The Digital Radiography Ability is used to manage x-ray images, and provides several annotation and post-processing tools that can be used to enhance your images as needed. It pairs well with several x-ray devices, and is an essential tool for many practices.
This article will guide you through the set up and daily use of the Digital Radiography. We also have a video series discussing this topic if you prefer a more visual style of learning.
- Setting up the DR Ability
- Using the DR Ability
- The CAPTURE workflow
- C - Create a Patient Visit
- A - Add the Visit Details
- P - Position your Sensor
- T - Take the Image
- U - Use any Post-Processing Tools
- R - Review the Layout
- E - Export, Print, or View
- The CAPTURE workflow
Setting up the Digital Radiography Ability
This section will cover the steps needed to configure the Digital Radiography ability so it's ready for usage. It assumes that you have just now had the DR Ability enabled on your license. If you already have access to the DR Ability, please skip to "Configuring Preferences" in this section.
Fetching Your License
If Digital Radiography has just been enabled on your license, it may be you won't be able to see the DR Ability in your Toolbar options immediately. If so, you will need to fetch your license.
To fetch your license, first navigate to the MacPractice Menu, and click Preferences.
Select "Abilities" in the sidebar. You'll be presented with a window with your office and license information. Click the "Fetch License" button in the upper right. This will take a moment.
When done, you'll be presented with a prompt asking you to log out to activate any new features. Log out and back in at your convenience.
If you are unable to access the DR Ability after this step, please contact MacPractice Support for assistance.
Adding DR to the Toolbar
Once you've fetched your license, the next step is to add the DR Ability to the toolbar. This is easily done by right clicking on any blank space on the toolbar. From there, you can left click and hold to drag and drop the DR Ability (or any desired icon) onto the toolbar.
Configuring your Layouts
Before diving fully into the nuts and bolts of the DR Ability, you'll want to consider your Layouts. A layout is a digital assembly that is used to arrange and rotate DR images in a particular way. By setting up your Layouts in advance, you can standardize and streamline your workflow in the DR ability.
You can choose to download our provided Shared Layouts, or you can create your own. We'll cover both options below.
Downloading Shared Layouts
Shared Layouts are pre-made Layouts provided by MacPractice that are freely available to download. To review and download these, navigate to the DR Ability, and click the "Shared Layouts" node in the sidebar.
By clicking on each layout in the upper half of the Shared Layouts view, you can see a preview of how that layout is assembled in the lower half. Once these layouts are downloaded, you can customize them to fit your needs as well. These can be best thought of as templates so you don't necessarily have to start from scratch.
If you find a Shared Layout you'd like to try, simply click to select that layout, then click the "Download" button on the right hand side of the Shared Layouts view. You'll get a prompt when the Layout is downloaded and installed. Your downloaded Layout will be located in the Layouts node.
Once a Shared Layout has been downloaded, they can be edited like any other Layout in the Layouts node. Before editing this layout, we strongly recommend duplicating a Layout by selecting it in the sidebar and choosing "Duplicate Record" in the Edit Menu. This will ensure that if you do make changes that you wish to revert, you can select the original Layout.
Creating a new Layout
If you would prefer to create a new Layout from scratch, you can easily do so by clicking on the Layouts node, then clicking the Green Plus in the sidebar. You can then name and set a description for the layout, as well as set the default sensor for this layout, either a Planmeca or Suni device. You can also leave this set at "None".
Remember to save the Layout by pressing Command-S once you've given it a name and description.
Adjusting and Testing your Layouts
Once you have either a New or a Shared Layout, you can then populate and make changes to that layout in the Layouts node.
To add a new "box" for an image, you can click the Green Plus in the upper right of the Layouts view. This will add a new box, denoted by a blue square. You can then click and drag that box to anywhere on the layout space.
You can also resize boxes by moving your cursor to one of the eight red dots, then left clicking and dragging that dot.
You can edit the details of each box either double clicking a box, or right clicking the box and selecting "Edit" from the menu.
The fields are:
- Layout Box Name: The name of this particular box in the Layout.
- Image Number: This number identifies the order in which images are added to the layout. 1 would indicate the first image will go into this box, 2 being the second, and so on. You can also set a range so multiple images can go into this particular box.
- Preset: The Preset is a particular configuration of post-processing that is applied to the image. By setting a Preset here, this box will automatically apply the preset to the image in this box.
Presets will be covered in the "U - Use Any Post Processing Tools" section of this article.
- Stamp: This selection will add an annotation clarifying whether this box is for the left side or the right side. You can choose Right, Left, or None.
- Tooth Numbers: This field indicates which teeth this box should relate to.
- Image Type: This selection allows you to assign an Image Type to the image in this box. Image Types can be found, and added or deleted in the "Images by Type" node.
We strongly recommend that you test your layouts with test patients before using the Digital Radiography in a live environment.
Finally, there are several Preferences available in the MacPractice Menu > Preferences > Digital Radiography section that can be adjusted to meet your needs. As you're just beginning to use the DR Ability, you may not be certain how to configure these. Likely you will need to return here once you've gotten accustomed to the DR Ability to maximize your workflow and tweak settings to your liking.
This tab allows you to set a Default Layout and Presets for your visits. You can also import and export Layouts and Presets here. More importantly, you can configure an Auto-Import folder here (covered in Setting Up an Auto-Import Folder)
This tab allows you to set the default configuration for tools and annotations, as well as calibrating the measurement units for integrated devices.
This tab allows you to set a Planmeca or Suni Integrated Digital Radiography device.
This tab allows you to configure the color schemes for Visit Layouts, Thumbnails, and Image Editing. You can also restore the color schemes to their default values here via the "Restore Defaults" button.
