering System adopted by the American Dental Association.
2.4.2 Regional Settings
These settings specify default values and available settings in the Patient Demographics.
Country
Defines the default country for demographics.
Language
defines the default language for demographics.
GENERAL SETTINGS
Show State & State Prompt
Enables showing an input field for patients home state or similar, and a freely configurable
prompt text.
Show PIN & Prompt
Enables showing an input field for patients personal identification number or similar, and a
freely configurable prompt text.
ProModel Price List
Specify the HTTP address location of the regional ProModel price list.
IMAGING
3 IMAGING
3.1 Panoramic
In the Panoramic tab you can make adjustments to the image quality settings of the
panoramic images.
Resolution, Bits Per Pixel and Image Format define how the images are stored in the
database after the image has been taken.
Autoenhancements include settings that affect the display of new exposures in Planmeca
Romexis.
3.1.1 Resolution
Normal
The pixel size is 0.132 mm.
Enhanced
The pixel size is decreased to 0.099 mm for improved image quality.
High
The pixel size is set to 0.066 mm and is the mode for a best resolution.
NOTE The size of the image is much larger and the handling of the image slower when the
pixel size is smaller.
IMAGING
NOTE The resolution selected in the Planmeca Romexis Configuration panoramic settings
does not affect the image size (pixel size is always 127m). Other Planmeca
RomexisConfig settings (BitsPerPixel, ImageFormat, Gamma, Sharpening, Median) are
same as the settings for other 2D images acquired with Dimax sensor.
3.1.2 Bits Per Pixel
This field defines whether the images are captured as 8 bit or 16 bit. The best dynamic
contrast range is reached by using 16 bit per pixel, but the images will be twice the size of 8
bit images.
3.1.3 Image Format
The format in which the images are stored in the database. The options are TIFF and JPEG.
JPEG Quality
The JPEG Quality can be set to Low, Medium, High or Maximum.
3.1.4 Auto Enhancements
The Auto Enhancements group includes settings that affect the visualization of the images in
Planmeca Romexis. They do affect the original images in the database.
Use normal preprocessing
When a new image is captured, the Adjust Levels operation is automatically performed to the
image with the Auto Enhancement group adjustments. If the automatic adjustment is not
satisfactory, it can be undone by clicking the Undo button in the Imaging Module, and the
adjustments can be done manually in Planmeca Romexis through the Adjust Levels function.
Gamma Correction:
Adjusts the gamma curve of the image. By adjusting the gamma value, the image can be
made to look more like a conventional X-ray image.
Sharpen:
The image can be sharpened with a specific filter and strength (Low, Medium or High).
Despecle:
A specific filter can be used to remove noise from the image by selecting Despecle.
Use custom preprocessing
For more information see section Custom Preprocessing in Planmeca Romexis allows
defining default preprocessing settings for all new exposures. The preprocessing settings to
be used are specified per image type in Planmeca Romexis 2D Module. on page I-15:
IMAGING
3.1.5 Bitewing Auto Enhancements
The Bitewing Auto Enhancements group includes dedicated settings that affect exposures
taken with the bitewing programs available in selected Planmeca X-ray units. They will not
affect exposures taken with intraoral sensors. The same values as for the Auto
Enhancements for panoramic images above apply.
3.1.6 Save Autofocus Images
Save Autofocus images as normal exposures among other X-ray images in Planmeca
Romexis.
Save auto Focus Images function is available only with Dimax sensor, as Autofocus is not
available with SmartPan.
3.2 Cephalometric
In the Cephalometric tab you can make adjustments to the image quality settings for the
cephalometric images.
The Resolution and Image Format settings define how the images are stored in the database.
Autoenhancements include settings that affect the visualization of the images in Planmeca
Romexis.
3.2.1 Resolution
Normal: With normal resolution the pixel size is 0.132 mm.
Enhanced: Enhanced resolution decreases the pixel size to 0.099 mm and improves the
image quality. Note: the size of the image is much larger and the handling of the image is
slower when the resolution of the image is higher.
3.2.2 Image Format
JPEG Quality: The JPEG Quality can be set to be Low, Medium, High or Maximum.
IMAGING
Planmeca Romexis. They do not affect the original images in the database.
image with the Auto Enhancement group settings. If the automatic adjustment is not
satisfactory, it can be undone by clicking the Undo button in the Imaging Module, and the
Gamma Correction
made to look more like a conventional x-ray image.
