user's manual 2D imaging - planmecausasupport.com angles PA TMJ 3 angles lateral TMJ PA...

Planmeca ProMax 3D Mid

EN

user's manual2D imaging

1002

6635

_11

TABLE OF CONTENTS

1 INTRODUCTION ..............................................................................................1

2 MAIN PARTS ...................................................................................................22.1 Sensors .......................................................................................................................... 22.2 Patient supports ............................................................................................................. 32.3 Exposure switch ............................................................................................................. 42.4 Emergency stop button .................................................................................................. 5

3 SWITCHING X-RAY UNIT ON .........................................................................5

4 PROGRAMS .....................................................................................................64.1 Panoramic programs ...................................................................................................... 84.2 Temporomandibular joint (TMJ) programs ................................................................... 104.3 Sinus programs ............................................................................................................ 12

5 CONTROL PANEL .........................................................................................145.1 General about control panel ......................................................................................... 145.2 General settings ........................................................................................................... 155.3 Selecting panoramic program ...................................................................................... 185.4 Selecting temporomandibular joint (TMJ) program ...................................................... 225.5 Selecting sinus program .............................................................................................. 25

6 PATIENT POSITIONING CONTROLS ...........................................................26

7 PREPARATIONS FOR EXPOSURE ..............................................................287.1 Attaching and removing sensor ................................................................................... 297.2 Preparing patient .......................................................................................................... 31

8 PANORAMIC EXPOSURE .............................................................................328.1 Patient positioning ........................................................................................................ 338.2 Taking an exposure ..................................................................................................... 38

9 TEMPOROMANDIBULAR JOINT (TMJ) EXPOSURE ..................................419.1 Double TMJ exposure (lateral, PA or lateral-PA) ......................................................... 419.2 Multi-angle TMJ exposure (PA or lateral) .................................................................... 48

10 SINUS EXPOSURE ........................................................................................5310.1 Patient positioning ........................................................................................................ 5410.2 Taking an exposure ..................................................................................................... 56

Planmeca ProMax 3D Mid 1User’s Manual (2D)

TABLE OF CONTENTS

The manufacturer, assembler, and importer are responsible for the safety, reliability and performance of the X-ray 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 pursues a policy of continual product development. Although every effort ismade to produce up-to-date product documentation this publication should not beregarded as an infallible guide to current specifications. We reserve the right to makechanges without prior notice.

COPYRIGHT PLANMECAReleased: 7 July 2014Publication part number: 10026635 revision 11

2 Planmeca ProMax 3D Mid User’s Manual (2D)

INTRODUCTION

1 INTRODUCTIONThis manual describes how to take 2D panoramicexposures. Make sure that you are fully acquainted withthe appropriate radiation protection measures and theseinstructions before you use the X-ray unit.

NOTE The software version is shown briefly on the controlpanel when the X-ray unit is switched on. This manualis valid for software version 2.7.6.0.r or later. Thissoftware version is compatible with Romexis softwareversion 3.7.0.r or later.

NOTE Refer to the User’s Manual for 3D imaging for detailson information displays and for any general adviceabout the X-ray unit.


MAIN PARTS

2 MAIN PARTSNOTE Refer to the User’s Manual for 3D imaging for a general

view of the X-ray system.

2.1 Sensors

Pro

f_1.

eps

3D Mid ProFace sensor

Mid

_85

3D sensor Dimax sensor

Mid

_3D

_15x

15.e

ps


MAIN PARTS

2.2 Patient supports

Bite

1.ep

s

Chin support

Bite piece

Chin cup

Chin rest

Temple supports

Chi

n2.e

ps

Bite

2.ep

s

Chi

n1.e

ps

Lip1

.eps

Adapter


MAIN PARTS

2.3 Exposure switch

The exposure switch can be mounted on the wall, or it canbe hung from the hook provided on the stationary columntop if a protected area is within reach.

On the exposure button and on the control panel a greenindicator light will come on when the unit is correctly setup and ready to take an exposure. Additionally, the wordREADY will stop flashing on the control panel display.

An amber indicator light will come on on the exposureswitch and on the control panel when you take anexposure. It indicates that the unit is generating radiation.You will also hear a radiation warning signal.

When you take an exposure you must press and holddown the exposure button for the whole duration of theexposure.

If you remove your thumb from the exposure buttonbefore the exposure cycle is completed radiation will beinterrupted, the C-arm will stop moving and a helpmessage will appear on the control panel display. Guidethe patient away from the X-ray unit. Then clear the helpmessage by touching OK.

_wal

l6_2

.ep

s

Exposure button withindicator light

AMBER = EXPOSURE

GREEN = READY

Exposureindicator light

Exposureindicator light

Readyindicator light(GREEN)

(AMBER)

CONTROL PANEL LIGHTS:

PX

R_D

sw._

2eps


SWITCHING X-RAY UNIT ON

2.4 Emergency stop button

The emergency stop button is located on the top of thestationary column. Press the button to stop the X-ray unitoperating in an emergency. When the emergency stopbutton is pressed down, all movements of the X-ray unitare blocked and the unit will not generate radiation. Theup / down movement will stop within a distance of 10 mm(0.4 in.).

A help message will appear on the control panel display.Guide the patient away from the X-ray unit. Then releasethe emergency stop button. The X-ray unit willautomatically restart.

3 SWITCHING X-RAY UNIT ON

The on / off switch is located on the underside of thestationary column top. When you switch the X-ray unit onthe main display will be shown on the control panel andthe X-ray unit will carry out a self-test which will last a fewseconds.

The X-ray unit is then ready for use.