Setting Up an Auto-Import Folder
An Auto-Import Folder, when set up, will automatically import any images placed in this folder when a new Visit is created, and then clear the folder. An Auto Import folder best functions when your Digital Radiography device software is configured to deposit imaged files in the same folder, so you can scan, then create a visit, which will port those files to your layout smoothly.
To set up an Auto Import Folder, navigate to the MacPractice Menu and select "Preferences". In the Preferences Window, select Digital Radiography in the sidebar.
From here, click the Green Plus in the Auto Import section. You'll be warned that any files set in here will be deleted once they are imported into MacPractice. Then you'll be prompted to select a folder.
Don't forget to check the "Enabled" checkbox once you've added the folder. This will activate the Auto Import folder.
The crux of the DR Ability is the CAPTURE Workflow, which stands for...
- C - Create a Patient Visit
- A - Add the Visit Details
- P - Position the Sensor
- T - Take the Image(s)
- U - Use any Post-Processing Tools
- R - Review the Layout
- E - Export, Print, and View
We'll cover each step of the workflow.
Visits are located in the "Patients with Visits" node on the sidebar. You can create a Visit from the Visit Selector by clicking the Green Plus above the Visit Selector. If you don't have a patient selected, you'll need to select a patient or click the Green Plus in the sidebar with the Patients with Visit node selected. This will bring up the patient selector.
Once you click the Green Plus in the Visit Selector, you'll be presented with the Visit Creation window, where 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.
The fields in the Visit Details window are:
- Visit Name: The name of the visit. This could be the reason for the visit, such as Bitewing, Panograph, X-ray, etc.
- Provider: The provider tied to this Visit.
- Office: The office that the Visit occurred at. For most practices, you'll only have the one Office. If you have multiple Offices, be sure to double-check to ensure you select the right one!
- Incident: The incident that the Visit is associated to.
- Layout: Required. This field selects the layout used to arrange the visit images.
- Notes: This field is for notes regarding this Visit.
- Date: The Date of the Visit.
- Click the Green 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.
There are three main ways to take or add images to a visit: through an integrated device, via an 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 via an Integrated Device
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 selected in the Device tab of the Digital Radiography panel in Preferences.
To set the device, install the device drivers according to the manufacturer's instructions 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.
In order for this to work efficiently, your scanning software should be configured to target a folder which MacPractice can access.
Once this is complete, you can set 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.
A prompt will appear, warning you that any image files in the designated folder will be deleted once they have been imported. When you visit the DR Ability and select a visit, those images will be imported and deleted at at that moment.
To drag and drop a file, simply left click an image file, and with the left mouse button pressed, hold and drag the cursor to the desired Layout box.
You can also drag and drop multiple images into a layout. By naming the image files by the same numbers as the layout boxes, these images will automatically insert into the appropriate layout boxes. To do this:
- Re-name the images to numeric values matching which layout square they should be inserted to. Example: For Layout Box 1, 1.jpg, for Layout Box 2, 2.jpg, and so on.
- Select all of the images
- Drag & Drop the images or image folder into the gray image thumbnail area above the layout boxes and the Layout and Sensor drop down menus.
Once you've pulled your images into your layout, the next step is to use post-processing to adjust the images to your needs. We'll cover the basics here, but more information will be available in "Use Post-Processing Tools" article.
Image Editing Window
In order to open up the Image Editing Window, double-clicking an image either in the summary thumbnail or in a Layout Box. This will open up the Image Editing Window.
In the center of the Window, you'll see the current image. You can use the arrow buttons at the top to navigate between layout boxes for your current layout. You can also right click the image to apply filters and flip/rotate the image.
On the left side of the Image Editing Window, you'll find your Tool Selector. This has a variety of tools that can be used to manipulate or annotate the image. By hovering your mouse over the various tools, a tooltip will appear with the name of that tool. You can find a complete list of the tools and their function in the Use Post Processing Tools article.
The Adjustment Palette can be found on the right side of the window. This contains your presets, which are previously configured filters that can be applied with a single click of the "Apply" button. To add Presets, click the Green Plus.
Below that are the list of filters, which can appear differently depending on whether you are on Gen 7 or Gen 9 of MacPractice.
MacPractice Gen 7 (Build 7.3 and prior)
In Gen 7, the Adjustment Palette contains all of the potential filters you can use. By clicking the drop down triangle on the left side of each filter, you can expand that filter to show its settings. To apply that filter, click the checkbox by the desired filter.
MacPractice Gen 9 (Build 10.0 and above)
In Gen 9, the Adjustment Palette is structured like a blank canvas. Using the "Add Filter" drop down menu, you can add filters to be used. This provides a cleaner layout that you can customize. You can re-order filters by dragging and dropping them in order.
For more information on what each filter does, please refer to our Use Post Processing Tools article.
Once you've completed applying filters and presets, now it's a good time to take a moment to review the layout to ensure everything is correct. If you find a need to adjust the layout you're working in, you can use the Layout drop down menu in the middle of the Visit Window to switch to that layout.
You can also edit the layout by right clicking on any layout box and selecting "Edit Layout". This will take you to the Layouts Node with that layout selected, so you can make changes there.
With the preceding steps finished, you're now done with your layout! You can now either export the Visit, print it, or simply refer to it in full screen.
You can export a visit by right clicking on that visit and selecting "Export All Visit Images". This will bring up a location selector window where you can choose where to export the images to, as well as select the file format, and whether annotations and filters are included when exporting.
You can print DR images by selecting the patient's Visit and either navigating to the File Menu and selecting Print. You can also hold down the Command key and press "P" for Print. Either method will bring up the printing prompt.
Full Screen View
To display any Visit in a full screen view, first select the Visit. There is a full screen button in the upper right of the layout view, parallel to the Layout and Sensor drop down windows. This will bring up the current layout into a full screen view.