manual ortopam gendex 9200_en.pdf

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Orthoralix 9200May 2005 - Operator manual

3. Safety procedures

5. Control panel

6. Preliminary procedures

7. Making an exposure in panoramic mode

4. General description

8. Standard panoramic programme

11. Making an exposure in Transversal tomography

10. Image quality

12. Making an exposure in cephalometric mode

13. Geometry of the x-ray projections

14. Hygienic procedures and cleaning

15. Configuration programme

16. Technical data

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Orthoralix 9200

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Contents

1. Read me first

2. Standards and Regulations

9. Special projection modalities 20

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English

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Orthoralix 9200May 2005 - Operator manual 2

1. Read me first

This manual in English is the original version.

Due to the constant engagement of Gendex to the technical improvement of its products, all data and information in thisOperator's Manual are subject to change without prior notice.

The operation of Orthoralix 9200 is supervised via the touch-control panel on the right sideof the unit, and by the mode selected with the x-ray collimator on the tubehead.

The keys necessary for the normal operation of the machine (pre-setting of techniquefactors, selection of the projection modality, patient positioning) are located in the lower partof the control panel. The upper part of the same is reserved for those keys whose use is notessential in all cases.

The collimator on the tubehead has four positions, corresponding to the following modes:

• Panoramic• Transcan• Cephalography, Latero-Lateral• Cephalography, Antero-Posterior

The first mode is available in all versions of the Orthoralix 9200, the others are accessibleonly if foreseen for that particular version.

A pictographic quick reference guide is positioned on the right side of the column, close tothe control panel. Step-by-step instructions necessary to execute a Standard Panoramicexposure are illustrated here. Refer to this manual for the differences in the operation for theother panoramic and for the Transcan mode.

In the case of a cephalometric tele-radiography attachment a similar pictographic quickreference guide is positioned on the ceph arm, illustrating the step-by-step actions necessaryto execute a Latero-Lateral exposure.

Three types of text are used in this manual:

Normal text, for the information that you should read through in order to operate Orthoralix9200 correctly;

Notes, indicated by the icon, for a more in-depth familiarity with the equipment;

Warnings, indicated by the icon.

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1. Read me first

This manual is intended to assist the user in the safe and efficient operation of the equipmentdescribed. The equipment must be used in accordance with the procedures contained in themanual and must not be used for purposes other than those which are described herein. Theequipment should only be used by persons having recognised qualifications and, if relevant,having adequate training on that particular equipment, especially regarding protective measuressuch as radiation protection. It is the responsibility of the user to ensure that existing legalregulations regarding installation of the equipment are observed. Moreover, the legalregulations regarding operation of the equipment must be observed. Incorrect operation, orfailure of the user to maintain the equipment in accordance with the maintenance schedule,relieves the manufacturer or his agent from all responsibilities for consequent non-compliance,damage, injury, defect and/or other malfunction.

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The Orthoralix unit is designed to meet the following standards:

• General electrical & mechanical safety:IEC 601-1 (1988) +Am 1 (1991) + Am 2 (1995)IEC 601-1-4 (1996) +Am 1 (1999)IEC 60601-2-7 (1998)IEC 601-2-28 (1993)CSA-C22.2 n. 114UL 187• Radiation protection:IEC 601-1-3 (1994)Röntgenverordung• Electro-Magnetic Interference:IEC 60601-1-2 (2001-09)• Lasers:IEC 60825 -1 (2001)

0051 The CE symbol ensures that the product herein specified, and manifactured from1998 onwards, meets the provisions of the European Council Directive 92/42 concerningmedical devices.

ClassificationThe Orthoralix 9200 is Class I and Type B electromedical x-ray equipment according toIEC 601-1(1998)

Explanation of symbolsThe following symbols are used in the equipment and/or in this manual:

Equipment classified as Type B by IEC 601.1

Consult written instructions (this Operator’s Manual)

General x-ray radiation warning

Laser warning label

Beware of moving mechanical parts

Warning (in this Operator’s Manual)

Note (in this Operator’s Manual)

Mandatory reporting according to the European Directive for 93/42 medical devicesIn order to fulfill the obligations foreseen by the CE marking, the user is obliged to report anyaccident involving the medical device; any alterations to its features or in its performance -including insufficient user's instructions - which could cause death, injuries or health hazards topatient and/or operator, to the competent Health Authorities. Such reporting must also be promptlynotified to the manufacturer or his agent, in order to permit the fulfilment of the obligations foreseenfor said manufacturer in the a.m. European Directive.

2. Standards and Regulations

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3. Safety procedures

In the interest of the safety of patient and user, the following points should be observed:• General

The equipment must never be used if it shows any electrical, mechanical or radiation defectswhatsoever. As all electromedical devices, this x-ray system requires correct installation, handling,maintenance and servicing in order to ensure safe and efficient operation. Refer to the TechnicalService Manual for the recommended programmed maintenance activities. Modifications andadditions to the equipment must be carried out only by Gendex personnel or third parties that areexpressly authorised by Gendex, and must comply with the applicable legal requirements as wellas with the generally accepted technical regulations.The tubehead contains mineral insulating oil . Such oils are potentially harmful in case of ingestionor contact with skin or mucosa. In case of a defect or fault, an oil leak can occur. Avoid directcontact with the oil and do not inhale its vapors. In case of minor leaks, the oil can be wiped awaywith a dry cloth, wearing protective gloves.

