The workflow in MacPractice's Digital Radiography ability can be described using the CAPTURE workflow:
- Create a Patient Visit
- Add Visit Details
- Position the sensor
- Take the images
- Use post-processing tools
- Review the Layout
- Export, Print, or View
Visits can be created in One mode, where a patient is already selected, or in Many mode, where no patient is selected.
Under Many mode, select a patient by clicking the plus button to open the patient search window. Search for and select the desired patient. Click the OK button. The patient's name will appear under the Patients with Visits node in the sidebar and One mode will be activated. The resulting window will be the visit creation window, to which visit details are added.
With a patient selected, the patient's name will display under the Patients with Visits node in the sidebar. Click the green plus button in the Visits table to create the new visit. The visit creation window will open, and you can enter details about the visit.
After creating the Visit, the visit details window will display. You can add visit details, including the Visit Names, Provider, Office, Incident, or Date. There is also an option to add any relevant Notes to the visit.
A Layout must be selected.
- Visit Name: Name the visit. This may be the reason for the visit, such as Bitewing, Panograph, X-ray, and so on.
- Provider: Select the provider for this visit.
- Office: Select the office.
- Incident: Associate the visit to an incident on the patients ledger.
- Layout: Select the layout (the view) in which to display the visit images.
- Notes: Notate specific information about this visit.
- Date: Change the date if today's date is not desired.
Add the visit details and click the Save button. The layout selected will display in the main window.
- Click the plus button in the Visits table to add another visit. Click the minus button to delete the visit from the visit list.
- In the Layout menu, an alternative layout can be selected.
- In the Sensor menu, an integrated device (Suni and Planmeca only) can be selected.
While positioning the sensor, it is important to follow the sensor manufacture's guidelines on sensor positioning as defined by the anatomy, rotation, exposure, and aesthetic of the desired resulting image. There are no specific guidelines to positioning in terms of the MacPractice software, however positioning the sensor appropriately is directly related to radiation dose and plays an important role in the final diagnostic quality of any image.
Before capturing the first image, consider this general information on Radiation & Positioning:
- Radiation: The ideal radiation to shoot for is 7 milliamps, 70 kilovolts, 16 pulse (time). Radiation should also be decreased depending on the image to be taken. For images of children, or for anterior teeth on adults, there should be a 30% decrease in radiation compared to an adult posterior image. This may be adjustable on the radiation source. If the radiation source is not adjustable, positioning can be used to decrease radiation. For example, repositioning the radiation source back three inches would decrease the radiation 30%.
- Positioning: Positioning is extremely important in the quality of x-rays. The radiation source should be as perpendicularly positioned with the sensor as possible. Incorrectly positioning the sensor can create inconsistent exposure across an image. For instance, the area between the teeth should be consistently dark from one side of the image to the other. If one side of the image appears to be lighter than the other, this indicates a problem with positioning.
For more information on image positioning and the relationship between final quality and the Digital Radiography device, please see the Contextual Guide to Post-Processing.
There are three main ways to take or add images to a visit: through an integrated device, import folder, or manually. Each of these methods will require that the device and any necessary drivers are installed per the manufacture's instructions.
- Integrated devices such as Suni and Planmeca will automatically import images into MacPractice once the device has been properly configured.
- Many devices can automatically import images to MacPractice through the use of an import folder. The device and MacPractice will need to be set to the same target folder.
- Images can also be added to MacPractice manually by browsing for the image or by dragging directly to the layout.
Adding Images - Integrated Devices
Integrated Devices, such as Suni or Planmeca devices, will automatically import images into MacPractice once the device drivers have been installed and the device has been set within the Device tab of the Digital Radiography panel in Preferences.
To set the device, install the device drivers and select the device from the Device menu.
Depending on the device selected, the Preferences window may offer additional settings. For more information, please see the Digital Radiography Preferences section.
For more information on the use of Suni devices, including Suni driver installation instructions, please see the Suni Integration documentation.