NOTE To prolong the lifetime of the Planmeca ProMax 3D MidX-ray unit, always switch the X-ray unit off when it isnot in active use.

on_o

ff_2.

eps

On / off switch

Stationary column top


PROGRAMS

4 PROGRAMSNOTE The images shown in this manual are only examples.

Program package Contents Sensor

3D imaging system

3D Dental programs (standard with 3D sensor)

Tooth

Teeth

Jaw

Face

Horizontal pair

3D

3D ENT programs (optional with 3D sensor)

Sinus

Middle ear

Middle ear pair

Temporal bone

Temporal bone pair

Vertebrae

Airways

3D

3D Dental programs + ProFace (standard with 3D Mid ProFace sensor)

Tooth (+ Face Scan)

Teeth (+ Face Scan)

Jaw (+ Face Scan)

Face (+ Face Scan)

Horizontal pair (+ Face Scan)

Face Scan

3D Mid ProFace

3D ENT programs + ProFace(optional with 3D Mid ProFace sensor)

Sinus (+ Face Scan)

Middle ear (+ Face Scan)

Middle ear pair (+ Face Scan)

Temporal bone (+ Face Scan)

Temporal bone pair (+ Face Scan)

Vertebrae (+ Face Scan)

Airways (+ Face Scan)

Face Scan

3D Mid ProFace

3D Model(optional)

3D Impression scan

3D Plaster cast scan

3D or 3D Mid ProFace

2D imaging system (optional)

Basic panoramic programs (standard)

Standard panoramic

Lateral double TMJ

PA double TMJ

PA rotational sinus

Standard panoramic + TMJ

3D, 3D Mid ProFace or Dimax

3D or 3D Mid ProFace


PROGRAMS

Advanced panoramic programs (optional)

Horizontal segmenting

Orthogonal panoramic

Interproximal panoramic

Bitewing panoramic

Lateral-PA double TMJ

3 angles PA TMJ

3 angles lateral TMJ

PA non-rotational sinus

Lateral non-rotational sinus

Midsagittal non-rotational sinus


Other panoramic programs (optional)

Bitewing panoramic

Horizontal and vertical segmenting


Cephalostat (optional)

Scanning Ceph

Planmeca ProCeph

Dimax

ProCeph

Dynamic Exposure Control (DEC) (optional)

Panoramic DEC

Cephalometric DEC

Dimax

Program package Contents Sensor


PROGRAMS

4.1 Panoramic programs

Standard panoramic program

The standard panoramic program has a traditional pathand angles of the beam.

Orthogonal panoramic program

The basic imaging geometry is the same as in thestandard panoramic program but the X-ray beam isperpendicular to the jaw.

NOTE This program is optimized for orthogonal imaging anda shadow of the opposite side teeth may therefore bevisible in the radiograph.

Interproximal panoramic program

The basic imaging geometry is the same as in thestandard panoramic program but the X-ray beam is moreparallel to the interproximal contacts of the teeth.

NOTE This program is optimized for interproximal imagingand a shadow of the opposite side teeth may thereforebe visible in the radiograph.

layer laser beam1 cm



PROGRAMS

Bitewing panoramic program

This program produces bitewing images from premolarand molar areas including parts of maxilla, mandible andrami. The bottom of the maxillary sinus as well as themandibular canal and the mental foramen are also visible.

The bitewing program uses interproximal angulationprojection geometry.

In the bitewing program radiation dose is reducedcompared to the standard panoramic program.

NOTE This program is optimized for interproximal imagingand a shadow of the opposite side teeth may thereforebe visible in the radiograph.

Standard + TMJ

Panoramic program Standard + TMJ takes exposures ofteeth and both temporomandibular joints (TMJs). Theprogram uses optimal and adjustable imaging angles forTMJ exposures.

The exposure is taken in two stages. Teeth are imagedduring the first exposure (1/2) and both TMJs during thesecond exposure (2/2).


2/2


1/2

1/22/2 2/2


PROGRAMS

4.2 Temporomandibular joint (TMJ) programs

Double lateral

Lateral TMJ exposures of closed (1/2) and open (2/2)temporomandibular joints. The imaging angle isadjustable (default angle: 17°).

Double PA

Postero-anterior TMJ exposures of closed (1/2) and open(2/2) temporomandibular joints. The imaging angle isadjustable (default angle: 17°).

PA exposures are taken perpendicular to the long axis ofthe condyle (90° - 17° = 73°). The condyle angle is shownas default angle.

1/21/2 2/22/2

1 cm

1/21/2 2/22/2


PROGRAMS

Double lat-PA

Lateral (1/2) and postero-anterior (2/2) TMJ exposures ofclosed or open temporomandibular joints. The imagingangles (lateral and PA) are adjustable (default angle: 17°).


3 angles PA (L / R)

Three postero-anterior multi-angle left-hand or right-handside TMJ exposures.

The imaging angle for image no. 2 is adjustable (threeimaging angles: 17° ±7° by default). The selected imagingangle is in image no. 2.


3 angles lat (L / R)

Three lateral multi-angle left-hand or right-hand side TMJexposures.

The imaging angle for image no. 2 is adjustable (threeimaging angles: 17° ±7° by default). The selected imagingangle is in image no. 2.

1 cm

1/21/2 2/22/2

1/32/33/3

1 cm

12

3

1 cm

1 2 3

2/33/3 1/3


PROGRAMS

4.3 Sinus programs

PA rotational

Postero-anterior rotational sinus exposure.

PA non-rotational

Postero-anterior non-rotational sinus exposure.

“Non-rotational” indicates that the C-arm moves linearlyand scans over the head with a linearly moving X-raybeam.

Lateral non-rotational (L / R)

Lateral non-rotational exposure of the left or right sinusarea.

X-ray

1 cm

X-ray

1 cm

X-ray (L)


PROGRAMS

Midsagittal non-rotational (L / R)

Lateral non-rotational sinus exposure in the middle of thejaw. Exposure can be taken from the left or right jaw side.

1 cmX-ray (L)


CONTROL PANEL

5 CONTROL PANEL

5.1 General about control panel

NOTE Never allow patients to touch the display when theyare positioned in the X-ray unit. Touching the displayduring exposure will stop the imaging process.

NOTE The contents of the control panel displays depend onthe configuration of the X-ray unit.

NOTE Refer to the User’s Manual for 3D imaging for detailson information displays.

To make a selection on the control panel, simply touch atext field or an icon with your finger or a soft stylus. Youwill hear a signal tone when a field or an icon is activated.

NOTE Do not use sharp objects to operate the control panel.

You can set the X-ray unit so that the current time will beshown at the bottom of the display. On information displayi210 you can choose in which format (e.g. 13:19) it will beshown.

On information display i230 you can set the X-ray unit sothat the radiation dose will be shown in a pop-up windowafter each exposure. The value shown on the displayindicates the highest radiation dose the patient wasexposed to during the exposure. Note that you will have toaccept the pop-up message by touching OK after eachexposure.

