User’s Manual

1
Quick Ceph® Studio Documentation
1. Getting Started
• Introduction
• About Quick Ceph Studio
• Computer Hardware Checklist and Setup
• Terminology and Conventions Used in the Manual
• Installing Quick Ceph Studio
• Activating Quick Ceph Studio
• Registering Quick Ceph Studio on Another Computer
• Deactivating Quick Ceph Studio on a Computer
• Updating Quick Ceph Studio
• Installing Quick Ceph Studio Media (The Smile Studio)
• Updating Quick Ceph Studio Media

2. Overview
• User Interface
• Patient ID
• Import Window
• Templates Window
• Tracings Window
• Media Window
• CT Scan Window
• Diagnostic Window

3. Importing Older Quick Ceph Patient Files to Quick Ceph Studio

• Converting Quick Ceph 2000 Files
• Batch Converting Quick Ceph 2000 Files
• Combining Separate Quick Ceph 2000 Files
• Importing Older Quick Ceph Files

2
4. Importing Color Images
• Importing Photos
• Adjusting Images
• Saving Patient Records
• Optional: Using Arrangements
• Adding Images to an Existing File
• Merging Multiple Sessions

5. Importing X-Rays and Models

• Capturing X-Ray and Model Images
• Importing X-Ray and Model Images
• Adjusting Images
• Saving Patient Records
• Optional: Using Arrangements
• Adding Images to an Existing File
• Merging Multiple Sessions

6. Using CT Scans
• Importing CT Scans
• Viewing CT Scans
• Adjusting CT Scans
• Digitizing CT Scans
• CT Scan Options
• CT Scan Tools

7. Digitizing X-Rays and Models

• Tracing Overview
• Calibration Ruler
• Calibrating Cephs
• Digitizing Cephs
• Correcting Ceph Tracings
• Aligning Tracings to Lateral Facial Image
• Customizing Displayed Tracings
• Sassouni Analysis

3
 • Input of Model Images with a Scanner
• Input of Model Images with a Digital Camera
• Digitizing Models
• Digitizing the Frontal X-Ray
• Aligning the Frontal Tracing with the Frontal Color Image
• Digitizing the Submentovertex (SMV) X-Ray
• CO-CR Conversion

8. Using Comparisons
• Creating Comparisons
• Available Tools
• Types of Superimpositions
• Displaying Comparison Measurements
• Displaying a Gallery Comparison

9. Treatment Planning
• Creating a Growth Forecast
• Creating a Treatment Simulation
• Morphing a Treatment Simulation
• Editing an Image
• Selecting a Portion of an Image
• Displaying a Treatment Simulation
• Documenting Treatment Diagnostics
• Creating Custom Treatment Diagnostics

10. Creating a Custom Analysis

• Copying Measurements from Existing Quick Ceph Analyses
• Creating Custom Measurements
• Measurement Types Defined and Illustrated
• Creating Custom Lines, Points and Arcs
• Displaying Curves & Teeth
• Creating Custom Landmarks
• Sharing Quick Ceph Custom Analyses

4
11. Templates
• Displaying Gallery Templates
• Creating Custom Galleries
• Sharing Quick Ceph Custom Galleries
• Creating Customized Reports
• Displaying Report Slideshows

12. Using Quick Ceph Studio for Presentations

• Preparing For Presentations
• Tools to Enhance Presentations
• Creating Presentation Templates
• Protecting Patients’ Privacy During Presentations

13. Preferences
• General Preferences
• Tracing Preferences
• Analyses Preferences
• Ratios Preferences
• Superimposition Preferences
• Templates Preferences
• Diagnostic Preferences
• Export Preferences
• Sound Preferences

14. Printing
• Selecting the Printer Settings
• Printing an Image, Measurement or Gallery
• Improving Print Quality
• Saving a File as a PDF Document

15. Patient File Management

• File Organization
• Searching Patient Records
• Backing Up Patient Files

5
16. Image Exporting
• Export Preferences
• Single Image Export
• Batch Export
• Batch Exporting Images for Practice Management
• Generic Batch Export Naming Convention
• Custom Batch Export
• Emailing Exported Images and Measurements

17. Menu Reference

• Apple menu
• Quick Ceph Studio menu
• File menu
• Edit menu
• View menu
• Format menu
• Session menu
• Analysis menu
• Tracing menu
• Media menu
• Documentation menu

18. Common Troubleshooting Questions

19. Appendix
• Bibliography
• Suggested Informed Consent Form
• Background on the Magnification of X-Rays

6
Chapter 1
Getting Started

7
Introduction
Welcome to the Quick Ceph family! We are committed to producing the most powerful
and innovative cephalometric software in the industry, while providing the best customer
service. As a valued member, we appreciate your comments and suggestions to help us
better address your needs. For the latest information about Quick Ceph Systems, Inc.,
please visit our web site at www.quickceph.com. If you wish to contact us by email, our
address is info@quickceph.com.

About Quick Ceph Studio

Quick Ceph Studio was designed for orthodontists and oral-maxillo-facial surgeons.
This integrated system allows you to capture and store high resolution images, produce
many predefined and customizable analyses in seconds, and generate growth forecasts
and treatment simulations on line tracings and real images of patients.
Superimpositions, a model analysis, and the sophisticated CO-CR conversion are
included. Quick Ceph Studio saves time by replacing tedious and fault-prone hand
tracings. The unique digital image enhancement function increases the quality of stored
x-ray images, making digitizing and tracing easier and more accurate. Expenses are
minimized by eliminating film, and no employee time is lost handling and mounting
pictures. By using Quick Ceph Studio, you will increase your knowledge in modern
treatment planning and advanced computer technology, and be able to communicate
your professional knowledge more efficiently and effectively to your patients and
referring dentists.

Computer Hardware Checklist and Setup

The following information is intended as a general setup guide for your hardware
system. For additional information regarding the setup of the computer, we recommend
following the instructions included with your computer. For more information on the
recommended and required equipment, visit our web site at www.quickceph.com.

Hardware Check List

! 1! Macintosh Computer (w/mouse,keyboard,monitor)! _____

! 2! Printer ! _____
! 3! Digital Camera ! _____
! 4! Scanner (w/Transparency Adapter), Digital ! _____
! ! Camera, or Digital X-ray Machine for X-rays
! 5! Card Reader for Digital Camera (optional) ! _____
! 6! USB Hub (optional) ! _____
! 7! Backup Drive (optional, strongly recommended) ! _____

8
Hardware Setup

1. Follow the instructions as documented by the Apple setup guide to configure the
computer.
2. Once the computer is set up, connect the USB Hub into one of the free USB
ports on the back of the computer. (The keyboard should be connected directly to
a USB port on the computer.)
3. Connect the printer, scanner, card reader, and backup drive to the USB Hub. If
the backup drive is a FireWire device, connect it to one of the FireWire ports on
the computer.

Terminology and Conventions Used in the Manual

Before we begin, we need to point out the terminology used in the manual and the
conventions we use to describe the features you will see. The following are names of
common elements used by Quick Ceph and by the Macintosh Finder:

Menu Folder Dialog Box

Menu
When referring to Menu names and items, the name of the menu item will be displayed
first, followed by a > symbol and then the name the item to be selected under the menu.
In the example image above, “selecting the Open command under the File menu”, will
be written as File > Open in this manual. All menu items will be written in bold.

Folder
When referring to folders in this manual, the name of the folder will be written in bold,
so the folder in the example image above will be referred to as untitled folder.

Dialog Box
Dialog boxes will also be written in bold print in this manual, and the name of the type
of dialog box will be capitalized. Therefore, the dialog box in the example image above
will be referred to as the Open Dialog Box.

9
Installing Quick Ceph Studio
To use Quick Ceph Studio, you will need to have Mac OS 10.5 (Leopard) installed on
your computer. Quick Ceph Studio is not compatible with earlier versions of Mac OS X,
so you must upgrade your system to take advantage of the features of this new
software.

Note: If you only need to update The Smile Studio (aka. Quick Ceph Studio Media), you
may skip ahead to the instructions at the end of this chapter.

1. Once the Quick Ceph Studio software has been downloaded from our web site,
double click on the downloaded file (QuickCephStudio_###.dmg). The program will
prompt you for a password. Type the password provided in the email. You should
check the box next to the “Remember password (add to Keychain)” option so that
you do not have to enter this password in the future.

The Quick Ceph® Studio disk image will appear on your desktop and the following
window will open.

NOTE: If you download using Safari, the Quick Ceph Studio folder will be copied to the
download location and the disk image and .dmg file will be deleted automatically.

10
2. Next, drag and drop the Quick Ceph Studio application icon from the open window into
the Application icon in the window, as shown below:

NOTE: If your computer does not display “Applications” in the side menu, choose Go >
Applications, then drag and drop the Quick Ceph Studio icon into the window that appears.

3. For faster access, you can place a shortcut to the program in the Dock by dragging
the original Quick Ceph Studio icon from the Applications Folder into the Dock.
The other icons will make room for your new icon.

! ! !

Activating Quick Ceph Studio

After installing the program, our servers will need to register your Quick Ceph Studio
software license upon initial use of the program. This process is called activation.
Please follow the steps below to activate your program:

1. When you purchase Quick Ceph Studio, or if you update your license
name or logo, you will receive an email from Quick Ceph Systems
with a file attachment named “License.qclicense”, shown to the right.
This is the Activation File. To activate Quick Ceph Studio, you must
first open this email from Quick Ceph and download the attachment.

2. Next, drag and drop the uncompressed Activation File onto the Quick Ceph Studio icon.
Another method of Activating your program is to first open Quick Ceph Studio, and then
drag and drop the Activation File into the licensing screen and press “Register”. Both
methods will open Quick Ceph Studio and activate your program. You will need to await
confirmation from Quick Ceph Systems, which will take less than 24 business hours.

11
3. Once your program is activated by Quick Ceph Systems, you can check if the
license name and logo are correct by selecting Quick Ceph Studio > License
Info... The following screen will appear displaying your license name and practice
logo. If this information is incorrect, please contact Quick Ceph Systems.

Registering Quick Ceph Studio on Another Computer

If you would like to run Quick Ceph studio on another machine you have these three
options available to you:

1. For a minimal fee, previous Quick Ceph 2000 users can send back a purple USB
key in exchange for a Quick Ceph Studio license. Please contact us before shipping
back a key and we will send you an RMA order by email for the return. We will
activate the additional computer and provide you with a grace period to return the
key before the software expires on that computer.

2. You can purchase an additional Quick Ceph Studio license, which will allow us to
quickly activate that additional computer.

3. You can deactivate a computer you have already activated and, after it has been
deactivated, you can register the new computer. Instructions for deactivating a
computer can be found in the next section.

Deactivating Quick Ceph Studio on a Computer

Before retiring an old computer running Quick Ceph Studio, you will need to deactivate
the software on that old computer. This will release the software license so that it can be
used to register your new computer. Please follow these steps to deactivate the
software on a computer:

12
1. Open the Quick Ceph Studio v2 software on the computer you wish to deactivate.

2. Please make sure that you have at least version 2.6.4 of Quick Ceph Studio installed
as earlier versions do not include this feature. To see which version of Quick Ceph
Studio you have installed, select Quick Ceph Studio > Check for Updates. If you
receive a message saying there's a new version available, please download and
install it first.

3. Once you have verified your Quick Ceph version, select Quick Ceph Studio >
License Info... This will display the Quick Ceph Studio Activation Dialog Box
(shown in the image on the previous page). If you do not see a "Deactivate" button,
this means you do not have at least Quick Ceph Studio v2.6.4. Please update to the
latest version in order to access this button.

4. Click on the “Deactivate” button. The software will automatically send us your
deactivation request by email and provide us with the serial number so you don’t
have to.

5. Once you have deactivated the old computer, you can then register the software on
another computer. If you require the download information for the new computer,
please contact us.

6. If you uninstall the software on a computer before deactivating it, please reinstall and
register the software on that computer again and go through the above deactivation
process. If your previous computer is not working, no longer in your possession or
has had its logic board replaced then you will have to wait 7 days for the license to
expire on its own.

IMPORTANT: If the software is deactivated by you, the activation of a new machine will
occur within 24 hours. On the other hand, if you request Quick Ceph Systems to
deactivate a computer, the activation of a new machine will occur after the license on
the old computer expires on its own (which can take up to 7 days). Thus, it is much
better if you handle the deactivation of this computer yourself.

Updating Quick Ceph Studio

Quick Ceph Studio has an automatic update feature that checks the Quick Ceph server
when the program is started to ensure the most current version of the software is
installed on your computer. When a new version is available, you will see the following
Software Update Dialog Box appear at startup.

13
 Software Version
Notifies you of the current version installed
and the latest version available.

Release Notes
Provides information about the changes made
during every Quick Ceph Studio update.

Update Options
Allows you to install the update immediately,
or reminds you to perform the update at a
later time.

IMPORTANT: Please note the advisory text written in red at the beginning of the release
notes. Since each update contains additional features and important improvements, we
recommend that you install it as soon as it is released. Also, please note that since each
version of the program has an expiration date, it is important to install the latest update
before the current version expires (which is typically one year from its release date).

To install the update, click on “Install Update”, as show in the previous image. The new
version will be downloaded and installed. To complete the update procedure, you will
then be asked to type in a password, which is the same one provided by Quick Ceph
Systems by email. This password may change periodically, but not very often, so please
refer to the most recent email from Quick Ceph Systems to ensure you have the most
current password. Once the update is successfully installed, you will be asked to restart
the program.

If you click on “Remind Me Later”, the Software Update Dialog Box will reappear the
next time you start the program.

To view the version number and expiration date of your Quick Ceph Studio software,
select Quick Ceph Studio > About Quick Ceph Studio. The screen shown on the next
page will appear displaying the version number, expiration date, and your license name.

14
When the program comes within one week of the expiration date, it will provide you with
a warning, as shown on the next page:

You should update this system to the latest version by manually checking for the latest
updates. To do this, select Quick Ceph Studio > Check for Updates... The program
will open the Software Update Dialog Box allowing you to update to the latest version.

Installing Quick Ceph Studio Media (The Smile Studio)

Please follow the instructions below if you are installing Quick Ceph Studio Media for
the first time. If you are installing a newer version of The Smile Studio, please skip to
the next set of instructions.

1. Double click on the downloaded file (QuickCephStudioMedia.dmg) and enter the

password when prompted. If you do not have this password, please call or email us.
The Quick Ceph® Studio Media disk icon will appear on your desktop.

15
2. Double click on the Quick Ceph® Studio Media icon.

3. In the window that appears, you will find a Quick Ceph folder and an alias to your
Application Support folder. (Alternately, you can open your hard disk, then the
Library folder, then Application Support.) Drag the Quick Ceph folder to your
Application Support folder.

4. To access The Smile Studio movies, open the Quick Ceph Studio program and
choose Media > The Smile Studio™. You can then select the individual movies you
wish to view.

! ! ! ! ! !

Updating Quick Ceph Studio Media

Please follow the instructions below if you need to install a new copy of the Quick Ceph
Studio Media information.

1. Double click on the downloaded file (QuickCephStudioMedia.dmg). The Quick

Ceph® Studio Media disk icon will appear on your desktop.

16
2. Double click on the Quick Ceph® Studio Media icon, then double click on the
Quick Ceph folder inside. You will find the file, TheSmileStudio.qcmedia.

3. Open the Macintosh HD, double click on the Library folder, then Application
Support. When this folder is open, locate the Quick Ceph folder.

4. Lastly, drag and drop the TheSmileStudio.qcmedia file into the Quick Ceph !folder.
You will receive a prompt to replace the older file with the new one. Please click on
OK to replace this file.

5. Once this file is replaced, the new Quick Ceph Studio Media file will be in the correct
location and you will be able to see the revised movies.

Transferring Custom Settings to Another Computer

If you have multiple machines that run Quick Ceph Studio or if you are transferring
Quick Ceph Studio from one machine to another, you may want to copy over any
custom analyses, galleries, reports or export conventions that you have created. Quick
Ceph Studio holds all these files in the Application Support folder on the machine you
created them on. The exact path to these custom settings is listed below:

[hard drive] / Users / [your name] / Library / Application Support / Quick Ceph

Each custom set of data will be in itʼs own folder. For instance, any custom analyses
you have created will be in the “Analyses” folder within the Quick Ceph folder located in
the Application Support folder. You can copy the entire folders or just the specific files
you want from each folder. Custom settings can be transferred to the target machine
through the network, using a flash drive or by emailing them. To email, start by selecting
the custom settings file you wish to email, then go to the Finder menu, highlight
Services and select New Email with Attachment. To install the custom settings on
another machine you need to copy them into the same location on the target machine.
Once the settings are on your target machine, you will have to restart Quick Ceph
Studio before you can use the transferred settings. Keep in mind that if you have copied
over a custom analysis that you will first need to enable it in the Tracing section in the
Quick Ceph Studio Preferences.

17
Chapter 2
Overview

18
Quick Ceph Studio is a full-featured imaging and diagnostic program that incorporates
the latest advances in digital imaging to allow practitioners to quickly diagnose and
simulate treatment plans for their patients. Quick Ceph Studio features a user interface
that is more intuitive and robust than previous versions of Quick Ceph. This chapter
provides an overview of the different components of Quick Ceph Studio. Other chapters
will provide instructions for using these new features.

User Interface
Quick Ceph Studio uses many familiar aspects of the Macintosh User Interface, so
users of the Mac will immediately feel at home. For users new to the Mac, we have
compiled a list of interface features that are used throughout the program.

These colored buttons, found in the upper left side of any window or
document on the Mac, allow you to Close the window, Minimize the window,
and Maximize the window, respectively. The left arrow allows you to display
the previously viewed window while the right arrow lets you navigate
forward.

When the cursor is placed on a vertical divider in the program, such as the
one between the Sessions and the Thumbnail Strip (both of which will be
described later), the cursor changes from an arrow to two arrows pointed in
opposite directions. This indicates that you can move the vertical divider in
the direction of the arrows, allowing you to shrink or expand the Sessions
section.

At the lower right corner of the window, you may find a double chevron icon
like the one shown to the left. This indicates that there are extra tool icons
that are not immediately visible. This could be due to a smaller window size
or an abundance of tools. By clicking on this icon, you can display all of the
tools available in a particular section.

When you notice a right-facing triangle placed next to any word, it

means that the word represents a category and there are some
items placed within this category. To view these items, simply
click on the triangle. This drops down the triangle and you are
able to see its contents or subheadings.

The menu at the top of the screen is the application menu, and it allows
you to access a program’s tools and functions. In this manual, we will
refer to the menu and its contents in the following manner: Menu Name
> Menu Item. For example, when describing the action shown in the
image to the left, the manual will ask you to “choose File > New”.

19
 Contrary to popular belief, the Mac does have a “right-click” option.
New Mac desktops come with Apple’s Mighty Mouse, which has a
right click button (even though it appears as a single button). For
laptops or if your mouse only has one button, hold down the “Control”
key and click to activate the right click. In Quick Ceph Studio, the right
click opens a menu that provides options specific to the section you
are in, making operations faster and more intuitive.

Patient ID
This area allows you enter the patient’s information that does not change, such as the
first and last name, gender, ethnic norms, and birth date. The Patient ID section is
shown in the image below:

! A! B! ! ! ! ! !

Section A contains the patient’s name, which is currently highlighted. Beneath the
name you will see the files created at different time points, or Sessions. You can create
an unlimited number of sessions (such as Initial, Progress, Treatment, etc.) for each
patient file. Clicking on each individual session will bring up its records.

Section B contains the patient’s information. Since this information remains the same
for all Sessions, it only needs to entered once.

20
Import Window
Click on one of the sessions. A new screen will appear on the right side of the window. If
it is not already selected, click on the Import button at the top of the window in section
C. This brings up the Import window. This area allows you to position, rotate, and crop
the images imported into the program.

! A! B! ! ! ! ! ! C

Section A again displays the patient’s name and Sessions. You will notice that now the
Initial session is highlighted. This means that the information displayed in the box on
the bottom left pertains to this session. The Status field is used to indicate the stage of
treatment for which a session is created. The Record Date field is used to indicate the
date that the session was created. This value can be modified. The Reference field
indicates which session a program-created session is derived from. Program-created
sessions include treatment and growth forecasts. The Color field is used to change the
color of the tracing. The field below Color can be used to enter notes.

Section B (top) contains six buttons, each of which are active in the
import window. This panel is called the Navigator. The six active
buttons let you choose between the different color or x-ray images
that you can import into the program. Clicking on any of these
buttons will display a different Import window in section C.
Section C shows the images imported into the patient’s file. Unlike

21
Quick Ceph 2000, these images can be edited at any time, so if they were positioned or
cropped unsatisfactorily, they can be readjusted. More information about using the
Import window can be found in the Importing Color Images chapter.

Templates Window
Clicking the Templates button at the top of the window will allow you to access the
Gallery Templates and the Reports modes.

! A! B! ! ! ! ! ! C

Section A remains the same from this point on, so it will not be further mentioned.

Section B (top) contains two active buttons in the Navigator.

Clicking once on the first button activates the gallery templates
mode. The available gallery templates are listed under the
Navigator in section B. Clicking on the second button activates the
Reports mode, which allows you to collect galleries and individual
images, tracings, and measurements into a unified set that can be
printed or used for presentation. When the Reports button is clicked, Section B displays
the different saved reports.

22
Section C displays the selected gallery or the collected views used in the reports. While
in the gallery template mode, the selected gallery can be exported by dragging and
dropping the image from Section C onto the desktop or into a folder. In the Reports
mode, the order and type of image displayed in the Report can be edited in Section C.

NOTE: Some gallery templates contain tracings. The analysis can be changed by
clicking on the Analysis pop-up menu in the Toolbar in both modes.

Tracings Window
Clicking on the Tracings button at the top of the window opens the Tracing interface,
which allows you to digitize x-rays, perform growth forecasts and CO-CR conversions,
and create treatment plans.

! A! B! ! ! ! ! ! C

Section B (top) contains five active buttons in the Navigator. These

buttons allow you to select which type of x-ray or model you would
like to trace. When you have selected which to trace, section B
shows all of the images and measurements pertaining to the
selected x-ray or model. Clicking on any thumbnail image in section
B displays it in full size in section C.

23
Section C is where you can digitize x-rays, create growth forecasts, plan treatments,
and perform other functions. More information on these features can be found in the
Digitizing X-Rays and Models chapter.

Media Window
Clicking the Media button at the top of the window opens the Media interface, which
displays the individual images and movies imported into Quick Ceph Studio.

! A! B! ! ! ! ! ! C

Section B (top) contains two active buttons in the Navigator. These

two active buttons allow you to toggle between viewing imported
images and movies in the Thumbnail Strip below the Navigator.
Quick Ceph Studio can store images and movie files (in any format
recognized by QuickTime).

Section C displays the full sized images and movies that are selected
in section B.

24
CT Scan Window
Clicking the CT Scan button at the top of the window brings up the CT Scan interface,
which allows you to view and manipulate images created by a cone beam CT (CBCT)
scan x-ray machine.

! A! B! ! ! ! ! ! C

Section B displays the different views and allows you to access the image manipulation
functions available in the CT Scan window. More information about using the CT Scan
window can be found in the Using CT Scans chapter.

Section C displays the full size version of the selected thumbnail in section B.

25
Diagnostic Window
Clicking the Diagnostic button at the top of the window brings up the Diagnostic
interface, which allows you to document the patient’s medical and dental conditions
during each Session. This is particularly useful for entering the patient’s pre-existing
conditions as well as any notes you may have.

! A! B! ! ! ! ! ! C

Section B is not used in this section.

Section C displays the different tabs to access the patient’s medical and dental
conditions, as well as comments, treatment objectives, treatment sequence, and
overview information. More information on these features can be found in the
Diagnosis chapter.

26
Chapter 3
Importing Older Quick Ceph Patient Files
to Quick Ceph Studio

27
Quick Ceph Studio patient files differ greatly from those created in Quick Ceph 2000 and
earlier. Unlike Quick Ceph 2000 files, which store images and data for a single time point,
Quick Ceph Studio files store images and data for multiple time points (what Quick Ceph
calls Sessions). The data in each file can be searched using Spotlight, Apple’s powerful
search tool. Spotlight is also used within the program to easily locate any Quick Ceph
Studio files on your hard drive or network. We highly recommend converting all of your
older patient files to the new Quick Ceph Studio format to take advantage of these and
other new features. The instructions below describe how to convert these files.

Converting Quick Ceph 2000 Files

Your Quick Ceph 2000 files can be opened by Quick Ceph Studio and saved as a Quick
Ceph Studio file. This will allow you to quickly search for the files using Spotlight. Follow
the instructions below to convert an individual Quick Ceph 2000 file into a Quick Ceph
Studio file:

1. Select File > Open... The Open Dialog Box will appear, as shown below.

2. Select the file you wish to open from within this dialog box, then click on “Open”. You
will receive the following notification informing you to save the patient file:

3. Click on “OK” to remove the warning window.

28
4. To convert the file from Quick Ceph 2000 format to the Quick Ceph Studio format,
you will need to save the patient file. Select File > Save As. The Save Dialog Box
will open, allowing you to select a location to save the new Quick Ceph Studio file.
The original file will be retained as a backup, but henceforth, you should use the new
Quick Ceph Studio file.

NOTE: Quick Ceph Studio files are named with a “.qc2” suffix.