Sharpen
Despecle
be used are specified per image type in Planmeca Romexis 2D Module. on page I-15:
IMAGING
3.3 Intraoral
In the Intraoral tab you can make adjustments to the image quality settings for the intraoral
images.
The Resolution, Bits Per Pixel and Image Format settings define how the images are stored in
the database.
3.3.1 Resolution
Normal: With normal resolution the pixel size is 0.038 mm.
High: High resolution reduces the pixel size to 0.019 mm and is the mode for best resolution.
Note: The size of the image is much larger and the handling of the image is slower when the
resolution is higher.
3.3.2 Bits Per Pixel
In the Bits Per Pixel group you can select whether the images are stored as 8 bit or 16 bit
images. The best dynamic contrast range is reached by using 16 bit per pixel, but the images
will be twice the size of 8 bit images.
3.3.3 Image Format
JPEG Quality: The JPEG Quality can be set to be Low, Medium, High or Maximum.
Planmeca Romexis. They do not affect the original images in the database.
IMAGING
image with the Auto Enhancement group settings. If the automatic adjustment is not
satisfactory, it can be undone by clicking the Undo button in the Imaging Module and the
Gamma Correction
made to look more like a conventional x-ray image.
Sharpen
Despecle
be used are specified per image type in Planmeca Romexis 2D Module. on page I-15.
NOTE See sections 1.5 Archiving on page A-3 and on page A-4 in chapter A GENERAL
for information on image processing and archiving.
Custom Preprocessing in Planmeca Romexis allows defining default preprocessing settings
for all new exposures. The preprocessing settings to be used are specified per image type in
Planmeca Romexis 2D Module.
NOTE All preprocessing adjustments are set and modified in Planmeca Romexis 2D Module
whereas the current settings can be viewed in Planmeca Romexis Configuration
Module.
To define Custom Preprocessing settings proceed as follows:
1. Take an exposure or open a 2D image in Planmeca Romexis.
2. Use the image specific toolbar to adjust levels or sharpen the image until acceptable image
quality is achieved.
3. Check that the correct enhancements are listed in the Image Operations field. Note that
applying the same enhancement several times on the image will slow down opening of
images. so it is better to try to minimize the number of enhancements if possible.
4. From the File menu select Capture > Save Image Enhancements as Default Enhancements
to set the current settings in the Image Operations list as default enhancements for the
current image type.
IMAGING
5. Check the preprocessing list and enable option Use Custom Preprocessing in Planmeca
Romexis Configuration for the image type.
Table 4: Custom image preprosessing
Planmeca Romexis 2D Module
Planmeca Romexis Configuration
application
File > Capture > Save Image
Enhancements as Default
Enhancements
IMAGING
3.4 CBVT
In the CBVT tab you can make adjustments to the image quality settings for the CBVT
images.
Default Settings and Auto Enhancements affect the visualization of the CBVT images when
they are opened in Planmeca Romexis.
3.4.1 Default Settings
Default Artefact Removal
Sets the default Artefact removal level that is selected in the 3D Exposure dialogue. The
default setting can be overridden by the user per exposure.
Bit Depth
Specifies the bit depth at which 3D exposures are stored in Planmeca Romexis image
database. The default value is 12bit. When 15bit is used 3D volumes can be exported
optionally in 12 or 15 bit depth. 15bit setting should be used only in cases where 15bit exports
to other systems are a requirement.
Window
Defines the amount of grey shades in the image. The window range is 0 - 4095 shades of
gray and it is typically set to 2000.
Level
Defines the midpoint for the shades of gray (0 - 4095). If level is set to 2000 and window is
2000, the shades of gray that are in use include values from 1000 to 3000.
IMAGING
Gamma Correction
Defines the default gamma value for the Auto Enhancement.
Auto Levels Min Pct (%)
Defines the percentage of cumulative shades of gray that is left out of the contrast range from
the lower end of the contrast range.
Auto Levels Max Pct (%)
Defines the percentage of the cumulative shades of gray that is left out of the contrast range
from the upper end of the histogram.
3.5 Display
3.5.1 Background colors
Background for X-Rays
Defines the background colour for the taking of X-rays.
Background for Photos
Defines the background colour for the image explorer.
3.5.2 Fonts
IMAGING
Default GUI Font and Default GUI Font Size
Define the default font for the graphical user interface.
Image Annotation Font Size
Defines the font size for the image annotations.