If you are using a Dimax sensor you can set the X-ray unitso that a preview of the X-ray image will be shown on thecontrol panel after each 2D exposure (information displayi25.5).

The display will automatically switch to stand-by mode ifyou do not touch the display or the exposure button formore than thirty minutes. In stand-by mode the greenready lights on the exposure button and control panelindicate that the X-ray unit is switched on even though thedisplay is dark. The display will switch on as soon as youtouch it again.

NOTE The control panel display can be adjusted to respondto your individual finger touch (information displayi25.4).

NOTE You can switch practice mode on if you wish topractice or demonstrate the functions of the X-ray unitwithout radiation (information display i410).

NOTE The exposure time indicated on the display (before anexposure is taken) is an estimated value. The realvalue is shown after the exposure. Variation inexposure time is caused by mA automation.

Time


CONTROL PANEL

5.2 General settings

5.2.1 Selecting patient size

Select the patient size by touching the corresponding sizesymbol in the Patient size field on the main display.

Select the smallest patient size symbol for a child.Selecting the smallest patient size symbol willautomatically reduce the exposure area and patient dose.The jaw shape & size setting will automatically change toNormal & Narrow.

Select the second patient size symbol for an adolescent.Select the third patient size symbol for a small adult.Select the fourth patient size symbol for an average-sizedadult. Selecting any of the patient sizes in the middle willautomatically change the jaw shape and size setting toNormal & Average.

Select the biggest patient size symbol for a large adult.Selecting the biggest patient size will automaticallychange the jaw shape and size setting to Normal & Wide.

The selected patient size will be highlighted.

NOTE The exposure values (kV and mA) will automaticallychange to correspond with the selected patient sizeand exposure program.

NOTE Jaw shape and size selection is not available in sinusprograms.

5.2.2 Selecting kilovolt and milliampere values

NOTE The exposure values will automatically change tocorrespond with the selected patient size andexposure program.

The preset exposure values are average values and theyare only meant to guide the user.

To change the preset exposure values, touch the kV / mAfield on the main display.

From left to right: ChildAdolescentSmall adultAverage-sized adultLarge adult


CONTROL PANEL

The Select kV / mA display appears. Select the requiredexposure values by touching the kV and mA values. Theselected values will be highlighted.

Confirm your selection and return to the main display bytouching OK.

The preset exposure values for the selected exposureprogram are shown in the quick buttons at the bottom ofthe display.

NOTE Selecting kV and mA values manually will override theautomatic quick button setting.

5.2.3 Changing exposure values for quick buttons

The quick button exposure values have been preset at thefactory. If needed, the preset values can be changed bythe user.

To change the preset values of a quick button, first selectthe required kV and mA values by touching thecorresponding fields on the parameter display and thentouch and hold the desired quick button at the bottom ofthe display until you hear a signal tone. The quick buttonwill now show the new exposure values.

The quick button values are program-specific, i.e. theexposure values can be set separately for each program.

NOTE To view the preset exposure values for each programtype, refer to the tables in chapters 8 “PANORAMICEXPOSURE” on page 32, 9 “TEMPOROMANDIBULARJOINT (TMJ) EXPOSURE” on page 41 and 10 “SINUSEXPOSURE” on page 53.

Confirm your selection and return to the main display bytouching OK.

Quick buttons


CONTROL PANEL

5.2.4 Setting vertical offset valueYou can set the X-ray unit so that the C-arm moves up atthe start of all 2D exposures (panoramic, TMJ and sinus).To do this, first go to information display Set panoramicimaging vertical offset (i27.3) and adjust the vertical offsetvalue between 0-20 millimetres (default 0 mm).

The selected vertical offset (e.g. 10 mm) will be shown onthe main display. The C-arm will now automatically moveup at the start of an exposure, i.e. the image area will beshifted 10 millimetres upwards.

5.2.5 Selecting patient entry position

The X-ray unit offers two patient entry positions: Entry 1and Entry 2. You can use either of them according to yourindividual preference.

Selecting Go Entry 1 will move the C-arm to the back,away from the patient positioning area. This full viewposition allows you to monitor and adjust the patient’sposition freely from all directions.

Selecting Go Entry 2 will position the C-arm around thetemple supports. This is the traditional closed patiententry position.

NOTE If needed, the Go Entry 1 function can be disabled oninformation display i230. This might be necessary ifthere is no space for the C-arm to move back.

Vertical offset 0 mm Vertical offset 10 mm(C-arm moves up)


CONTROL PANEL

5.3 Selecting panoramic program

To select a panoramic program, touch the Prog. field onthe main display. The main display is the display that isshown when the X-ray unit is switched on.

The Select program type display appears. Select programtype Pan.

NOTE The Select program type display will show all theexposure programs that the X-ray unit features at themoment. The X-ray unit can be upgraded with newexposure programs, contact your dealer for furtherinformation.

On the next display, select the panoramic program youwish to use.

Refer to section 4.1 “Panoramic programs” on page 8 fora more detailed description of the program types.

NOTE Program type Standard + TMJ is not available for X-rayunits with Dimax sensor.

When you have selected the program the main displaywill be shown again.

X-ray units with Dimax sensor:X-ray units with 3D sensor and SmartPan license:


CONTROL PANEL

5.3.1 Selecting jaw shape & size in panoramic programs

This function adjusts the form of the image layer toaccommodate patients with different jaw shapes andsizes.

NOTE The setting in the jaw field will automatically change tocorrespond with the selected patient size.

Selecting the smallest patient size will automaticallychange the jaw shape and size setting to Normal &Narrow.

Selecting any of the three patient sizes in the middle willautomatically change the jaw shape and size setting toNormal & Average.

Selecting the biggest patient size will automaticallychange the jaw shape and size setting to Normal & Wide.

If necessary, you can select the jaw shape and sizemanually by touching the Jaw field or jaw icon on the maindisplay.

The Select jaw shape & size display appears. Themarking on the jaw icon demonstrates the image layer.Select the required jaw shape and size by tapping thecorresponding icon. The selected jaw icon will behighlighted.

NOTE Selecting jaw shape and size manually will overridethe automatic setting.

Confirm the selection and return to the main display bytouching OK.

Jaw size:

Narrow

Average

Wide

Jaw shape: NormalV-shaped Square


CONTROL PANEL

5.3.2 Selecting segmentation in panoramic programsNOTE Horizontal segmenting is not available for the bitewing

program.