Batch Converting Quick Ceph 2000 Files

If you have many Quick Ceph 2000 files, they can be quickly converted into individual
Quick Ceph Studio files using a single command. The Batch Convert feature automatically
creates individual Quick Ceph Studio files from your Quick Ceph 2000 files without
changing the original documents. One benefit of converting is that you can quickly search
through your files using Spotlight. Follow the instructions below to do this:

1. Click on the File menu and select Batch Convert Files... The Batch Convert Files
Dialog Box will appear, as shown below.

2. Click on the Source Directory... button to select the folder that contains your patient
files. Next click on the Destination Directory... button to select where your newly
converted files will reside.

NOTE: The Destination Directory must be different than the Source Directory.

3. To convert the files, click on Upgrade.

29
Combining Separate Quick Ceph 2000 Files
Quick Ceph Studio differs from Quick Ceph 2000 in that a patient file can contain
images from multiple time points during that patient’s treatment. Images and analyses
from each time point are separated into Sessions. For instance, an initial, progress and
final file created by Quick Ceph 2000 can be incorporated into one Quick Ceph Studio
file and separated into individual Sessions. To combine multiple Quick Ceph 2000
patient files into one Quick Ceph Studio patient file, please follow the instructions below:

1. Drag and drop the first Quick Ceph 2000 file onto the Quick Ceph Studio icon or
alias. This will open this patient file within Quick Ceph Studio.

NOTE: The Patient I.D. information from the file will automatically be loaded into the
program. This information stays the same for all sessions and can be accessed by
clicking on the patient’s name in the upper left corner of the window. Session
information can be accessed by clicking on each session name.

2. Then, drag and drop the other Quick Ceph 2000 patient files onto the open Quick
Ceph Studio patient file window, as shown in the image below:

30
3. The program will add those files to the open patient file and
list them under the Sessions column.

NOTE: Dragging a file onto the Quick Ceph Studio icon will
open the file in a new window and will not add it to the
existing file.

4. You can create an unlimited number of sessions in a patient

file. The name of the session can be changed in the Status
field, as shown in the image to the right. The Session
Identifier is used to identify images exported from a specific
Session to a practice management program. For more
information about this, please refer to the Image Exporting
chapter. The Record Date field stores the date that the
session was created, and can be changed if necessary. The
tracing color for the session can be selected by clicking on
the Color box. The blank field below the Color option can
be used to write notes. These notes are searchable through
Spotlight and pertain only to the selected Session.

Importing Older Quick Ceph Files

Quick Ceph Studio does not directly open or import patient files
from versions prior to Quick Ceph 2000. However, if you need to
convert older data to a format that Quick Ceph Studio can
interpret, this can be accomplished by opening the files in Quick
Ceph 2000 and re-saving them.

1. Open your older patient file in Quick Ceph 2000, by dragging and dropping the file’s
icon onto the Quick Ceph 2000 program icon or alias.

2. While the patient file is open on your screen, select File > Save As...

3. You will be prompted choose a location to save the new Quick Ceph 2000-formatted
copy of this patient file.

NOTE: This can be a temporary location such as your Desktop, or you can place it
in your standard patient folder if you wish to retain it for later.

4. You may then follow steps 1 through 3 of Importing Quick Ceph 2000 Files (found
earlier in this chapter) to complete the process.

5. If you no longer have Quick Ceph 2000 available, you can send us the patient files
to convert for a minimal processing fee.

31
Chapter 4
Importing Color Images

32
To begin using Quick Ceph Studio, images must first be captured. We recommend
using a high-resolution digital camera to capture intraoral and extraoral images. The
image is then transferred from the camera to the Macintosh, at which point it can then
be opened and manipulated within the program. This section will describe how to input
these images to Quick Ceph Studio.

We strongly recommend reading the operating instructions of your digital camera before
initial use.

TIP: Use a “slave” flash with an optical sensor to eliminate profile shadows. Place the
“slave” flash immediately behind the patient’s head, and make sure it is pointing toward
the background. This flash is triggered by the internal camera flash, producing light from
behind the patient’s face that eliminates profile shadows. The type of slave flash you
require depends on the particular digital camera you are using. Wall-mounted light boxes
with a built-in slave flash work very well and were used for the images in this chapter.

Importing Photos
Please use the following instructions to bring color photographs of your patients into
your Mac and import them to Quick Ceph Studio.

1. Insert the camera’s memory card into the card reader attached to your Macintosh
computer. Alternately, you may connect your digital camera directly to your computer
via a USB cable if you do not have a separate memory card reader.

NOTE: If you opt to connect your camera directly to the computer, you should
disconnect it as soon as you are finished importing images to avoid draining its
batteries. Typically the camera will not automatically power itself off if it remains
connected to your computer.

2. A camera card icon will appear on the desktop. Double click on this icon to access
the images.

Optional: You may instead use iPhoto to import and store camera images for use
with Quick Ceph Studio. iPhoto is a photo organization program that is included with
every new Macintosh computer.

3. Select the images of the patient, then drag and drop them onto the Quick Ceph
Studio icon or alias.

TIP: To add new photos to a previously saved patient file, open the file, then drag
the images directly onto the Quick Ceph Studio window displaying this patient file. If
you need to create a new Session for the new images, select File > New Session.

33
4. Quick Ceph Studio will open, and the patient's images will be displayed as
thumbnails in the Thumbnail Strip (see section B below), and the Photo Import
window will display an image outline indicating where the images need to be placed.

! ! ! A! B! ! ! C

5. Drag the individual images from the Thumbnail Strip onto the corresponding !icons,
as shown below. Placing additional images will be discussed later in this chapter.

! ! ! A! B! ! ! C

34
6. If an image was put into the wrong placeholder, hold down the “option” key and drag
the image to the desired location. If an image is already in this position, the images
will trade places.

7. If you need to flip an image or rotate it by a multiple of 90º, first click on the image,
then click the appropriate the Geometry tool at the bottom of the window.
a b c d e.

! ! ! ! !
! ! ! ! Tool a: Revert to original
! ! ! ! Tool b: Rotate counter clockwise
! ! ! ! Tool c: Rotate clockwise
! ! ! ! Tool d: Flip vertically
! ! ! ! Tool e: Flip horizontally

8. You can also rotate an image by smaller increments to correct a slight tilt in the
camera or scanner. Observe that a large cross appears on any image you click (A).
Hold the mouse button and drag the handles of this cross so that the horizontal line
parallels the plane which you wish to make horizontal to the ground (B), such as the
Frankfort Horizontal. Release the mouse button to see your rotated image (C).
Repeat as needed to fine tune the rotation.
A B C

9. The thick blue borders at the top and to the left of the importer window house the
Horizontal and Vertical Reference Lines, which are used for aligning and scaling
adjacent facial and intraoral images. To use these lines, place the cursor on the
vertical or horizontal blue border, then click, hold, and drag a line down across the
images. You can have the lines bisect any reference point. For facial photos, we
recommend placing one reference line through the pupil of the eyes and a
second line through a fixed point, such as subnasale. To hide these lines,
you can click on the Hide Guidelines tool.

35
10. If you have additional images of the patient, you can select the middle
button in the Navigator to take you to the secondary positions reserved
for color images, as shown below:

11. Images that do not fit into the pre-defined image types listed in the primary
and secondary image positions can be placed into additional spaces
known as Holding Areas, which can be accessed by selecting one of the
three bottom buttons in the Navigator. There are three Holding Areas,
shown below, and each contains spaces for 20 images, allowing you to save a total of
89 cropped images and x-rays in a single patient session.

36
Adjusting Images
To make changes to an image, click on the Adjust Image tool. The Adjust
Dialog Box below will appear, allowing you to adjust different aspects of the
image. Settings not mentioned below are not used for the color image.

Brightness: Shifts the entire image towards lightness or

darkness without changing other settings.
Contrast: Changes the difference between the brightest and
the darkest colors on the image. Increased contrast means
greater color variation.
Saturation: Changes the color intensity in the image. The
greater the saturation, the more vibrant the colors appear.
Exposure: Changes the white balance of the image.
Gamma: Changes the gray balance of the image.
Hue: Changes the color balance to more red or more green.

The Revert button restores the image to its original color

settings. The Transparency slider allows you to change the opacity of the Adjust
Dialog Box so you can see the image beneath it.

Once you have finished importing and editing the images, you are ready to go to the
next section.

37
Saving Patient Records
It is important to save patient files regularly, so we recommend saving after each major
step. Follow the instructions below to save a patient file:

1. Select File > Save As... If you are saving the file for the first time, the Patient I.D.
window will appear, as shown below. Fill in the required information, shown below,
as the program will not allow you to save the file otherwise.

Case Number: Provided

by your practice
management program.
First and Last Name,
Gender: Required.
Norm and Birth Date:
For norm value
classifications, one of the
four racial norms must be
selected and the birth date
must be entered.
Address: You can enter
the patient’s address here
for use in letter writing.

2. Next, select File > Save As... again to display the Save Dialog Box. Choose the
appropriate patient folder to store the file, then click on “Save”.

View and edit

the file name.

Indicates the folder in which the

file is to be saved. Click on it to
access the correct folder.

Displays contents of current

folder.

Creates a new folder

inside the currently
selected folder.

38
Optional: Using Arrangements
If you always take the same number of patient images in the same order, you can save
time importing the images into Quick Ceph Studio by using the Arrangement feature.
Once it has been set up, this feature allows the program to position, rotate, crop, and
resize a group of imported images with a single button click. To set up an Arrangement,
please follow the instructions below:

Creating an Arrangement

1. Prior to creating an arrangement, it is important that you select a set of images

representative of the arrangement you wish to create. We recommend that you
double check that the images are taken in the correct order and that any extra
images are removed, as this will affect the Arrangements.

2. When the representative images are ready, import them into Quick Ceph Studio and
place them in the correct positions. If they are always taken in a particular
orientation, you may wish to rotate them as well. We recommend that you do not
resize the images unless each image of this type needs to be resized the same way
(i.e., Panoramic x-rays that need to be reduced in size to see the condyles).

3. Once the images have been sorted and edited to your

preference, click on the Arrangements drop down menu at the
bottom of the Import window, then select Save Arrangement...
to save the name of this setting. You can create and save an unlimited number of
arrangements, which is useful if you take a different number of photographs for
different Sessions.

Using a Saved Arrangement

1. When you import the next set of images, delete any unwanted images and
ensure that the set contains the same number of photos as the saved
Arrangement. Then, click on either the Arrangements menu and select the
name of your arrangement, or simply click on the Arrange and Fix button, which
activates the current arrangement selected, to automatically arrange and edit all of
the images you have imported.

2. If you import a different number of images than you had initially imported to
create the selected arrangement, you can still have the software automatically
crop and rotate the images. First, drag and drop the images into their correct
positions, and then click on the Fix tool.

3. Once the images have been arranged and/or fixed, you may still wish to make some
other minor adjustments to the size or orientation of the images on a case-by-case
basis.

39
Transferring an Arrangement

Arrangements can be transferred to another computer by transferring your Preference

file. This file contains your Arrangement information as well as the Preferences settings.
To transfer this file, follow the instructions below:

1. Locate the Quick Ceph Studio preference file, which is stored in the following location
on your computer:

[hard drive] / Users / [your name] / Library / Preferences /

com.quickceph.QuickCephStudio.plist

2. To share the preference file with another computer, you can copy this file across
your network, copy the file onto a USB flash drive, or email the file from this
computer. Then, place this file in the Preferences folder on the other computer(s).

Emailing an Arrangement

To email the preference file, you will need to first compress the file in a .zip format. To
do this, please follow the instructions below:

1. Locate the preference file (“com.quickceph.QuickCephStudio.plist”).

2. Hold down the Control key on the keyboard

and click once on the preference file. The
drop down menu shown to the right will
appear.

3. Click once on Compress “[name of file]”.

This will create a “.zip” file in the same location
as the original.

4. You can now email this “.zip” file to other

computers, offices, or colleagues.

40
Adding Images to an Existing File
If you have already created a patient file, you can add or replace images at any time.
Follow the instructions below to do this:

1. Open the patient file to which you wish to add the images, then click on the
appropriate session.

2. When the patient’s images appear on the screen, select the images of the patient
from the camera card or iPhoto, then drag and drop them into the patient window,
as shown in the example below.

IMPORTANT: Do not drag and drop these images on to the Quick Ceph Studio icon
or a new patient file will be created.

3. When the new photos are dragged into the patient window, they appear in the
Thumbnail Strip. Follow the instructions above for positioning and cropping images.

41
Merging Multiple Sessions
If you have created multiple files but would like to merge them into one session, QCS
allows you to do this. Follow the steps below to do this:

1. Open a file and choose your target session. Then select Session > Merge
Session...

2. The Open Dialog Box will appear. Select the patient file that contains the session
you wish to merge with your target session and click on “Open”. If the patient file
chosen has multiple sessions, you will be prompted by the following window to
choose which session you want to merge and then click “OK”.

3. You will be prompted with the following message reminding you that any images or
tracings in the same positions as the ones in the selected session will be
overwritten. Click on “Yes” to continue merging the files if this is acceptable.

4. Once the files have merged, you will have full access to all of the images and
tracings stored in the previous session.

42
Chapter 5
Importing X-Rays and Models

43
There are a few different ways to capture images for use in Quick Ceph Studio. The
most common methods of obtaining x-ray images are scanning physical x-rays, taking
photos of physical x-rays, or importing the x-ray image from a direct digital x-ray
machine.

The most common methods of obtaining model images are scanning the model, taking
photos of the models, or importing a model image exported from a digital source.

Capturing X-Ray and Model Images

Scanner
When capturing an x-ray or model image using a scanner, you can select any resolution
at which to scan the image. Quick Ceph Studio will be able to automatically obtain this
resolution by scanning the image once it’s imported into the program.

Camera
If you plan to digitize an x-ray or model image obtained using a camera, please make
sure the image includes a ruler in the image or, at the least, two points marked at a
known distance. Without these landmarks, the image cannot be calibrated accurately.

Exported from Digital Source

If the image is exported from a direct digital source, please make sure the source file
includes an image of a ruler or other landmarks of known distance for calibration.

Additional information can be found in the Digitizing X-Rays and Models chapter.

Importing X-Ray and Model Images

5. Drag and drop the scanned or digital x-rays and models onto the Quick Ceph Studio
icon or alias.

Tip: Do you need to add new photos to a previously saved patient file? First open
this patient file, then drag the x-ray images directly onto the Quick Ceph Studio
window displaying this patient file.

6. The patient's x-rays and models will be displayed as thumbnails in the Thumbnail
Strip (see section B on the next page), and the Photo Import window will be
displayed in the main window.

3. Select the third button in the Navigator to display the positions

reserved for x-rays and models. The X-Ray Import window displays an
image outline indicating where the images need to be placed (see
section C on the next page).

44
! ! ! A! B! ! ! C

5. Drag the individual images from the Thumbnail Strip (Section B) onto the
corresponding icons, as shown below:

! ! ! A! B! ! ! C

45
6. If you need to rotate or flip an image, first click on the image, then select one of the
Geometry tools shown at the bottom of the window.

a b c d e.

! ! ! ! !
! ! ! ! Tool a: Revert to original
! ! ! ! Tool b: Rotate counter clockwise
! ! ! ! Tool c: Rotate clockwise
! ! ! ! Tool d: Flip vertically
! ! ! ! Tool e: Flip horizontally

7. You can also rotate an image by smaller increments to correct a slight tilt in the
scanner or camera. Observe that a large cross appears on any image you click (A).
Hold the mouse button and drag the handles of this cross so that the horizontal line
parallels the plane which you wish to make horizontal to the ground (B), such as the
Frankfort Horizontal. Release the mouse button to see your rotated image (C).
Repeat as needed to fine tune the rotation.
A B C

8. Images that do not fit into the pre-defined image types listed in the primary
and secondary image positions can be placed into additional spaces
known as Holding Areas, which can be accessed by selecting one of the
three bottom buttons in the Navigator. There are three Holding Areas,
shown on the next page, and each contains spaces for 20 images, allowing you to save
a total of 89 cropped images and x-rays in a single patient session.

46
Adjusting Images
To make changes to an image, click on the Adjust Image tool. The Adjust
Dialog Box below will appear, allowing you to adjust different aspects of the
image. Settings not mentioned below are not used for x-ray or model images.

Enhance: Uses a proprietary algorithm to enhance the x-ray

image. Moving the slider to the right increases the enhancement.
Radius: Adjusts the size of the enhancement.
Invert: Changes each color to its inverse on the color wheel.
Brightness: Shifts the entire image towards lightness or
darkness without changing other settings.
Contrast: Changes the difference between the brightest and
the darkest colors on the image. Increased contrast means
greater color variation.
Exposure: Changes the white balance of the image.
Gamma: Changes the gray balance of the image.

The Revert button restores the image to its original color settings. The Transparency
slider allows you to change the opacity of the Adjust Dialog Box so you can see the
image beneath it.

Once you have finished importing and editing the images, you are ready to go to the
next section.

47
Saving Patient Records
It is important to save patient files regularly, so we recommend saving after each major
step. Follow the instructions below to save a patient file:

1. Select File > Save As... If you are saving the file for the first time, the Patient I.D.
window will appear, as shown below. Fill in the required information, shown below,
as the program will not allow you to save the file otherwise.

Case Number: Provided

by your practice
management program.
First and Last Name,
Gender: Required.
Norm and Birth Date:
For norm value
classifications, one of the
four racial norms must be
selected and the birth date
must be entered.
Address: You can enter
the patient’s address here
for use in letter writing.

2. Next, select File > Save As... again to display the Save Dialog Box. Choose the
appropriate patient folder to store the file, then click on “Save”.
View and edit
the file name.

Indicates the folder in which the

file is to be saved. Click on it to
access the correct folder.

Displays contents of current

folder.

Creates a new folder

inside the currently
selected folder.

48
Optional: Using Arrangements
If you always import the x-rays and models in the same order, you can save time
importing the images into Quick Ceph Studio by using the Arrangement feature. Once
it has been set up, this feature allows the program to position, rotate, crop, and resize a
group of imported images with a single button click. To set up an Arrangement, please
follow the instructions below:

Creating an Arrangement

1. Prior to creating an arrangement, it is important that you select a set of images

representative of the arrangement you wish to create. We recommend that you
double check that the images are taken in the correct order and that any extra
images are removed, as this will affect the Arrangements.

2. When the representative x-ray and model images are ready, import them into Quick
Ceph Studio and place them in the correct positions. If they are always taken in a
particular orientation, you may wish to rotate them as well. We recommend that you
do not resize the images unless each image of this type needs to be resized the same
way (i.e., Panoramic x-rays that need to be reduced in size to see the condyles).

3. Once the images have been sorted and edited to your

preference, click on the Arrangement menu at the bottom of
the Import window, then select Save Arrangement... to save
the name of this setting. You can create and save an unlimited number of
arrangements, which is useful if you take a different number of images for different
Sessions.

Using a Saved Arrangement

1. When you import the next set of x-rays and models, delete any unwanted
images and ensure that the set contains the same number of photos as the
saved Arrangement. Then, click on either the Arrangements drop down menu
and select the name of your Arrangement, or simply click on the Arrange and
Fix tool, which activates the current arrangement selected, to automatically arrange and
edit all of the images you have imported.

2. If you import a different number of images than you had initially imported to
create the selected arrangement, you can still have the software automatically
crop and rotate the images. First, drag and drop the images into their correct
positions, and then click on Fix.

3. Once the images have been arranged and/or fixed, you may need to make some
other minor adjustments to the size or orientation of the images, as described in the

49
 instructions above.

Transferring an Arrangement

Arrangements can be transferred to another computer by transferring your Preference

file. This file contains your Arrangement information as well as the Preferences settings.
To transfer this file, follow the instructions below:

1. Locate the Quick Ceph Studio preference file, which is stored in the following location
on your computer:

[hard drive] / Users / [your name] / Library / Preferences /

com.quickceph.QuickCephStudio.plist

2. To share the preference file with another computer, you can copy this file across
your network, copy the file onto a USB flash drive, or email the file from this
computer. Then, place this file in the Preferences folder on the other computer(s) the
desired destination.

Emailing an Arrangement

To email the preference file, you will need to first compress the file in a .zip format. To
do this, please follow the instructions below:

1. Locate the preference file (“com.quickceph.QuickCephStudio.plist”).

2. Hold down the Control key on the keyboard

and click once on the preference file. The
drop down menu shown to the right will
appear.

3. Click once on Compress “[name of file]”.

This will create a “.zip” file in the same location
as the original.

4. You can now email this “.zip” file to other

computers, offices, or colleagues.

50
Adding Images to an Existing File
If you have already created a patient file, you can add or replace images at any time.
Follow the instructions below to do this:

1. Open the patient file to which you wish to add the images, then click on the
appropriate session.

2. When the patient’s images appear on the screen, select the images of the patient
from the camera card or iPhoto, then drag and drop them into the patient window,
as shown in the example below:

IMPORTANT: Do not drag and drop these images on to the Quick Ceph Studio icon
or a new patient file will be created.

3. When the new images are dragged into the patient window, they appear in the
Thumbnail Strip. Follow the instructions above for positioning and cropping images.

51
Merging Multiple Sessions
If you have created multiple files but would like to merge them into one session, QCS
allows you to do this. Follow the steps below to do this:

1. Open a file and choose your target session. Then select Session > Merge
Session...

2. The Open Dialog Box will appear. Select the patient file that contains the session
you wish to merge with your target session and click on “Open”. If the patient file
chosen has multiple sessions, you will be prompted by the following window to
choose which session you want to merge and then click “OK”.

3. You will be prompted with the following message reminding you that any images or
tracings in the same positions as the ones in the selected session will be
overwritten. Click on “Yes” to continue merging the files if this is acceptable.

4. Once the files have merged, you will have full access to all of the images and
tracings stored in the previous session.

52
Chapter 6
Using CT Scans

53
Before importing CT scans into Quick Ceph Studio, please make sure the DICOM
image files (with the file extension .dcm) are placed in the same folder as the
DICOMDIR file, as shown below:

Importing CT Scans
1. Drag and drop the DICOMDIR file (or the entire folder containing the .dcm files) onto
the Quick Ceph® Studio icon or alias. The following progress bars will be displayed
while the program imports the CT scans:

2. Once the CT scan has been imported into the program, the Presets Dialog Box will
appear allowing you to select the best view of the volumetric data. You can select to
view just the bone structure, skin, both, or create a custom view. Select the view you
wish to display, then click “Apply”.

54
3. The CT scan will now be displayed volumetrically in three different views within the
Calibration window:

4. Once the CT scan has been imported, you will need to calibrate the model to ensure
it is in the proper orientation. Click and drag the model in the lateral view so the
condyles and orbits are superimposed over each other, assuming the patient’s head
is symmetrical, as shown in the image below:

5. You will notice that the orientation of the other two views are linked to the lateral
image, and should now be corrected. You can now proceed to the next sections to
manipulate the CT scan.

55
Viewing CT Scans
Once the CT scan has been imported and calibrated, it can be viewed and manipulated
within the program. Follow the instructions below to do this:

1. Select Session > New CT-Scan X-Ray View. The three volumetric model views will
appear. To display any view in the main window, double clicking on it as shown:

2. To only display the volumetric model in the main window, double click on the image
again. To display all three views again, double click on the image a third time.

56
3. To manipulate the model, click and drag any area inside one of the three views. The
CT scan model will move accordingly and all three views will change perspective.
Note the 3D box in the upper right corner of each image displaying its orientation.

4. To display a view of the position of the planes currently being viewed in Quick Ceph
Studio, click on the first icon in the Thumbnail Strip. The view below will appear:

5. The viewing planes can be changed by dragging the intersection of the vertical and
horizontal red lines on any of the three views. Double clicking on any of these
images will enlarge it to individually fill the main window.

57
6. You can use the View Tools at the bottom of the window to manipulate and view the
patient’s files. When you click on an image view, the tools that can be used to
manipulate the selected image will be highlighted. The function of each tool is
described below:
a b c d e

! Tool a: Reset - resets the CT scan to the original orientation and view
! Tool b: Zoom - allows you to zoom in and out of the displayed image
! Tool c: Pan - allows you to move the entire view within the window
! Tool d: 3D Rotate - manipulates the image in 3D
! Tool e: Z-Axis Rotate - rotates the Model view around a central Z axis

Adjusting CT Scans
Once a CT scan has been imported into Quick Ceph Studio, you can control how it is
rendered (converted to an image on screen). Follow the steps below to do this:

1. To adjust any CT scan image, click on the Show Histogram tool. The
Transfer Function window, which allows you to adjust the image, will appear
beneath the main window.

C
A

D
B

2. The Transfer Function window consists of several elements, as displayed in the image
above. The functions of these elements are described below:

A: The shaded graph area in the above image represents the image graphically. The
horizontal axis represents the tissue density, with lower density on the left and higher
density to the right. The vertical axis is the number of data points with that density.

B: The points connected by lines are the Transfer Function itself, and can be moved
to adjust the density of the image. The horizontal axis of the transfer function is still
the tissue density, but the vertical axis shows the opacity of tissue at that data point.
The shape of the function defined by the position of the points determines the
opacity of the overall image. In the predefined “bone” settings shown on the previous

58
 page, you will see that the function is not present at the low end, gradually increases
to a peak in the midrange, and plateaus throughout the high density region. This
creates a model with no visible soft tissue, but well defined bone structure. Dragging
the points to the left would increase the visibility of low density elements, such as
skin. Each point can be moved independent of the others.