Image Measurement Font Size
Defines the font size for the measurements made on the images.
3.5.3 General settings
Use system file dialogue
3.6 Dental Record
3.6.1 Image Acquisition Request
IMAGING
Approval Expiry / Days
Sets the image acquisition request approval expiration time in days (1 day = 24 hours).
Approval Expiry / Hours
Sets the same time in hours.
3.6.2 Clinical Menus
Show Menu Numbers
Shows Clinical Menu numbers.
Show Menu Guidance
Shows menu guidance.
Show Tooltips
Enables tool tips in the clinical menus.
3.6.3 Odontogram
Show Tooltips
Enables tool tips in the Odontogram.
Show Large Perio Boxes
Enables large perio boxes in the Odontogram.
3.6.4 Case History
Create CaseHX Note for Approvals
Creates a case history note of every approval.
Warn About Unapproved Notes
If Warn About Unapproved Notes is selected, Planmeca Romexis warns about unapproved
notes.
IMAGING
3.6.5 Student Evaluation
Show Student Grade Evaluation
Enables the Grade Evaluation when approving case notes.
Show Student Free Evaluation
The Free Evaluation field is presented.
Grade Scale
The Grade Scale can be selected manually, for example (A, B, C,...) or, alternatively, (10, 9,
8,...) by setting the grade scale from the best to the worst.
3.7 PlanLink & Diagnostics
3.7.1 Clinic overview and log refresh rate
Sets the refresh rate for the clinic status overview and log screens. The high refresh rate may
be useful for troubleshooting.
IMAGING
3.7.2 PlanLink Compact Unit Lock
Specifies whether the dental unit should be locked when PlanLink proxy service is not
available to collect diagnostic information. If locking is enabled, the dental unit will be
inoperable when the connected PC running PlanLink proxy is shut down or otherwise
connection cannot be established between the PC and the dental unit. When connection is
re-established the dental unit will again become operable after a power cycle.
3.7.3 Save Diagnostic Events to Database
Specifies whether the diagnostic events and messages collected from the dental unit should
be save into the database. The default setting is recommended.
3.7.4 Export Ergodata files
Export to Zip
Use this function to export all recorded diagnostic data (ergodata) from dental units to a zip
file for troubleshooting purposes.
3.7.5 Dental Unit User Settings
Send Service Modes
Enable this setting to include dental unit service mode settings when dental unit settings are
stored to database and restored back to dental units. In normal operation this should be left
disabled but can be useful at dental unit installations if numerous new dental units must be
configured identically.
3.7.6 E-mail Notification
Planmeca Romexis Server can be configured to send alert e-mails when specific diagnostic
events take place in dental units. Planmeca Romexis sends the e-mails to the SMTP Server
configured here. Device alerts can be configured using Planmeca Romexis Client Admin
Module.
SMTP Server Host Name
Defines the SMTP Server host
SMTP Server Port
Defines the SMTP Server port.
IMAGING
Notification period (mins)
Defines the delay in minutes after which an error is considered to be important enough to be
reported in an e-mail. If an error is negated by itself or fixed by a user within this time limit,
then no error will be reported. The error will still be shown in the dental unit event log.
Don't e-mail for same error in (mins)
Defines the time limit during which a persistent error will not be reported again.
3.8 Print
3.8.1 Updating Print Logo Files
Client Logo
Shown in the top left corner of the printed paper.
Planmeca Romexis Logo
Shown in the top right corner of the printed paper. By default it is the Planmeca Romexis logo.
Footer Logo
Shown in the bottom left corner of the printed paper. The image which will replace a logo must
be in Portable Network Graphics file format (.png). The height of all logos is limited to 1.0
inches.
By clicking the Browse button the user can browse for desired image and by clicking the
Update button the image is updated to Planmeca Romexis database.
IMAGE & DATA MANAGEMENT
3.8.2 Show Logos in Printouts
The logos showing in printouts can be selected here.
4 IMAGE & DATA MANAGEMENT
4.1 Data folders
Romexis data folders
In the Romexis Data Folders settings sheet allows re-configuration of the Planmeca Romexis
image and ergodata (dental unit diagnostic data) storage paths can be re-configured and all
existing data can be relocated to a new folder.
Set path
Use the Set Path button to specify a new root folder for Planmeca Romexis Data folders. Eg.
if the root folder is specified as R:\romexis_data\ then Planmeca Romexis_images,
romexis_cache and romexis_ergodata folders will be automatically created under it. After the
Planmeca Romexis Server service is restarted all new images will be stored to the new
location.