This optional function allows you to take exposures ofdifferent jaw segments. This will reduce the radiation doseas only diagnostically interesting sections need to beincluded in the exposure.Touch the Segment field or segment icon on the maindisplay.

The Select segmentation display appears. The displayshows an icon which is divided into three horizontalsectors (and five vertical sectors, depending on the unitconfiguration). The segment numbers on the main display(1 2 3 4 5) refer to the five vertical sectors.Touch the corresponding arrow field(s) to deselect thesector(s) that should not be exposed. The sectors whichwill not be exposed will turn dark red. The sectors whichwill be exposed remain white.

NOTE It is not possible to expose two separate horizontalsectors.

Touching the arrow of a deselected sector again willchange the sector’s color back to white.


NOTE The image shown on the display is only an example.The actual size of the exposed area depends on thepatient’s anatomy.

5.3.3 Dynamic Exposure Control (DEC) in panoramic programs

NOTE Dynamic Exposure Control (DEC) is an optionalfeature for X-ray units with Dimax sensor. DEC has tobe activated on information display i310 before youcan start using it.

NOTE DEC and vertical segmenting can be usedsimultaneously. However, the right-most verticalsector (segment 5) cannot be deselected.

NOTE DEC and horizontal segmenting cannot be usedsimultaneously.

NOTE If Autofocus is switched on (AF ON), DEC will beautomatically switched off for the first exposure (scoutimage).

Deselectedsectors -

Sectors

no exposure

to be exposed

ExposureNo exposure


CONTROL PANEL

Touch the DEC field on top of the main display to switchDynamic Exposure Control (DEC) on or off for theexposure you are going to take.

Dynamic Exposure Control (DEC) automatically providesoptimal exposure values for each patient during exposure.This function adjusts the exposure values individually foreach patient based on their anatomic structure and bonedensity. Switching DEC on improves the image quality asthe function produces images of more consistentbrightness and contrast.

When DEC is switched on the exposure values will beautomatically adjusted during exposure. The kV value willbe adjusted by max ±4 kV and the mA value will beadjusted by max +4/-3 mA within the available scale.

Adjusting DEC density

If the images appear to be too bright or too dark, DECdensity can be adjusted on the DEC Settings display(i25.1).

To adjust DEC density for panoramic exposures toucheither of the Panoramic density arrow fields. DEC densityis expressed in percentage in comparison to DECcalibration value. The setting can be adjusted between20% (lower exposure values -> brighter image) and 200%(higher exposure values -> darker image). Therecommended setting is 100% (default setting).


CONTROL PANEL

5.3.4 Autofocus (AF) in panoramic programs

NOTE Autofocus is an optional feature for X-ray units withDimax sensor. It is available for standard,interproximal and orthogonal panoramic programs.

NOTE Autofocus has to be activated on information displayi310 before you can start using it.

NOTE The layer light is disabled when Autofocus is switchedon.

NOTE If Autofocus is switched on (AF ON), DEC will beautomatically switched off for the first exposure (scoutimage).

Touch the Autofocus field on the main display to switchAutofocus on (AF ON) or off (AF OFF) for the exposureyou are going to take.

Autofocus adjusts the layer position automatically. Thefunction positions the image layer individually for eachpatient based on the position and angle of the apices ofthe upper central incisors.

The exposure will be taken in two stages and the C-armwill move twice.

5.4 Selecting temporomandibular joint (TMJ) program

To select a temporomandibular joint (TMJ) program,touch the Prog. field on the main display. The maindisplay is the display that is shown when the X-ray unit isswitched on.



CONTROL PANEL

The Select program type display appears. Select programtype TMJ.


On the next display, select the TMJ program you wish touse. If the program is not shown on the display, you canuse the down arrow to scroll through the list.

Refer to section 4.2 “Temporomandibular joint (TMJ)programs” on page 10 for a more detailed description ofthe program types.


5.4.1 Selecting jaw size and adjusting imaging position & angle in TMJ programsThis function adjusts the image layer (focal through) toaccommodate patients with different jaw sizes.

NOTE The setting in the jaw field will automatically change tocorrespond with the selected patient size.

Selecting the smallest patient size will automaticallychange the jaw size setting to Narrow.

Selecting any of the three patient sizes in the middle willautomatically change the jaw size setting to Average.

Selecting the biggest patient size will automaticallychange the jaw size setting to Wide.

If necessary, you can select the jaw size manually bytouching the Jaw field or jaw icon on the main display.

The Select jaw size, adjust position and angle displayappears. The marking on the jaw icon demonstrates theimage layer. Select the required jaw size by tapping thecorresponding icon. The selected jaw icon will behighlighted.

NOTE Selecting the jaw size manually will override theautomatic setting.


CONTROL PANEL

To adjust the imaging position or angle, touch thecorresponding arrows on either side of the display. Theimaging position or angle on the other jaw side willchange accordingly if the setting in the top right field is setto Symmetric.

If the patient’s right and left side are asymmetric you willneed to set the imaging position and angle separately onthe other jaw side. To do this, touch the field forsymmetric / asymmetric setting to select the asymmetricsetting and adjust the other jaw side as required.


NOTE You can set the X-ray unit so that the imaging positionwill be automatically moved forwards for the open jawexposure (i27.1).

NOTE The default imaging angle (17 degrees for lat and PA)can be changed (i27.1).

5.4.2 Selecting jaw side in double TMJ programs

This function enables you to select on which side theexposure(s) will be taken.

On the main display, touch the Segment icon.

The Select side display appears. Touch the arrow field todeselect the jaw side that should not be exposed. Thisside will turn dark red. The jaw side which will be exposedremains white.

Touching the arrow of a deselected side again will changethe color back to white.


Symmetric / asymmetricexposure


CONTROL PANEL

5.5 Selecting sinus program

To select a sinus program, touch the Prog. field on themain display. The main display is the display that isshown when the X-ray unit is switched on.

The Select program type display appears. Select programtype Sinus.


On the next display, select the sinus program you wish touse.

Refer to section 4.3 “Sinus programs” on page 12 for amore detailed description of the program types.




PATIENT POSITIONING CONTROLS

6 PATIENT POSITIONING CONTROLS

NOTE Never allow patients to press the positioning controlswhen they are positioned in the X-ray unit.