To delete a point from the transfer function, click once on it (it will be highlighted in
yellow), then hit the “delete” key. To add another structure to the function, click on
the “+” button. To delete a structure, click once on it (a selected structure will also be
outlined in yellow), then either hit the “delete” key or select the “-” button.

C: You can change the color at each selected image density by double
clicking on each point. Doing so will display the Color Dialog Box,
allowing you to select any color. Note that portions of the CT scan will
also change to this color. You can use this function, for instance, to
highlight the soft tissue in one color and the bony tissue in another color.

D: Placing the cursor within the structure allows you to move the
entire function. This is useful, for instance, if you want to
progressively reveal lower density tissue by moving it left and reveal
higher density tissue by moving it right.

3. If you have customized a transfer function, you can save it as a Preset for later use.
To do this, first click on the “Save” button in the lower left corner of the Transfer
Function window to display the Presets Dialog Box. Next, click on the “Save As”
button in this dialog box to display the New Preset Dialog Box:

Type the name of the custom setting in the “Monicker” field, select the category
where you would like this setting to appear in the Presets Dialog Box, then select
“Save”.

4. To access this or any of the preset transfer functions, click on the Presets tool.
This will display the Presets Dialog Box, allowing you to reset the gallery
settings.

59
Digitizing CT Scans
1. To extract the lateral, frontal, and submentovertex views from the CT scan for
digitizing, the model must first be properly calibrated, as described in the first section
of this chapter. If the model is not calibrated, please repeat those procedures before
proceding to the next step.

2. Once the CT scan has been calibrated, click on the FreezeDry tool. The
program will automatically capture the lateral, frontal, and submentovertex
views from the CT scan and upload them into the correct positions in Quick
Ceph Studio, as shown in the following image.

3. Please refer to the Digitizing X-Rays and Models chapter for more information on
digitizing these images.

60
CT Scan Options
The Session menu contains options to allow you to display different CT
scan views. These views are described below.

Displaying a New CT Scan Model View - The “New CT Scan Model

View” option is similar to the “New CT Scan X-Ray View” discussed
earlier, but offers different presets than the X-Ray View that emphasize
the patient’s soft and hard tissue in the CT scan. To display this view,
choose Session > New CT Scan Model View. The Presets Dialog Box will appear, as
shown below. You can select to view just the bone structure, skin, both, or create a
custom view. Select the view you wish to display, then click “Apply”.

Once the Preset is selected, the CT Scan Model view will appear as shown below:

61
Displaying a Condyle View - Quick Ceph Studio can extract the condyle views from the
CT scan slices. To display this view, choose Session > New Condyle View. The image
below will appear. Follow the instructions below to manipulate the view:

1. Drag the top and bottom tabs (circled in red in the above image) so the reference
plane is focused on the condyles.

2. Next, drag each of the rectangular boxes (highlighted by the arrows in the above
image) onto the inferior border of the Ramus beneath where the condyles reside.

3. Move the red control bars to adjust the orientation of the rectangle so the green
center line is superimposed on the Ramus. The condyles should be visible in the
bottom series of images.

4. To control the magnification, drag the white circles at the corners of the rectangle
towards or away from the center of the rectangle to zoom in or out of the image,
respectively.

5. To save the condyle image, click on the FreezeDry tool. The image will be
copied to the Thumbnail Strip in the Import section, which will allow you to
place it in the position of your choice.

62
Displaying a Panoramic View - Quick Ceph Studio can also extract a panoramic view
from the CT scan data. To open this view, select Session > New Panoramic View. The
image below will appear. Follow the instructions below to manipulate the view:

D
B

1. Drag the red box marked “A” to the incisors to fit the template over the bone structure.

2. Next, drag the red circle marked “B” to resize and reorient the template to the teeth.
The template should fit loosely around the mandible at this point.

3. Position the white circle at “C” over the condyle on each side of the arch. Using the
circles and the white X at “D”, widen the arch to ensure the green line passes
through the center of the mandibular arch. You will see how this affects the final
panoramic image in the lower right corner. The final view should resemble the
following image:

63
4. The red arrow in the previous image indicates the zoom slider for the cross sectional
image in the upper right corner of the window. Moving the red box away from the
center enlarges the image.

To view the contact point of each tooth along the arch, place the cursor in the center
of the red line and drag it to the desired tooth. The upper right corner image will
display the contact position. To view the panoramic x-ray in the large window, double
click on the image. The results are shown below:

5. To save the panoramic image, click on the FreezeDry tool. The image will be
placed into the correct position in the Import section and will be displayed in
each gallery that contains a panoramic x-ray image.

64
Displaying an Airway View - Quick Ceph Studio can measure a patient’s upper and
lower pharyngeal airway width from the CT scan data. To open this view, select
Session > New Airway View. The image below will appear.

B
E
C
D

To use the Airway View, you must first define the pharyngeal pathway within the
program. Start by placing the white circle labeled “A” in the upper pharyngeal area and
the white circle labeled “C” in the lower pharyngeal area. The center white circle should
be placed in the center of the airway and the white “X’s” should be used to manipulate
the green line so it cleanly travels through the airway. The red line labeled “B” in the
image shows the current location in the airway as depicted in the volumetric “pink”
image and in the two-dimensional image below it. The image to the right of these depict
the length of the airway.

Using the slider labeled “D”, position the two-dimensional image so that the cross-hair is
directly in the center. This allows you to accurately measure the airway without any
obstructions. The red and purple lines on the two-dimensional image measures the
cross-sectional width of the airway at the point along the pharyngeal pathway specified
by the line at “B”. To measure the width of a specific diameter, move the “E” slider. The
width and length of all three lines are displayed in the lower right corner of the window.

65
CT Scan Tools
To Crop and View a Specific Area - To view only a specific area on the CT Scan,
you can change the Volume of Interest (VOI). To do this, click on the VOI tool. A
cube with red circles on each cubic face will be displayed around each CT Scan
image. Move any of the circles toward the center of the image to crop the view on that
plane. The example below shows how the initial image appears and how it appears
after the red circles are used to emphasize the volume of interest (in this case the
mandible).

66
Adjusting the Clipping Frame - Selecting the Clipping tool allows you to adjust the
reference plane of the image to focus on just the portion you would like to review.
This tool is available in any CT scan view and, when activated, displays tabs
(circled in red) that can be used to narrow the view, as shown below:

To Capture A CT Scan Image - If you have a CT Scan image that you would like to
capture and use as a static image within Quick Ceph Studio, you can click on the
Snapshot tool. This tool captures the image on the screen, then places it inside
the Thumbnail Strip so you can import it into the position of your choice.

To Enhance an Individual Image Slice - You can change the view of a CT Scan
slice by clicking on the Image Adjust tool. This tool allows you to enhance the
slices, as well as change different aspects of the image (such as the brightness,
contrast, gamma, etc.).

High Quality CT Scan Images - For the best quality CT Scan image, you can click
on the Best tool after you have finished making adjustments to the image. This
will enhance the quality of the image surface. This tool is recommended if you
plan to export the image for a lecture.

67
Chapter 7
Digitizing X-Rays and Models

68
Tracing Overview
After importing the x-rays and models into the program, you can now calibrate and
digitize them. Follow the instructions below to calibrate and digitize the lateral x-ray.

NOTE: This sample patient file contains both x-rays and color images, although the
latter is not necessary for digitizing purposes.

1. Click on the Tracings button at the top of the window to display the tracing interface.
The lateral x-ray will show up in section C.

! ! A! ! B! ! ! ! ! ! C

2. Click on the Trace tool, located on the Image Tools at the bottom of the
window.

3. You will see a ruler displayed across the x-ray. This is the calibration ruler. Before
digitizing, you must calibrate the x-ray using the calibration ruler. Please follow the
instructions on the next page to calibrate the x-ray.

NOTE: If you scanned the x-ray, the calibration ruler can automatically determine
the correct calibration based on information your scanner stores in the image. This
feature will be covered in the next section.

69
Calibration Ruler
Calibration Ruler Components

The main components of the calibration ruler are described below:

! ! ! ! a b! c! ! ! ! ! d e

! a: ! The ends of the ruler have circular handles which allow you to resize the ruler
for calibration. This lets you calibrate based on an object of known length in
an x-ray. If the ruler measures 100mm, for example, you can move and resize
it next to a 100mm object in your x-ray.
! b:! This lock icon prevents the resolution from being changed.
! c: ! The calibration resolution of the x-ray is displayed here.
! d:! This value is the length of the calibration ruler.
! e:! This triangle is dragged to adjust the units measured by the calibration ruler.

Calibration Ruler Preferences

When you double click on the calibration ruler, the Calibration Window with additional
options will appear allowing you to fine-tune the calibration settings.

! Midsagital vs. Film Plane Option: This option allows you

to select whether the calibration ruler is placed at the
midsagital plane (against the ruler in the x-ray image)
or if it is placed at the film plane (where the film or x-
ray sensors are placed).
! Magnification: This option allows you to change the
magnification of the image (Midsagital only). Each
digital x-ray machine has a certain magnification
(which is usually around 10%). You can get this
information by using the formula on page 72 (step 5) or
from the manufacturer of your digital x-ray machine.
! Film Plane Resolution: This is the resolution of the image
at the film plane. If you are using a scanner, this is the scanned resolution of
the x-ray.
! Length: This is the default length of the calibration ruler.
! Auto-Sense From File: Clicking this button automatically senses the resolution of
! ! a digital file that has an included resolution. This is useful for x-rays obtained
! ! through a drum scanner (such as a phosphor plate x-ray system), flatbed
! ! scanner and some direct digital x-ray machines.

70
! Choose Default: This option allows you to choose from your 3 available custom
calibration settings.
! Save Default As: This option allows you to save up to 3 custom calibration
settings, including the placement and orientation of the ruler. This is useful for
practices that have multiple x-ray image sources.
! Locked: This prevents the selected settings from being changed.

Calibrating Cephs
Calibrating Scanned X-rays

Scanned x-ray files obtained through a flat-bed or drum scanner contain a resolution
value that is automatically recognized by Quick Ceph Studio, so calibration is not
required. To ensure a scanned x-ray is calibrated correctly, please follow the instructions
below:

1. Import the scanned x-ray into the appropriate position in the Import section, then
click on the Tracings button to view the Tracings section.

2. Click on the Trace tool icon, then double click on the ruler when it appears.

3. When the Calibration Ruler Preference appears, make sure it is set to “Film Plane”
then click on the “Auto-sense from file” button. This will automatically set the calibration
to the file’s internal setting. If the “Auto-sense from file” does not work then you should
manually input the dpi the x-ray was scanned at into the “Film Plane Res” box.

4. Once this is done, you can close the preferences. If you regularly obtain x-rays from this
source, you can click on the “Save Default As...” button and choose “Default Calibration”
to save the calibration settings. You can have 3 different default calibrations saved.
Each default calibration includes all the settings of the Calibration Ruler Preference
window as well as the location of the ruler onscreen.

Calibrating Direct Digital X-Rays

There are two options to calibrate a direct digital x-ray. You can either calibrate at the
midsagital plane or at the film plane. Quick Ceph provides both options for the
practitioner.

NOTE: Digital x-ray calibration needs only to be done once, as the settings will be valid
for all future x-rays from the same machine.

71
Calibrating at the Midsagital Plane
If the digital x-ray you are using has a ruler at the midsagital plane, you can use it to
calibrate your x-ray. Display the x-ray on the screen, then follow the instructions below:

1. Click on the Trace tool icon.

2. When the calibration ruler appears, double click on it to display the Calibration
Ruler Preferences.

3. Select the Midsagital box, underlined in the image to the right.

4. The Magnification field should also be changed to reflect the

estimated or actual magnification between the midsagital plane
and the film (sensor) plane.

5. To determine the true magnification value, use the following

formula:

Distance from the emitter to the film (sensor) plane (EF)

divided by the
Distance from the emitter to the mid-sagittal plane (ES).

Type the resulting value (1.xx) in the Magnification field of the Calibration Ruler
Preferences. For additional calibration information, please review the Appendix.

6. Click on “Close” when this is done.

7. Next, determine the length of the visible midsagital plane ruler on the x-ray, then
double click on the calibration ruler length value and type in the ruler length.

8. After this is done, drag the ends of the ruler to match the distance written on the ruler,
as shown below, to calibrate the film plane resolution (shown as 144 dpi above).

72
9. The calibrated film plane resolution on the ruler is the same as the one found in the
Calibration Ruler Preferences. To verify that the x-ray is consistent, perform Steps
1 - 7 for additional x-rays. If you regularly obtain x-rays from this source, you can click
on the “Save Default As...” button and choose “Default Calibration” to save the
calibration settings. You can have 3 different default calibrations saved. Each default
calibration includes all the settings of the Calibration Ruler Preference window as well
as the location of the ruler onscreen.

10. You can now digitize the calibrated x-ray. Please follow the instructions later in this
chapter for digitizing x-rays.

Calibrating at the Film Plane

If your x-ray does not have a midsagital plane ruler, calibrate using these
instructions. Take an x-ray of a metal wire of known length (Quick Ceph
recommends a wire that is at least 100mm in length) that is placed in front of the
sensor without attaching it directly to the sensor. This is necessary as any item
affixed directly to the sensor will not be visible on the final x-ray image. Once the
image is taken, drag this x-ray image onto the Quick Ceph Studio icon and place it in
the appropriate position (i.e., lateral x-ray position if you are calibrating a lateral x-
ray). Next, follow the steps on the next page to calibrate the x-ray.

! ! ! ! a b! c! ! ! ! ! d e

73
1. Double click on the calibration ruler to display the Calibration Ruler Preferences.
Make sure the “Film Plane” option is checked, as shown to the right.

2. Next, double click on the calibration distance (d) and type the
numerical length of the ruler or metal wire on the x-ray. The
calibration ruler does not have to match the exact size yet.

3. Place one endpoint (a) of the ruler on one end of the metal wire,
then the other endpoint on the opposite end of the wire. When
the ruler matches the wire, the x-ray is calibrated. NOTE: You
will notice that the resolution (c) will change.

4. If you regularly obtain x-rays from this source, you can click on
the “Save Default As...” button and choose “Default Calibration” to
save the calibration settings. You can have 3 different default calibrations saved. Each
default calibration includes all the settings of the Calibration Ruler Preference window
as well as the location of the ruler onscreen.

NOTE: The location of the calibration ruler is saved with each of the 3
calibration defaults. If the ruler is accidentally moved offscreen, click on Hide
Calibration tool, then the Show Calibration tool to move the ruler back to
the middle of the screen.

Quick Measurements and Angles

Once your ceph x-ray is properly calibrated you can take quick measurements and
angles on your x-ray before doing your ceph tracing. To do these please follow the
instructions below:

1. Make sure you are using the Select tool, your cursor should look like a
standard pointer arrow.

2. Hold down the option key and click the mouse button on the first point you wish to
start your measurement from. With the mouse button held down, drag the cursor to
the location you wish to complete the measurement. A yellow measurement line will
appear. Below is a picture showing a measurement from pterygoid to nasion.

74
 You will notice there are three measurements, the actual distance of the line is
shown at 59.8mm. The vertical distance between the two points is shown at 24.2mm
and the horizontal distance is shown at 54.7mm.

3. To take a quick angle you follow the same steps above to create your first line, keep
in mind the starting point of your first line will be the location of the angle. With your
first line created move your mouse where you want the second side of the angle to
go, then hold down option again and click the mouse button, now you can drag
around the second arm until it is in the location you like. You should now have an
angle measurement. Below is screen shot showing an angle measurement between
nasion and orbitale intersecting at pterygoid.

Digitizing Cephs
1. Once the x-ray has been calibrated, it can be accurately digitized. The Image Tools,
shown below, allow you to create and modify the x-ray tracing:

a b c d e f g h i

!
! Tool a: Select! - exits a procedure
! Tool b: Trace! - digitizes landmarks
! Tool c: !Correct Tracing - corrects landmarks and lines
! Tool d: Align !Tracing - aligns tracing to lateral and frontal image
! Tool e: Treat !- activates the treatment function
! Tool f: ! CO-CR Conversion - activates the CO-CR Conversion function
! Tool g:!! Highlight Tracing - allows tracing lines to be individually highlighted
! Tool h:!! Edit Image - allows access to drawing tools for editing images
! Tool i:! !Marquee - allows you to select a portion of the image in the main window

75
2. Select the Trace tool to begin digitizing the landmarks. The current landmark is
displayed at the top of the window (section C) and in the Current Point pop up
menu (section D), along with a visual and written description of the landmark.
Clicking on the prompted landmark in the x-ray displays a yellow dot and landmark
name, as well as advances the program to the next landmark. To toggle the landmark
labels, click on the Show Labels check box in Section D.

! A! B! ! ! ! C! ! ! ! ! ! D

3. The digitized landmarks and location descriptions are listed below:

76
 Soft Tissue Glabella

5
Nasion
Sella
0

1 4
Porion Pterygoid 6
Orbitale
3

R3
Articulare 16
17
2
8 PNS 7
Basion ANS
mx 1 root
25 20 9
mx 6 root A-point
18 R1

mx 6 distal 24

Ramus down 15
md 6 distal 23
26 md 1 21
Occlusal crown mx 1 Lip embrasure
plane 19 crown

14 md 6 root
27 22
Corpus left md 1 root B-point
10
11 PM

12
13 Pogonion
Menton

Soft Tissue Menton

! 0 -! Sella! Center of Sella Turcica

! 1 -! Porion! Most superior point of external auditory meatus
! 2 -! Basion! Most inferior point of the Occipital bone
! 3 -! Hinge Axis! Center of rotation of the Condyle
! 4 -! Pterygoid! Eleven o’clock position of the Pterygoid fissure
! 5 -! Nasion! “V” notch of frontal, and nasal bones
! 6 -! Orbitale! Most inferior point of the Orbital contour
! 7 -! ANS ! Tip of the anterior nasal spine
! 8 -! PNS! Tip of the posterior nasal spine
! 9 -! A-Point! Deepest point between ANS, and the upper incisal alveolus
! 10 -! B-Point! Deepest point between Pogonion, and lower incisal alveolus
! 11 -! PM! Point where curvature changes between B-point and Pogonion!
! 12 -! Pogonion! Most anterior point of the Symphysis
! 13 -! Menton! Most inferior point on the symphyseal outline
! 14 -! Corpus left! Left point of a tangent of the inferior border of the Corpus
! 15 -! Ramus down! Lower point of a tangent of the posterior border of the Ramus
! 16 -! Articulare ! Intersection of inferior cranial base surface & posterior surface of Condyle
! 17 -! R3! Most inferior point of the Sigmoid notch of the Ramus
! 18 -! R1! Deepest point on the curve of the anterior border of the Ramus
! 19 -! mx 1 crown! Tip of the crown of the upper incisor
! 20 -! mx 1 root! Tip of the root of the upper incisor
! 21 -! md 1 crown! Tip of the crown of the lower incisor
! 22 -! md 1 root! Tip of the root of the lower incisor
! 23 -! Occl. plane! Midpoint between upper, and lower 1st Bicuspids or Incisors
! 24 -! mx 6 distal! Distal contact point of maxillary first molar (~2 mm above occlusal plane)
! 25 -! mx 6 root! Distal buccal root of maxillary first molar
! 26 -! md 6 distal! Distal contact point of mandibular first molar (~2 mm below occlusal plane)
! 27 -! md 6 root! Distal root of mandibular first molar

77
4. If you make a mistake during the tracing, you can “undo” it by either
holding down the Command (⌘) and Z keys or by choosing Edit >
Undo. Alternately, you can selectively redigitize landmarks by clicking
on the Current Point pop up menu and selecting a landmark.

NOTE: In the Current Point menu, the landmarks that have already
been digitized will appear in black, while landmarks that have yet to
be digitized will appear in red.

5. While digitizing, you may find the need to magnify an area to see a
landmark easier. One method is to use the Magnifier tool. You can
activate the magnifier by using the Magnifier drop down menu and
choosing Locked or Unlocked, as shown in the image
below:!! ! !

You can also use the M key on the keyboard to cycle between the Locked,
Unlocked and Hidden options. If you don’t want the magnifier to show every time
you click the Trace tool, you have to select the Hidden option.

A
B

When you have the Locked option selected the magnifier will stay in one place to
help with your tracing or you can choose the Unlocked option and have the
magnifier follow your cursor. Holding down the Shift key will keep the magnifier still
while it is unlocked. To adjust the size of the magnifier, click and drag the tab labeled
“A” in the lower right hand corner of the magnifier (You will need to hold down the
Shift key if the magnifier is unlocked). To increase the magnification within the
magnifier, drag the red slider labeled “B” around the perimeter of the magnifier.
Again, you will need to hold down the Shift key if the magnifier is unlocked.

Another option is to use the Zoom tools, shown to the right. These tools
allow you to zoom into or out of an image incrementally, make the image
fit to the screen, and display the image at a 1:1 size with the original
image. Unlike the Magnifier tool, using these tools affects the entire image, which is
useful for displaying more of the bone or teeth structures while digitizing.

78
6. When you are zoomed into an image, you can view other areas of the
image by moving either the vertical or horizontal sliders. A better method is
to hold down the Space Bar when you are zoomed in. This changes the
cursor icon to a hand icon, as shown to the right. You can then hold down
the mouse button and drag the image to view other areas.

7. To adjust the visibility of the x-ray, click on the Adjust

Image tool to display the Adjust Dialog Box. Clicking
on the checkbox to the right of “Enhance” will enhance
the x-ray image. You can control the intensity of the
enhancement by moving the horizontal slider to the right of
this box. Moving the slider next to “Radius” changes the area
of enhancement. You can also adjust the brightness, contrast,
saturation, exposure, and gamma settings in this dialog box to
improve the image quality.

8. To mark a deciduous (milk) tooth while digitizing an x-ray or a

model in Quick Ceph Studio, simply hold the Shift key while clicking the
prompted tooth landmarks. When you are finished digitizing, the
deciduous tooth will be distinguished by a dashed outline. To designate a
missing tooth, hold the Option key while clicking the prompted
landmarks. These teeth templates will be denoted by a thin dotted line.

9. Once the landmarks are digitized, you will need to digitize additional lines.
The lines required in the program are as follows:

Upper Profile Line

Place the crosshair cursor at the top of the profile near the soft-tissue Glabella. Hold
down the mouse button and carefully trace the upper profile down to the upper-lip
embrasure. Release the mouse button at the upper-lip embrasure.

Lower Profile Line

Start the second line at the lower-lip embrasure. Hold down the mouse button and
begin tracing the lower profile down the soft-tissue Menton and back toward the
neckline to include the entire chin.

Mandibular Contour Line

When tracing the mandible, it is important to trace the mandibular points in the
following order: Begin at the anterior alveolar crest of the lower incisor, and follow
down through B point. Continue through “PM”, “Pogonion”, “Menton”, “Corpus left”,
“Ramus down”, “Articulare”, over the Condyle to “R3”, around the muscular process
through “R1”, and ending distal to the lower molars. Important: Do not trace the
Symphysis at this time. The Symphysis can be optionally traced at a later time, as
shown in the next step.

79
 Maxillary Contour Line
The tracing order is important for the maxilla as well. It must be traced directly after
the mandible. Begin tracing at the labial surface of “mx 1”, to “A-point”, through
“ANS”, back to the “PNS”, and forward along the palatal surface, ending distal to the
upper incisor.

10. After these four lines have been traced, the program will call out “Line”, prompting
you to trace any additional lines you wish to add (e.g., sella turcica, pterygoid, etc.).
If there are no other lines you wish to trace, please skip to the next step.

NOTE: Selecting the “ABO” analysis while digitizing prompts you to digitize four
additional lines in the following order: Outer Symphysis, Inner Symphysis, Nerve
Canal Upper, and Nerve Canal Lower.

11. To complete the digitizing procedure by clicking on the Select tool located on
the Image Tools at the bottom of the Tracings window.

12. After you digitize the x-ray, you can view the individual tracing by clicking on the
tracing icon in the Thumbnail Strip (Section B). The photo with tracing,
measurements, and standard deviation diagrams can also be accessed by clicking
on their respective thumbnail icons.

Correcting Ceph Tracings

Correcting Digitized Landmarks and Lines

1. To make any corrections to the tracing after digitizing, click on the Correct
Tracings tool, located in the Image Tools. The landmarks will turn yellow and
the traced lines will turn blue as shown on the next page.

80
CHAPTER 6 - DIGITIZING Quick Ceph® 2000

! ! A! ! B! ! ! ! ! ! C
Correcting Peripheral Digitized Landmarks and Tooth Position
To correct a peripheral landmark or tooth position, place the cursor at the location of the landmark that
needs to be corrected. The cursor will change to a circle, indicating that the landmark has been located.
Click the mouse button once. The cursor will become a crosshair symbol. Place the crosshair at the cor-
rect position, and click the mouse again. The landmark will be relocated accordingly, and the tracing will
be re-drawn, as seen in Figure 6-5. The digitized landmarks on the incisors and molars, along with Sella,
Nasion, Basion, and Hinge Axis, can all be corrected using this method.

Important: Do not correct the position of the landmarks Porion, Pterygoid, and Orbitale, as doing so may
produce rounding errors associated with rotations of the Frankfurt Horizontal.

Figure 6-5
This series gives
an example of how
to change a posi-
tion of a tooth.