Move data
To move all existing data files to a new location and update all database references to point to
the moved files click the Move Data button
It is possible to change the path to point to a new location and have new files stored there
while keeping existing files in the old location.
NOTE Planmeca Romexis Server service must be restarted after changing the root path or
moving images for the changes to activate the modifications.
4.2 Trash
Reactivate and Empty Trash
To search for inactivated patients, images and devices select the suitable alternative from the
drop-down menu.
To reactivate patients, images or devices select the appropriate alternative from the list and
click the Reactivate button. The selected items are restored to Planmeca Romexis.
To permanently delete patients, images or devices from the Planmeca Romexis database
click the Empty Trash button.
4.3 Long Term Archive
Long Term Archive (LTA) allows old images to be moved to a more permanent storage based
on their age. Long Term Archive is not a backup system but appropriate backups should be
maintained in addition to LTA media.
4.3.1 Create Long Term Archive
These settings specify which images are to be placed in the Long Term Archive (LTA), where
the archived files should be placed and whether a maximum size for a single archive should
be enforced eg. 650 MB for CD.
Archives will be created as subfolders named ARCHIVE_1, ARCHIVE_2 etc. under the
Archive path. If archive size exceeds the set maximum limit, then any remaining images will
be spanned into the next archive. Every archived image is accompanied by an image
information text file that will allow manually linking the images back to correct patients in a
disaster scenario, or to manually locate single images inside the archive.
Archived images will have an archive thumbnail shown in Planmeca Romexis client in place
of the actual image thumbnail. When the thumbnail is double clicked the user is presented
with an option to browse to the correct archive with the Archive path provided as default.
Archive Images button will start the process of moving images from Planmeca Romexis
images folder to the Archive path. Summary and progress information for the process is
shown in the area below.
START-UP
5 START-UP
5.1 Client Parameters
NOTE This tab can be used to configure only the Client that is installed on this current
workstation.
5.1.1 Connect to Romexis Server
Server Address and Server Port
Define the Planmeca Romexis Server address into which Planmeca Romexis Client connects
to. Host address can be either IP or DNS name.
User ID and Password
are login information for the Client, and they are optional.
START-UP
5.1.2 Java VM Parameters
JVM Path
Set the Java Virtual Machine to be used by Planmeca Romexis client.
Stack Size
Defines the amount of stack memory in use. This parameter is optional, and needs to be
configured only if certain TWAIN devices are used.
Max Heap Size
Defines the maximum amount of memory which Planmeca Romexis Client has in use.
3D Rendering
Defines the rendering method for 3D images.
5.1.3 User Interface
Language
Defines the language file used with Planmeca Romexis Client.
Main Window Size X and Main Window Size Y
These parameters can be used to force the Client's main window to a certain size.
5.1.4 Set Defaults
To restore the default settings click this button.
START-UP
5.2 Planmeca Romexis Service
Planmeca Romexis Service is a Windows program that starts Planmeca Romexis Server
every time Windows is started. In this tab all settings for the Planmeca Romexis Service can
be configured.
NOTE Changes to these parameters take effect after you restart Planmeca Romexis Service.
5.2.1 Planmeca Romexis Service
Windows Service Name
Defines the name of the Planmeca Romexis Service in the Windows Services list.
Executable Name
Name of the wrapper executable to be used as Planmeca Romexis Service.
Startup Delay (min)
Defines the Planmeca Romexis Service Startup Delay in minutes.
START-UP
5.2.2 Java VM Parameters
These parameters affect the way Planmeca Romexis Server is launched.
JVM Path
Defines the path to the Java Virtual Machine in use.
Classpath
Defines the files that the Virtual Machine uses.
Main Class
Defines the Main Class inside the Planmeca RomexisServer.jar.
Optional App Args
Allows passing optional configuration parameters to Planmeca Romexis Server, normally
specified in romexis_server.properties.
Optional JVM Args
Allows passing optional configuration parameters to Planmeca Romexis Servers Java Virtual
Machine. Normally specified in RomexisService.ini.
Max Heap Size
Defines the maximum amount of memory which Planmeca Romexis Server has in use.
Aggressive/Multi-core Garbage Collection
By selecting Aggressive/Multi-core Garbage Collection, the garbage collection can be
enhanced.