• Radiation protectionThe Orthoralix 9200 implements various built-in measures to prevent excess radiation (leakage,secondary, and scattered) from reaching the patient, the operator, and other persons. It is theresponsibility of the qualified Radiation Protection Inspector to ensure that the proper measuresare taken to prevent undue radiation exposure to personnel and to the public at large. All personnelin the examination room must exercise radiation safety procedures. To protect the patient againstunnecessary radiation, other accessories can be used whenever necessary, in addition to thoseprovided on the x-ray equipment itself (collimators, shields, spacers and filters). Care must betaken, however, that these accessories do not interfere with the proper radiographic operation ofthe apparatus. For instance, lead-shielded collars should be avoided as they may block the useful x-ray beam. The following points must always be observed by the operators:- Always ensure that the film cassettes are in perfect condition;- Maintain a safety distance of at least 2m from the x-ray tube during exposure;- All persons not directly involved with the patient should be outside the examination room, orbehind lead or leadglass shielding, during the exposure;- A film badge should be carried for personal monitoring.If the above mentioned precautions are observed, the cumulated dose imparted to personnel is wellbelow the applicable limits specified by the national and international standards.

• Electrical safetyOnly qualified service personnel should be authorised to remove the covers of, or otherwise obtainaccess to, parts of the equipment that include line voltage powered circuits. The equipment mayonly be used in rooms which comply with the relevant national and/or international legislation andrecommendations concerning electrical safety in rooms used for medical purposes, e.g. IEC, USNational Electrical Code, or VDE standards.Always disconnect or switch off the equipment before cleaning or disinfecting. No water or anyother liquid should be allowed to enter the equipment, as they could cause short-circuits andcorrosion.

• Mechanical SafetyDue care must be taken when the system is used to ensure that neither patient nor personnel reachinto the equipment or get their clothing caught in it. The equipment contains mechanical componentssuch as cables, rubber belts and gears, which are subject to operational wear and tear. To preventany risk of injury to patient and operator due to components which no longer comply to normalsafely standards (e.g. worn cables subject to movement), the equipment must be subject to regulartechnical testing and maintenance.

• Explosion safetyThis equipment is not suitable for use in the presence of flammable gases or vapours. Certaindisinfectants vaporise and form explosive mixtures. If such disinfectants are used, the vapoursmust be left to disperse before the equipment is powered-up again.

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• Positioning safetyDuring Panoramic procedures, the patient is positioned facing the positioning mirror in front of him.On reset position, the cassette holder will be at his right and the tubehead at his left.

When using the Orthoralix 9200 with film and cassette with intensifying screens, please payattention to the way of introduction of the cassette into the cassette holder.On the surface of the cassette supplied with the Orthoralix 9200, there’s a mark “tube side” whichhas to be placed in the direction of the tubehead when loading the cassette. Inside the cassette, theprovided intensifying screens are reporting the letters L (left) and R (right) for the identification ofthe image sides.Once the exposure has been performed, positioning references (L and R) will be displayed on theacquired image:

L (Left) to indicate the left side of the patient’s mouth,R (Right) to indicate the right side of the patient’s mouth.

On symmetrical images both L and R can be used, on half-exposure images only one letter (L or R),indicating the side of the mouth, is useful for the image identification. No letter is placed incorrespondence of the centre of the mouth.It’s strongly recommended to pay attention to the L and R letters to identify the anatomical side andto avoid any mistake during the its evaluation.The L and R letters have to be shown, not mirrored, at the bottom of the image.Whenever using a film cassette different from the one provided with the Orthoralix 9200, it’sstrongly recommended to pay the maximum attention to its correct introduction way and to refercarefully to the user instruction of that cassette for a correct use.

When using the Orthoralix 9200 with phosphor plates (PSP), the cassette is not equipped withintensifying screens, so no reference letters are inserted in it.It’s strongly recommended to refer carefully to the instructions of the cassette, the Phosphorplates and the scanning system for a correct image interpretation. Usually the Phosphor plates areincluding reference letters to identify the image sides and the user has to follow the manufacturer’sinstructions to use it properly.During Cephalometric symmetrical projections, taken with either film or Phospor plates, neither Lnor R is displayed on the image, due to the impossibility for the system to detect if the patient isplaced in Antero-Posterior or Postero-Anterior position. It’s user responsibility to pay attention tothe anatomical side.• Laser safety

This equipment is designed in accordance with IEC 60825-1: 2001 the position of laser soucesare emphasised by mean of the following warning labels (black on yellow).

Although compliant to the safety rules, it is a good practice for the operator to avoid to expose hiseyes and patient's eyes directily to the laser beam

• Location of lasers apertureTwo lasers for the lighting of the mid-sagittal plane (vertical laser beam) and the lighting of theFrankfurt plane (horizontal laser beam) are positioned behind the mirror (see picture next page).The laser for lighting on the canine, corresponding to the roots of the lateral incisors (verticallateral laser beam) is positioned on the rotating arm, on the left of the sensor (see picture nextpage).Caution - use of controls or adjustments or performance of procedures other than those specifiedin manual may result in hazardous radiation exposure.

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The Orthoralix is a system for rotational panoramic radiography of the dento-maxillo-facial area.