Cursor changes to a circle Cursor positioned over new After clicking, landmark
when over a landmark location moves to new location

Adjusting Profile and Contour Lines

QC2000 utilizes a sophisticated editing system, known as Bézier curves, to allow adjustments to profile
and contour lines. When the Correct tool is selected, the screen will display blue dots along the lateral
2. To correct the tracing, place the cursor on the Anchor Point of the landmark and drag it to
profile and contour lines. Blue dots that are filled-in are called anchor points. Anchor points determine the
the desiredlocation
location.
of theTo
line.change theconnected
Hollow dots curvature of a line,
to the anchor points drag the
are called Control
control points. Points that flank
These control
the Anchor points
point. The
allow for image below
adjustments provides
to the curvature more
of the information
line connecting about
the anchor points.this
By procedure.
adjusting the
anchor and control points, as shown in Figure 6-6, you can fit the digitized line to the x-ray and color image.

Figure 6-6
This image
demonstrates how
to adjust the Anchor
Bézier curves on
the profile using Control Point

the Correct tool.

Figure 6-6

3.Figure
Click6-7on the
Retracing
Select the toolX-Ray
whenAfter youDigitizing
are done to display the corrected tracing
The figure shown
superimposed If thereon
on the left is the the
are too x-ray.
many corrections to make with the Correct tool, you can redig-
Retrace Dialog itize part, or the entire tracing. To do this, click on the Crosshair (digitizing)
Box. tool while the x-ray and tracing are showing. The dialog box shown on the
right will appear. Select the position at which you wish to start redigitizing.
Re-Digitizing a Ceph
NOTE: When one of the options shown on the right is chosen, all options
shown beneath the selected option must also be redigitized.
1. If the lines on a tracing are drawn incorrectly, it may sometimes be easier to
retrace the individual lines rather than correcting them. To do this, firstFigure
select
6-7
the Trace tool.
38 Quick Ceph® Systems

81
2. When the side menu appears, click on the pop-up menu under
“Current Point” and select the name of the line you wish to retrace.
Quick Ceph will then prompt you to redraw this line. As soon as you
click the mouse on the ceph, the previous line will disappear and
you can retrace the line. Repeat this process for each of the lines
you wish to retrace.

3. When you have finished retracing the ceph, click on the Select tool to display
the corrected tracing superimposed on the x-ray.

Aligning Tracings to Lateral Facial Image

Once an x-ray has been digitized, the tracing needs to be aligned to the patient’s lateral
facial image. Follow the steps below to align the tracing.

! ! A! ! B! ! ! ! ! ! C

1. Click on the Align Tracing tool. The measurements will be removed and the
tracing will display additional alignment boxes, one at the glabella and the other
at the lip embrasure, as shown in the image above.

2. Place the mouse in the lower box, and drag it until the lip embrasure of the tracing is
at the same position as the actual lip embrasure on the lateral facial image.

82
3. Place the mouse in the upper box and drag it to scale and rotate the profile tracing
until it matches the facial image. Further adjustments of the scaling boxes may be
required, but it should be possible to match the tracing with the photo.

4. When you are finished, click on the Select tool. The measurements will
reappear and the tracing will now be aligned with the photo.

5. The tracing may need to be adjusted to match the photo, as there may be slight
differences in the head angle or lip posture. Use the Correct Tracings tool to
make these adjustments as needed.

6. When you are finished, click back on the Select tool.

Customizing Displayed Tracings

Once an x-ray has been digitized, you can display it on screen. Quick Ceph Studio
offers many options to display the tracing exactly as you want. This section describes
how to customize the displayed tracings.

Changing the Analysis

Quick Ceph Studio can instantly change between any of its built-in and
custom analyses. To change the displayed analysis, click on the Analysis
Drop Down Menu and select the analysis you wish to display. The tracing
and measurements in the main window will instantly display those
associated with the newly selected analysis.

Changing the Tracing Color

The default tracing color for each session can be found in the Preferences.
However, you can manually change the tracing color at any time. To do this, simply click
on the Color field in the Sessions section. A window will appear
allowing you to adjust the color of the tracing in the selected Session.

Using the Highlight Tracing Tool

The Highlight Tracing tool allows you to temporarily highlight lines and teeth in a
tracing. You can access the Highlight Tracing tool by clicking on the last button in
the Image tools at the bottom of the patient window, shown to the right. Then click
on any line or tooth to highlight it. The highlighted line or tooth will be displayed in red
and will be visible on individual tracings as well as in gallery templates and comparisons
containing tracings. To “unhighlight” a line, you can either click on it again when the
Highlight Tracing tool is activated or you can close the file. Highlighted lines will
continue to be displayed until you close the file and are not saved with the file.

83
Hide / Show Tracing
The tracing can be toggled on and off of the x-ray or photograph by selecting
the Hide / Show Tracing tool. When the tracing is displayed, the Hide
Tracing icon is displayed at the bottom of the patient window. When this tool
is selected, the tracing will be removed and the Show Tracing icon will now be
displayed. To display the tracing again, you can click on the Show Tracing tool.

Another way to toggle the tracing on the x-ray or photograph is to click on the “T” key on
the keyboard.

Sassouni Analysis
To select the Sassouni analsyis, you must first make sure that the analysis is activated
from within the Quick Ceph Preferences. Please follow the instructions below to activate
and select the Sassouni analysis.

1. Select Quick Ceph Studio > Preferences.

2. When the Preferences Dialog Box appears, click on the Tracing preferences and
locate the Analysis section. Select the Sassouni analysis, circled in the image below:

84
3. Next, close this dialog box and open the patient file.

4. Click on the Tracings button at the top of the window, then click on the Analysis
drop-down menu to select Sassouni.

5. Next, select the Trace tool to begin digitizing the landmarks. You will digitize
the original 28 landmarks shown in the previous sections.

6. After digitizing these landmarks, the Sassouni analysis requires you to digitize an
additional eight landmarks, which are listed and illustrated below.

Sella Posterior

Sella Inferior

Clinoidale

Cribiform

Temporale

Floor of the Orbit

Roof of the Orbit

Supraorbitale

7. To complete the digitizing procedure, click on the Select tool located on the
Image Tools at the bottom of the Tracings window.

85
Input of Model Images with a Scanner
1. Set the scanner setting to reflective mode and place the maxillary model face-down
on the scanner. Do NOT close the scanner lid. This will scan the model with a black
background. Repeat this process for the mandibular model. The program requires
you to scan the models as two separate images instead of one large image.

2. OPTIONAL: If you plan on printing the model images, you can save ink by creating
a white silhouette background for the model. To do this, place the maxillary model
face down on a piece of white paper and trace a loose silhouette. Next, cut out and
discard the inner traced portion and place the remaining paper on the scanner bed.
Make sure that the overhead light in the room is turned off before scanning.

3. Drag and drop the scanned images into the patient file
window. Select the third button in the Navigator, shown to the
right, to display the positions reserved for x-rays and models.
When the Import screen appears, as shown below, place
these images in their correct positions.

4. Select File > Save to save these images to the patient file.

86
Input of Model Images with a Digital Camera
1. Place the maxillary model on a flat surface and align a ruler horizontally or vertically.

2. Take a picture of the model, making sure to include at least 100 mm (10 cm) of the
ruler in the image. Then do the same with the mandibular model. Both should be
taken at the exact same distance, or they will not be calibrated correctly.

3. Download the images from the digital camera, and then drag and drop the photo
icons onto the Quick Ceph Studio window that displays your patient file. You can
then crop within the program. Make sure that 100 mm is still visible on the ruler in
the cropped images. This ruler is necessary for calibrating the models for digitizing.

Digitizing Models
1. Before digitizing, you must calibrate these models. Display the maxillary model
in the Tracing window, then click on the Trace tool. The calibration ruler will
appear on the screen.

2. If you scanned the model image, double click on the ruler to

display the Calibration Ruler Preferences. Select the option,
“Auto-sense from file” to automatically calibrate the model based
on the scanned image resolution. Skip to Step 6.

3. If you took a photo of the model, you will need to calibrate the
model by using the calibration ruler, shown below:

! a b c! ! ! ! ! ! d e

4. Start by double clicking on the calibration distance (d) and typing in the numerical
length of the physical ruler displayed in the image.

5. Next, place the calibration ruler over the physical ruler by dragging the endpoints ((a)
and (e)) of the ruler until the length of the calibration ruler matches the length of the
physical ruler. The measurements in both rulers should line up. When this is done,
the maxillary model is calibrated. Repeat Steps 3-5 for the mandibular model.

NOTE: The resolution (c) will change with the ruler length. The resolution of the
maxillary model image may differ from the mandibular model image.

87
6. The program will display a prompt for the landmark, “R. Mx 6 Distal”. Begin by
digitizing this landmark on the right-hand side of the model, as shown below.

7. Once you digitize this landmark you will be prompted for the next landmark, “R. Mx 6
Mesial”. Proceed with digitizing the model following each prompt. If a tooth is
missing, you may skip it by clicking on the Current Point menu, circled in red in the
image above, then selecting the distal contact point of the next non-missing tooth. To
toggle the landmark labels, click on the Show Labels checkbox.

8. After the maxillary model has been digitized, the computer will prompt you for the “L.
Md 6 Distal” landmark in the mandibular model. Follow the same steps above to
digitize this model. The last point in this process is the landmark “R. Md 6 Distal”.

9. After this point is entered, click on the Select tool. A yellow catenary-curve will
appear on the image of the mandibular occlusal model. The catenary-curve will
connect the distal contact points of both lower-first molars found on the
horizontal reference line. The length of this curve can be adjusted within the
designated window by dragging it with the mouse.

88
NOTE: The yellow catenary-curve should be adjusted to demonstrate the present arch
length. It should pass slightly distal of the tips of the lower cuspids. Make sure the anchor
points at the distal contact of md 6 are correct. Moving these two points lingually or
bucally changes the shape of the curve. If there is an error in the tracing, make the
necessary adjustments using the Correct Tracing tool.

Ten numbers can be seen on the occlusal views. They are, from top to bottom, maxilla
then mandible: the Bolton discrepancy from 3-3, the Bolton discrepancy from 6-6, the
Moyers estimated right, total, and left arch length discrepancy (ALD) in the maxilla, the
Moyers estimated ALD in the mandible (right, total, and left), the calculated ALD in the
mandible using the catenary curve, and the Irregularity Index of the lower incisors.

Moyers Arch Length

Bolton Discrepancy 3-3 Discrepancy
(right, total, left)
Bolton Discrepancy 6-6
Calculated ALD (with
catenary curve)
Moyers Arch Length
Discrepancy Irregularity Index
(right, total, left)

To view the measurements corresponding to the numbers displayed on the model

tracing, click on the thumbnail icon of measurements directly below the model
and tracing, circled in the image to the right.

NOTE: The calculated ALD is the difference between the length of the
catenary curve and the sum of the mesio-distal distances of all the teeth in the
lower arch. The ALD measurement will be omitted if deciduous teeth are
present. In this case, the estimated Moyers ALD should be used.

Digitizing the Frontal X-Ray

The frontal analysis is a modified Ricketts analysis with some additional Grummons
measurements. There are 30 landmarks that must be digitized in the order provided by
the computer prompts. These landmarks are shown below. Follow the instructions
below for digitizing the frontal x-ray:

1. Click the Tracings tab, then click on the frontal image icon (shown to the right.)
2. Click once on the Trace tool. Calibrate the image as necessary.
3. Select the landmarks as they are prompted by the program. These landmarks
are listed below. If you digitize a point in an incorrect location, you can correct it
using the Correct Tracing tool.

89
Zygomatic suture right Zygomatic-frontal suture at intersection of orbits right

Zygomatic suture left Zygomatic-frontal suture at intersection of orbits left

Zygomatic arch right Zygomatic center of root of zygomatic arch right

Zygomatic arch left Zygomatic center of root of zygomatic arch left

Nasal cavity right Nasal cavity at the widest area right

Nasal cavity left Nasal cavity at the widest area left

Jugular process right Intersect of zygomatic buttress and outline of tuberosity right

Jugular process left Intersect of zygomatic buttress and outline of tuberosity left

Antigonial notch right Antigonial notch right

Antigonial notch left Antigonial notch left

Anterior nasal spine Tip of anterior nasal spine

Menton Point of inferior border of symphysis below mental protuberance

Right mx 6 crown Most buccal point at molar crown

Right mx 6 root Tip of buccal root of molar

Right mx 1 crown Midpoint of incisor edge

Right mx 1 root Tip of incisor root

Left mx 1 crown Midpoint of incisor edge

Left mx 1 root Tip of incisor root

90
 Left mx 6 crown Most buccal point at molar crown

Left mx 6 root Tip of buccal root of molar

Left md 6 crown Most buccal point at molar crown

Left md 6 root Tip of buccal root of molar

Left md cuspid crown Tip of cuspid crown

Left md 1 crown Midpoint of incisor edge

Left md 1 root Tip of incisor root

Right md 1 crown Midpoint of incisor edge

Right md 1 root Tip of incisor root

Right md cuspid crown Tip of cuspid crown

Right md 6 crown Most buccal point at molar crown

Right md 6 root Tip of buccal root of molar

4. When all of the points have been digitized, the program will then prompt you for a
“Line”. Lines, including the mandible, nasal cavity outline, and other additional
structures, can be digitized in any order. Important: We recommend digitizing the
mandible in two lines, with the first line starting from either the left or right condyle
and stopping at menton and the second line starting from menton to the opposite
condyle. This helps facilitate alignment with the frontal image.

5. Once digitizing has been completed, click on the Select tool.

NOTE: Limited treatment simulations can be performed on individual outlines
and landmarks in the frontal tracing by using the Correct Tracing tool.

91
Aligning the Frontal Tracing with the Frontal Color Image
Aligning the frontal x-ray tracing to the frontal image is similar to the procedure for
the lateral x-ray. First, click on the Align Tracing tool. The tracing will change to
display only the lines that you have traced. Adjust the lower alignment box first,
then the upper alignment box (shown in the image below). When the mandible is
in the correct orientation, click on the Select tool.

Digitizing the Submentrovertex (SMV) X-Ray

The Submentovertex analysis requires six landmarks to be digitized. They are listed
below:

0 - Right marker rod

1 - Left marker rod
2 - Right lateral condyle
3 - Right medial condyle
4 - Left lateral condyle
5 - Left medial condyle

92
CO-CR Conversion
While this step is not mandatory, CO-CR Conversion allows repositioning of the
mandible from centric occlusion (habitual position of the mandible, where the radiograph
has been taken) to centric relation (the seated hinge axis of the mandible). Using an
articulator, such as the SAM facebow or the PANADENT, you can reposition the
occlusal models in the centric relation. Mark down the Mandibular Position Indicator
(MPI or CPI) readings made with the SAM facebow or the PANADENT, so that the
corrected position of the lower jaw is calculated.

To initiate CO-CR conversion, choose Session > New CO-CR Conversion. A new CO-
CR Conversion Session will be created and you will see the CO-CR conversion tools
displayed, as shown below.

The solid black circles represents the centric occlusion points (CO) for the right and left
mandible, while the hollow circles represents the centric relation points (CR). Initially
these points will be superimposed. Drag the CO point away from the CR point until the
displayed graph matches both facebow flags. Quick Ceph Studio will calculate the
“average delta-x”, and the “average delta-z”, and will replace the lateral tracing
with a corrected lateral tracing after clicking the Select tool to end the conversion.

Once the CO-CR conversion has finished, you will notice that the mandible on the facial
image has shifted, and that the hinge axis is replaced with two icons. The large cross
icon represents the new position, whereas the smaller cross represents the original
position, as seen in the image on the next page.

93
94
Chapter 8
Using Comparisons

95
Quick Ceph Studio allows you to compare multiple sessions in a separate grouping
called Comparisons, which is located below the Sessions grouping in section A. Both
Images and Tracings can be compared in the form of galleries and superimpositions.
Follow the instructions below to create and use comparisons within Quick Ceph.

Creating Comparisons
1. The comparison feature requires the patient file to contain at least two
sessions. The sample patient file to the right has both an Initial and a
Final session.

2. To create a new comparison session, choose Session > New

Comparison, as shown to the right.

3. Depending on whether the Templates section or the Tracings section

was displayed, selecting New Comparison displays the image
galleries or the superimpositions, respectively. The Comparison looks
like the image below:

! A! B! ! ! ! ! C

4. Beneath the Sessions in Section A you will see the Name field, which
allows you to change the comparison’s name. Below this you will see a
list of the available Sessions in your file. Use the checkboxes to the left
of each session’s name to select the sessions to compare. To change the color of a
session’s tracing, click on the color box to the right of its name, and select a color.

96
Available Tools
Several tools are available at the bottom of the main window (section C as seen on the
previous page).

NOTE: Some tools are only accessible when manual superimpositions are selected.
More information about manual superimpositions can be found on the next page.

a b c d e f g

! Tool a:!! Info - displays notes and other information about each superimposition
! Tool b:!! Zoom Tools - changes the size of an image on the screen
! Tool c:!! Hide/Show Tracing - toggles the tracing on or off
! Tool d:!! Alignment - positions the tracings according to a predefined orientation
! ! ! (available only while in manual superimposition mode)
! Tool e:!! Transparency - controls the transparency of each superimposed x-ray;
! ! ! as one x-ray is made brighter, the other becomes less noticeable
! Tool f:! ! Show X-Ray - allows you to select which x-ray is superimposed on the
! ! ! initial x-ray
! Tool g:!! Analysis - changes the displayed analysis

Types of Superimpositions
Quick Ceph Studio can display three different types of superimpositions:
superimpositions on landmarks parallel to lines, superimpositions on traced
outlines, and superimpositions on bony structures on x-rays. Each of these
three types of superimpositions will be described in detail below.

To display a superimposition, select the Tracings button at the top of the

window, then select the Comparison Session (created in an earlier section in
this Chapter). The available superimpositions will be displayed in the center
column (section B from the previous page), as shown on the right.

Superimpositions on Landmarks Parallel to Lines

By default, the first superimposition displayed in the main window show the full
lateral tracings superimposed on a pre-specified landmark parallel to pre-
specified lines. The landmark and lines for this superimposition, shown
highlighted by a red square in the image to the right, can be set for any of the
tracings (lateral, frontal, SMV, and model). Please follow the instructions on
the next page to setup this superimposition:

97
1. To define the superimposition landmark and lines, select
Quick Ceph Studio > Preferences. Once the
Preferences window appears, select the
Superimposition button.

2. Using the drop-down menu next to the type of

superimposition, select the landmark at which the selected
tracings will be superimposed and the reference line
where the tracings will be parallel to each other. For
example, the default settings, shown to the right, indicate
that the lateral tracings will be superimposed at Pterygoid
with the tracings parallel at the line from Porion to Orbitale
(Frankfort Horizontal).

Quick Ceph includes other superimpositions based on digitized landmarks. The

following superimpositions are all included within the program. With the exception of the
first, the superimposition landmark and lines of these superimpositions are fixed and
cannot be modified or adjusted.

98
99
Superimpositions on Traced Outlines
The second type of superimposition offered in Quick Ceph allows you to
superimpose two or more tracings along traced outlines, such as the facial
profile.

To access this superimposition, select the second superimposition from the

Thumbnail Strip (shown highlighted in red in the image to the right). This will
display the superimposition on traced outlines, shown below.

! ! !

Superimpositions on Bony Structures

The third type of superimposition offered in Quick Ceph is the superimposition on bony
structures. This feature allows you to manually adjust the superimposition of traced x-rays
based on their bony structure. We believe superimpositions on bony structures is unique
to Quick Ceph Studio and that it cannot be done with other programs. It is also the most
accurate method in our opinion.

For more information please read the

Guide to superimposition of profile radiographs by “The Structural Method”. Developed

by Professor Arne Björk at www.angle-society.com/case/guide.pdf

To access this superimposition, follow the instructions below:

1. Scroll down on the Thumbnail Strip in section B (shown on the next page) until you
see a number of superimpositions with a green background, which indicates that the
tracing can be superimposed along the bony structure. For our example, we will use
the full lateral superimposition. Click once on the complete lateral tracing (the first
superimposition with a green background).

100
! A! B! ! ! ! ! C

2. Once the type of superimposition is selected, click on the Show X-

Ray menu to select the Session x-ray that you would like to
compare to the x-ray from the Initial Session. The two x-rays will
appear superimposed and a crosshair with white circular control points at its center
and the ends of each line, shown above, will appear on the x-ray.

NOTE: Unless the patient has grown, the compared x-rays should be relatively the
same size. If there is any significant size discrepancy between the compared x-rays
and tracings, please check the accuracy of the Sessions’ x-ray calibration, as
described in Chapter 5.

3. The superimposed x-ray can be moved relative to the fixed initial x-ray by clicking and
dragging anywhere on the x-ray image. To rotate the x-ray, drag one of the four white
control points at the ends of the crosshair lines. To change the center of rotation of the
superimposed x-ray, drag the control point at the center of the crosshair.

You can also move the x-ray by holding down any arrow key on the keyboard. To rotate
the x-ray, hold down the Shift key while hitting either the left or right arrow key. To move
the center of rotation of the x-ray, hold down the option key and hit any arrow key.

4. To turn off the tracing, you can click on the Hide Tracing tool or hit the T key on the
keyboard. You cannot rotate the x-rays while the tracings are not displayed.

101
5. To position the tracings according to a pre-defined
orientation prior to manual superimposition, click on the
Alignment tool and choose from the listed settings. This
option is only available in the manual superimposition mode
when the x-ray is displayed.

Displaying Comparison Measurements

1. Scroll down on the Thumbnail Strip in section B until you see the analyses. Click once
on the first measurement icon. The following image will appear:

! A! B! ! ! ! C

2. The measurements of each of the selected sessions will be displayed in the

Measurements window. The different values will also appear in the standard
deviation diagrams in the program. The Ricketts analysis, shown in the image on the
previous page, will also display the different summary descriptions for each selected
session.

Displaying a Gallery Comparison

1. To display multiple sessions comparisons, select the Comparison session in Section
A, then click on the Templates button at the top of the window. The Thumbnail

102
 Strip will display the available galleries. Click on a gallery in the Thumbnail Strip to
display a full sized version in Section C.

! A! B! ! ! ! ! C

NOTE: Each image in this gallery displays the session it

originated from and the age of the patient at the time of the
photo. This option can be turned off in the Templates
Preferences by deselecting the “Show Comparison Caption” button.

The patient information section in the middle of the gallery displays the patients
identity, birthdate and age, case number, and details about each compared session
in its respective color. This can also be turned off in the Templates Preferences by
deselecting the “Show Patient Info In Galleries”.

2. If the selected sessions were generated from within Quick Ceph Studio (such as a
Growth or a Treatment session), the galleries would also display a disclaimer
specifying that the images are not a guarantee of orthodontic results. More
information about Comparison templates can be found in the Templates help
document.

103
Chapter 9
Treatment Planning

104
Quick Ceph Studio enables you to graphically simulate a patient’s visual treatment
objectives (VTO). You can also simulate a patient’s growth to aid you in determining a
realistic treatment plan. To create a patient’s growth or a treatment session, their x-ray
must first be traced and the tracing must be aligned to their facial image. The image
below will be used to describe the procedures for accessing both the growth forecast
and the treatment simulation.

! A! B! ! ! ! C

Creating a Growth Forecast

Quick Ceph Studio allows you to perform a growth prediction to augment your treatment
simulation. Growth predictions should be done prior to treatment simulations.

1. Select the session under Section A on which you would like to perform the growth
prediction.

2. Next, choose Session > New Growth Forecast. The Growth

Dialog Box will appear, allowing you to type the duration of growth
(in years) you would like to simulate. By default, the program sets
a maximum of 2.0 years of growth at a maximum age of 14 for
girls and 18 for boys. However, you can manually change these
values. Click on OK when you have typed the amount of growth.

105
3. A new session named Growth will appear in section A, and the corresponding
tracing, which is green by default, will appear in section C. You can now proceed to
the treatment simulation.

Creating a Treatment Simulation

Once you have traced the patient’s x-ray and aligned the tracing to the patient’s facial
image, and once you have completed the optional growth prediction, you are ready to
create a treatment simulation. Follow the steps below to create a treatment simulation.

3. Select the session under Section A from which you would like to base the treatment
simulation.

4. Next, choose Session > New Treatment. A new session named Treatment will
appear in Section A, and the corresponding tracing, which is red by default, will
appear in Section C. This Treatment session allows you to treat the patient without
affecting the original file. Multiple treatment sessions can be created in this way to
simulate different procedures, an important tool if you or the patient are deciding
among different treatment options.

5. Once a Treatment Session has been created, the patient file will appear as shown
below. You will notice that a new panel containing the Treatment Control
information (Section D) will slide out of the right side of the patient file.

A! B! ! ! C! ! ! ! ! D

4. The treatment simulation can be performed on the tracing alone or with the tracing
superimposed on the patient's x-ray or facial image. To switch between these
modes, simply click on the icon of the desired mode in Section B.

106
 OPTIONAL: You can adjust the soft tissue ratios
according to the patient’s facial condition. To
access the soft tissue ratios, choose Quick
Ceph Studio > Preferences, and then select the
Ratios button. You can select from a number of
preset ratios using the drop down menu, or you
can create your own by clicking on the “+” sign
next to the ratio name.