5.2.3 Planmeca Romexis Service Control
Start Service
Starts the Planmeca Romexis Service.
Stop Service
Stops the service.
START-UP
Remove Service
Stops the Service and removes it from the Windows Services list.
Show Log
Opens the Planmeca Romexis Service Log.
5.2.4 Set Defaults
To restore default settings click this button.
SERVER PARAMETERS
6 SERVER PARAMETERS
6.1 Server
6.1.1 RMI - Server/Client Communication
RMI Server Host
Planmeca Romexis Server IP or DNS name is configured here.
RMI Server Port
Defines the port for Planmeca Romexis Server-Client-communication.
SERVER PARAMETERS
6.1.2 Class Server
Class Server Enabled
If this option is selected, Planmeca Romexis Server provides the latest PMUAPI classes to
PMUAPI proxies which communicate with the dental units.
Class Server Port
The port the Server listens to.
6.1.3 Unit Communication (PlanLink)
Diagnostics Enabled:
Enables the communication between Planmeca dental units and Planmeca Romexis.
Diagnostics Log Enabled:
Starts the logging of the diagnostic communication.
Save diagnostic data only when patient is selected
Diagnostic Port
Defines the Planmeca Romexis Server port for diagnostic communication.
6.1.4 Server Log
To open the Romexis Server Log click the Show Log button.
6.1.5 Set Defaults
SERVER PARAMETERS
6.2 Database
6.2.1 Database connection
The database that is used with Planmeca Romexis can be selected among the three
alternatives shown in this field.
Solid
Oracle
SQL server
Firebird
JDBC Connect URL
Planmeca Romexis uses JDBC driver to connect to the database. If you use a different
database than the one provided in the Planmeca Romexis installation, you must acquire
JDBC driver for the alternative database.
JDBC Connect URL is the connection string which JDBC driver uses to locate the data
source. An example URL can be seen beside the database names, but because it is defined
SERVER PARAMETERS
by the provider of the driver, it can differ from the example URL. In such case contact the
provider of the JDBC driver.
User ID and Password
The login information to enter the Planmeca Romexis Database.
Test connection
The database connection can be tested by clicking the Test Connection button.
Set Defaults
6.3 External communication
6.3.1 Data gate - External Patient Management System
SERVER PARAMETERS
Planmeca Romexis can connect to an external patient management system through data
gate. Data gate is a connection to the database from which Planmeca Romexis polls for new
external information.
Active from
Defines the starting hour of the day for the automatic data gate polling.
Active to
Defines the last hour of the day until which the data gate polling is on.
Poll Interval (min)
Defines the time interval between consecutive queries into the database.
6.3.2 DICOM
Planmeca Romexis can be configured to use auto storage to automatically sen DICOM
images to external PACS image database after acquisition . Planmeca Romexis polls for new
DICOM images according to the Poll Interval from the Planmeca Romexis database.
DICOM Polling Enabled
Defines whether polling and automatic storage are performed.
Active from
Defines the starting hour of the day for automatic DICOM polling.
Active to
Defines the last hour of the day until when the DICOM polling is on.
Poll Interval
Defines the time interval between consecutive queries into image database.
6.3.3 Set Defaults
Planmeca Romexis Appendix A-1 Users manual
APPENDIX A:PLANMECA PROMODEL
1 QUICK GUIDE FOR PLACING PLANMECA
PROMODEL ORDERS
Planmeca ProModel is designed for dental professionals to use as an assisting tool for
preoperative planning of difficult dental and maxil-lofacial operations. In no circumstances
ProModel can be used in vivo.
1.1 Overview of ProModel service
ProModel order button opens the integrated order form in 3D Master Menu Toolbar i
User has three options to place Planmeca ProModel orders via integrated ordering interface:
o Online order sends image and order form to Plan-mecas FTP server.
o Burn ProModel order on CD using this option burns image and order form to portable
media which can be mailed to Planmeca.
o Export to My Documents exports zip-folder which includes the image and order form to
users local com-puters My Documents (OS WinXP).
Using any of the above described ordering methods in Romexis software the patients image
is automatically anonymized meaning that all patients person-related information is
removed from the 3D volume.
To place a Planmeca ProModel online order with integrated ordering interface in Romexis
software, computer needs to be online (Internet access) and possible firewalls need to be set
to accept outgoing FTP-connections.
Order confirmation and courier package tracking number will be sent to customers email
account.