The system consists of: - A counter-balanced motorised column to be fixed to wall, or to an optional free standing

base, - A motorised over-head carriage with controls for patient positioning, technical factors

and radiographic projection geometry; - Cassette drive system with flat cassette for 15 x 30 cm film; - X-ray tubehead, with DC power supply to the x-ray tube via electronic converter; - Remote control box and handswitch; - An optional cephalometric arm (tele-radiography).

During a panoramic exposure, the x-ray tube and cassette holder move on a trajectoryaround the patient head. The beam from the x-ray tube is collimated by a slit diaphragm.The flat cassette passes behind a secondary collimator, which suppresses the scatteredradiation originating from the patient.

All movements for the radiographic panoramic projection are performed by four independent,microprocessor controlled stepper motors. Various projection geometries for panoramicexposures and for different diagnostic purposes are possible.

Patient positioning is simple, accurate and consistent thanks to the motorised headrest, themotorised displacement of the x-ray generator assembly while the patient remains immo-bile, the indication of the positioning data, and various other available positioning devices.

Thanks to the robotized movement technology, various exposure modalities with differentprojection geometries can be executed.

For common panoramic radiography, the Standard Pan modality should be selected. Withthis projection programme, the entire dental and alveolar region as well as the rami and theTMJ can be depicted.

Depending on machine version, programmes for several other projection modalities can beselected in addition to the Standard Pan.

The different versions and options available are:- Orthoralix 9200 - equipment with limited projection programmes functionality (withoutAEC program)

- Orthoralix 9200 Plus - equipment with full projection programmes functionality (withAEC program);

- Orthoralix 9200AEC - equipment with limited projection programs functionalityand AEC program supported);

- Dento-Maxillo-Facial option (DMF for Orthoralix 9200);- Transverse Scannography option (Transcan for Orthoralix 9200);- Ceph option (for both 9200 & 9200 Plus versions).

By upgrading an Orthoralix 9200/9200AEC with both the Dento-Maxillo-Facial (DMF) optionand the Transcan option, you obtain an Orthoralix 9200 with full capability.


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Projection programmes available in all versions (Orthoralix 9200/9200AEC/9200 Plus):

• Standard Panoramic• Child Panoramic• Orthogonal Dentition• Right Half-Panoramic• Left Half-Panoramic• Lateral TMJ (central on film)• Lateral TMJ (external on film)

Special projection programmes of the Dento-Maxillo-Facial option:

• Left Half-Orthogonal Dentition (also for Transcan option)• Right Half-Orthogonal Dentition (also for Transcan option)• Front Dentition (wide stratum)• Frontal TMJ• Frontal sinus• Right lateral sinus• Left lateral sinus

Projection programmes of the Transversal tomography option (Transcan mode):

• RR Incisors 3 mm (right incisors)• RR Posteriors 3 mm (right cuspids, right premolars, right molars)• RR Incisors 6 mm (right incisors)• RR Posteriors 6mm (right cuspids, right premolars, right molars)• LL Incisors 3 mm (left incisors)• LL Posteriors 3 mm (left cuspids, left premolars, left molars)• LL Incisors 6 mm (left incisors) left cuspids• LL Posteriors 6mm (left cuspids, left premolars, left molars)

If the optional tele-radiography arm and cephalostat is installed (Ceph option), the Cephmode provides facilities for cephalography in Latero-Lateral, and for Antero-Posterior orPostero-Anterior projections.

AEC MODE (Orthoralix 9200 Plus)

For the major part of the panoramic and cephalometric projections (Latero-Lateral, Posterior-Anterior or Anterior-Posterior) available in the configuration "9200 Plus/9200AEC " it ispossible to activate the Automatic Exposure Control (AEC) mode.AEC is a real-time control of the dosage necessary to obtain the correct exposure of theradiography, varying the preimposed technical factors for the selected patient type (kV forPanoramic projections, and exposure time in Cephalometric mode). For further informationrefer to the subsequent paragraphs.

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-kV Decrease kV for the next exposure;

+kV Increase kV for the next exposure;

- mA Decrease mA for the next exposure;

+mA Increase mA for the next exposure;

-s Decrease s for the next exposure(s)(ceph mode only);

+s Increase s for the next exposure(s)(ceph mode only);

The unit is in Ceph mode;

The unit is in Transcan mode;

The unit is in Panoramic mode;

Patient size indicator (small, medium, large);

Patient size selector;

Browse between the available projections;

Browse between the available projections;

Select the Standard Panoramic programme;

Move the overhead x-ray carriageposteriorly to patient;

Move the overhead x-ray carriageanteriorly to patient;

Select/deactivate Automatic exposureControl;

Close the headrest;

Open the headrest;

Switch on the timed centering lasers;

Move the x-ray overhead carriage up;

Move the x-ray overhead carriage down;

Reset position, moves overhead x-raycarriage into start position:

Dummy run, execute a simulation of theselected programme by performing themovements without x-ray emission;

The equipment is ready for an x-rayemission;

X-rays are being emitted.

5. Control panel

Each keystroke is associated with one, and only one function or operation: the operator therefore, does notuse more than one key to initiate a given function. Where applicable, each keystroke is confirmed by anassociated LED light and/or a buzz. Each key is labelled with a pictogram graphically related to the performedfunction.

AEC

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Prior to actually positioning patients and executing radiographic exposures, some preliminaryoperations may be necessary. In particular, it is necessary to establish the proper sensitivityfor the screen-film combination to be used and to configure the unit accordingly (only ifdifferent from the default settings).