Abbreviations used for Ratios:

! ! mand: mandible
! ! max:!maxilla
! ! def: deficient
! ! exc: excess
! ! vme: vertical maxillary excess

5. Orthodontic treatment simulations should be performed before surgical simulations.

One goal of orthodontic treatment is to eliminate the Arch Length Discrepancy
(ALD). If you have digitized the patient’s models, the ALD value is automatically
calculated and entered into a field in the Treatment Control area of Section D. You
can also manually enter an ALD value into this field if you choose not to digitize
models. Negative values indicate crowding while positive values indicate space.

TIP: The cursor icon is

displayed as a pair of pliers
when placed over specific
landmarks that perform
orthodontic movements, and
as a scalpel when placed
over landmarks that perform
surgical movements.

6. To move the incisors or molars, you can either type in the distance (in mm) to be
moved in the Treatment Control fields or you can simply drag the tooth icon, as
shown in the image above. When the cursor is placed over a tooth, the tooth and
any lines affected by the tooth movement will change to blue. Each treatment
movement is described in the chart on the following page.

NOTE: The soft tissue does not automatically move to the new tracing position. This
will be resolved by morphing the image, which will be covered later.

107
# MODIFIER CURSOR PLACEMENT MOVEMENT
1 Inside a tooth outline Translate a tooth
2 Box at tip of molar root Tip or upright molar
3 Box at tip of incisor root Torque incisors
4 Box over occlusal plane Change tip of occlusal plane
5 Box at A-point Move A-point
6 Box at PM (superpogonion) Translate corpus of mandible
6 + “option” key Box at PM Translate corpus of mandible and maxilla together
7 Box at Gnathion Rotate entire mandible around hinge axis
7 + “option” key Box at Gnathion Rotate entire mandible and maxilla around hinge axis
8 Box at Menton Rotate corpus of mandible around mx1 tip
8 + “option” key Box at Menton Rotate corpus of mandible and maxilla around mx1 tip
9 Box at PO (pogonion) Genioplasty
10 Box distal of ANS Translate anterior maxilla
11 Box at ANS Rotate anterior maxilla around mx1 tip
12 Box mesial of PNS Translate posterior maxilla
12 + “option” key Box mesial of PNS Translate total maxilla
13 Box at PNS Rotate posterior maxilla around mx1 tip
13 + “option” key Box at PNS Rotate total maxilla

108
7. In addition to moving the treatment boxes, you can also simulate the various
orthodontic procedures listed in the Treatment Control fields by typing the amount
of space gained in their respective fields. The Net Change field displays the amount
of crowding or free space in the mandible after these procedures have been
performed.

8. You may have noticed that there are two differently colored tracings in the above
image, the red tracing from the Treatment Session and the original black tracing
upon which the treatment is based. These so called Ancestor Tracings are useful
for displaying the original tooth position, and can be toggled by clicking on the Show
Ancestor pop-up menu.

Note: Multiple ancestor tracings may exist if a growth simulation was performed.

9. When you have completed the orthodontic treatments, you can simulate the effect of
treatments that change the maxillary or mandibular position, such as surgeries and
certain appliances. To do this, you can either type into its respective field the
distance the treatment would reposition a particular maxillary or !mandibular
segment, or you can simply drag the specific control square along the maxilla or
mandible that corresponds to your desired movement, as shown in the image below.

Placing the cursor over any of these boxes highlights in blue the hard and soft tissue
segments that are affected by moving the box, as shown above. The various control
boxes and the movements they can simulate are displayed in the chart on the
previous page.

10. When all treatment movements have been made, correct the upper and lower
profile lines to meet at the lip embrasure to facilitate better morphing. To do
this, click on the Correct tool, highlighted in the image to the right, then move
the control points on the upper and lower profile lines until they connect. As the

109
 endpoints are moved closer, they will “snap” together, as shown in the image below.
You are now ready to morph the image, as described in the next section.

Morphing a Treatment Simulation

Once all of the treatment movements have been made, and the upper and lower profile
tracings meet at one distinct point, you are ready to morph the image to simulate the
patient’s new profile image after treatment. Follow the instructions below to perform the
profile adjustment.

1. Make sure the Treatment session is selected in Section A (shown on the following
page) and the patient’s lateral image with the tracing superimposed is displayed in
Section B. The tracing will not match the patient’s image.

2. Click on the Morph tool to morph the image to match the tracing. The image
will slowly move the facial image to match the treatment tracing, as shown by
the images on the next page.

110
NOTE: The speed of the morphing can be adjusted by
changing the number of Morph Steps. To adjust this
value, select Quick Ceph Studio > Preferences. When
the Preferences appear, click on the Tracing option. By
default, the Morph Steps are set to 10. For faster
morphing, select a lower number. For smoother (albeit
slower) morphing, select a larger number.

Before Morphing

A B C D

111
After Morphing

A B C D

112
Editing an Image
If corrections need to be made to the image, click on the Edit Image tool. A
panel with image adjustment tools will appear on the right side of the window as
shown in the image below:

! ! A! B! ! ! C! ! ! ! ! D

The image tools that appear in Section D are the Smudge tool, the Stamp tool, and the
Brush tool. Below these tools, you will find the sliders that control the Size of the area
being edited, the Pressure (or intensity) of the edits, and the Softness of the edges of
the edited area. Last is the Revert button that returns the image to the original. Click on
Done to save the changes made.

Smudge Tool
The Smudge tool smears the color from one selected point into another. If two colors
are adjacent, clicking and dragging a Smudge tool along the boundary will smudge the
darker color onto the lighter one. This causes a gradual shading instead of a sharp line
of demarcation.

Stamp Tool
The Stamp tool allows the user to clone a particular portion of an image.
This is useful for removing artifacts from an non-uniform background,
touching up a facial image, or repairing discontinuities that may have been
created during morphing. When you first select the Stamp tool, a cross icon
will replace the cursor. Click on the image to select the area from which you
wish to clone. This position will now display a red dot signifying the cloned
area and the cursor is now displayed as a circle. Click and drag to
reproduce the texture and color of the selected area. If you release the

113
mouse button, the red dot will return to the original saved location. To select a different
source location, click on the Select Source button.

Brush Tool
The Brush tool paints in the color displayed in the Color field. Unlike the
Stamp tool, the Brush tool will not reproduce patterns, only individual
colors. This tool is useful for drawing on an image during patient
consultations to highlight a specific problem or for editing an image.

To change the brush color, click on the Color field beneath the tool. The
Colors selection window (shown below) will appear allowing you to select
colors from a variety of palettes. To select an image from the screen, click
on the Crayon icon, then click on the magnifying glass icon. A large
magnifying glass will appear on the screen, allowing you to select any color currently
displayed. By selecting a skin tone or by selecting the background color, you can easily
paint an image using a tone that matches the ones in the image.

114
Selecting a Portion of an Image
The Marquee tool, available in either the Tracings or Media sections, allows you
to select a portion of the image on the screen, as shown in the image below:

This feature is useful not only for capturing a portion of an image, but also for image
touch up and as a quick method for treatment planning. To use the Marquee tool, follow
the instructions below:

1. Display the patient image that you would like to capture in either the Tracings or
Media section, then click on the Marquee tool. In the Tracings section, the tool is
located in the Image Tools and in the Media section. Both are shown below:
Tracing Section Media Section

2. Once you have selected the Marquee tool, a panel with selection tools
will appear on the right side of the window. The panel consists of three
selection shapes: rectangular, oval, and lasso (freehand), as shown to
the right. These shapes allow you to make your selection on the
screen. Click on one of these shapes to select it.

3. Next, place the cursor on the image, then click and drag to select a portion of the
image in the selected shape. The selections are drawn outwards from the
point at which you initially clicked. If you select the Lasso, then you can
draw any selection shape on the image.

115
 4. If the image is selected using the rectangular or circular
marquee, you will see that there are white circles around
the border of the image, as shown.

These positioning circles allow you to manipulate the size

of the selection frame. The corner circles allow you to
enlarge or reduce the size of the image both vertically and
horizontally, while the center squares limit movement of the marquee to one
plane. You can reposition the entire frame by placing the cursor in the middle of
the image and dragging.

5. When you have selected the portion of the image you want to use, you can copy
it by selecting Edit > Copy. You can now paste it into another application, such
as TextEdit, Mail, or Preview, to use.

6. Another option is to use the selected image within Quick Ceph, such as during a
quick treatment simulation. To do so, after selecting Edit > Copy, immediately
select Edit > Paste. This will place a copy of the selected image portion on top of
the original image itself. You can then reposition this image to the location you
desire, then alter it using the white positioning circles. An example of using this
method for treatment simulation is shown below:
Original Marquee, then Copy Paste, then Click on screen to
Reposition remove marquee

7. If you do not like the changes you have made, you can select “Clear” at the
bottom of the slide out panel and start over. To save the changes, click “Done”.
Please note that clicking “Done” makes the changes permanent, and you cannot
“Undo” the changes. Thus, it is recommended that you create a new Session if
you plan to create a treatment simulation with the Marquee tool.

116
Displaying a Treatment Simulation
Once you have created a treatment
session, you can display or print out a
treatment simulation. Printing out any
image that includes a tracing will also
display a measurement box that
contains the treatment changes made.

The printed image also displays a

Disclaimer that states that the
presentation is a simulation and does
not guarantee actual results. The text of
the Disclaimer can be changed in the
Quick Ceph Preferences, which can be
accessed by selecting Quick Ceph
Studio > Preferences, and then the
General button. You can choose to
have the disclaimer printed or not
printed along with the tracing.

To display the initial and the Treatment (and/or Growth) sessions, you will need to
create a new Comparison. This allows you to display gallery templates that display pre-
and post-treatment images, as well as superimpositions and comparison
measurements. To make a new comparison, follow the instructions discussed in the
Using Comparisons chapter. You can also follow the instructions for creating a
presentation in the Using Quick Ceph Studio for Presentations chapter.

Documenting Treatment Diagnostics

Beyond performing treatment simulations, Quick Ceph Studio also allows you to
document and explore your patients case through comprehensive diagnostic tools.
Found in the Diagnostic section, these tools enable you to document your observations
of your patient’s medical and dental conditions. You can also edit the patient’s treatment
objectives, treatment sequence, as well as view an overview of the patient’s condition
and treatment. Use of the Diagnostics section ensures a thorough review of the patient
that will help you better avoid potential conflicts or treatment issues, resulting in faster,
more predictable treatment.

117
To use the patient diagnostic tools, follow the instructions below:

1. Click on the Diagnostic section. By default, the Dental Conditions section will open
first, displaying the patient’s dental condition information, as displayed in the image
below:
! ! A! B! ! C!

2. In Section A, you will find a listing of each dental category. Select the categories in
order starting with “Facial Type”.

3. When a category is selected, the options available in each category will appear
under Section B. Select the one that best describes your patient. The selected
information will appear in Section C.

4. To select additional features in the Diagnostic section, simply click on the name of
the feature in the heading. The functionality of the features are the same as the
Dental Conditions.

118
Creating Custom Treatment Diagnostics
The treatment diagnostics settings found within Quick Ceph Studio can be customized
with your own treatment diagnostic information. You can choose to either modify the
default treatment diagnostic analysis or create your own analysis from scratch.

Accessing Treatment Diagnostic Settings

To access the treatment diagnostic settings, select Quick Ceph Studios >
Preferences. When the Preferences panel opens, select the Diagnostic tab to open
the Diagnostic section, shown in the image below.

To create a custom diagnostic analysis, start by clicking on the “New” button. This will
display the following dialog box, which will be used to either modify the default treatment
diagnostic analysis or to create a new one.

119
Modifying Default Analysis
To copy and modify the default diagnostic analysis, select the “Copy From Default”
option in the dialog box displayed on the previous page. Next, type in the name you
wish to call this treatment diagnostic analysis, then select “Create”. The window below
will appear:
! ! A! ! ! ! ! ! !B

The five tabs that appear at the top of the program window are: “Medical Conditions”,
“Dental Conditions”, “Comments”, “General Tx Objectives”, and “Tx Sequence”. Each of
these five tabs contain preset categories and observations that can be modified. By
default, the “Dental Conditions” tab is preselected. The items on the left side (section A)
are the default categories in the “Dental Conditions” section. To rename a category,
double click on the name of the category. The text will become highlighted in a light blue
color, allowing you to rename the category listing.

120
To move a category, place the cursor over a category, hold
down the mouse button, then drag it to the desired location,
as indicated by the blue line. When you let go of the mouse,
the category will be moved to the new location.

To add a new category, click on the “+” button located at the

bottom left corner of this column (section A). A blank tab will
appear at the bottom of the list (as shown to the right), allowing
you to type the name of the new category.

To remove a category, click once on the name of the category

you wish to remove. Then, hold down the “-” button located at the bottom left corner of
the column. There is no “undo” so if a category is deleted incorrectly, click on the
“Cancel” button in the lower right corner to exit without saving the file and start anew.

When a category is selected, the observations that pertain to that category are
displayed in section B. To add a new observation, click on the “+” underneath the
“Observation” column in section B. To remove an observation, click on the one you wish
to remove, then select “-” in section B. Observations can be reorganized by clicking and
dragging it to the desired location, just like categories.

To save your custom diagnostic analysis, click on the “Save and Close” button in the
lower right corner of the window. Your analysis can now be selected from within the
Preferences Dialog Box.

Creating a New Analysis

To create a new analysis, open the Diagnostic Preferences
and select “New”. When the dialog box shown to the right
appears, make sure the “New” option is selected. Next,
type in the name you wish to call this treatment diagnostic
analysis, then select “Create”.

A blank screen will appear with the five tabs displayed at

the top and no preset categories or observations. You can
now select one of these tabs and then add your own custom categories and
observations.

After you have completed your custom diagnostic analysis, click on the “Save and
Close” button.

121
Using the Diagnostic Setup Preference
The Diagnostic Setup Preference allows you to select the default diagnostic analysis
that will appear when you click on the main Diagnostic tab. The options available in the
Preference pane are shown below:

To set the default diagnostic analysis, click on the top pop-up menu in the Preference
and select the name of the diagnostic analysis.

To edit a custom diagnostic analysis, select it from the pop-up menu, then click on the
“Edit” button.

To remove a custom diagnostic analysis, select it from the pop-up menu, then click on
the “Remove” button.

To email a custom diagnostic analysis, select it from the pop-up menu, then click on the
“Email” button.

122
Chapter 10
Creating a Custom Analysis

123
Quick Ceph Studio allows you to easily create custom analyses. You can define your
own custom measurements or copy and paste measurements from existing analyses
defined within the program. An unlimited number of custom analyses can be created,
stored, and shared with your colleagues. To setup a custom analysis, please follow the
instructions below.

Copying Measurements from Existing Quick Ceph Analyses

If your custom analysis consists of measurements already defined in other analyses,
please follow the instructions below to copy these measurements into your analysis.

1. Select Quick Ceph Studio > Preferences. When the Preferences window opens,
click on the Analyses (protractor) button.

2. You will notice that the first analysis listed in the pop-up menu is Ricketts. To create
your own analysis, simply click once on the + button next to the Ricketts pop-up
menu, circled in the image below.

124
3. A dialog box will appear prompting you to name the new analysis. After typing in the
name of the analysis in the New Analysis field you may choose to base it on an
existing analysis. To do this select an analysis from the Copy Existing pop-up
menu. If you would like to create an analysis that is not based on an existing one,
you only need to select the type of analysis you would like to create in the Type pop-
up menu.

4. If you have selected to base your analysis on an existing analysis, it may contain
measurements you do not wish to use. To delete a measurement, click once on the
name of the measurement in your analysis, then click on the – button next to
Measurement Table.

NOTE: Multiple measurements cannot be deleted at the same time.

125
5. To copy existing measurements from other analyses, you must
first view the other analyses. Click on the pop-up menu that
shows the name of your analysis at the top of the window, as
shown on the image to the right, then select an analysis whose
measurements you wish to copy.

When this analysis is displayed, select the measurement(s) you

would like to copy. To highlight multiple measurements, hold
down the Command (⌘) key, then click on the measurements
you wish to select. When you have selected the measurements
you wish to copy, choose Edit > Copy (or hold down the
Command (⌘) key and hit the C key).

6. Once the measurements are copied, select your analysis from the drop down !menu.
Then choose Edit > Paste (or hold down the Command (⌘) key and hit the V key).
This will paste all of the selected measurements into your analysis. You can do this
for all of the measurements you wish to include in your analysis.

126
7. When all of the measurements are copied, you can reorganize the measurements
within your custom analysis simply by dragging them to the desired location. To do
this, select the measurements you wish to move, then drag them to where you would
like them to be placed in your analysis, as highlighted by the red arrow below. The
cursor displays a blue line which indicates the final location for the selected
measurements.

Creating Custom Measurements

If you have a special measurement that is not defined in any of the existing analyses,
you can easily define your own custom measurement. At the end of this chapter you will
find a key indicating the meaning of the different measurement types.

1. To create a new measurement, click on the + button next to Measurement Table,

circled in the image below.

127
2. When this button is clicked, the details of the new
measurement become editable, and you will see
the options shown to the right. Type the name of
the new measurement in the Name field.

3. Click on the Type pop-up menu to select the type

of measurement you would like to create. The
options are listed below and the definitions are
on the following page:

4. Depending on which measurement is selected, you may need to choose the

landmarks that make up the measurement. You can do this using the two
corresponding pop-up menus beneath the Type pop-up menu. These menus display
all of Quick Ceph Studio’s landmarks.

5. Once the landmarks for the custom measurement are defined, you can decide if you
would like to have the measurement displayed on the tracing. If so navigate to the
Label drop down menu and which landmark the measurement should be adjacent
to. The Offset values x and y allow you to define the distance from the selected
landmark that the measurement is placed. If you do not want the measurement to be
displayed on the tracing, simply choose No Value from the Label pop-up menu.

6. The Negate option allows you to change the sign of a measurement. If, for example,
an angle is negative when it should be positive, the sign can be flipped without
reorganizing the custom analysis.

7. To add norm values to your analysis, click once on the + button next to Norm
Values, circled in the above image. This allows you to select among four ethnic

128
 norms; choose between male and female; and define the specific value, standard
deviation, and age and growth rate at which the norm value changes.

Measurement Types Defined and Illustrated

No Value: Selecting this option allows you to create a title, section
header, or section separator.
Angle Between Lines: The angle between two lines selected from
among the digitized landmarks. To specify a line, choose the two
landmarks that make up the line, as shown to the right.

Bolton 3-3: Measures the distance between the mandibular

cuspids.
Bolton 6-6: Measures the distance between the mandibular
molars.
Complementary Angle Between Lines: Measures the
complementary angle (180º - angle) of the earlier Angle Between
Lines measurement.

Difference Between Measurements: Calculates the difference of

two selected measurements from your analysis.

Irregularity Index: This measurement adds the five distances of

the contact point of one tooth to the contact point of the next tooth
from cuspid to cuspid in the lower arch. A large number indicates
that the four lower incisors are very irregular.
Mandible Arch Length Discrepancy: Selecting this option places
the ALD calculated from the model analysis into your custom
analysis.
Moyers Mandible Arch Length Discrepancy: Calculates the
Moyers ALD from the model tracing. To use this, select the two
teeth in the mandible which you would like to calculate the ALD
between.

129
Moyers Maxilla Arch Length Discrepancy: Calculates the
Moyers ALD from the model tracing. To use this, select the two
teeth in the maxilla which you would like to calculate the ALD
between.

Percentage of Measurements: Calculates the quotient of one

measurement to another as a percentage.

Point to Line Distance: Calculates the distance from a selected

point to the closes point on specified line. To specify a line, choose
the two landmarks that make up the line, as shown to the right.
The “Stretch” option lengthens the line.

Point to Point Distance: Calculates the linear distance from two

selected point to a specified line.

Point to Point Parallel to Line: Calculates the distance between

two selected points as measured along a specified line.

Point to Point Perpendicular to Line: Calculates the distance

between two selected points as measured along an imaginary line
perpendicular to the specified line.

Ratio of Measurements: Calculates the ratio of two

measurements selected from your custom analysis.

Sum of Measurements: Calculates the sum of multiple

measurements selected from your custom analysis. To add a
measurement, click on the “+” button shown in the image to the
right.

Witt: Calculates the linear distance between A and B point

perpendicular to the functional occlusal plane.

130
131
Creating Custom Lines, Points and Arcs

Custom lines can be added to an analysis. To add a custom line, click on the Lines
button located under the name of your analysis, and then follow the instructions below.

1. Click on the + button next to Lines.

2. Then select the two endpoints that

make up the line from the pop-up
menus (circled in the image to the
right).

3. The Color box allows you to

choose the color of the line. You
can define individual colors for
each defined line.

4. To place an icon on specific

landmarks, click on the + button
next to Points. You can select the
type of icon by clicking on the Type
drop down menu. You can also
select the color and the size.

5. To add an arc, click on the + button

next to Arcs, then select the
Center, Start, and End landmarks
from the pop-up menus.

Displaying Curves & Teeth

Clicking on the Curves & Teeth button
displays a window that allows you to select
which lines and teeth outlines are displayed
on your custom analysis. To hide a specific
line, you can uncheck it from the “Draw”
column.

NOTE: The Mandible and Maxilla curves are

checked under the Treatment column,
signifying that these curves are necessary for
treatment.

132
Creating Custom Landmarks
While Quick Ceph Studio includes 28 digitized landmarks and 64 calculated landmarks,
you are given the ability to create additional landmarks. To access the Landmarks
section, click on the Landmarks button located under the name of your analysis and
follow the instructions below:

1. ABO-specific lines, including Outer

Symphysis, Inner Symphysis,
Nerve Canal Upper, and Nerve
Canal Lower, can be included into
your analysis if you select the
Include ABO Lines check box.

2. To add a digitized landmark to your

analysis, click on the + button next
to Digitized Landmarks, then type
the name of the landmark. You will
be prompted to digitize this
landmark when you digitize x-rays.

3. To add a calculated landmark to

your analysis, click on the + button
next to Calculated Landmarks,
then type in the Name of the
calculated landmark.

4. Next, click on the Type pop-up

menu to define the type of
calculation for this landmark. The
choices are listed in the menu to the right and the
definitions are listed below:

X-Y: The landmark is calculated according to the

selected X and Y coordinates.

Midpoint: The calculated midpoint between multiple landmarks.

Intersection: The intersection of two lines.

Point Parallel to Line: A landmark through a selected

existing landmark parallel to a selected line.

Point Perpendicular to Line: A landmark through a selected existing landmark that

is perpendicular to a selected line.

133
Orient Point and Dens Point: These landmarks are located on the outline of a tooth.

Radius Point: A landmark through a selected existing landmark parallel to a

selected line.

Radius Perpendicular: A landmark through a selected existing landmark

perpendicular to a selected line.

Angle Bisector: Landmark that forms a line that bisects a selected angle.

Line Intersect with Curve: A landmark at the intersection between a line and a
drawn curve.

134
Sharing Quick Ceph Custom Analyses
Quick Ceph custom analyses files are designed to be easily shared on multiple
computers in your office and with your colleagues. All custom analyses are stored in a
folder named “Analyses” in the following location on your computer:

[hard drive] / Users / [your name] / Library / Application Support / Quick Ceph / Analyses

The individual analysis files or the folder of all your custom analyses can easily be
shared with other computers over your office network or sent to colleagues by email as
an attachment.

Emailing Custom Analysis

Custom analyses can be emailed directly through the Quick Ceph Studio program if the
email program on your computer is already setup. To email an analysis, please follow
the instructions below:

1. Select Quick Ceph Studio > Preferences. When the Preferences window opens,
click on the Analyses icon at the top and select the custom analysis in the Analysis
menu that you would like to email, as shown below.

2. Once the desired custom analysis has been selected, click on the “Email” button
shown in the image above. Quick Ceph Studio will automatically open a new email
message and attach that particular analysis file, allowing you to send it to the
recipient of your choice

Installing a Shared Custom Analysis

When the custom analysis is received the recipient can easily install it by double clicking
on the custom analysis file. You will receive the following message confirming that the
analysis has been installed.

To activate the new analysis, restart Quick Ceph Studio.

135
Chapter 11
Templates

136
Once images have been imported into the program, you can display and print them in
the Templates section. Images can be arranged in a variety of layouts called gallery
templates. You can also collect gallery templates, as well as individual images, tracings,
and measurements into a unified Report that can be printed or used for presentation.

Displaying Gallery Templates

Gallery templates are available for single sessions as well as comparisons between
multiple sessions. To display a gallery template, please follow the instructions below:

1. Click on the session whose images you wish to view in a gallery template (section A
below.) If you wish to show multiple sessions in one gallery, please create a Comparison
session first, using the instructions found in the Using Comparisons document.

! ! A! B! ! ! ! ! ! C

2. Next, click on the Templates button at the top of the window, then make
sure the Gallery icon in the Navigator is selected (section B).

3. Select your desired gallery template from the Thumbnail Strip (section B).
Note: A different selection of galleries will be available when viewing a single session
as opposed to a comparison.

4. The selected gallery will appear at full size in the main window (section C). You can
either print or export this gallery according to your needs (see the Printing or the

137
 Image Exporting chapters for more information). You may also drag and drop the
image from Quick Ceph Studio directly into a presentation program such as
Microsoft Powerpoint or Apple’s Keynote software.

5. Since Quick Ceph Studio includes so many gallery templates, you can save
and display only your favorite galleries. To do this, simply select the gallery
that you wish to save, then click on the Make Favorite tool. This will place a
yellow star icon on the this gallery to distinguish it from others, as shown on
the image to the right. To display only your Favorites, click on the Show
Favorites tool.