Adding Images via an Import Folder
Auto import folders can be used to automatically import images from a target folder. Set the target folder of the device as the auto-import folder in the General tab of the Digital Radiography node in MacPractice Preferences. Click the green plus button, select the target folder from the resulting window, and click the Open button. The path will be added to the list of Auto import folders and checked in the Enabled column.
When using an Auto import folder to add images to Digital Radiography, images will be deleted from the target folder as they are imported. The images will automatically import directly to a visit layout once a visit is selected in MacPractice.
There are two methods for Drag & Drop: Single, and Group.
Single Drag & Drop:
- Select the image from the image folder.
- Drag & Drop the image into the correct layout box.
Group Drag & Drop:
- Name the images as numbered in the layout Capture Order which they should be placed.
- Select the images or image folder.
- Drag & Drop the images or image folder into the gray image thumbnail area.
Post-Processing in Digital Radiography can involve changing image attributes such as tooth numbers or tags, adding filters, annotations, cropping, and so on.
The Options Menu
Image information attributes can be modified in the Options menu. To access the Options menu, right-click (or Control-Click) on the image. From the resulting menu, select Edit Image Details...
Within the Image Details window, change the associated Visit and Image Type, or add a Tooth Number, Capture Order Number, or Description.
- Visit: If necessary, associate the image to a different visit.
- Tooth No. or Tag: If applicable, add a Tooth number or Tag.
- Type: Associate the image to a specific Image Type.
- No.: If necessary, assign a different Capture Order number to the image to change the layout location.
- Desc: This field automatically pulls the date the image was created and its file size.
Apart from the Edit Image Details window, the Option menu can also be used to modify image attributes:
- Open Image: Opens the selected image in the Layout even if there are multiple images assigned to the layout block.
- Open Image in Layout Item: Opens all images that are in the layout block.
- Export As: Opens an Export window.
- Export Original As: Opens an Export window with the option to Include Patient Name and/or Annotations on export.
- Delete: Removes a single image in the selected layout.
- Delete All In Layout Item: Removes all images associated to the layout.
- Edit Layout: Accesses the Layout node in the sidebar.
- Browse For Image: Browses for images to import.
- Permanent Upper, Lower and Primary Upper, Lower: These options associate images to Restorative Charting.
- Presets: Displays the list of added Presets to apply to the image.
- Rotate Clockwise, Counterclockwise: Rotate the image.
Image Editing Window
The Image Editing Window allows the manipulation of image using the toolbar. To access this, double-click on the image thumbnail or in the layout box. The Image Editing Window will open. The Adjustment Palette will be present on the right pane as shown in the below screenshot.
If the Adjustment Palette does not appear, click the right "Toolboxes" button in the toolbar.
You can customize the Toolbar at the top by right clicking (or Control-Clicking) the toolbar and select Customize Toolbar from the Toolbar menu.
The Customize Toolbar window will appear with each of the toolbar Icon options. This functions much like the MacPractice "Customize Toolbar" option. Drag the default toolbar to include the standard configuration, or you can drag and drop individual icons around to meet your needs.
The important icons to note are the left and right "Toolboxes" icons. These control whether the left or right panes are visible. The left pane contains the Tool Selector, and the right pane contains the Adjustment Palette.
Right Click Context Menu
In the Image Editing window, you can right click (or Control-Click) to gain access to a Context Menu. The options available in this menu depend on what you currently have selected. Without an annotation selected, the annotation-specific options are greyed out.
- Tools: This item allows you to quickly select a tool instead of using the Tool Selector. Please refer to the next section on descriptions of all of the available tools.
- Export Image: Allows you to export the image to a file format outside of MacPractice. This brings up an Export window where you can configure the options for the exported file.
- Flip Horizontally/Vertically: These options flip the entire image accordingly.
- Rotate Clockwise/Counter-Clockwise: These options rotate the entire image accordingly.