NOTE Touching any of the positioning controls (button orjoystick) will switch the patient positioning lights on.

X-ray unit up / down

The X-ray unit up and down buttons are used to adjust theX-ray unit to suit the height of the patient.

The X-ray unit moves slowly at first, then faster.

NOTE If for some reason either of the buttons gets stuckduring operation, you can stop the up / downmovement by pressing any of the other controlbuttons or the positioning joystick. This is a safetymeasure that guarantees that the up / down movementcan be stopped in an emergency.

NOTE Be careful that the X-ray unit does not hit the ceilingwhen you press the up button. The maximum heightcan be adjusted to suit offices with low ceiling, contactyour service technician for help.

NOTE Make sure that there is no object under the telescopiccolumn when you press the down button. If somethingis in danger of becoming trapped, release the buttonimmediately to stop the movement.

NOTE The column movement stops automatically if theemergency stop plate at the bottom is pressedupwards. Clear any obstruction before moving thecolumn again.

NOTE When positioning wheelchair patients always firstmove the X-ray unit down before you position thepatient in the unit.

Positioning joystick

The positioning joystick is used for horizontal fine-adjustment of the target area in 3D imaging. It is usedwhen the patient is positioned in the X-ray unit.

Open / close temple supports (2D imaging)

Move target area up

Move X-ray unit up

Positioning joystick (3D imaging)

Move X-ray unit down

Move target area down(3D imaging)(3D imaging)

Down Up

emer

gen

cy_s

top

.ep

s

Stop plate


PATIENT POSITIONING CONTROLS

Target area up / down

The target area up and down buttons are used for verticalfine-adjustment of the target area in 3D imaging. Thebuttons are used when the patient is positioned in the X-ray unit.

The X-ray unit moves slowly when you press the up /down button. The height of the patient support table is notchanged, i.e. the patient remains in the same position.

Open / close temple supports

Press the temple support button to open the templesupports in 2D imaging. The temple supports can beclosed by pressing the temple support button again.

Down Up


PREPARATIONS FOR EXPOSURE

7 PREPARATIONS FOR EXPOSURENOTE The available sensors are shown in section 2.1

“Sensors” on page 2.

NOTE If a movable Dimax sensor is attached to thecephalostat (optional), the sensor must be moved tothe C-arm if you wish to use it for taking panoramicexposures.

NOTE If the X-ray unit has a SmartPan license and a Dimaxsensor, you can - use a 3D sensor to take 3D and SmartPan (SmartPan,SmartTMJ, SmartSinus) exposures OR - use a 3D sensor to take 3D exposures and a Dimaxsensor to take panoramic exposures. This option hasto be selected on information display i230(Behavioural preferences -> Use Dimax sensor forpanoramic).



7.1 Attaching and removing sensor

NOTE FOR PROFACE SENSOR:Do not touch the glass windows when you hold thesensor. Fingerprints or other stains on the glasssurface destroy image quality.

CAUTION Do not drop the sensor. Planmeca limitedwarranty does not cover damage which isdue to misuse, e.g. dropping the sensor,neglect, or any cause other than ordinaryuse.Do not use the sensor if the shock indicatoris red - contact your service technician forhelp.If you have any reason to believe that thesensor might be faulty, take a test exposurebefore taking a patient exposure.

Attaching sensor to C-arm

Push the sensor onto the connector on the C-arm.

Turn the locking knob over the fastening mechanism. Thiswill secure the sensor in position.

Glass windows

ProFace sensor

Shock indicator

Dimaxsensor

Sensor

Locking knob



Push in the C-arm electrical connector button on the otherside. This will make the electrical connection between thesensor and C-arm.

Detaching sensor from C-arm

NOTE Do not remove the sensor during imaging process.

Push in the C-arm electrical connector. This willdisconnect the electrical connection between the sensorand C-arm.

The locking knob can now be turned 180 degrees. Thiswill release the locking mechanism.

Carefully pull the sensor out.

Mid

_84.

eps

C-arm electricalconnector button

C-armelectricalconnector

Sensor

Lockingknob



7.2 Preparing patient

Ask the patient to remove any spectacles, hearing aids,dentures, hairpins, and personal jewellery such asearrings, necklaces and piercings as these can produceshadows or reflections in the image. The patient shouldalso remove any loose items of clothing (e.g. scarf, tie)that might get caught in the arms of the X-ray unit.

NOTE High contrast objects, such as gold teeth or amalgam,may cause artefacts in the image.

Place a protective lead apron over the patient’s back ifrequired.


PANORAMIC EXPOSURE

8 PANORAMIC EXPOSUREInsert the chin rest and a bite piece into the adapter.Insert the adapter into the holes in the patient supporttable.

For edentulous patients or for patients who are unable touse the bite piece you can use the chin cup or the chinsupport.

NOTE We recommend that you use the chin support whentaking bitewing exposures.

Select the panoramic program you wish to use (seesection 5.3 “Selecting panoramic program” on page 18).Select the patient size (see section 5.2.1 “Selectingpatient size” on page 15).

The exposure values will automatically change tocorrespond with the selected exposure program andpatient size. The preset exposure values are shown in thefollowing table. The preset exposure values are averagevalues and they are only meant to guide the user. Ifnecessary, you can change the preset values asdescribed in section 5.2.2 “Selecting kilovolt andmilliampere values” on page 15.

NOTE FOR X-RAY UNITS WITH DIMAX SENSOR:The preset exposure values are optimized for takingexposures at enhanced resolution (Romexis setting).You can use lower exposure values when takingexposures at normal resolution.

NOTE Always try to minimize the radiation dose to thepatient.

The setting in the jaw field will automatically change tocorrespond with the selected patient size. You can selectthe jaw shape and size manually as described in section5.3.1 “Selecting jaw shape & size in panoramic programs”on page 19.

You can take a segment exposure by selecting onlycertain vertical or horizontal segments of the jaw, refer tosection 5.3.2 “Selecting segmentation in panoramicprograms” on page 20.