6. Another viewing option is to display a descendant tracing (such as a

growth, CO-CR conversion, or a treatment) superimposed on top of its
ancestor tracing, the tracing upon which it was based (such as the initial
tracing). To do this, click on the Show Overlay tool. The resulting
superimposition will be displayed in any gallery template that contains a
tracing, as shown below. To remove the superimposed tracing, simply click
on the Hide Overlay tool.

138
Creating Custom Galleries
Quick Ceph Studio allows you to customize your own galleries by either editing existing
galleries (both single and comparison galleries) or by creating entirely new ones. Once
a custom gallery has been created, it can be shared with other Quick Ceph Studio
users. To create a custom gallery, please follow the instructions below:

1. First, scroll through the menu of the existing galleries and select the one that is most
similar to the one you wish to create. If the gallery you have in mind is unlike any in
the menu, then you can skip this step.

2. Click on the New Gallery tool at the bottom of the Quick Ceph Studio window
to create a new Gallery. A window will appear allowing you to name your
Gallery and asking if you wish to either copy the currently selected template
or create a new template. When creating a new gallery you can also choose the
paper size as well as the orientation (for printouts). When you have made your
selections, click on “Create Template”.

3. When you click on “Create Template”, a blank window with your name or logo will
appear in the main window (section C) and a new sidebar will appear
to the right of this window. This sidebar provides you with the A
elements needed to create your new gallery template. The icons in
the sidebar are described below: B

C
! ! A) Images without Tracings
! ! B) Images with Tracings D
! ! C) Tracings Only
! ! D) Measurements Only E
! ! E) Text
! ! F) Patient Info F
! ! G) Disclaimer
! ! H) Superimpositions (only available in comparison galleries) G
! ! I) Gallery Preferences
H
I

139
4. To edit a gallery’s preferences, click on the Gallery Preferences
button (labeled “I” in the picture above). The window shown to the
right will appear, allowing you to select the margin size, background
color, and whether you would like the logo or letterhead to appear.
Once you make your selection, click on “OK” to continue.

5. To add an element to your custom Gallery, simply drag and drop it from the sidebar
onto the main window, as shown in the image below:

6. When any element is dropped into the main window, a second window displaying its
constituent images will appear, as shown below. Click on any of these images to add
it to your Gallery. NOTE: The “1 to 1” option (shown in the image below) displays
the image in its original size, which may be useful for tracings and x-rays.

140
7. Once an image has been added, you will see that it is surrounded by
black squares, or handles. These handles allow you to resize the image
in your Gallery. To move the images to a different location, place the
cursor in the center of the image and drag it to the desired position.

8. You can add as many images as you want to the gallery template. When additional
pictures are added to your gallery, they can be aligned to existing elements, as
shown in the image below. The yellow lines indicate which elements are aligned. The
numbers shown represent the element’s distance from each edge.

9. If you are creating a comparison gallery, you can choose the Session from which the
images are displayed, as shown below. If you add a disclaimer, it will only be
displayed if you are creating a comparison gallery template displaying a treatment
plan Session. If you add images with tracings or measurements, you can choose the

141
 default analysis to display in the gallery.

10. Quick Ceph Studio also allows you to add text to a gallery. To start, drag and drop
the Text element icon from the sidebar onto the open window. This will create the
text box and will display a Text Dialog Box, as shown below:

A)

B)! C)

11. Type the text you wish displayed in the gallery into the main field (A). To change the
font style and size, click on the “Font” tool above this field. To change the text
justification, click on the “Align” tools.

To add personalized information, such as the date, doctor’s name, and patient name,
you can click on these options in the lower left side of this window (B). This will
display additional information in the next window (C). To select a specific option,
simply double click on the name. It will appear in the text in the main field (A), and

142
 will be replaced by the correct information when the gallery is displayed.

Click on “Done” to complete the text changes and return to the main window. The
generic text will be replaced by the information in the file and gallery will look like the
image below:

12. If you are creating a comparison gallery, you can add superimpositions to your
custom gallery with the Superimposition element icon. When adding a
superimposition, you can select which sessions are visible, the title position and Auto
or Manual alignment.

143
13. When you have finished making all of the changes you desire to the custom gallery
template, click on the “Done” button in the lower right corner of the window. This will
save the gallery template for later use or for sharing. To edit this gallery at a
later time, select it from the Thumbnail Strip, then click on the Edit Gallery
tool.

Sharing Quick Ceph Custom Galleries

Quick Ceph custom gallery files are designed to be easily shared on multiple computers
in your office and with your colleagues. They are stored as individual files in a collective
folder on the computer’s hard drive. Please follow the instructions below to locate,
share, and install custom gallery files.

Quick Ceph Studio gallery files are stored in the following location on your computer:

[hard drive] / Users / [your name] / Library / Application Support / Quick Ceph / Galleries

144
As you can see in the image to the right, the
custom gallery is named with a “.qcgallery” suffix.
The “Galleries” folder can contain an unlimited
number of custom gallery templates.

Advanced: By default, custom galleries are

stored in the home directory on your computer,
meaning they can only be used by one account. If
you have multiple user accounts on your
computer (i.e., a “Doctor” and a “Staff” account),
you need to move your “Galleries” folder into the
following folder in your hard drive to be
recognized by all of the accounts on your
computer:

[hard drive] / Library / Application Support / Quick Ceph / Galleries

NOTE: This “Quick Ceph” folder also contains the “TheSmileStudio.qcmedia” file.

To share the custom gallery file with another computer, you can copy this folder across
your network, copy the files onto a USB flash drive, or email the file from this computer.
To copy a specific gallery, simply drag the respective “.qcgallery” file to the desired
destination.

To email the analysis, you will need to first compress the file in a .zip format. To do this,
please follow the instructions below:

1. Open the aforementioned “Gallery” folder and locate the galleries you wish to email.

2. Hold down the Control key on the keyboard and click

once on the gallery you wish to email. The drop down
menu shown to the right will appear.

3. Click once on Compress “[name of file]”. This will

create a “.zip” file in the same location as the original.

4. You can now email this “.zip” file to other computers,

offices, or colleagues.

Once you have transferred the “.qcgallery” file to the computer you would like to use it
on, you next need to correctly install it. Please follow the instructions below:

145
1. Open any patient file in Quick Ceph Studio.

2. Next, drag the “.qcgallery” file anywhere in

the open patient window, as shown in the
image to the right. The custom gallery
template will automatically be installed in
the correct location, and you will receive
the confirmation message below:

To activate the new gallery template, simply restart Quick Ceph Studio.

Creating Customized Reports

With Quick Ceph Studio, users can easily gather multiple gallery templates, images,
tracings, and even measurements to be printed, emailed, or used during a patient
presentation, all with a single click. These Reports are useful for printing or emailing
patient referral material to the referring dentist, sending patient case information to
insurance companies, and even creating an education package for patients or their
parents. To create a Report, follow the information on the next page:

1. Click on the Templates button at the top of the Quick Ceph Studio window,
then make sure the Report icon in the Navigator is selected.

2. Next, click on the New Report tool to create a new Report. A dialog box will
appear allowing you to name your Report. Click on “OK” to start the new
report.

146
3. A blank window will appear in the main window and a new sidebar will appear to the
right of this window. This sidebar provides you with the elements needed to
create your new Report template. The icons in the sidebar are as follows:

! ! A) Gallery Templates! !
! ! B) Images without Tracings
! ! C) Images with Tracings
! ! D) Tracings Only
! ! E) Measurements Only

4. To add an element to your custom Report, simply drag and drop it from the
sidebar onto the main window. The image below depicts the a new Gallery being
added:

5. When any element is dropped into the main window, a second window displaying its
constituent images will appear, as shown on the next page. The image on the left
shows the images available if the gallery template element is dropped in the main
window while the image on the right shows the images available if the Image without
Tracings element is used. To add an image to your Report, simply double click on
your preferred image.

147
6. You can add as many gallery templates, individual images, tracings, and
measurements as you want to the Report. If you add images with tracings or
measurements, you can choose either a specific analysis to display in the Report or
you can choose to have it display the default analysis. You can have multiple
tracings and measurements with different analyses in your Report. The finished
Report will look similar to the one shown below.

7. To reorient any element (from landscape to portrait and vice-versa), click once
to select the element, then click on the Orientation tool.

8. When you have finished creating your Report, click on the “Done” button in the
lower right corner of the window. To edit this report at a later time, select it
from the Thumbnail Strip, then click on the Edit Report tool.
9. To change the display size of the images in the Reports
window, move the Size slider. Moving it to the right will
increase the size of each image while moving it to the
left will decrease the image size.

148
Displaying Report Slideshows
To use the images in your report in a Slideshow, click on the Start Slideshow
tool. Quick Ceph Studio will display the images selected for your Report full
screen with a black background. At the bottom of the screen you will see the
following toolbar:

!! !! A! ! ! B! C! D E

F) Playback Tools (Back/Play/

Pause/Next)
When the slideshow is first opened, it automatically is set to Play. Each image will
be displayed on the screen for three seconds before fading out to display the
next image. If you wish to stop this automatic playback, hit the Pause button.
This will allow you to narrate at your own pace. To move the presentation forward
or backward, you can either hit the left or right arrows or you can hit the right or
left arrow keys on your keyboard.

G) Index Sheet
Clicking on this button displays all of the images in your Report on the screen,
allowing you to navigate to the image you wish to display, as shown below:

To display a specific image, simply double click on it in this window.

149
H) Fit to Screen
This feature displays the image in the full screen mode. If you click once on this
button, you will be given a second option to display the image full-size.

I) Add to iPhoto
This option allows you to add a specific image to iPhoto.

J) Close
This option closes the slideshow. You can also exit the slideshow by hitting the
“Esc” button on your keyboard.

150
Chapter 12
Using Quick Ceph Studio for
Presentations

151
Quick Ceph Studio was designed to provide you with many options for presenting
images, x-rays, tracings, growth predictions, and treatment plans during a patient
consultation or lecture. This chapter will highlight the presentation features in Quick
Ceph Studio, as well as provide suggestions for their use.

Preparing For Presentations

This section will describe how to setup Quick Ceph Studio for presentations. Quick
Ceph Studio uses certain conventions found throughout Mac OS X which facilitate using
the program to present.

Maximizing the Window

To enlarge the window to fill the screen, simply click on the green “maximize”
button in the upper left corner of the window. When the cursor is placed over this
button, a “+” sign will appear signifying its function. The window will automatically
fill the screen horizontally and vertically (down to the top of the Dock). To revert the size
of the window back to the previous size, simply click back on this icon.

Resizing Window Panes

To further increase the size of the image within the program, the Sessions section of the
Quick Ceph Studio window can be minimized. To do this, place the cursor on the
vertical divider separating the Sessions menu from the Thumbnail Strip. The cursor will
change to a vertical line with two arrows pointing left and right, as shown in the
image to the right. This indicates that you can move the vertical divider left or
right, hiding the Sessions section, as shown below.

To view the Sessions again, simply place the cursor on any part of the left edge of the
frame and, when the cursor icon changes to the double arrow icon, drag to the right.

152
Resizing Patient Windows
Any patient window in the program can be resized. This is useful if you want to increase
the size of the window frame or if you have multiple windows open and wish to display
both windows on the screen at the same time. In the lower right corner of a
window, you will find three parallel lines. By clicking and dragging this corner,
you can resize the window, as shown in the following images.

Tools to Enhance Presentations

Quick Ceph Studio includes several tools for enhancing presentations. This section will
describe the function and location of the tools, as well as usage suggestions.

Setting the Preferences

By changing the Preferences setting in Quick
Ceph Studio, you an customize the look and feel
of the images and tracings for your presentation.
To access the Tracing Preferences, select Quick
Ceph Studio > Preferences, then select
Tracing.

You can modify the size of the landmark points,

the width of the tracing lines, as well as the
tracing font and size. These modifications will
help you make better presentations, especially if
you are using a large screen.

153
Highlight Tool
The Highlight tool, found in among the Image Tools in the Tracings section,
allows you to temporarily highlight lines and teeth in a tracing. You can access the
Highlight tool by clicking on the last button in the Image tools at the bottom of the
patient window, shown to the right. Then click on any line or tooth to highlight it. The
highlighted line or tooth will be displayed in red and will be visible on individual tracings
as well as in gallery templates and comparisons containing tracings. Multiple individual
lines can be highlighted, as shown in the image below.

To “unhighlight” a line, you can either click on it again when the Highlight tool is
activated or you can close the file. Highlighted lines will continue to be displayed until
you close the file and are not saved with the file.

Zoom Tools
The Zoom tools, located in both the Tracings and Media sections, allow you
to zoom into or out of an image incrementally, make the image fit to the
screen, and display the image at a 1:1 size with the original image. These
tools are useful during a presentation if you want to magnify a certain portion of the
image on the screen.

When you are zoomed into an image, you can view other areas of the image
by moving either the vertical or horizontal sliders. You can also hold down the
Space Bar when you are zoomed in. This changes the cursor icon to a hand
icon, as shown to the right. You can then hold down the mouse button and
drag the image to view other areas. If you using a Macintosh laptop, place two
fingers on the Trackpad to move within the frame. Lastly, if you have an Apple Mighty
Mouse, you can scroll within the frame using the small ball on the top of the mouse.

154
Media Section
Individual images and movies can be viewed in the Media section.
Images to be viewed are selected from the Thumbnail Strip. To view
the next image, either select it from the Thumbnail Strip or hit the up or
down arrow keys on your keyboard to navigate.

Slideshow
The Start Slideshow tool, found in the Reports mode in the Templates section,
allows you to view a slideshow of images saved in a Report. When this button is
selected, the images will be displayed full screen with a black background. By
default, each image will be displayed for three seconds before fading out to display the
next image. To pause the slideshow, click the Pause button on the navigation toolbar at
the bottom of the screen. To move the presentation forward or backward, you can either
hit the left or right arrow icons on the bar or you can hit the right or left arrow keys on
your keyboard.

Transparency
The Transparency tool, found in the Tracings section, allows you to
superimpose the patient’s x-ray and facial image. By adjusting the slider, you
can vary the level of image transparency. Before using this tool, the x-ray
needs to be traced and the tracing needs to be aligned to the face. To activate this tool,
simply click on the tool icon and drag the vertical slider until the desired level of
transparency is reached. Then, click anywhere on the screen to make the slider
disappear.

155
Creating Presentation Templates
If you find that you are often making very similar presentations, you can create a
presentation template using the Reports feature to automatically generate or collate
content, saving you time while making your presentations seem more polished. The
following instructions will help you to create presentation templates. (For more
information about Reports, please refer to the Templates chapter.)

1. Open the Reports mode in the Tracing section, then click on the New Report
tool to create a new report. You should name the new Report according to the
type of presentation you plan to create. In the example below, we are creating
a new Comparison Report:

2. When the Report has been named, you will see a blank screen and A
a sidebar on the right. This sidebar provides you with the elements
needed to create your new Report template. For Comparisons, the B
icons in the sidebar are as follows:
C
! ! A) Gallery Templates! !
! ! B) Images without Tracings
D
! ! C) Images with Tracings
! ! D) Tracings Only
! ! E) Measurements Only E
! ! F) Superimpositions
3. Drag the images from this sidebar to the main screen. This will F
display a second window containing the images available for the
creating your template. To select an image for your Template,
double click on the image you wish to use.

156
4. In addition to using Quick Ceph generated images and galleries for your
presentation template, we recommend creating customized galleries specific to the
template you are creating. (For instructions on how to create a custom gallery, we
recommend you refer to the Templates chapter for more details.)
Using a custom gallery, you can develop images that highlight specific problem
areas that need to be addressed. By tailoring your images and message to the
patient’s specific needs, you can enhance your patient presentation. The images
used for your presentation can look like the following sample Report.

5. By creating multiple Presentation Templates, you will be able to select the

presentation that is most suitable for your patient. By pre-defining these templates
you will be able to minimize the preparation time required for producing your patient
presentations.

157
6. For the best presentation, we recommend using the aforementioned Slideshow
feature found in the Reports. Using the Playback Tools, you can manually control
when the next image is displayed, allowing you to narrate your presentation at your
own pace.

Protecting Patients’ Privacy During Presentations

Quick Ceph Studio provides several options to visually protect your patients’ privacy
during presentations. These options do not affect the original file and can easily be
switched on or off during normal usage.

Privacy Mask
When turned on, this option displays a black bar across the patient’s eyes to protect his
or her identity in any image that contains a facial photograph, including individual photos
and gallery templates. While Quick Ceph Studio’s default placement should cover most
eyes, you can edit the location on each image for best results. To edit the privacy mask
location and to activate this option, follow the instructions below:

1. Open the patient file, click on the Media button, then select one of the
patient’s individual facial images. Click on the Edit Privacy Mask tool to
display a black bar over the patient’s eyes on the facial image, as shown
below:

2. The mask contains white editing circles which allows you to adjust its size. To
reposition the mask, place the cursor in the box, then drag it until the black box
covers the eyes.

158
3. Once you have finished correcting the box, click on the Done Editing
Mask tool to save the mask location for that image. Repeat for any image.

4. To activate the privacy mask option, select View > Privacy Mode
On. The privacy mask will be displayed on individual facial images
and in all gallery templates, as shown in the image on the next
page.

Anonymous Patient Information

The patient I.D. is normally displayed on each printed image and on each standard
gallery template. However, it is possible to turn off this information for patient privacy
during presentations. Please follow the instructions below to do this:

159
1. Select Quick Ceph Studio > Preferences,
then click on the Templates icon. The
Preferences Dialog Box will open, displaying
the items shown.

2. Uncheck the option, “Show Patient Info in

Galleries.” This will turn off the patient
information shown throughout the program on
displayed and printed images.

160
Chapter 13
Preferences

161
Quick Ceph Studio allows you to customize and save settings within the Preferences
panel. These selected settings are stored separate from the application in the hard
drive. When an update is performed, these settings remain on the computer so you do
not have to reset them manually. To access the Preferences Panel, choose Quick
Ceph Studio > Preferences.

General Preferences
Tenacious Network Access:
Click this box if you have a slower
internet connection to allow Quick
Ceph Studio to open correctly.
Refer to the Troubleshooting
section for more information.

Show Splash Window: Click this

box if you want the Quick Ceph
Studio opening window to appear
when the program starts up.

New Window Opens Full

Screen: Selecting this option
opens each patient file to fit the full
screen.

Zoom Follows Window:

Selecting this option allows
images to resize when the window
is resized. If this option is
unchecked, the image size
remains the same even if the
window size is changed.

Open Session in New Window: Selecting this option opens each newly created
Session in a new window view.

Show Titles: Selecting this option displays the name of each gallery template and
superimposition above the window.

Show Tool Mode Alert: If multiple image views are open for the same patient, you
cannot perform multiple functions at the same time. For example, carrying out treatment
in one view and correction in another view. Selecting this option displays an alert box to
inform you that this is not allowed.

162
Norm is Displayed As: This section allows you to type in how you would like the
different patient norms to be named when they are displayed in the Patient ID window.
The four current races are Caucasian, Latin, Oriental, and Black.

Maximum Thumbnail Width: This slider allows you to determine the maximum width of
the Thumbnail Strip in the main window. Moving the slider to the right increases the
maximum width, while moving it to the left decreases the maximum width.

Date Input Format: This drop down menu allows you to

choose the order in which the patient’s birth date and record
date are input and displayed in the patient’s file.

Disclaimer: This field allows you type in the treatment simulation disclaimer. This can
be rewritten by the doctor in any language available on the Macintosh.

Print Disclaimer: This option allows you to print the disclaimer in documents.

Document Name Format: This option allows you to select

the format in which the names are saved. The options are
displayed to the right.

Patient Name Format: This option allows you to select the

format in which the patient’s names are displayed on the
screen.

Document Name Suffix: This field allows you to append additional text to the end of
the Quick Ceph Studio file name, such as “ABO Case”.

Document Icon Image: This drop down menu allows you

to select the default file icon image from among different
thumbnail views. The options are shown to the right.

Back Up Documents: Selecting this checkbox renames the current Quick Ceph Studio
file when you save an updated file. This way, if a file is saved incorrectly or by accident,
you can always retrieve the previously saved file. The options below the checkbox allow
you to select where you would like the backup files stored.

Default Save Location: This option allows you to select the default folder where
patient files will be saved.

163
Tracing Preferences
Point Size: This slider lets you
chooses the size of the landmarks.
Moving the slider to the right
increases the size.

Line Width: This slider lets you

choose the width of the tracing
line. Moving the slider to the right
increases the thickness of the line.

Default Color: These options

allow you to determine the default
tracing colors of the tracings from
different Sessions. The “Next
Session” area allows you to
choose the colors of the next new
Sessions created.

Tracing Color: This option allows

you to select the color of
landmarks and lines during the
tracing process.

Tracing Font: This option allows you to set the font type and size of the text that
appears on the tracings.

Curve Threshold: This field allows you to enter the distance between the dots that are
generated when you trace lines in the program. A larger curve threshold number results in a
line tracing with the dots spaced farther apart and is less sensitive to mouse movements,
whereas a smaller value results in a tracing that is more sensitive to mouse movements.

Analyses: This menu allows you to select which analyses you would like displayed in
the Analysis drop down menu found in different areas of the program. You can have
more analyses in the program than are displayed.

Default Analyses: This option allows you to select which analyses are pre-selected
when a lateral, frontal, model, and submentovertex tracing is displayed.

164
Lateral Orientation: This option allows you to select the
lateral orientation of the tracing. The options are shown to the
right.

Morph Steps: This field allows you to enter the number of

intermediate graphical steps displayed while patient images are
morphed. Larger values allow for a smoother morphing display on the screen, but takes
longer to view. Fewer steps take less time to morph, but the transitions are more abrupt.

Default Norm: This drop down menu allows you to select the default norm that will
appear when patient measurements are displayed.

Analyses Preferences
This section allows you to create
your own custom analyses. You
can either base your custom
analyses on existing
measurements, lines, and
landmarks, or you can create your
own.

Please refer to the Creating a

Custom Analysis chapter for
information on how to setup and
utilize these preferences.

Email: Once you have created

your own custom analysis, you
can email it to your colleagues or
your other computers running
Quick Ceph Studio. Select your
custom analysis from the drop-
down menu, then click on “Email”.
Quick Ceph Studio will launch your
mail program and automatically
include your analysis as an
attachment. You simply need to type in the recipient’s email address and click “Send” to
send your analysis.

165
Ratios Preferences
The Default drop down menu
allows you to select the preset or
default soft tissue ratio or create a
new set of ratios. The menu of
preset ratios are provided below:

Glossary of abbreviations used

above:
Mand: mandible
Max: maxilla
Def: deficient
Exc: excess
VME: vertical maxillary excess

To create a new set of ratios, click

on the + button next to the name.

You can edit the X, Y, and < (Angle) fields to indicate the percentage of soft tissue
movement at a particular location if a certain treatment action is taken.

For example, a value of 100% in the X and Y fields for mandibular osteotomy (handle
at PM) to soft Menton means that if the patient’s mandible was moved 1 mm in the X
or Y direction during the genioplasty, the chin would also move 1 mm in that direction. If
both X and Y fields displayed 50%, the soft tissue Menton would only move 0.5 mm.

166
Superimposition
Preferences
This section allows you to define
how various tracings offered in
Quick Ceph Studio are
superimposed over each other.
The steps presented below walk
you through setting up the
superimposition for the lateral
tracing, but you can follow the
same steps for the other tracings
available in Quick Ceph Studio:

1. The Lateral drop down menu

allows you to select the five
standard superimpositions
available for lateral tracings.
The options are displayed
below:

2. Once you have selected a superimposition name, you can select the landmark at
which the tracings are superimposed using the at landmark drop down menu.

3. The parallel to line drop down menu allows you to determine the line at which the
superimposed tracings are set parallel to each other. The drop down menus allow
you to determine which two landmarks make up that line.

Tooth Opacity: This slider allows you to change the opacity of the teeth templates on
the superimpositions.

167
Templates
Preferences
Show Comparison Captions:
This checkbox allows you to
toggle between displaying or not
displaying captions placed under
images in the Comparisons
galleries.

Show Patient Info In Galleries:

This checkbox allows you to
toggle between displaying or not
displaying the patient information
in the Patient Info text box in the
galleries.

168
Diagnostic
Preferences
This section allows you to
customize a set of patient
diagnostic criteria, either based on
the default criteria offered in Quick
Ceph Studio or based on your own
research.

Please refer to the Creating

Custom Treatment Diagnostics
section of the for information on
how to setup and utilize these
preferences.

To set the default diagnostic

analysis, click on the top pop-up
menu in the Preference and select
the name of the diagnostic
analysis.

To edit a custom diagnostic

analysis, select it from the pop-up
menu, then click on the “Edit” button.

To remove a custom diagnostic analysis, select it from the pop-up menu, then click on
the “Remove” button.

To email a custom diagnostic analysis, select it from the pop-up menu, then click on the
“Email” button.

169
Export Preferences
Default Export Convention: This
drop down menu allows you to
select the naming convention of
the batch exported images. The
drop down menu includes the
following options:

These options correspond to

naming conventions that are
compatible with specific practice
management programs. If you use
a practice management program
that is not on this list, you can edit
the naming convention of the
images by clicking on the “Edit” button. More details for creating a custom batch export
convention can be found in the Image Exporting section.