- Stamps: Allows you to set a Left or Right stamp on the image for easy marking/identification. You can also remove stamps via this option.
- Hide/Show Annotations: If Annotations are showing, this option will allow you to hide Annotations. If they are already hidden, then this option will show Annotations.
- Delete Selected Annotations: If an annotation is selected, this option will be available and will allow you to delete the selected annotation.
- Delete All Annotations: This option will delete all annotations from the image.
- Rotate Selected Annotations 90 Degrees Clockwise/Counter: This option is only available if a valid annotation is selected, and rotates the annotation as indicated. Not all annotations can be rotated.
- Reset Filter Settings: This option will reset any applied filters to the image.
Tool Selector
On the left side of the Image Editing Window, you can find several tools to annotate and manipulate your images. By hovering your cursor over an icon, you can get a bit more information for each tool.
All annotations can be copied and pasted by using the Command-C/Command-V keyboard shortcuts.
The tools available in the left pane of the Image Editing Window are:
- Flip Image Horizontally: Flips the image on its x axis. You can also do this by right clicking on the image and selecting "Flip Horizontally".
- Flip Image Vertically: Flips the image on its y axis. You can also do this by right clicking on the image and selecting "Flip Vertically".
- Rotate Image Counter Clockwise: Rotates the image to the left. You can also do this by right clicking on the image and selecting "Rotate Counter-Clockwise".
- Rotate Image Clockwise: Rotates the image to the right. You can also do this by right clicking on the image and selecting "Rotate Clockwise".
- Invert Image: This inverts all of the colors on the image.
- Sepia Tone Image: This sets the image to a Sepia tone.
- Zoom In: Makes the image larger.
- Zoom Out: Makes the image smaller.
- Arrow Tool: This is the default selector tool. If an item has been placed on the Image, this tool can move that item around.
- Hand Tool: When zoomed in, the hand tool can pan/scan the image when dragging.
- Line Measure Tool: This will create a line and define the measurements as set in Preferences > Digital Radiography > Image.
- Angle Measure Tool: This measure the angle of two created lines by a measurement set in Preferences > Digital Radiography > Image.
- Text Tool: This creates a box in which text may be typed. Right clicking on the text will bring up text options for size. Apple automatically renders a drop shadow on text objects. This shadow does not apply to other annotations.
- Text Bubble Tool: This creates a comic-book-like speech bubble that can be resized and moved over different places on the Image.
- Rectangle Tool: This creates a rectangle that can be resized and moved over different places on the Image.
- Oval Tool: This creates an oval that can be resized and moved over different places on the Image.
- Star Tool: This creates a star shape that can be resized and moved over different places on the Image.
- Point Tool: This will create dots on the Image.
- Open Polygon Tool: This will create dots on the Images similar to the Point Tool but multiple dots will be connected by a line between two points.
- Closed Polygon Tool: Similar to the Open Polygon Tool, this allows the creations of multiple dots. As each dot is placed, a shape is formed instead of a single line from point to point.
- Left Arrow Tool: Dragging creates the image of a left facing arrow.
- Right Arrow Tool: Dragging creates the image of a right facing arrow.
- Freehand Tool: Dragging creates a line that follows the cursor.
- Line Tool: Similar to the Point Tool, this creates a line between two points. You can add arrow pointers to a Line by right-clicking it and selecting "Line Annotation End Point Style". You can add an arrow pointer to either end of a line.
- Contrast Tool: With this selected, the contrast can be adjusted by dragging the cursor up, down, left and right.
- Spot Enhancer Tool: This turns the cursor into a magnifying glass. It enhances the contrast the showcase lighter or darker areas.
- Crop Tool: Dragging will open up the image within the box drawn.
- Magnify Tool: This turns the cursor into a magnifying glass on the image.
- Weight: This will change the width of the line any value between 0.00 and 20.00
- Color: This changes the color of the lines on the Image.