Bite

2.ep

s

Bite

1.ep

s

Adapter

Chin rest

Bite pieceC

hin2

.eps

Chi

n1.e

ps

Chin cup

Chinsupport

Lip1

.eps


PANORAMIC EXPOSURE

If you are taking a combined exposure (Standard + TMJ),select the jaw size and image position parameters (targetposition, imaging angle, symmetric / asymmetric setting)as described in section 5.4.1 “Selecting jaw size andadjusting imaging position & angle in TMJ programs” onpage 23.

Move the C-arm to the patient entry position if it is notalready there. Refer to section 5.2.5 “Selecting patiententry position” on page 17 for differences between the twopositions.

Prepare the patient for the exposure as described insection 7.2 “Preparing patient” on page 31.

8.1 Patient positioning

Press the temple support button to open the templesupports if they are not already open.

Guide the patient to the unit so that they are facing thechin rest.

To adjust the height of the unit, press either of the heightadjusting buttons until the chin rest is on the level of thepatient’s chin.


Panoramic exposure values

PATIENT kV VALUE mA VALUE

Child 62 5

Adolescent 64 6

Small adult 66 8

Average-sized adult 68 10

Large adult 70 13

Templesupportbutton

Height adjustingbuttons


PANORAMIC EXPOSURE

Ask the patient to step forward, grasp the patient handles,stretch and straighten their back and neck, and bite thebite piece. The incisal edges of the maxillary andmandibular teeth must be in the groove in the bite piece.

NOTE If you are using the chin support, position the patientso that the chin, just below the lower lip, touches thetop bar.

NOTE If you are using the chin cup or chin support, use forexample a cotton roll to ensure that the patient’s upperand lower incisors do not overlap.

The following positioning lights will come on:

Bite piece

Patient position withchin support

3DM

id_l

ight

s1.e

ps

Frankfort

Midsagittal plane light

Layer light

plane light


PANORAMIC EXPOSURE

Note that the positioning lights will automatically switch offafter two minutes. If the lights go out before you havepositioned the patient, switch them on by touching thethumb wheel on the underside of the patient support tableor by pressing any of the positioning controls (button orjoystick).

Position the patient’s head so that the midsagittal planecoincides with the midsagittal plane light beam.

Position the patient’s head so that the Frankfort planecoincides with the Frankfort plane light beam. Adjust thetilt of the patient’s head by raising or lowering the unit withthe height adjusting buttons. The patient’s back and neckshould be straight.

The Frankfort plane is a plane which joins the infra-orbitalpoint to the superior border of the external auditorymeatus.

patp

oslig

hts3

.eps Thumb wheel

Patient support table

Positioningcontrols


Frankfort plane light


PANORAMIC EXPOSURE

The Frankfort plane light, which is located on the side ofthe column, can be moved up or down. This is done byrotating the thumb wheel below the light slot.

Position the apices of the patient’s upper central incisorswithin the image layer of the unit.

To do this, rotate the thumb wheel located on theunderside of the patient support table to move the layerlight until it falls between the second incisor and thecanine. For an average patient, this procedure will placethe apices of the upper central incisors within the imagelayer.

NOTE The layer light is disabled when Autofocus is switchedon (AF ON).

Check that the Frankfort plane light and the midsagittalplane light are still correctly positioned. Reposition them ifnecessary.

Frankfortplanelight

Thumbwheel

Canine

Apices of upper central incisors

Layer light

Secondincisor

Layer light

patp

oslig

hts3

.eps

Thumbwheel


PANORAMIC EXPOSURE

Panoramic program Standard + TMJ

If you are taking a combined exposure, the TMJ imagingposition and angle must be checked when the patient ispositioned in the X-ray unit:

Touch the Jaw field on the main display, or alternatively,tap the jaw icon on the right side of the display. The Selectjaw size, adjust position and angle display will appear.

Imaging position: Use a ruler to measure the distancebetween the layer light and the patient’s temporo-mandibular joint to determine the exact imaging position.Adjust the imaging position with the left / right arrowsaccording to your measurement.

Imaging angle: Take a submento-vertex exposure (axialprojection) to determine the exact imaging angle. Adjustthe imaging angle with the left / right arrows according toyour measurement.

NOTE The ruler measurement depends on the position of thelayer light. On retakes always use a ruler to measurethe position. Do not rely on numeric position values.

Imaging position: Ruler measurement

Layer light

Imaging angle: Submento-vertex exposure


PANORAMIC EXPOSURE

8.2 Taking an exposure

NOTE Make sure that you have selected the right patient andthe panoramic exposure mode in the PlanmecaRomexis program before you take an exposure. Referto the Romexis User’s Manual.

When you are ready to take an exposure touch the Readyfield on the main display. The X-ray unit will move to theready position and the temple supports will automaticallyclose.

On the exposure button and on the control panel a greenindicator light will come on. Additionally, the word READYwill be shown on the control panel display. The Romexisprogram will show the Waiting for Ready message on thecomputer screen.

The green indicator lights and the word READY will flashwhile the unit moves to the ready position. They will stopflashing when the unit has reached the ready position.The Romexis program will now show the Waiting forExposure message on the computer screen.

Ask the patient to close their lips on the bite piece,swallow, place their tongue flat against the roof of themouth, breathe normally, and stand as still as possible.

Move to a protected area.

NOTE Maintain audio and visual contact with the patient andunit during exposure. If the C-arm stops movingduring exposure, or moves in an erratic way, releasethe exposure button immediately.

Standard, interproximal, orthogonal and bitewing panoramic programs

Press and hold down the exposure button for the durationof the exposure. The C-arm will move once around thepatient’s head. The radiation warning lights on theexposure switch and on the control panel will come onand you will hear a radiation warning tone. When the C-arm has completed the exposure cycle the templesupports will automatically open. You can now guide thepatient from the unit.

When you have taken the exposure the image will beshown on the computer screen. Note that you mustaccept the image in the Planmeca Romexis program -only accepted images will be stored in the database.Refer to the Romexis User’s Manual.

Exp

_sw

_wal

l6_2

.ep

s

Green ready indicator light

Dsw

._2e

ps

Amber exposure indicator light


PANORAMIC EXPOSURE

Panoramic program Standard + TMJ

The exposure will be taken in two stages and the C-armwill move twice. The teeth area is imaged during the firstexposure and the temporomandibular joints (TMJs) duringthe second exposure. The C-arm is automatically movedupwards between the exposures. You will hear a warningtone when the C-arm moves up.

Press and hold down the exposure button for the durationof both exposures.