The Orthoralix 9200 is supplied with a radiographic cassette(s) pre-loaded with high-qualityrare-earth intensifying screens. For panoramic and for Transcan exposure modes, the 15x30cm cassette is provided with a Kodak Lanex Medium screen (speed = 250 approx.). ForCeph exposure mode, when available, the supplied 18x24 cm cassette is provided with aKodak Lanex Regular screen (speed = 400 approx.).

The preset exposure technique factors that Orthoralix 9200 proposes by default, for the various patient sizesand projection modalities, have been established for these screens in combination with the recommendedKodak EKTAVISION FILMS supplied as samples in the packaging (to be used only for demostration andnot for clinical use), processed with fresh chemicals, specific for dental x-ray films, in a common dental x-ray film automatic processor operating at 28°, with approximately 5 min total processing time (such as e.g.the Gendex Clarimat 300). Even in the above conditions there can be broad variations in the average filmdensity, or blackening, achieved by different Orthoralix 9200 units on the same subject, due to differencesin the yield of the x-ray tube, the speed of the specific intensifying screen or the efficiency of the filmprocessor. In addition, each user may have individual preferences for more or less dense images. WithOrthoralix 9200, it is possible to customize the default mA technique factor in order to accommodate for adifferent overall system exposure speed, separately for the Pan and Transcan modes and for the Cephmode. This adaptation should be made if the user deems that the images he gets are consistently too light(not enough density) or too dark (too much density). It should always be done if a different type of film and/or intensifying screen is used, having a nominal speed different from the one of default. Optimal averagefilm density for dental diagnosis is usually deemed to be around OD = 1.2, but this may vary broadlydepending on the observer habits and performances, and the type of diagnostic task to be performed.

KODAK, LANEX, EKTAVISION are registred trademarks of EASTMAN KODAK COMPANYof ROCHESTER, N.Y., USA.

To obtain generally darker images, decrease the system exposure speed, which causesthe preset mA to increase.

To obtain generally lighter images, increase the system exposure speed, which causes thepreset mA to decrease.

In order to change the preset system exposure speed, please refer to chapter ConfigurationProgramme.

The preset mA is inversely linear proportional to the exposure speed.

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In general, mixing film and screens from different brands is not advisable. In particular, bluefilms should never be used with green screens.

For good image quality, it is also essential to ensure the following:- Make sure that the dark room is indeed light-proof, and that the proper safety red light is used;- Load the cassette in the dark room;- The film processor has to be properly maintained according to manufacturer’s instructions;- The level of chemicals has to be checked regularly;- Chemicals have to be replaced after the appropriate time interval (depending on the number of films processed), following manufacturer’s instructions.

Film and cassette handling

The cassette must be unloaded in an absolutely light-tight darkroom or in a suitable day-light loader forfilm processor.Pull the lever on the side to open the cassette. Grip the film by a corner, remove from and close thecassette; develop the film immediately.Take a fresh film from the film store, insert it into the cassette, close and lock the cassette.The loaded cassette is now ready for use in the unit cassette holder.It is common practice in radiological departments that unloaded cassettes be kept unlocked (to preventmixing of loaded and unloaded cassettes).

The integrated AEC (Automatic Exposure Control) System for Orthoralix 9200 PLUS & Orthoralix 9200PLUS CEPH/9200AEC has been calibrated using the cassette(s) consigned with each unit. Error freeAEC performance can only be assured when employing the supplied cassettes during exposure.Should the cassettes or intensifying screens have to be changed or substituted for any reason, a newcalibration must be done according to the procedure described in the service manual of this unit.

Statistical evaluation of claims shows that the majority of all faults of image quality are due to improperfilm processing or handling in the darkroom. To ensure optimal image quality, the directions for useprovided by the film and screen manufacturers should be followed.

X-ray film packs should be opened only in the darkroom with appropriate darkroom lighting red.X-ray film is very sensitive to pressure. An opened film pack should be stored upright to avoid accidentalpressure on it (for example, from heavy objects placed on it).Film packs should be stored in a cool, dry location (10-25 °C). The cooler, the better.To minimise the effect of electrostatic discharges, the film should be gripped only on the edges whenloading and unloading cassettes. X-ray films and intensifying screens should never be handeled withgreasy hands!X-ray films must be used within the expiration date indicated on the package by the manufacturer.

Radiographs should not be viewed and diagnosed by looking at them against a window or a light-bulb.Rather, they should be examined with the help of a illuminated viewbox, properly masking the excess lightfield, in subdued ambient illumination. Objective studies indicate that improper viewing conditions mayadversely affect a correct diagnosis.

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Preparation

Make sure that the equipment is powered-up, or switch it on by pressing the power-on button.

Slide a film-loaded cassette into the Pan cassette carriage.

Make sure that the tubehead is parallel to the Pan cassettecarriage. If not, manually turn it into the correct position.

Make sure that the lever of the collimator (primary slit) in thetubehead assembly and the lever in the cassette drive system(secondary slit) correspond to the Pan position indicated by

. If not, press and slide the levers and slide to align themwith the symbols. The symbol on the control panel will lightsup.

If the position of the collimator and tubehead are not correctlyaligned, the message COLLIMATOR or TUBEHEAD isdisplayed in the control panel. Turn the tubehead or move thecollimator lever to the proper position to correct this.