Image Export Format: This drop down menu allows you to

select the default format that the exported and batch exported
images are saved as. The options are shown to the right.

Image Export Dimensions: This option allows you to

select the maximum width, height, or dimensions (in pixels)
at which the images are exported.

Copy Dimensions: This option allows you to select the maximum

width, height, or dimensions (in pixels) at which the images are copied to the clipboard
during a copy/paste procedure.

Export Ruler With Traced Images: This option allows the calibration ruler image to
displayed on an exported x-ray image. This is necessary when using digital x-rays
printed from Quick Ceph Studio for ABO cases.

Patient Directory Uses: This radio box allows you to select if the folder in which the
images are exported is named according to the patient name or the patient number.

170
Batch Export Options: These options allow you to select specific options that affect
where the images are batch exported.

Remove All Previously Exported Items: This checkbox allows the user to delete all
previously exported files from the selected batch export folder.

Automatically Batch Export When Saving: This checkbox allows the user to choose
if they want to have the images automatically exported to a pre-selected folder when the
patient’s file is saved. When this option is selected, you have the option to select where
the images are being saved using the following options:

Export Current Session: This checkbox allows the user to select whether all of
the images from a patient’s file are automatically batch exported when the file is
saved or if only the current session is exported.

Create Patient Folder: This checkbox allows the user to choose if they want to
!have the images exported to a folder named after the patient.

Create Subfolders for Sessions: This checkbox allows the user to choose if they
want to have the images from different sessions exported into folders named after
each Session within the batch exported folder.

Export to: This option allows you to select where the images are automatically batch
exported to. You can have images batch exported to the location where the patient’s
file is stored or you can have it batch exported to a selected folder.

171
Sound Preferences
The Sound preferences can be
selected by clicking on the arrow
next to the Export button and
selecting “Sound”, as shown
below:

The Sound preference contains

the following options:

Use Voice Prompts: This

checkbox allows you to toggle the
voice prompts within Quick Ceph
Studio. When this option is
checked, you can edit the sounds
used in the program.

To listen to any of these sounds,

you can double click on the names or you can click once on the name and then click on
the Play button.

To re-record over a sound, you can click on the name of the file you would like to
replace, then click on the Record button. Quick Ceph Studio will record your voice until
you click on the Stop button.

To revert a sound back to the original sound in the program, click on the Revert button.
Please note that you will need to restart the program for the sound to be restored.

The Next button navigates you to the next sound file in the list.

172
Chapter 14
Printing

173
In Mac OS X, the Print Dialog Box has been standardized. Consequently, the printing
procedure in any program is virtually identical, regardless of the printer model used.
This feature makes it easy to become accustomed to the printing process. In this
chapter, we discuss the method used to print each image, including the specific steps
needed to print selected images and galleries. We will also discuss some of the other
print options available.

Selecting the Printer Settings

Before you print, you need to select certain settings in the Page Setup Dialog Box. To
do this, follow these instructions:

1. Open a patient file and select the image or gallery that you would like to print.

2. Choose File > Page Setup. The Page Setup Dialog Box, shown below, allows you
to select the paper size, paper orientation, and size of scaling. You should always
check the settings before printing to ensure they are correct for the selected image.

3. In the Format for: drop down menu, select the printer you are using. If you have
multiple printers in this menu to print from, use the default setting of Any Printer.

4. Select the paper size of the paper you are printing on in the Paper Size: drop down
menu. This includes using US Letter or A4 size.

5. The two Orientation: options are shown above Select the specific orientation
according to the image or gallery you are printing.

6. Click on OK when you are finished selecting the options in the Page Setup Dialog Box.

174
Printing an Image, Measurement or Gallery

After the settings in the Page Setup Dialog Box have been selected, you are now
ready to print. Follow these instructions to print the selected image, measurement, or
gallery.

1. Choose File > Print. The Print Dialog Box shown below will appear.

2. Select the printer you wish to use by clicking on the Printer: drop down menu.

3. Type the number of copies you wish to print into the Copies: field. Selecting the
Collated option allows you to print multiple pages in order.

4. To select additional options, such as color or black and white, print quality, number of
printouts on one page (among others), click on the Quick Ceph Studio drop down
menu. NOTE: The number and type of options in this menu varies according to the
selected printer, so options that appear when one printer is selected may not appear
when another is chosen. Additional information for this feature will be presented in
the following section.

5. By default, Quick Ceph Studio prints the x-ray tracing at a 1:1 size, but prints the x-
ray image (with or without the tracing) to fill as much of the printed page as possible.
However, if you need to print the x-rays and the tracings at a 1:1 size (as required by
the ABO Boards, for example), select the Print 1 to 1 checkbox.

6. If you are printing photographs, we recommend selecting the Use High Quality
Images checkbox.

7. When you are ready to print, click on the Print button.

175
Improving Print Quality

By default, Mac OS X is setup to print to “Plain Paper”, which means the print quality is
low resolution. If you use higher quality paper, you will need to change the setup to take
increase the resolution of the printout. Please follow the instructions below to do this.

1. Click on the Quick Ceph Studio drop down menu in the

Printer Dialog Box. Then select the option that allows
you to change the media type, such as Quality & Media
in the example shown to the right.

NOTE: Each printer will display different setting names.

2. When this option is selected, Printer Dialog Box will

change to display the quality and media options. Please
select the appropriate option to change the paper type. In
this case, you should select the “Media Type” option. The
various types of paper available to be used with this specific printer are listed below,
but the options displayed on your printer may vary.

176
 NOTE: Most printers list only the names of the paper sold
by their company. If you are using paper made by a
different company, you should choose a paper type from
this menu that most closely matches the type of paper you
are using. For example, “Photo Paper Pro” is the thickest
glossy paper made by Canon, whereas “Glossy Photo
Paper” is the thinnest. If you use inkjet paper, you can
choose “High Resolution Paper”. These options vary from
printer to printer, so you may need to perform tests to see
which option works best for your specific paper.

3. After you have made your selections you can save these settings in the Presets:
menu. To do this, click on the drop-down menu next to Presets: and select Save As...

4. A dialog box will appear, prompting you to name

the saved setting. Type in your preferred name
for this setting, then click on OK.

To access these settings in the future, simply

click on the Presets drop down menu from the
Printer Dialog Box and select the saved setting.

5. When you are ready to print, click on the Print button.

177
Saving a File as a PDF Document

Mac OS X allows you to easily capture printed output as a Portable Document Format
(PDF) file. This format allows users of both Macintosh and PC platforms to read and
print the content of your documents exactly as they appear on your screen. PDF files
are high quality and they are transferable on the Internet without requiring special
compression. Please follow the instructions below to print PDF documents.

1. Open the patient file(s) that you want to print.

2. Choose File > Print to open the Printer Dialog Box. When
this appears, click on the PDF button at the lower left
corner of the dialog box.

You will be presented with many options to allow you to

save, fax, and email the file as a PDF document. To save
the PDF as a file, simply click on “Save as PDF...”.

3. Once this option is selected, the Save Dialog Box will

appear allowing you to name the file and choose the
location where you want the PDF document to be saved.

For added security, you can password protect the PDF file from unauthorized access
by clicking on the “Security Options...” button, highlighted by the red arrow in the
image below. A dialog box will appear allowing you to select the password protection
and other options.

! !

178
Chapter 15
Patient File Management

179
File Organization
The windows of the Finder, containing icons and folders on the Macintosh, actually
comprise a sophisticated filing system. Folders can contain other folders, individual
applications, and files.

Files and folders in any window can be viewed as icons, or arranged as a list by name,
date modified, kind, etc. To change the organization of the files, go to the View menu
and select any of the arrangement options. Notice the way the files and folders in the
active window change. You can have one window arranged as icons, and another
stored in a list format, as shown below.

Viewed
as List

Viewed
as Icons

We recommend that you create a folder named “Patient File Folder” to store your
patient files. Inside this “Patient File Folder”, you can create separate patient file folders
to store the files chronologically, such as “Patients 2008”. This method makes it easier
to back up the files.

You can keep this “Patient File Folder” in your hard drive or in your “Documents” folder,
as well as create an alias on your desktop or Dock for easy access. To create this
folder, follow the steps below:

1. Open the location you wish to store your patient files.

2. Select New Folder under the File menu. An “untitled folder” icon will appear.

180
3. The folder name will be highlighted, allowing you to edit the name. Type in “Patient
File Folder”.

4. When you are finished, click on the File menu and select Make Alias. Drag and drop
the “Patient File Folder alias” onto the desktop.

5. To place an alias of the “Patient File Folder” in the Dock, click and drag the original
“Patient File Folder” icon to the right side of the Dock (between the vertical divider
and the Trash icon). The other icons in the Dock will move aside for the new icon.

Searching Patient Records

Quick Ceph Studio uses Apple’s powerful Spotlight search engine to easily locate any
Quick Ceph Studio files on your hard drive or network. To search for patient files, click on
the File menu and select Open with Spotlight... The Open With Spotlight Dialog Box
will appear showing all of the patient files on your computer in the order in which they
were last opened, as shown on the following below:

Search Field

Search Results

File Location

To search for a particular patient file, click in the Search Field (indicated by the arrow in
the above picture) and type in any part of the patient’s name. The Search Results
window will only display patient files that fit that naming criteria, helping you narrow
down the search. If you click on any name, the File Location section will show you
where the file is stored in your computer should you need to locate the original.

To open the files, either double click on the name in the search results section or click
once on the name and then again on the Open button.

181
Backing Up Patient Files
While Mac OS X is the easiest and most reliable operating system available today,
every computer runs the risk of data loss. Common threats include hard disk failure or
accidental file deletion. Therefore, backing up your files is vitally important. Quick Ceph
offers a built-in method for backing up your patient files, but you may want to use other
means to save your data. You may even wish to consider keeping a backup off-site in
case your computer is lost or your office experiences a major catastrophe.

In this section, we will discuss how Quick Ceph Studio handles patient file backups, as
well as recommend two easy and safe methods for personal backups.

Quick Ceph Backup

Quick Ceph Studio includes a built-in backup procedure that places the previously
saved copy of a file in a pre-defined location when a new copy of the file is saved. This
is useful because it allows you to revert back to an older file if it is found that the latest
saved copy contains a mistake. To check if this feature is activated, or to choose the
folder that contains the previously saved files, select Quick Ceph Studio >
Preferences, then click on the General Preferences. The following window will appear:
This feature is activated if the option, “Back Up Documents” is checked. The options
below this allow you to determine where the backup files are saved.
You can save the backup file in the same folder as your original file or
you can save it in a location of your choice. The backup file is named
with a “.qcbackup2” suffix, as shown in the image to the right. To
restore the backup file, rename the suffix to “.qc2”, then open the file.

182
Backup Program
Besides Quick Ceph, you can back up your data using dedicated file
backup software that can store your data onto external hard drives. This
method has become much easier since the release of Mac OS X v. 10.5
(Leopard), which comes standard with a backup system called Time
Machine that periodically backs up all of your selected data to an external
hard drive as long as it is connected to your Mac. Implementing Time
Machine is as simple as purchasing a FireWire or USB hard disk and plugging it in to
your Mac. The first time you connect a new hard disk to your Mac, Mac OS X v. 10.5 will
ask if you wish to use this drive for backup. Once you select this hard disk, Time
Machine will automatically back up your files to this drive at pre-specified intervals.

To access the Time Machine preferences, select Apple > System Preferences..., then
click on Time Machine. From here, you can select the backup hard drive and the time
intervals for your backups. The backups will generally take place once every 24 hours,
but you can also manually back up your data by clicking on the Time Machine icon in
the menu bar.

After Time Machine has copied all of your data, any file that has been backed up can be
retrieved, even if it has been recently deleted from your Mac. To retrieve lost files, you
can access previously backed up time points to locate the file. This program works best
with larger hard drives, as it allows you to search farther into the past for lost or
undamaged files. We currently recommend using at least a 500GB backup drive to take
advantage of this powerful software. Once Time Machine is finished backing up a drive,
you can choose to take the drive off-site as a preventative measure.

183
Disk Backup
To store files for long term archival, optical discs are preferred over the use of hard
drives, as they are designed to be more resistant to data corruption. We recommend
backing up files onto either CD-R, DVD+R, or DVD-R disks. CD-RW and DVD-RW are
not recommended for long term archival as they were designed to be rewritten, so they
are more volatile than the non-rewritable disks. CD-R/W discs store up to 700MB of
patient data, which is ideal for cost effective monthly archives, while DVD+/-R disks store
4.7GB of data (single sided) or 7.4GB of data (double sided), which is ideal for annual
backups. Use the following instructions for burning CDs or DVDs of your patient data:

1. Insert a blank CD or DVD into the computer (for this example, we will use the term
“disc” to refer to both). A dialog box will appear prompting you to name the disk.

2. Type in the name you wish to call the disk. We recommend naming the disc
according to the date for easy referencing. Click on OK when you are finished. A
disk icon will appear on the desktop.

3. Locate the patient files or folders you wish to backup, then drag and drop them onto
the disk icon. The computer will copy the files from your hard drive in preparation to
burn them onto the disc.

4. When the files are finished copying, select File > Burn Disc... to burn the files onto
the disc. A dialog box will appear asking you if you are sure you want to burn the
disc. Click on Burn. Once the disk has been burned, it will appear on your desktop.
Eject and store this disc for safe keeping.

184
Chapter 16
Image Exporting

185
Quick Ceph Studio features sophisticated tools to allow you to customize how images are
exported from the software. These images can be used in letters, scheduling, and for
presentations. Images can be either manually or automatically exported in several Mac and
PC compatible formats depending on your requirements. They can also be named according
to a preset naming convention, such as those required by practice management software.

Export Preferences
Image export options are found in the
Export Preferences panel, and are
applicable for all exported or copied
images. This panel can be accessed by
clicking Quick Ceph Studio >
Preferences.

Default Export Convention: This drop down

menu allows you to select the default export
convention you would like used when you
select File > Batch Export. The “Edit” button
next to this menu allows you to edit the name
and specific images that are exported. This
option will be discussed in further detail later.

Image Export Format: This drop down

menu allows you to select the default
format that the exported and batch
exported images are saved as. The options
are shown to the right:

Image Export Dimensions: This option

allows you to select the specific width or height (in pixels) at which the images are
exported. By default this value is 1200 pixels.

Copy Dimensions: This option allows you to select the specific width or height (in
pixels) at which the images are copied to the clipboard during a copy/paste procedure.
By default, this value is 1200 pixels.

Export Ruler With Traced Images: This option allows the calibration ruler image to
displayed on an exported x-ray image. This is necessary when using digital x-rays
printed from Quick Ceph Studio for ABO cases.

Patient Directory Uses: This radio box allows you to select if the folder in which the
images are exported is named according to the patient name or the patient number.

Remove All Previously Exported Items: This checkbox allows the user to delete all
previously exported files from the selected batch export folder.

186
Automatically Batch Export When Saving: This checkbox allows the user to choose
if they want to have the images automatically exported to a pre-selected folder when the
patient’s file is saved. When this option is selected, you have the option to select where
the images are being saved using the following options:

Export Current Session: This checkbox allows the user to select whether all of
the images from a patient’s file are automatically batch exported when the file is
saved or if only the current session is exported.

Create Patient Folder: This checkbox allows the user to choose if they want to
!have the images exported to a folder named after the patient.

Create Subfolders for Sessions: This checkbox allows the user to choose if they
want to have the images from different sessions exported into folders named after
each Session within the batch exported folder.

Export to: This option allows you to select where the images are automatically batch
exported to. You can have images batch exported to the location where the patient’s
file is stored or you can have it batch exported to a selected folder.

Single Image Export

There are two ways to export individual images from Quick Ceph Studio. The first method is
simply to drag and drop an image from either the Thumbnail Strip (section B in the image
below) or the main window (section C) onto the desktop or into a folder of your choice. The
image will be exported in the format and size pre-selected in the Export Preferences.

! ! ! A! B! ! ! ! C

187
NOTE: While this method is the easier of the two single image export methods, it can
only be used with gallery and individual images. To export measurements, CT Scans, and
the original sized image, you need to use the second export method described below.

The second method to individually export an image is to select File > Export. This
command allows you to export a single image, tracing, gallery view, list of
measurements, or the original CT Scans in a patient file. To export a single view, follow
the steps below:

1. Open the specific patient file from which you wish to export.

2. Find and display the image, measurement, or CT Scan you wish to export.

3. Select File > Export.

4. The Save Dialog Box will appear allowing you to select where you would like to
save the patient image. To export the original unedited image, click the “Export
Original Images” checkbox. Click the checkbox next to “Export to folder with patients
name” to create a folder for the images to be store. Select the folder you wish to
store the exported image and then click the Choose button.

Batch Export
The Batch Export commands, located under the File menu,
allow you to export multiple images from the selected session
for use with a practice management or presentation program.
To export multiple images from a session, follow the steps
below:

1. Open the specific patient file you wish to export from.

2. Select File > Batch Export to export the default batch

export convention (mentioned earlier in this document).
This will display the Batch Export Dialog Box.

3. The Batch Export Dialog Box allows you to specify where

you wish to place the images. Like a Save As Dialog Box, the Batch Export Dialog
Box allows you to navigate to the folder where you would like to save your images. It
also contains several options that allow you to customize the batch exported images.
These will be described on the following page.

188
 Image Format: You can change the format of the images by using this drop down
menu.

Max: By selecting this drop down menu, you can choose the maximum width,
height, or dimension (in pixels) of the exported image.

Remove Previously Exported Items: This checkbox allows you to select whether
you want to remove the files from the directory in which you are saving the batch
exported images.

Create Patient Directory: Selecting this option allows you to create a new directory
named in the following format, “Patient Last Name, Patient First Name”.

4. When you have finished selecting the options you need, click on the Export button
to export the images into the selected folder.

189
Batch Exporting Images for Practice Management
Images created in Quick Ceph Studio can be exported and
used in many different practice management programs. By
default, Quick Ceph Studio can export images with the naming
conventions used by the practice management companies
shown in the image on the right.

To select the naming convention, please follow these instructions:

1. Click on the Quick Ceph menu and select Preferences.

2. When the Preferences Dialog Box opens, please click on the Export icon.

3. When the Export options appear, click on the Default Export Convention drop down
menu and select the practice management program of your choice.

4. To batch export images, you can now follow the instructions in the previous section.

Generic Batch Export Naming Convention

If your practice management program is not listed in the Default Export Convention
drop down menu, you may select the Generic export convention instead. When using
the Generic batch export, the file names will be exported according to the naming
convention shown below:

! Status-Bird's Eye Photo.jpg

! Status-Closeup Smiling 1 Photo.jpg
! Status-Closeup Smiling 2 Photo.jpg
! Status-Front Intraoral Model.jpg
! Status-Front Intraoral Photo.jpg
! Status-Frontal Photo.jpg
! Status-Frontal Smiling Photo.jpg
! Status-Frontal X-ray.jpg
! Status-Full Body Photo.jpg
! Status-Lateral Smiling Photo.jpg
! Status-Left Intraoral Model.jpg
! Status-Left Intraoral Photo.jpg
! Status-Mandible Model.jpg
! Status-Mandible Photo.jpg
! Status-Maxilla Model.jpg
! Status-Maxilla Photo.jpg
! Status-Overbite Photo.jpg
! Status-Overjet Photo.jpg

190
! Status-Panoramic X-ray.jpg
! Status-Right Hand X-ray.jpg
! Status-Right Intraoral Model.jpg
! Status-Right Intraoral Photo.jpg
! Status-Right Lateral Photo.jpg
! Status-Right Lateral Trace.jpg
! Status-Right Lateral X-ray.jpg
! Status-Right Oblique Photo.jpg
! Status-Right Oblique Smiling Photo.jpg
! Status-Submentovertex X-ray.jpg
! Status-TMJ X-ray.jpg
! Status-Worm's Eye Photo.jpg

Note: In the Generic list above, “Status” will reflect the name of the Session (i.e. initial,
treatment, final, etc.)

Custom Batch Export

Quick Ceph Studio allows you to customize the naming convention and the images that
are exported. This feature is useful if you are using a practice management program
that has a specific naming convention and is not yet programmed by Quick Ceph.
Please follow the instructions below to do this:

1. Open the Preferences Dialog Box and then click on the Export icon.

2. Then, click on the “Edit” button to the right of the Default Export Convention drop
down menu. The following Export Conventions window will appear.

3. If you are creating a custom batch export preference for the first time, this window
will be blank (as shown above). Please click on the “New” button to create a new
Export Convention.

191
4. When you select the “New” button, you will see an option to either create a new
convention or copy an existing naming convention. In this example, we will create a
new naming convention. You can click on the “Create” button to continue.

5. As soon as the “Create” button is selected, the Export Convention Editor window will
appear, as shown below. The features of this window are lettered.

(A)
! (B)
! (C)
(D)
(E)

(F)

(G)

(H)

192
 A) Name: Type in the name of your new Export Convention.
B) Field Delimiter: This lets you select how the text fields in the measurements and
patient information are separated.
C) Line Ending: Choose the operating system that you are exporting the images to.
D) Text File Encoding: Select the language in which the measurement files will be
exported.
E) Image: You can choose to define five different types of images:

Images without Tracings

Images with Tracings
Tracings Only
Measurements Only
Patient Info

These options can be accessed by clicking on icon and then selecting the image
that you wish to use.

F) Selected Images: This field displays the names of the images to be exported.
You can edit the “Identifier”, which is the text to distinguish the images, by
clicking on the “Identifier” field and typing in the name. To remove an existing
image, you can click on the “Remove” button that appears after the image has
been selected.
G) Name Elements: Drag these name elements to the Final Exported Name field
(G) to create the filename that you wish to use.
H) Final Exported Name: This field shows you the final naming convention used.
You can add dashes or other words in this field. Any item added to this field will
be present on all of the exported images.

6. To add pictures or measurements to the list of batch exported files, click on the
appropriate Image icon (E). Once you click on the the type of file you want to export,
another window will appear allowing you to select the specific image or file to export.

193
The image shown below appears when you select the “Image with Tracings” icon:

194
7. You can add as many batch exported images as you like. Your completed Export
Convention Editor window should look like the following image:

8. Once you have finished making the changes to the Export Convention Editor, click
on the Save button to save your changes. The saved file will now appear in the
Default Export Convention drop down menu in the Export Preferences, and can be
selected when you batch export images.

Emailing Exported Images and Measurements

Images and measurements in Quick Ceph Studio can be easily emailed, either
individually or as a group. Follow the instructions below to do this:

Emailed Individual Images or Measurements

1. Open the patient file, then select the session in which the image or measurement
you wish to email resides.

195
2. Next, navigate to the section that contains the images you wish to email. For
example, click on the Templates tab if you want to export galleries, click on the
Tracings tab for measurements, tracings, or images with tracings superimposed, or
click on the Media tab for images and movies.

3. Then, click on the individual image or measurement you

wish to email in the Thumbnail Strip, then click on the image
or measurement in the main window.

4. Select File > Mail. Your default Mac mail program will open
and the selected image or measurement will be included as
an attachment. The file will be in the image format specified
in the Image Export option found in the Export
Preferences.

5. You can now email this file to your colleagues or patients.

Emailing Multiple Images or Measurements

1. Open the patient file, then select the session in which the images or measurements
you wish to email reside.

2. If you have pre-selected the images you wish to export using the Batch Export
Preferences, you can select File > Batch Export to export the images to the
predefined location. Skip to Step 7.

3. Otherwise, navigate to the section that contains the images you wish to email. For
example, click on the Templates tab if you want to export galleries, click on the
Tracings tab for measurements, tracings, or images with tracings superimposed, or
click on the Media tab for images and movies.

4. Then, click on the individual image or measurement you wish to email in the
Thumbnail Strip.

5. Next, select File > Export... This command will allow you to export an individual
image to a location of your choice. The Save Dialog Box will allow you to select the
destination.

6. Repeat the above steps until you have exported all the desired images.

7. When you are finished exporting, select the exported images in the saved location.
You can hold down the Shift key or the Command (⌘) key and click on these
images to select multiple files.

196
8. When all of the images are selected, select File > Compress
(x) items (where x is the number of images you have
selected). This will zip all of these items into a file called
"Archive.zip" in the same folder containing your images.

9. Open your e-mail application and create a new e-mail

message. There should be an option on the message to add
an attachment or file. Click on this button and then choose
the "Archive.zip" file from your Desktop and select "OK".
When you are ready, you can send this e-mail to the
appropriate recipient.

197
Chapter 17
Menu Reference

198
Apple menu
Clicking the Apple in the upper left corner of the
screen reveals a menu that includes important
commands and settings that that can be used in
all applications. Many of these commands will not
be used specifically with Quick Ceph Studio, but it
is a good idea to familiarize yourself with them.
The most commonly used commands are
described below:

• Force Quit
This command allows you to quit out of a
currently running program if the program is not
responding or is frozen. Please note that this command does not allow you to save
changes made to a file.

• Sleep, Restart, Shut Down, Log Out

These options are used in all applications. The “Sleep” function is used to conserve
energy (or batteries on a laptop). “Restart” and “Shut Down” are self-explanatory. “Log
Out” allows you to change users if you have multiple user settings programmed into
the computer.

Quick Ceph Studio menu

• About Quick Ceph Studio
Clicking on this option opens a window that provides
information about your current version of Quick Ceph
Studio. Click on Close to end the display.