NOTE Do not release the exposure button before the end ofthe second exposure.

During the exposures the radiation warning light on theexposure switch and on the display will come on and youwill hear a radiation warning tone.

When the C-arm has completed the second exposurecycle the temple supports will automatically open. Youcan now guide the patient from the unit.


Standard, interproximal and orthogonal panoramic programs using Autofocus (X-ray units with Dimax sensor)

Autofocus adjusts the layer position automatically. Thefunction positions the image layer individually for eachpatient based on the position and angle of the apices ofthe upper central incisors.

The exposure will be taken in two stages and the C-armwill move twice.

Press and hold down the exposure button for the durationof the first exposure. The first exposure is a short, low-dose exposure during which the optimal position for theimage layer will be calculated.

The radiation warning lights on the exposure switch andon the control panel will come on and you will hear aradiation warning tone.

Dsw

._2e

ps


_Dsw

._2e

ps

Exposure 1(scout image)


PANORAMIC EXPOSURE

The following display will appear on the control panel andcomputer screen.

The calculated layer position will be shown with a whiteline on the image.

If necessary, you can adjust the layer position by touchingthe plus/minus (+/-) fields on the control panel display.Touching the plus field will move the layer forwards andtouching the minus field will move the layer backwards.The new position will be shown with a red line on thecontrol panel display. The movement range is from +15mm to -15 mm. The distance from the center point will beshown at the bottom of the display (e.g. 2 mm).

NOTE Make sure the patient does not move betweenexposures.

Press and hold down the exposure button again to takethe second exposure. The second exposure will producethe actual image and the C-arm will now move throughone complete exposure cycle.

NOTE Alternatively, you can touch the OK field on the Autofocus layer definition display and then press theexposure button.

The radiation warning lights on the exposure switch andon the control panel will come on and you will hear aradiation warning tone.


NOTE If the imaging process is cancelled from the Romexisprogram, Autofocus has to be switched off (AF OFF)and back on (AF ON) again before the next Autofocusexposure can be taken.

Move layer positionDistance from center Back to main display

Calculatedposition =white line

Positionselectedby user =red line

Exposure 2(final image)

_Dsw

._2e

ps


TEMPOROMANDIBULAR JOINT (TMJ) EXPOSURE

9 TEMPOROMANDIBULAR JOINT (TMJ) EXPOSURE9.1 Double TMJ exposure (lateral, PA or lateral-PA)

This exposure will produce closed and open views of theleft and right temporomandibular joints.

NOTE You can set the X-ray unit so that the imaging positionwill be automatically moved forwards for the open jawexposure (information display i27.1).

Insert the chin support into the adapter. Insert the adapterinto the holes in the patient support table.

9.1.1 First exposure - jaw closedSelect the double TMJ program you wish to use (seesection 5.4 “Selecting temporomandibular joint (TMJ)program” on page 22).Select the patient size (see section 5.2.1 “Selectingpatient size” on page 15).Select the image position parameters (target position,imaging angle, symmetric / asymmetric setting, left / rightside exposure) as described in sections 5.4.1 “Selectingjaw size and adjusting imaging position & angle in TMJprograms” on page 23 and 5.4.2 “Selecting jaw side indouble TMJ programs” on page 24.

The exposure values will automatically change tocorrespond with the selected exposure program andpatient size. The preset exposure values are shown in thefollowing tables. The preset exposure values are averagevalues and they are only meant to guide the user. Ifnecessary, you can change the preset values asdescribed in section 5.2.2 “Selecting kilovolt andmilliampere values” on page 15.


Bite

1.ep

s

Lip1

.eps

Chin support

Adapter





9.1.2 Patient positioning


Guide the patient to the unit so that they are facing thechin support. Explain to the patient that you will take adouble exposure and that the unit will rotate twice.

To adjust the height of the unit, press either of the heightadjusting buttons until the opening in the chin support isapproximately level with the patient’s mouth.


Exposure values for TMJ program “Double lateral”


Child 64 7

Adolescent 66 8

Small adult 68 9


Large adult 72 11

Exposure values for TMJ programs “Double PA” and “Double lat-PA”


Child 66 7

Adolescent 68 8

Small adult 70 9


Large adult 74 11

Templesupportbutton




Ask the patient to step forward, grasp the patient handles,stretch and straighten their back and neck, and press theirlips against the chin support. The patient's nose must reston top of the support and their mouth must be closed, andtheir teeth must be together.

The positioning lights for the midsagittal plane, Frankfortplane and layer position will come on. Note that they willautomatically switch off after two minutes. If the lights goout before you have positioned the patient, switch themon by touching the thumb wheel on the underside of thepatient support table or by pressing any of the positioningcontrols (button or joystick).


patp

oslig

hts3

.eps Thumb wheel


Positioningcontrols




Position the patient’s head so that the Frankfort plane istilted down five degrees. To do this support the back ofthe patient’s head with your hand and, using the Frankfortplane light as a reference line, adjust the position of thepatient’s head by raising or lowering the unit with theheight adjusting buttons. Make sure the patient’s backand neck are straight.


The imaging position and angle must be checked whenthe patient is positioned in the X-ray unit:

Touch the Jaw field on the main display, or alternatively,tap the jaw icon on the right side of the display. The Selectjaw size, adjust position and angle display will appear.



Frankfort plane

5°


Frankfortplanelight

Thumbwheel









Layer light

wal

l6_2

.ep

s





Ask the patient to stand as still as possible.


Press and hold down the exposure button for the durationof the exposure. The C-arm will move through onecomplete exposure cycle and then automatically return tothe ready position. The temple supports will remain closedand hold the patient in position for the second exposure.During the exposure cycle the radiation warning lights onthe exposure switch and on the control panel will come onand you will hear a radiation warning tone.


9.1.3 Second exposure - jaw open

Ask the patient to open their mouth as wide as possible.Make sure that the patient’s upper lip is still touching thechin support.

When you are ready to take the second exposure touchthe Ready field on the main display.