Press the reset key. Please note that the equipment mustalways be in the reset condition as a pre-requisite for startingthe execution of any exposure programme.

If the above mentioned operations have been carried outcorrectly, the current projection modality and default exposuredata are displayed, and the ready symbol lights up.

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You can now change the desired exposure modality, or programme, by using keys and . On power-up the Standard Pan modality is set per default and the relevant key

lights up. You can go to Standard Pan anytime by pressing the key.

Should the AEC (Automatic Exposure Control) option be selected (Orthoralix 9200 Plus/9200AEC version), the three LED's indicating the various patient sizes will light upintermittently and the message "CHOOSE PATIENT SIZE" will be displayed. The AECmode can be activated by simply pressing the key marked AEC.

Press the select patient size key and choose between (small, e.g. a small younglady or teenager), (medium, which is proposed by default), (large, e.g. big adultmale or elderly person with strongly calcified dentate jaws). The relevant exposure techniquefactors (kV, mA, s) will be set and displayed.

With the deactivated AEC mode kV and mA can be individually adjusted (in the wholerange), should the operator deem it necessary to do so, via keys +kV, -kV, +mA, -mA inthe upper part of the control panel. Should the selected technique factors differ from thedefault values, then the relevant key lights up. The exposure time (s technique factor) issolely determined by the exposure modality chosen. You can always reset back to thedefault technique factors by pressing the relevant patient size key.

The exposure settings are dependent on the object absorption and the intensifying screens used, as well as thetype of x-ray film and film processing. Increasing mA manually from the preset value will result in an incrementof film density, or blackening, with constant contrast. The opposite result is obtained by decreasing mA, theimage contrast remaining constant. Increasing kV manually from the pre-programmed value will result in anincrease in film blackening with a decrease in the contrast. Therefore, in order to obtain a low-contrast imagewith constant film blackening, kV must be increased and mA must be decreased accordingly. A percent changein kV affects the film blackening proportional to a power two (square) law respect to a percent change in mA.Please note that, in accordance with the requirements in the IEC standards, the kV value displayed for panoramicexposure is the maximum value during exposure. This is the kV value necessary to compensate for spineabsorption at the centre of the image, whereas the actual momentary kV in other parts of the exposure may bedifferent from this maximum value in order to account for the different absorption therein.

To execute a test run (a no-radiation simulation of the currently-selected projection programmeor modality), press key . This key must be kept pressed throughout the whole run time(key operates in “dead-man” mode), otherwise the movement will stop.

Return to the start position by pressing the reset key . In case of emergency, movementduring this return operation can be stopped by pressing key .

Before the patient is positioned, all metal articles such as spectacles, removable dentures andearrings must be removed. If he/she is to be fitted with a lead-lined apron for radiation protection,make sure that the neck is not covered, as this will cause unexposed areas in the radiogram.

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Whatever panoramic projection modality is used, one notable feature of the Orthoralix 9200 is that the magnification atthe center of the image layer (the focal trough) is constant throughout the entire image. The focal trough is fashioned soas to adapt to the theoretical average jaw shape, as reported and published in the scientific literature by independentstudies.

AEC Mode for panoramic modality and for special projections: General Informations

The exposure control modality "AEC" is available in the Orthoralix 9200 PLUS/9200AEC version. Although the keymarked "AEC" is present on the control panel, the Orthoralix "9200" version is not enabled to execute this function. It ispossible to enable, or if required, to disenable the "AEC" mode when powering-up the Orthoralix 9200 PLUS systemusing the user configuration programme (see Configuration Programme).

The AEC function uses a sofisticated sensor to measure the energy dosage emerging from thepatient in real time and correcting when necessary, either by increasing or reducing, the preimposedkV value of the selected patient type (APR system, Automatic profile Recognition).

At the end of the exposure, and in case of any correction during the exposure time, theoperator can verify the maximum value reached by pressing either the kV+ (LED on) key incase of an increment or the kV- (LED on) key in case of a reduction. The value will beindicated on the control panel.

The correction limit of the "AEC" mode is set at +/- 6kV: should values outside these limitshave to be corrected the system will automatically disable the "AEC" mode (display of the"AEC DISACTIVATED" message in the control panel). In this case the system will use thepreimposed values selected for patient size.

The possibility to manually change the technical factors for exposure is inhibited when the AEC function is activated.

The AEC mode can be selected for all panoramic and special projections, excluding the hemi-orthogonal, frontal and Transcan projections.

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When the Standard Panoramic modality programme is selected, the key "standard pan”on the control panel lights up and the message STND PANORAMIC is displayed. Should thisnot be the case verify the collimator lever position and/or press key to select it.

After having slid in the cassette, executed a reset and selected the patient size and/or theexposure factors, (see “PREPARATION”) you can proceed with patient positioning.

Normally the bite block is used. The chin rest is used in the case of edentulous patients.

Insert any of these positioning aids into the bite blockholder mounted on the handgrip.Tighten firmly the rotating knob to block the positioningaid. (clockwise = tighten ; anticlockwise = loose).

For hygienc reasons, the bite block must be coveredwith a new disposable hygienic bags before use withany new patient.

Open the motorised headrest to full aperture, if not alreadyso, by using key .