• License Info...
Clicking on this option displays your license name
and practice logo (if applicable).

• Show Message Of The Day

Clicking on this option displays the current daily
message sent from Quick Ceph highlighting tips,
news, and other information.

• Check For Updates...

Quick Ceph Studio will automatically download and install new versions of the
software for you when it is turned on. You can also manually update by selecting the
Check for Updates... menu item.

199
• Screen Share with QuickCeph
This option allows one of Quick Ceph Systems’ technicians to view your screen and
control your mouse, making technical diagnosis fast and simple. To initiate screen
sharing, call Quick Ceph Systems, then click on this option when told to do so.

• Preferences...
Allows you to change settings in Quick Ceph Studio. See the Quick Ceph Studio
Preferences section for more information.

• Services
This option is not used in Quick Ceph Studio.

• Hide Quick Ceph Studio, Hide Others, Show All

These options allow you to control the windows of all active programs. Hiding Quick
Ceph Studio makes the windows disappear, but does not turn it off. This is useful if
you need to view or access folders on the desktop, such as the Scanned Images
folder, to import pictures into an already existing patient file. Hide Others hides all
other open applications, and Show All displays all applications, including those that
were previously hidden.

• Quit Quick Ceph Studio

Click Quit Quick Ceph Studio to leave Quick Ceph Studio. If the patient record has
not been saved, a dialog box will appear giving you the opportunity to save it.

File menu
• New
This command creates a new patient file.

• Open
Clicking on the Open command displays an Open
Dialog Box, which allows you to open existing files on
your hard drive or desktop. The second method for
opening patients is to drag and drop the Quick Ceph file
onto the Quick Ceph Studio icon.

• Open with Spotlight...

This command allows you to search for a file stored on
your computer or network using Apple’s search tool.

• Open Recent
This command will display a sub-menu which lists the 10 most recently opened files in
Quick Ceph Studio. You can select one of these files for quick access rather than

200
 looking through your hard disk to find it.

• Import
The Import command allows you to import either image files or CT scans. When this
button is selected, a dialog box opens to allow you to select images or patient files
(from camera cards, external hard disks, etc.) to add to the open patient file.

• Close
Clicking on the Close command closes the active window. You can also use the close
button in the upper left corner of a window to close it. If a window containing a newly
created tracing or image is closed, a dialog box will appear asking if you want to Save.
This prevents accidentally discarding files. The automatic reminder can be disabled for
the Treatment window by de-selecting Save Request under the Option menu.

• Save
The patient files you create need to be saved on the hard drive (or any other disk) or
they will disappear as soon as you close the window or quit the program. The Save
command saves the current record. If the Patient I.D. information has already been
input, selecting Save in the File menu will bring up the Save Dialog Box. By default,
Quick Ceph Studio will display “last name, first name”, i.e., “Smith, John”. However,
you can give the file any name you choose. Therefore, the name of the file and the
name in the Patient I.D Dialog Box may not be the same.

• Save As...
This feature is similar to Save, but it prompts you to save a new copy of the file under
a new name, leaving the original unaltered.

• Export...
The Export command is used to export an individual image, gallery view, or text file
from Quick Ceph Studio to be used outside of the program.

• Batch Export...
The Batch Export command allows you to export multiple image or text files at one
time in order to share images and measurements with other programs. The images to
be batch exported can be pre-selected in the Export Preferences. More information
about this option can be found in the Image Exporting section.

• Batch Export Originals...

This option allows you to export multiple original images from the patient file.

• Mail
Selecting the Mail command will export the current image or gallery as an individual
graphic file and attach it to a new email message.

• Revert
This command will discard all changes you have made to the patient file in case you

201
 wish to start over with the most recent saved version. This is functionally equivalent
closing the file without saving your changes, then opening it again.

• Batch Convert...
This option allows you to convert multiple Quick Ceph 2000 files and Quick Ceph
Studio 1.0 files into the Quick Ceph Studio 2.0 file format.

• Page Setup...
The Page Setup command allows you to select the orientation and size of the
document to be printed.

• Print...
Selecting the Print command opens the Print Dialog Box, which allows you to select the
printer settings. This dialog box allows you to print individual images, as well as PDF
documents. It also allows you to select which active windows to print and the number of
copies. More information about printing can be found in the Printing section.

Edit menu
• Undo and Redo
Undo and redo allow you to quickly reverse changes
you made to a file. For example, if you cropped a
patient’s image you could immediately go to the Edit
menu, then Undo or Redo to toggle between pre-
and post-cropped versions of this file.

• Cut, Copy, Paste, and Paste and Match Style

All Macintosh programs include Cut, Copy, and
Paste commands. These are very useful for
transferring pictures and text from one application to
another. It is possible to Copy measurements,
images, and tracings from Quick Ceph Studio and
Paste them into other applications, such as a word processor, spread sheet, data
base, statistical, or desktop publishing program. The information transferred is a
duplicate of the original. The Paste and Match Style option places the copied text into
the target area while keeping its current format.

• Copy Special
This option allows you to copy measurements from Quick Ceph Studio into a single
line for data analysis use in spreadsheets. You can select to copy the data as a Single
Line With Headers (which includes the measurement name, type, etc.) or simply as a
Single Line. The former is useful for the first line of data copied into your spreadsheet
and the latter is recommended for all subsequent data.

202
• Delete Object
This command allows you to remove images from Quick Ceph Studio. For example if
you inadvertently add an image that you do not want, you may click once on it to
select it, then go to Edit and click on Delete.

• Select All
The Select All command will highlight all text in the current field. For example if you are
typing the patient’s name, you can choose Select All to highlight the name. This is useful
in conjunction with the Cut, Copy, Paste, and Paste and Match Style commands.

• Find, Spelling, and Special Characters

The Find and Spelling commands allow you to search long blocks of text for certain
words, as well as perform spell checking commands. While you may use them when
taking notes on a certain image, they are not commonly needed in Quick Ceph Studio.
Special Characters will display a palette of special symbols and letters that are not
readily usable on a normal keyboard layout. For example, accents on certain letters
such as ü.

View menu
• Zoom In
Each time it is selected, this option will cause the image you
are viewing to be zoomed closer.

• Zoom Out
Each time it is selected, this option will cause the image you are
viewing to be zoomed out.

• Fit To Screen
If you have zoomed in or out, this will return the image display to a size which fits
easily on your computer screen.

• 1 to 1
This command will attempt to display the current image at a life-like size.

• Show Magnifier
This option is like a digital magnifying glass. It will cause a magnifier to be displayed
on the screen, which allows you to move around and zoom in on specific portions of
an image, while the rest of the image remains at is usual size.

• Privacy Mode On
This option allows you to display a privacy mask that blocks the on the patient's eyes
on the facial images and gallery templates.

203
Format menu
• Font
Allows you to change fonts, size, style, spacing, and colors.

• Text
Allows you to change justification and display the ruler.

• Bring To Front / Send To Back

These tools allow you to position images that are placed on top of one another during
the creation of a custom template.

Session menu
• New Session
Quick Ceph Studio stores each time point or patient
visit as a “Session” in the patient file. This command
creates a new entry in the Session list.

• New Growth Forecast

Selecting New Growth Forecast creates a new
Session that displays the predicted growth of the
patient over a selected period of time.

• New Treatment
Selecting the New Treatment command creates a new Session in which you can alter
the patient’s digitized tracing to simulate treatment. After adjusting the tracing, you can
then morph the color photo to display the treatment projection. Please refer to the
Treatment Planning chapter for more information.

• New CO-CR Conversion

CO-CR Conversion allows repositioning of the mandible from centric occlusion
(habitual position of the mandible, where the radiograph has been taken) to centric
relation (the seated hinge axis of the mandible).

• Merge Session...
This feature allows you to combine two Sessions into one Session, which is useful for
when you have accidentally created multiple Sessions for the same patient.

• New Comparison
Quick Ceph Studio allows you to compare and superimpose images and tracings from
multiple patient Sessions. See the Using Comparisons chapter for more information.

204
• New Superimposition
When using comparisons, you can superimpose multiple images and tracings either
automatically or manually. This command creates a new manual lateral
superimposition in the current patient file.

• New CT-Scan Model View, New CT-Scan X-Ray View, New Copy of CT-Scan View,
New Condyle View, New Panoramic View, New Airway View
These options allow you to take your manipulate the CT Scan data to obtain various
views of the patient and to extract images and data for treating the patient.

Analysis menu
The Analysis menu is used for switching between analyses. You can
use it to select one of the existing analysis that was included with the
program, as well as your own custom analyses.

Custom analyses can be created in the Preferences window, and will

show up in this menu automatically. Please refer to the Creating
Custom Analyses chapter for more information.

Tracing menu
• Trace
This begins the digitizing process. It is functionally equivalent to clicking
on the Trace icon in the toolbar at the bottom of the screen.

• Clear Tracing
This command completely clears the tracing, allowing you to begin
again. Note: You must first select Trace from the Tracing menu, or click on the Trace tool
at the bottom of the Quick Ceph Studio window, before using the Clear Tracing option.

• Correct Tracing
This allows you to correct mistakes in your tracing. It is functionally equivalent to
selecting the Correct Tracing tool in the toolbar at the bottom of the screen.

• Align Tracing
This allows you to align your tracing to the color image so that is can accurately morph
the color image. It is functionally equivalent to selecting the Align Tracing tool in the
toolbar at the bottom of the screen.

• Morph
This morphs the color image based on the treatment you have performed. It is

205
 functionally equivalent to clicking the Morph tool in the toolbar at the bottom of the
screen.

Media menu
The Media menu allows you to access the Smile Studio patient
education movies.

Window menu
• Minimize
This option moves the current window offscreen
by shrinking it into the Dock. To access it again,
click on its icon in the Dock. This option is
equivalent to the yellow minimize button in the
upper left corner of the window.

• Minimize All
This option moves all currently open windows offscreen into the Dock.

• Zoom
This option toggles the current window size between two sizes. This option is
equivalent to the green zoom button in the upper left corner of the window.

• New Window
This option opens up an additional window of the currently opened patient to allow you
to display multiple views side by side.

• Bring All to Front

Mac OS X allows you to display windows from different applications overlaid on top of
each other. The Bring All to Front option moves all Quick Ceph Studio windows to the
front of your desktop.

• Patient name and window number

This last section displays all of the currently opened patient files. If you have multiple
files open, you can switch between them by clicking on the desired file’s name.

Documentation menu
• Show Documentation
Clicking on this option displays the Quick Ceph Studio Manual.

206
Chapter 18
Common Troubleshooting Questions

207
Q: The Quick Ceph Studio program will not open.

A: Please verify the following:

• Your computer is connected to the Internet. Each time the Quick Ceph Studio
application or a Quick Ceph patient file is opened, the program contacts our licensing
server to check if the computer you are using is registered with Quick Ceph. If you are
not connected to the Internet, then the program will not work and will give you the
following error message.

• You have placed the Quick Ceph Studio application in the Applications folder in the
root directory of your hard drive. If the application is placed anywhere else, the
program will not open correctly.

• You have installed the latest version of Quick Ceph Studio. To find
out which version you are currently using, locate your Quick Ceph
Studio program, click once on the icon, then select File > Get Info.
The window shown to the right will appear, providing all of the
application’s information. The version of the software will be listed
in the middle of this window. Please provide the Quick Ceph
technician with this information so we can further assist you.

Q: The Quick Ceph Studio program does not open consistently.

A: If you have a slower internet connection, the program

may have difficulty consistently contacting our servers. To
remedy this, when the Quick Ceph Studio program is open,
select Quick Ceph Studio > Preferences, then click on
the “General” button.

When this window is open, check the box next to

“Tenacious Network Access”. This will allow the computer
to connect to the Quick Ceph server across a slow
connection.

If you are unable to open the Quick Ceph program, you

can turn on Tenacious Network Access manually. Please
follow the instructions on the next page.

208
A (cont.): To manually enable Tenacious Network Access, please follow the steps below.

1. Open the following folder: Macintosh HD \ Applications \ Utilities

2. Double-click on the Terminal application.

3. When the program opens, type the following text (you can also copy & paste the text
if you wish), then press the “Return” key:

defaults write com.quickceph.QuickCephStudio QCPreferenceLicensingTenaciousNetworkAccess 1

4. Try to open Quick Ceph Studio version 2.0 now. The Tenacious Network Access will
permit the application to communicate with our servers at a slower data speed.

Q: When opening an older Quick Ceph 2000 patient file or a Quick Ceph Studio
1.0 patient file, I receive the following error message:

A: This message is received when opening patient files in formats other than the Quick
Ceph Studio 2.0 format. To fix this problem, save the patient file in Quick Ceph Studio 2.0.

Q: The Smile Studio does not display movies properly.

A: You may be using an older version of the Quick Ceph Studio Media file with a newer
version of Quick Ceph Studio. Please visit the Quick Ceph Studio download page to
obtain a new copy of this media file.

Q. The tooth outlines in my tracing are too large or too small.

A. The size of the tooth is determined by the calibration. If you have not calibrated your
ceph, or the calibration is not done properly, this will result in incorrectly sized teeth. To
calibrate the tooth correctly, please view the Digitizing X-Rays and Models section.

Q. I am unable to open a CT Scan in Quick Ceph Studio.

A. The CT Scan file may be created by a machine that is not currently recognized by
Quick Ceph Studio. Please contact our offices and provide the following information
to our technicians:

209
 1) Name of CT Scan machine being used.
2) Sample of CT Scan images. These can either be sent via the internet or through
the mail in the form of a CD. This will allow our programmers to develop a reader to
accept these images.

Q. Spotlight Search (in either the opening splash screen or in the menu bar) does
not work.

A1. If you have multiple copies of Quick Ceph Studio on your computer, they may affect
each other and cause this feature to stop working. To resolve this, only keep one copy
of Quick Ceph Studio on your computer at any time.

A2. Your computer may need to be re-indexed. To do this, select File > Preference >
Spotlight. Next, click on the Privacy tab. Last, drag the folder containing your files or,
better yet, your entire hard drive into the window that prevents Spotlight from searching
the selected folder. When the folder or hard drive icon appears in this window, click
once on the “-” icon to remove it from the list. The program will now re-index your
selected folder or hard drive.

Q. When opening a Quick Ceph patient file, I receive the following error message:
The Document “Doe, Jane.qc2” could not be saved”.

210
A1. This will happen if the file being opened has improper
permission settings. File permissions are a very important
aspect of the Mac OS. When they are set incorrectly it will
cause problems when trying to open or save files. To correct
the permissions of a particular file, navigate to that file using the
Finder, highlight it, then select File > Get Info. Open the
Sharing & Permissions section at the bottom of the Get Info
window and make sure that all users listed have Read & Write
privileges for this file.

A2. It is common to get file permissions issues when

connecting to a server computer or accessing files from a
shared folder on the network. If this happens, please make sure
you are connected to the server or shared folder using the
administrator account name and password.

211
Appendix
Additional Information

212
Bibliography
[1] Downs, W.B.: “THE ROLE OF CEPHALOMETRICS IN ORTHODONTIC CASE
ANALYSIS AND DIAGNOSIS”, American Journal of Orthodontics, 38:162, (1952)

[2] Epker, N.E.: Fish, L.C.: “DENTOFACIAL DEFORMITIES”, Mosby, Vol 2:17-21, (1986)

[3] Kim,Y.H.: “OVERBITE DEPTH INDICATOR WITH PARTICULAR REFERENCE TO

ANTERIOR OVERBITE”, American Journal of Orthodontics, 65:586-611, (1974)

[4] Kim,Y.H., VIETAS J.J.: “ANTERIOPOSTERIOR DYSPLASIAINDICATOR: AN

ADJUNCT TO CEPHALOMETRIC DIFFERENTIAL DIAGNOSIS”, American Journal of
Orthodontics, 73:619-633, (1978)

[5] Koyata, H.: “A COMPARATIVE STUDY OF BLACK PATIENT SAMPLE TAKEN

FROM HOWARD UNIVERSITY, COLLEGE OF DENTISTRY ORTHODONTIC CLINIC
TO THE CEPHALOMETRIC STANDARDS SETUP FOR NORTH AMERICAN BLACK
AND CAUCASIAN PATIENTS ESTABLISHED BY ROCKY MOUNTAIN DATA
SYSTEMS, INC.”, Masters’ Thesis, Howard University, (1979)

[6] McNamara, J.A.: “A METHOD OF CEPHALOMETRIC EVALUATION”, American

Journal of Orthodontics, 86:449-469, (1984)

[7] Miura, F.; Inove, N.; Suzuki, K.: “CEPHALOMETRIC STANDARDS FOR JAPANESE
ACCORDING TO THE STEINER ANALYSIS”, American Journal of Orthodontics,
51:288-295, (1965)

[8] Nezzu, H.; Nagata, K.; Yoshida, Y.; Kikuchi, M.; Kosaka, H.: “CLINICAL NORMS OF
JAPANESE COMPARED WITH CAUCASIANS”, 14th F. O. R. Meeting at Monterey,
California, (1981)

[9] Panagiotis, G.; Witt, E.: “DER INDIVIDUALISIERTE ANB-WINKEL”, Fortschr.

Kieferorthop., 38:408-416, (1977)

[10] Ricketts, R.M.; Bench, R.W.; Gugino, E.F.; Hilgers, J.J.; Schulhof, R.J.:
“BIOPROGRESSIVE THERAPY”, Rocky Mountain/Orthodontics, (1979)

[11] Ricketts, R.M.; Bench, R.W.; Roth, R.H.; Chaconas, S.J.; Schulhof, R.J.; Engel,
G.A.: “ORTHODONTIC DIAGNOSIS AND PLANNING”, Rocky Mountain/Orthodontics,
Vol 1, (1982)

[12] Ricketts, R.M.; Bench, R.W.; Roth, R.H.; Chaconas, S.J.; Schulhof, R.J.; Engel,
G.A.: “ORTHODONTIC DIAGNOSIS AND PLANNING”, Rocky Mountain/Orthodontics,
Vol 2, (1982)

213
[13] Rocky Mountain Data Systems, Inc.: “DETAILED SPECIFICATIONS FOR
FUNDAMENTAL COMPUTERIZED CEPHALOMETRIC SYSTEM”, University
Instruction Manual, April/May (1970)

[14] Steiner, C.C.: “CEPHALOMETRICS FOR YOU AND ME”, American Journal of
Orthodontics, 39:729-755, (1953)

[15] Tweed, C.A.: “THE FRANKFURT-MANDIBULAR PLANE ANGLE IN

ORTHODONTIC DIAGNOSIS, CLASSIFICATION, TREATMENT PLANNING AND
PROGNOSIS”, American Journal of Orthodontics, 32:175-232, (1946)

[16] Valarde, E.: “NORMS FOR THE MEXICAN POPULATION USING THE TWEED
STEINER AND RICKETTS ANALYSIS”, Unpublished Masters’Thesis, Loma Linda
University, (1974)

[17] Wolford, L.M.; Hilliard, R.W.; Dugan, D.J.: “SURGICAL TREATMENT OBJECTIVE”,
Mosby, (1985)

[18] Brons, R.: “FACIAL HARMONY, STANDARDS FOR ORTHOGNATHIC SURGERY

AND ORTHODONTICS”, Quintessence Publishing Co, Ltd., (1998)

[19] Herzberg, B.L.: “FACIAL ESTHETICS IN RELATION TO ORTHODONTIC

TREATMENT”, Angle Orthod., 22:3-22, (1952)

[20] Powell, N.; Humphreys, B.: “PROPORTIONS OF THE AESTHETIC FACE”, The
American Academy of Facial Plastic and Reconstructive Surgery, Thieme-Stratton Inc.
New York, (1984)

[21] Spradley, F.L.; Jacobs, J.D.; Crowe, D.P.: “ASSESSMENT OF THE ANTERIOR-
POSTERIOR SOFT TISSUE CONTOUR OF THE LOWER FACIAL THIRD OF THE
IDEAL YOUNG ADULT”, American Journal of Orthodontics, 79:316-325, (1981)

[22] Kosaka, H.; “BIO-PROGRESSIVE THERAPY”, Rocky Mountain/Orthodontics,

Japanese edition (1987)

[23] Legan H.L.: “SOFT TISSUE CEPHALOMETRIC ANALYSIS FOR ORTHOGNATHIC

SURGERY”, Journal of Oral Surgery
38:744-751, (1978)

[24] Bjork, Arne: “GUIDE TO SUPERIMPOSITION OF PROFILE RADIOGRAPHS BY

“THE STRUCTURAL METHOD’”, http://www.angle-society.com/case/guide.pdf, (2010)

214
Suggested Informed Consent Form
The following is suggested to be made available to the patient on the practitioner’s own
letterhead:

Informed Consent, Contractual/Warranty Disclaimer, and Treatment Confirmation as

Related to Computerized Imaging

The orthodontist(s) and staff of (••doctor’s name••), as well as the other professionals
involved in my orthodontic and/or oral surgery treatment have shown me proposed
alterations of my dental/facial structure through the use of Computerized Imaging.

I understand that the images shown to me by this imaging technique are for the
purposes of illustration and discussion only. I realize that orthodontics/oral surgery, like
other healing arts, are not exact sciences, and that the results of my treatment are
related directly to my individual healing characteristics. I also realize that there may be
no relationship between the computer generated images, and my final treatment result
because of the significant differences in the way that living tissue heals and reacts to
treatment techniques.

I have read, and understand the materials that have been provided to me regarding the
proposed outcome, the risks of the procedure(s), and the alternatives to treatment. I
consent to this treatment with full knowledge of my right to decline such treatment.

I certify my understanding of the fact that (••doctor’s name••), and the individuals
involved in my treatment have not made any contractual agreement or express/implied
warranties as to my final appearance or results by their use of these computer altered
video images.

_____________________________________________________________________
Patient (Parent, if patient is under 19 years old) ! ! ! ! Date

_____________________________________________________________________
For: (••doctor’s name••) ! ! ! ! ! ! ! ! ! Date

_____________________________________________________________________
Witness ! ! ! ! ! ! ! ! ! ! ! ! Date

215
Background on the Magnification of X-rays
Because X-rays are projections of a subject onto a film plane, the resulting image is
necessarily magnified. Historically, measurements from film plane x-rays have been
used in research, and data on statistical norms is based on these magnified x-rays. The
advent of digital x-ray machines introduces some confusion as to how x-rays should be
calibrated with imaging and analysis tools such as Quick Ceph Studio. Here we
illustrate the differences between the traditional Analog x-ray setup and a modern-day
digital x-ray setup.

Traditional

This is the traditional analog x-ray setup. From the geometry of the situation, we can
calculate that the magnification factor is the distance between the emitter and the film
plane divided by the distance between the emitter and the subject (EF/ES). This number
is typically a number between 1.08 and 1.12. That is, x-ray images are typically between
8% and 12% larger than the real-life size of the subject.

In order for analysis programs to perform measurements on a digitized image, a

corresponding calibration between the pixels in the image and a real-life measurement
must be calculated. This calibration is typically specified in dots-per-inch (DPI). For
calibration purposes, it is relatively easy to tape a piece of wire of known length (say
50mm) to the film cassette, and mark this out to the program. For example if the
reference is 50mm and the distance between the endpoints on the image is 300 pixels,
then the calibration is 300pixels/50mm * 25.4mm/inch = 152DPI. This is the film plane
calibration.

216
Modern

The modern digital X-ray setup is, of course, very similar to the traditional setup, except
that the film plane is typically a moving sensor rather than a static film cassette. This
makes it inconvenient to try to place a reference at the film plane. Most of these x-ray
machines come with a ruler at the midsagital plane. This can be used for calibration, but
it gives a midsagital plane calibration, and not the film plane calibration. For example
let's say that the ruler at the midsagital plane is the same 50mm as the reference in the
traditional setup, and on the final image the distance between the end points of the ruler
is the same 300pixels. The midsagital plane calibration is 152DPI, but the film plane
calibration is not 152DPI. The reason for this is that the image of the midsagital ruler as
projected onto the film plane is actually larger than 50mm - don't let the gradations on
the ruler fool you!

If we estimate the magnification factor at 10%, then the image of the ruler at the film
plane is actually 55mm. This gives a calibration at the film plane of 300pixels/55mm *
25.4mm/inch = 138DPI. An easy shortcut to arrive at this number is to divide the
midsagital calibration by the magnification factor: 152DPI/1.1 = 138DPI.

Calibrating x-rays with Quick Ceph Studio

The statistical norms that ship with Quick Ceph Studio are based on film plane
calibrations, and the calibration ruler that is used to calibrate x-rays is a film plane
calibration. Quick Cep Studio allows you to calibrate the x-ray whether you have a
reference ruler at the midsagital plane or at the film plane. To calibrate the x-ray, follow
the instructions in the Digitizing X-Rays and Models chapter.

217
Comparing x-rays From Different Sources

If you want to create superimpositions that compare x-rays from different sources, it is
important that the x-rays are calibrated to the same magnification factor even though it
may not be the exact magnification factor that the x-ray was originally created at.

The reason for this is that magnification factors for various x-ray machines are not
equal, and the error range for a magnification factor can negate any actual growth of the
patient. That is, an x-ray taken at a later date for the same patient can appear smaller
when compared with an earlier one.

The best course to take if you want to compare x-rays from different sources is to
always use the midsagital calibration and magnification factor (the procedure above)
regardless of the type of machine the x-rays came from. This will ensure that the
tracings come out at the correct relative sizes in a comparison.

218