On the exposure button and on the control panel a greenindicator light will come on. Additionally, the word READYwill be shown on the control panel display. The Romexisprogram will show the Waiting for Exposure message onthe computer screen.



w._

2eps


wal

l6_2

.ep

s




Press and hold down the exposure button for the durationof the second exposure. During the exposure cycle theradiation warning lights on the exposure switch and on thecontrol panel will come on and you will hear a radiationwarning tone. When the C-arm has completed the secondexposure cycle the temple supports will automaticallyopen. You can now guide the patient from the unit.



w._

2eps


1/21/2 2/22/2



9.2 Multi-angle TMJ exposure (PA or lateral)This exposure will produce three exposures with differentangles from the left or right temporomandibular joint.

Note that the C-arm will move through three exposurecycles.

Insert the chin support into the adapter. Insert the adapterinto the holes in the patient support table.

Select the multi-angle TMJ program you wish to use (seesection 5.4 “Selecting temporomandibular joint (TMJ)program” on page 22). Select the patient size (see section 5.2.1 “Selectingpatient size” on page 15).Select the image position parameters (target position andimaging angle) as described in section 5.4.1 “Selectingjaw size and adjusting imaging position & angle in TMJprograms” on page 23.

The exposure values will automatically change tocorrespond with the selected exposure program andpatient size. The preset exposure values are shown in thefollowing tables. The preset exposure values are averagevalues and they are only meant to guide the user. Ifnecessary, you can change the preset values asdescribed in section 5.2.2 “Selecting kilovolt andmilliampere values” on page 15.


Exposure values for multi-angle lateral TMJ programs


Child 64 7

Adolescent 66 8

Small adult 68 9


Large adult 72 11

Exposure values for multi-angle PA TMJ programs


Child 66 7

Adolescent 68 8

Small adult 70 9


Large adult 74 11

Bite

1.ep

s

Lip1

.eps

Chin support

Adapter





9.2.1 Patient positioning


Guide the patient to the unit so that they are facing thechin support. Explain to the patient that you will take amulti-angle exposure and that the C-arm will movethrough three exposure cycles.



Ask the patient to step forward, grasp the patient handles,stretch and straighten their back and neck, and press theirlips against the chin support. The patient's nose must reston top of the support and their mouth must be closed, andtheir teeth must be together.


Templesupportbutton


patp

oslig

hts3

.eps Thumb wheel


Positioningcontrols




Position the patient’s head so that the Frankfort plane istilted down five degrees. To do this support the back ofthe patient’s head with your hand and, using the Frankfortplane light as a reference line, adjust the position of thepatient’s head by raising or lowering the unit with theheight adjusting buttons. Make sure the patient’s back isstraight.

The Frankfort plane light, which is located on the side ofthe column, can be moved up or down. This is done byrotating the thumb wheel that is below the light slot.

The imaging position and angle must be checked whenthe patient is positioned in the X-ray unit:

Touch the Jaw field on the main display, or alternatively,tap the jaw icon on the right side of the display. The Selectjaw shape and size display will appear.



Frankfort plane

5°


Frankfortplanelight

Thumbwheel






9.2.2 Taking an exposure




Layer light



On the exposure button and control panel a greenindicator light will come on. Additionally, the word READYwill be shown on the control panel display. The Romexisprogram will show the Waiting for Ready message on thecomputer screen.




Press and hold down the exposure button for the durationof the exposure. The C-arm will move through threeexposure cycles. The radiation warning lights on theexposure switch and on the control panel will come onand you will hear a radiation warning tone.

When the C-arm has completed the third exposure cyclethe temple supports will automatically open. You can nowguide the patient from the unit.



w_w

all6

_2.e

ps


w._

2eps


1/32/33/3


SINUS EXPOSURE

10 SINUS EXPOSUREThis procedure will produce an exposure of the maxillarysinus along the selected plane.Insert the chin support into the adapter. Insert the adapterinto the holes in the patient support table.

Select the sinus program you wish to use (see section 5.5“Selecting sinus program” on page 25). Select the patientsize (see section 5.2.1 “Selecting patient size” on page15).The exposure values will automatically change tocorrespond with the selected exposure program andpatient size. The preset exposure values are shown in thefollowing tables. The preset exposure values are averagevalues and they are only meant to guide the user. Ifnecessary, you can change the preset values asdescribed in section 5.2.2 “Selecting kilovolt andmilliampere values” on page 15.

Exposure values for sinus program “PA rotational”


Child 74 8

Adolescent 76 9

Small adult 78 10


Large adult 82 12

Exposure values for sinus program “PA non-rotational”


Child 74 7

Adolescent 76 8

Small adult 78 9


Large adult 82 11

Exposure values for sinus programs“Lateral non-rotational” and “Midsagittal non-rotational”


Child 62 6

Adolescent 64 6

Small adult 66 6


Large adult 70 7

Bite

1.ep

s

Lip1

.eps

Chin support

Adapter


SINUS EXPOSURE




10.1 Patient positioningPress the temple support button to open the templesupports if they are not already open.

Guide the patient towards the unit so that they are facingthe chin support.



Ask the patient to step forward, grasp the patient handles,stretch and straighten their back and neck, and press theirlips against the chin support. The patient's nose must reston top of the support and their mouth must be closed.


Templesupportbutton


patp

oslig

hts3

.eps Thumb wheel


Positioningcontrols


SINUS EXPOSURE

Position the patient’s head so that the midsagittal planecoincides with the midsagittal light beam.

Position the patient’s head so that the Frankfort plane istilted up between 0 and 30 degrees depending on thebuild of the patient. To do this support the back of thepatient’s head with your hand and, using the Frankfortplane light as a reference line, adjust the tilt of thepatient’s head by raising or lowering the unit with theheight adjusting buttons. The patient’s back and neckshould be straight.





Frankfort

30°

plane

Frankfortplanelight

Thumbwheel


SINUS EXPOSURE

10.2 Taking an exposure




Ask the patient to swallow and stand as still as possible.


Press and hold down the exposure button for the durationof the exposure. The C-arm will move through onecomplete exposure cycle. During the exposure cycle theradiation warning lights on the exposure switch and on thecontrol panel will come on and you will hear a radiationwarning tone. When the C-arm has completed theexposure cycle the temple supports will automaticallyopen. You can now guide the patient from the unit.



w_w

all6

_2.e

ps


w._

2eps



user's manual 2D imaging - planmecausasupport.com angles PA TMJ 3 angles lateral TMJ PA...

Documents

Transcript of user's manual 2D imaging - planmecausasupport.com angles PA TMJ 3 angles lateral TMJ PA...