Move the overhead carriage to the proper height, byreleasing the electro-magnetic brakes, so that the

bite block is at the level of the patient’s mouth, or the chin rest at the level of the patient’schin.

Specially with nervous patients (e.g. children), you have the possibility to perform a test run,to prepare them for the actual exposure procedure and show them that it will not be harmful.

Have the patient stand under the headrest and in front of the handgrip.

Place the patient close to the bite block or chin rest and position the motorised x-ray carriageusing the keys on the control panel so that either the bite block is level with the occlusalplane of the patient, or his chin aligned with the chin rest.

Use the (up) or (down) keys on the control panel to move the x-ray carriage on the column.Continued pressure on the keys for ca. 2 sec. results in a gradual acceleration at the maximum speed of

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the carriage; lightly touch selected key for a millimetric movement of thecarriage.

The patient should firmly grasp the handgrip with both handsas far forward as possible.Patient’s feet should be moved forward and brought together,so the patient’s body is straight and slanted, he/she shouldslightly hang from the handgrip (compatible with his/herphysical possibility to maintain this slightly uncomfortableposition throughout the examination).The purpose of this position is to stretch the spine as muchas possible in order to decrease the artefact shadow thatwould be cast onto the image.In any case, patients may also stand in a natural and morecomfortable position if they cannot hold the above-describedposition (e.g. elderly people). Patients in wheelchairs can alsobe positioned.

Make the patient bite on the bite block so that the incisors fitinto the grooves. Make sure he/she is not biting to far forward,beyond the grooves. Edentulous patients should use the chinrest. If the chin rest is used with dentate patients, then he/sheshould bite so as to align lower and upper incisors tips.Switch on the positioning triple laser beam with key . Thelasers are timed and will switch off automatically after 30 s.

Although compliant to the safety rules, it is a good practicefor the operator to avoid to expose his eyes and patient's eyes directly to the laserbeam; theposition of laser sources are emphasized by mean of warning labels.Caution - Use of controls or adjustments or performace of procedures other than those specified in this manual may results in

hazardous radiation exposure.

Gently displace or tilt the patient's head sidewaysuntil the front vertical laser beam coincides with themid-sagittal plane, i.e. the midline of the face.Remember that the center of the dentition shouldcorrespond to the midline of the positioning aid (biteblock or chin rest).

The horizontal laser beam should coincide with thelower margin of the orbit by using the lever at theright side of the mirror. Tilt the patient’s headbackwards or forwards by gently raising or loweringthe motorised overhead carriage, so as to

horizontally align the Frankfurt plane (i.e. the line from the lower margin of the orbits to thetragus at the external auditory meatus).


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Beware not to hurt the patient by raising or lowering thecarriage too fast ( keystroke for more than 2 sec on the upor down keys).

The vertical lateral laser beam indicates the foremostposition that the focal trough will reach during theexposure. This should be made to correspond to theroots of the lateral incisors, which is normally equivalentto aligning the light beam onto the center of the cuspid.If it is not already so, attain this by displacing the entireoverhead carriage, and the lateral vertical light beamwith it, from the nominal default position (Y=7 mm) by

using key (forwards) or key (backwards).

Do not move the patient himself/herself.

When the bite block is used, the overhead carriage and the vertical lateral laser beamshould be shifted a few millimetres backwards (Y > 7 mm) for the case of protrudingincisors, and a few millimetres forwards (Y < 7 mm) for the case of straight incisors.

The nominal default position in the Y longitudinal axis of the overhead carriage and the lateral vertical laserbeam is 7 mm, i.e. the most frontal point of the focal trough during an exposure is 7 mm behind the groovein the bite block where the incisor tips bite. The total displacement range is from 0 (forwards) to 14 mm(backwards). The actual Y position in mm (along the longitudinal axis) is momentarily shown on thedisplay whenever the lights-on key or the Y displacement keys and are operated.

When the patient’s head has been properly positioned, using key and to close the head rest flippersuntil the forehead leans on them, making sure he/she will not shift position during the process.

Ask the patient to press his/her tongue to the palate and to stay immobile during the exposure. Make theexposure by pressing the exposure handswitch. Do not forget to observe the applicable radiation safetyprocedures.

In order to comply with Federal regulations the technique factors must be visible to the operator during theexposure.

The exposure handswitch must be kept firmly pressed during the whole exposure procedure,otherwise x-ray emission and carriage movements will be stopped (“dead man” exposuremode). Should this happen, the unit must be reset, the cassette reloaded in the case that x-rayhad been emitted, and the patient positioning re-done.

During the emission of x-rays (which takes place only during part of the cycle, part of thetime being used for re-positioning of the machine) the yellow signal lights up, and anaudible buzz is emitted, both at the unit itself and at the remote station, if installed.When the exposure cycle has been concluded, the head-rest flippers will automaticallyopen to full width and the patient can be moved away; the machine should be reset, thecassette removed and the film processed.

18

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Typical radiograph

X-ray projection geometry

The X-ray tube-head needs to cool down before performing another exposure; the waiting time dependson the technical factors used. During the cooling-down phase, the message "cooling-down" with thewaiting time (decreasing) is shown on the display; when the message disappears, it's possible to start anew exposure cycle.

Specifications of the Standard Projection modality programme:• Total Exposure time: 12 s• Total Cycle time: 24 s• Magnification: 1.25• Adaptation of focal trough to jaw morphology: from 0 to 14 mm (default = 7 mm)• Default kV factor: 70 kV small patient,

74 kV medium size patient,78 kV large size patient.