Appendix A-2 Planmeca Romexis Users manual
2 PLACING PLANMECA PROMODEL ORDERS
Planmeca ProModel is a patient specific physical model made from Promax 3D imaged
volume. The ProModel can be used as a supportive tool in preoperative planning of dental
and maxillofacial operations. The ProModel is designed to be used with the original ProMax
3D imaged volume, the ProModel should not be used as only tool for planning operations.
This users manual is valid for Planmeca ProModel order with integrated ordering interface in
Romexis (version 2.0.0.0.R and later) for placing Planmeca ProModel orders.
2.1 3D Master Menu Toolbar with Planmeca ProModel Order
In this manual new features (available in Romexis 2.0.0.0.R and later versions) Planmeca
ProModel ordering button and interface are introduced.
The master menu toolbar contains buttons common to all 3D modules. The functions are
explained in detail in Romexis Users Manual starting from the version 2.0.
Planmeca ProModel order button is enabled by default. In case you would like remove the
order button from 3D Master Menu Toolbar follow the instructions below.
Disabling the Planmeca ProModel ordering button
NOTE User must have administrator rights in Romexis to disable (or enable) the Planmeca
ProModel ordering button.
1. Select Admin from the toolbar.
2. Click the Local Settings tab.
3. Click the Show ProModel Order Button.
4. Click Save.
5. Restart your Romexis software.
After restarting Romexis software, the Planmeca ProModel order button has been disabled.
Planmeca ProModel order
Opens the Planmeca ProModel order form to place an order from current 3D volume. Only
available in 3D module. Clicking the Planmeca ProModel order button opens the integrated
order form in Romexis, please see figure 3.
To place a Planmeca ProModel order from current volume user must fill the required fields in
the form (bolded). The fields in order form are explained in detail below (see figure 4).
NOTE A volume must be opened in the Explorer tab in order to use the ProModel ordering,
otherwise the button is greyed.
NOTE Planmeca ProModel is not autoclavable and it is not recommended to use liquid
disinfection by default.
NOTE In case of artefacts caused by high-density objects, such as amalgam or other metallic
bodies it is recommended to use the Artefact Removal tool in your Romexis software
before placing Planmeca ProModel order.
NOTE In case of separate mandible and maxilla is needed, patients 3D exposure should be
taken with a mouthpiece on.
2.2 Overview of Planmeca ProModel Order Form
Required fields include common information concerning the order (company, name,
address, postcode, city, state and country). Order confirmation will be sent to users email
account, please give a valid email address.
ProModel ID will be printed on ordered ProModel to make it individual. As a default value is
the person id of the volume under examination. The default value is given by Romexis
software. This value can be changed, as user likes. It can be in text, numbers or special
characters format.
Comments field (not mandatory) is for special requests, e.g. if user prefer the ProModel in
different colour than the default white. Also if user likes to have marked ROI in ProModel or
give a notice to Planmeca concerning the volume it can be written down in this field.
Reference is for order processing.
Price List button opens ProModel price list to your default web browser, if your computer is
not online clicking of Price List button gives the URL of the price list in your default web
browser. The prices in price list are recommended prices, please contact your local Planmeca
dealer for further price in-formation.
Include nerves and Implants check box. Tick the Include Nerves and Implants box, if user
has drawn mandibular nerve or placed implants in the patients data in Romexis. The colored
nerve can be printed in ordered ProModel. Implants will be included as cylinder
representations. Note: In order to get the nerves showing in the ordered ProModel, the
ProModel order should be placed from Romexis 3D Module's Cross Section/Implant tab
Add Billing Address button will be enabled if user switches the tab from Same address for
Delivery and Billing to Different Address for Delivery and Billing. After switching user can
push the Add Billing Address -button and give billing address in case user has different
delivery and billing addresses, please see figure below.
Add Dealer Information button opens a new window in which users local Planmeca dealer
information can be given. Dealer information is required for billing purposes, this infor-mation
is filled by your local Planmeca dealer and it needs to be given once. Please see figure .
Payments of the ProModels by default via bill from your local Planmeca dealer other option is
COD by UPS or Exchange Col-lect by UPS. Check the availability of the UPS payment
service in your country on www.ups.com.
Terms and Conditions can be found by clicking the hyper-link in the terms and conditions
section. By selecting this box, I agree to these Terms and Conditions - tab user must
select the box to place one Planmeca ProModel order.
Save this order form as a template button. By saving the order form as a template user do
not need to refill all the required fields every time when placing Planmeca ProModel order.
