Hyperion X5 3D – s/n 708H0065 –

Service ticket ref. 3292823

Image “1.tif”

Overall the image quality and diagnostic value of this image is good. Simmetry is good and
sharpness/contrast are more than acceptable. Position of the canine laser (focal trough) is also good.
Only minor concern is the frankfurt plane orientation, the “flatness” of the occlusal plane shows that
the patient’s head was tilted a few degrees up from optimal orientation, however this did not affect
the image quality in any significant way.
I’ve increased the overall brightness of the image by applying some gamma correction in iRys, but
this depends basically on personal taste and screen characteristics.
Image “2.TIF”

This image shows a good amount of detail, but the canine laser this time was not set too well, the
condiles are quite far from the margins of the FOV, and some of the spine is visible in the FOV.
However sharpness is still well within acceptable levels. There is also a slight tilt on the sagittal
plane (this can be avoided checking the sagittal laser). The dark area around the upper incisors roots
is because the patient was not holding the tongue against the upper palate.
Image “3.TIF”

Focus is ok, even though it could be hard to place the canine laser correctly on a patient with such
amount of restoration work. I see no major quality concerns here, again it is noticeable that the
tongue was resting on the soft palate, it should have been pushed up, preventing over-exposure on
the maxillary area. Anyway, I see no real loss of detail beacuse of this. The areas circled in yellow
are those affected by the air pocket forming over the relaxed tongue.
Image “4.TIF”

Major issue on this image is the rotation of the patient’s head around the vertical axis. Patient R side
is significantly larger, and the right condile is also partially out of the picture. This shows that
patient was rotated towards its ritght. This affects focus in various areas and proportions as well.
Tongue position was good in this case, and no “bubble” of air above the tongue.
Image “5.TIF”

There is a significant problem here with franfurt plane alignement, the patient’s head was tilted way
too far upwards, this has had an influence on overall focus, the user clearly struggled to place the
canine’s laser (set to +6) because of the error in Frankfurt plane alignment. General lack of focus,
many structures are far behind the focal trough resulting in excessive magnification and blur.
Tongue is relaxed on the lower half of mouth.
Image “6.TIF”

Frankfurt plane alignment is wrong, the patient’s head was tilted too far downwards on this image,
this again made it difficult to place the canine laser (-5 offest was used) and result is some focusing
problems, and excessive overlapping in the maxillary area (tilting the head downwards brings the
maxillary area in front of th focal trough, reducing magnification and increasing overlapping). The
toingue was not well positioned resulting in slight over-exposure on the upper incisor roots
Image “7.TIF”

Frankfurt plane alignment is good, but canine laser is misplaced in this picture. Setting was -4, it
was likely shining on tooth 24 rather than 23. This results in slight lack of focus, magnification is
lower than normal, so more overlapping is noticeable, the condiles are far from the picture edges
and the spine is very noticeable.
Tongue was relaxed and slight over-exposure, combined with lack of focus results in slight loss of
detail on the maxillary roots 12,11,21,22.
Conclusions and advice

Image quality can be improved reliably across the range of images with some extra attention to
patient positioning.
Specifically the most relevant issue seen across the images above is related to frankfurt plane
alignment, which often goes along with issues in the canine laser positioning, when the dental
structures do not fall within the limit of the focal area, or are very close to the edge, a loss of
sharpness and abnormal magnification are to be expected.
Regarding this I would suggest trying out the multi-pan feature of the unit. Of course proper
positioning should be paramount, but multi-pan can help on cases where image quality is “almost
there” but not as good as expected on a single layer. Being able to slightly shift the focal area after
the exam does indeed increase the chance of having a better diagnostic result.
Crowns overlapping is also related to this. When magnification is lower than normal, specifically
when structures are placed in front of the focal trough (patient looking “down” or canine laser set
too far towards the molars), all structures are rendered as smaller than real and interproximal spaces
get cramped and overlapping is increased. Said that, a certain degree of overlapping is to be
expected from any OPG protocol. Overlapping is reduced with DENTITION protocols (not to a
great degree, but it is reduced indeed). If absolute precision is required in a restricted ared, and
analisys of the interproximal spaces is the objective, then a local intraoral picture is more suitable
than any panoramic image.
I would also suggest putting more effort into communicating with the patient about pushing the
tongue against the upper palate during exposure, the patients don’t always manage to do so, but
it’s worth trying, and seeing the number of images with relaxed tongue (6 out of 7) I wouldn’ t be
sure if the message is getting across at all.
Also, I see that a dose offset was applied (-4kV, -2mA), I guess this was done in order to reduce the
dose according to local regulations. This is ok, but of course a slight trade-off in image quality is to
be expected. All the diagnostic information is preserved at the cost of slightly lower grayscale detail
and slightly higher graininess of the images. In none of the images I see any loss of clinical detail
due to this setting, so apart from a merely aestethic point of view I would not deem this as a cause
for concern.