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9. Special projection modalities

Operation and patient positioning for the other projection modalities in panoramic mode issimilar to the one described for Standard Panoramic, therefore please refer to that part ofthe manual for what is not otherwise specified.

Use keys and on the control panel to browse between the different projection modalitiesavailable. The currently selected modality programme is displayed along with the relevantpreset technique factors(in AEC mode, the LED's next to the patient size keys light up). Youcan always press key to re-select the Standard Panoramic modality.

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Child panoramic

Child Panoramic is a common panoramic projection adapted to the specific infantile morphology. Takingadvantage of the shorter shape of a child’s jaw, it is possible to achieve good orthogonality of the x-raybeam to the dentition in the premolar area, and as a consequence un-deformed images of those teeth withlittle crown overlap, while covering the whole dento-maxillary complex including the TMJ.

Operation and patient positioning is exactly the same as for Standard Panoramic.

Specifications of the Child Projection modality programme:• Total Exposure time: 11 s• Total Cycle time: 24 s• Magnification: 1.25• Adaptation of focal trough to jaw morphology: from 0 to 14 mm (default = 7 mm)• Default kV factor: 62 kV small patient,



21

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Typical radiograph


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23

Orthogonal dentition

Orthogonal Dentition is a panoramic projection modality restricted to the dentition only,without the rami and TMJ. The orthogonality of the x-ray beam to each single element of thedentition is better than in a conventional Standard Panoramic of the whole jaw, and as aconsequence the images of those teeth are nearly un-deformed and with little crown overlap.

This imaging modality, however, requires a more careful patient positioning (it is less tolerant of positioningmistakes), because the image layer is about twice as thin as in Standard Panoramic. An improper patientpositioning would also cause artefacts in the shape of vertical dark bands, more evident than with StandardPanoramic. This programme might not be adequate for patients having very protruded incisors, and should notbe used whenever there are amalgam fillings, bridges, implants, or other radio-opaque (metallic) objects in themost posterior molars, as these would cause white artefacts to the image.

Operation and patient positioning is otherwise the same as for Standard Panoramic.

Specifications of the Orth. Dentition modality programme:• Total Exposure time: 9.6 s• Total Cycle time: 24 s• Magnification: 1.25• Adaptation of focal trough to jaw morphology: from 0 to 14 mm (default = 7 mm)• Default kV factor: 68 kV small patient,


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Typical radiograph


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Right & Left Orthogonal Half-Dentition (DMF - Transcan option)

To be able to put a panoramic and a tomografic image (Transcan) of a given patient side by side onthe same film, an advantage in the clinical and chirugical phases of these two diagnoses, its necessaryto use the orthogonal projection of the hemi-arch.

These programmes (right half-dentition & left half-dentition) have been designed to occupy thespace on the radiogram left unexposed by the Transcan exposure.

It is not important in which order you acquire the Transcan and the hemi-dentition images (don'tchange the film from one exposure to the next), as the patient positioning and related procedures arethe same for each as described in the Orthogonal-Dentition Programme.

As the hemi-orthogonal is derived from the Orthogonal Dentition projection it guarantees excellentresults (orthogonality of the projection beam) but requires the same attention in patient positioningrecommended for the examination of the whole dentition.

Specifications of the Orthogonal Half-Dentition modality programme:• Total Exposure time: 7 s• Total Cycle time: 24 s• Magnification: 1.25• Adaptation of focal trough to jaw morphology: from 0 to 14 mm (default = 7 mm)• Default kV factor: 68 kV small patient,


The AEC mode is not applicable to this programme

25


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Typical radiograph

26


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Frontal Dentition - (DMF option)

The Frontal Dentition programme reproduces the anterior elements of the frontal arch with a focusedimage stratum which is larger than that of a standard examination.

This mode is recommended for patients in orthodontic treatment or for patients with off-centreocclusions.

The larger focal trough makes sure that the position of not perfectly aligned incisors, as required bythe standard and orthogonal modalities, do not prejudice the image results.

Procedures and patient positioning are the same as described for a Standard Panoramic.

Specifications of the Frontal-Dentition programme:• Total Exposure time: 6.4 s• Total Cycle time: 24 s• Magnification: 1.25• Adaptation of focal trough to jaw morphology: from 0 to 14 mm (default = 7 mm)• Default kV factor: 68 kV small patient,


The AEC mode is not applicable to this programme

27


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Typical radiograph


28


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Right jaw & left jaw (Right Half-panoramic, Left Half-panoramic)

The Half Jaw projection modality programmes, Right Jaw and Half Jaw, are dedicatedx-ray projections of the respective sides of the mouth. They are not just a StandardPanoramic split in two exposures, the movement and consequent projection geometryis different to that in Standard Panoramic and provide better x-ray beam orthogonalityto dentition (with less apparent crown overlap in the premolar area), and theradiographic shadow from the spine is almost entirely outside the useful image area.

Operation and patient positioning is the same as for Standard Panoramic.