After all mandatory fields are filled the Continue button will be enabled. Clicking the button
opens the last window where user can select the appropriate ordering type. The ordering
options include:
o Online order
o Burn ProModel Order on CD
o Export ProModel Order to Desktop
For most of the fields a help text can be found making the order process as easy as possible
for the user.
Planmeca Romexis Appendix B-1
Chapter
Users manual
APPENDIX B:ROMEXIS VIEWER
1 GENERAL
Romexis Viewer application can be distributed freely with images taken using Planmeca
equipment. Romexis is a convenient tool for sending images for referral allowing images to be
easily accessed even in case the user does not have full Romexis software installed. The
features available in Romexis Viewer are the same with the Romexis installation used to
export the viewer with some limitations. Eg. If the Romexis has been used to export the
viewer with Implant module enabled, then Implant module will also be available in the viewer
except the saving feature. In general the Viewer can be used to measure images while
making new exposures, however saving changes or measurements is not possible. Also
printing is more basic compared to the full version of Romexis software. Romexis Viewer can
open 2D files in DICOM format, 3D files in DICOM MultiFrame and DICOMDir filesets.
2 OPENING IMAGES
Romexis Viewer is most commonly exported from Romexis accompanied with a DICOMDir
fileset of a patient's images. In these cases the DICOMDir will reside in the same folder with
Romexis Viewer and will be automatically presented to the user when Romexis viewer is
started. The user can then select a subset of images from the DICOMDir or open all available
images for viewing. Please note that no preview is available for 3D images. After selecting
images and clicking Import the images will be opened in the image browser. To view 3D
images move to the 3D module using the module browser on the far left. For more information
on how to view and enhance 2D images please see Romexis manual section 2D IMAGING
MODULE. Please note that some features such as exposure, export, and DICOM are not
available in Romexis Viewer.
Appendix B-2 Planmeca Romexis Users manual
3 VIEWING 3D IMAGES
To view 3D images in Romexis Viewer first move to the 3D module by using the module
browser on the far left. Select the image you want to view and then click View or double click
on the item. Switch between Explorer, Panoramic and Cross Section / Implant modules (if
available) by using the browser tabs on the left edge of the viewing area. For more
information on how to view and enhance 3D images please see chapter D 3D IMAGING
MODULE. Please note that some features such as exposure, export, and DICOM are not
available in Romexis Viewer.
4 OPENING ADDITIONAL IMAGES
Romexis Viewer can also be used to open single DICOM
images or to open DICOMDir filesets outside the default
Viewer folder. To open a single DICOM image click the
Open DICOM File icon on the toolbar.
Alternatively you can use the File menu option Open
DICOM File. Next browse to the DICOM file you wish to
open in Romexis. RomexisViewer will present you with a
list of images found in the folder and require you to
choose which image to open. Please note that when a
single DICOM image is opened, any previously opened
images will be closed. To open a DICOMDir use Open
DICOMDir icon on the toolbar.
Alternatively you can use the File menu option Open
DICOMDir. Next browse to the DICOMDir you wish to
open and proceed with opening the DICOMDir as when
starting the Romexis Viewer.
Planmeca Romexis Appendix C-1 Users manual
APPENDIX C: ORDERING SURGIGUIDE DRILL
GUIDES WITH PLANMECA ROMEXIS
After having finished the implant plan in Planmeca Romexis you can order a Surgiguide with
Planmeca Romexis ordering wizard.
1. To launch the order wizard click the Order Guide button.
2. The following window opens
3. Fill in the order form.
If necessary you can send plaster model with the order by selecting the correct ordering
option.
Appendix C-2 Planmeca Romexis Users manual
4. When the order is completed click Place Order button.
5. You will soon receive an automatic confirmation e-mail.
6. To complete the order send the e-mail to Materialise Dental Support Service.
NOTE If a suitable internet connection is not available, the order can be saved to file and sent
to Materialise Dental manually. In this case no automatic e-mail will be sent
Materialise Dental SurgiGuide specialist will contact the customer to implement the guide
design and discuss it with the customer.
After production the customer receives the SurgiGuide ready for use in surgery via their
Materialise Dental distributor.
Planmeca Oy | Asentajankatu 6 | 00880 Helsinki | Finland
tel. +358 20 7795 500 | fax +358 20 7795 555 | sales@planmeca.com | www.planmeca.com

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