In MacPractice Builds 7.3 and earlier, all available filters are automatically listed. You can click the triangle drop down to adjust that particular filter, and click the checkbox to enable/disable that particular filter.
MacPractice Gen 9
In MacPractice Gen 9, you can control which filters appear by clicking the "Add Filter" drop down and selecting which filters you'd like to use. They then appear in the Adjustment Palette. You can then click the X in the upper right corner to close a filter.
If you have multiple filters added, you can also drag and drop them into whichever order you prefer. This may have an impact on how the image is filtered. The filters will be applied in order from top to bottom.
- Presets: Creates Automatic Adjustments.
- Image Histogram Equalization: Adjusts contrast using the histogram by spreading the most frequent intensity values. The method is useful in images with backgrounds and foregrounds that are both bright or both dark.
- Auto Levels: Analyzes a histogram and adjusts the levels to maximize the dynamic range. The Cut Off slider allows adjustment to the grayscale midpoint.
- Pseudo Median: Reduces noise using possible medians.
- Median: Reduces the amount of "salt and pepper" noise (where pixels have independently become black or white) by replacing these pixels with the appropriate median intensity.
- Noise Reduction: Reduces the amount of noise in an image by smoothing graininess.
- Level: Smooths by harmonizing pixels with neighboring pixels.
- Sharpness: Reduces blur applied by noise reduction level smoothing.
- Unsharp Mask: Increases contrast of edges between differently colored pixels.
- Intensity: Controls magnitude of line edge contrast.
- Radius: A smaller radius enhances smaller-scale detail.
- Sharpen Luminance: Increases image detail through a sharpening.
- Color Control: Controls brightness, saturation and contrast.
- Saturation: Affects the vividness of a color's hue.
- Brightness: Controls the lightness from dim to bright.
- Contrast: Controls the brightness range between light and dark areas.
- Exposure: Controls the intensity of light.
- Gamma: Controls the relationship between the brightness of a pixel as it appears on the screen and the numerical value of that pixel.
- Hue: Controls the tint of the source pixels.
- Color Map: Transforms colors values using tabled values.
- Emboss: Filters the image to appear raised or stamped by suppressing internal color and darkening edges.
- Crop: Removes unwanted areas from an imageThe R button next to each filter is the reset button. The reset button will become active when the filter is enabled. If the reset button is selected, it will return the filter back to its original settings.
- Histogram: The Histogram box displays a graph that shows the values of the pixels in an image. It plots the number of pixels in the image on the vertical axis with a particular brightness value on the horizontal axis. For more on the importance of the Histogram tool in image editing, please see the Histogram documentation.
Filter Settings Control
Filter Settings can also be found through the Image Preview window by right-clicking on the image within Image Preview. Select the Filters option on the resulting menu. Next, select the specific filter which should be applied to the image.
When filters are applied through the Image Preview menu itself, the Filter setting selected will open a Control window, where filter settings can be adjusted next to an adjustment preview. Adjustments made with the Control sliders will be reflected in the Control window. The Preview checkbox can also be checked in order to preview the adjustments in the Image Preview menu.
Filters that are not available to preview using the Control window method include Image Histogram Equalization, Invert Image, Median, and Sepia Tone. When selected from the Filters list, these filters will automatically be applied.
While designing and editing Layouts may be part of the initial Digital Radiography configuration process, it is also possible that the Layout may require further adjustment or a different Layout may be desired for the unique visit.
A completed layout can be exported, printed, or displayed in full-screen for onsite diagnosis. The layout will also be saved in the Patients with Visits node for future editing or review.
To Export all images for a visit, right click the visit and select Export All Visit Images... from the option menu.
The images for the visit will display within full screen mode, with thumbnails below to select any other image from the visit.
Within full screen mode, you may also select a new visit or layout from the left menus. The center segmented button selects to display the image layout, or just the individual images from within each layout. The sensor menu selects a new sensor.
Click the full screen button to the right to exit full screen view and return to the MacPractice window.