Specifications of the Half Jaw (Right & Left) modality programme:

• Total Exposure time: 8 s• Total Cycle time: 18 s right 32 s left• Magnification: 1.25• Adaptation of focal trough to jaw morphology: from 0 to 14 mm (default = 7 mm)• Default kV factor: 70 kV small patient,


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Typical radiograph



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Lateral TMJ - Central & External

The Lateral TMJ programme is a projection modality of the Temporo-Mandibular Joint, bothright and left side, where the TMJ is viewed with projections along the major axis of thecondyles (sagittal view of the condyle). This is not exactly a lateral projection, as the condyleis generally not perpendicular to the mid-sagittal plane of the skull.

With the Lat. TMJ Central programme, both right and left TMJ are shown on the central partof the same film. With the Lat. TMJ External, they are shown on the external part of the film.The film areas used for the Central and for the External programme do not overlap eachother.

The patient can be positioned by means of the special skull cephalostat for TMJ examinations(optional). If this is not available, then he must be positioned using the chin rest, either theregular one with ridge (glossy) or (preferably) with the chin rest without ridge (white) andthe TMJ ruler.

Switch on the centering lasers by using

key .The ear plug of the ruler must be put intothe right auditory meatus, and the headmust be displaced back and forth until thevertical lateral laser line coincides with thevertical line in the TMJ ruler.An average head will thus be positionedapproximately at the same position as forstandard panoramic, i.e. the lateral verticallaser beam should be at the first premolaror the corner of the mouth. The center ofthe fossa should be about 75 mm behindthis laser beam.

The assumption for this standard patient positioning is that the angle between the major condylar axis andthe perpendicular to the median/sagittal plane is about 10°. If the exact angle is known (this can bedeterminated using the submento vertex exam), patient positioning should be done by moving the verticallateral laser beam to coincide with the reference values indicated on the TMJ ruler - for both open andclosed mouth projections. This procedure optimizes the orthogonal incidence of the x-ray beam relative tothe major condylar axis, ensuring the highest possible diagnostic value of the exposure.

It is possible to repeat the exposure of the same patient with open and closed mouth, without replacing thefilm in the cassette, thus obtaining the radiography in both conditions of both sides on the same film (ifnecessary for the purpose of evaluating thecondyle displacement during jaw protrusion). For optimalimage congruence, the use of the special skull cephalostat for TMJ examination is recommended.

In the TMJ programmes, the longitudinal pre-positioning displacement of the overheadcarriage is inhibit, and the machines always starts the exposure cycle from the defaultreset position at Y = 7 mm. Operation is otherwise the same as for Standard Panoramic.

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32

Typical radiograph


Specifications of the Lateral TMJ modality programme:• Total Exposure time: 8 s• Total Cycle time: 27 s central 30 s external• Magnification: 1.23• Default kV factor: 70 kV small patient,


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Frontal sinus (Dento-Maxillo-Facial Option)

The Frontal Sinus programme provides a broad- layer linear scannography of the skull inpostero-anterior view, at the level of the nasal sinuses.

The chin rest without ridge (in white plastic) should be used for patient positioning.

Operation is otherwise the same as for Standard Panoramic. You can displace the positionof the image layer frontward or backward, by using keys and , depending on the areaof interest in the sinus.

Specifications of the Frontal Sinus modality programme:• Total Exposure time: 6.2 s• Total Cycle time: 22 s• Magnification: 1.24• Adaptation of focal trough to morphology: from 0 to 14 mm (default=7 mm)• Default kV factor: 72 kV small patient,


The not exposed parts of the frontal sinus radiography can be used for the lateral left & right sinus views. Do


33

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Typical radiograph


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not remove the film from the cassete from one exposure to the other.

Lateral sinus - Right & Left (Dento-Maxillo-Facial Option)

The Lateral Sinus programmes provide a linear scannography of the skull in lateral view,limited to the nasal sinuses of the chosen side.

The chin rest without ridge (in white plastic) should be used for patient positioning.

In the Sinus programmes, the longitudinal pre-positioning displacement of the overheadcarriage is inhibited, and the equipment always starts the exposure cycle from the defaultreset position at Y = 7 mm.

Operation is otherwise the same as for Standard Panoramic.

Specifications of the Lateral Sinus (Right & Left) modality programme:• Total Exposure time: 2.5 s• Total Cycle time: 18 s right 26 s left• Magnification: 1.27• Default kV factor: 70 kV small patient,


The non exposed central part of the lateral sinus radiography can be used for the frontal sinus view (seeinstructions in the preceeding paragraph). Do not remove the film from the cassette from one exposure tothe other.

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Typical radiograph


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37

Frontal TMJ (Dento-Maxillo-Facial Option)

The frontal projection of the Temporo-Mandibular Joint is obtained by means of the so-calledReverse Geometry Projection. A frontal view of both the right and left TMJ is depicted onone film. This radiographic projection permits the assessment of the exact shape of thecondyle, with coronal view, e.g. for the diagnosis of arthrosis. In combination with the lateralTMJ projection, it allows a complete diagnostic assessment of the TMJ.

The special skull cephalostat for TMJ examinations (pt. nr. 9801 401 30004 - optional) isstrongly recommended for patient positioning. If this is not available, then he/she must bepositioned with the help of the chin rest.

The patient should keep the mandible as protruded as possible, or open, so as to displacethe condylar head forward, under the eminence. The head must be tilted forward so as tohave the Frankfort plane slightly (approximately 5°) beyond horizontality (cervical spineslightly more extended than with the positioning for a standard panoramic radiograph).Excessive tilt backwards may involve the overlap of the orbital base / palatine vault on thediagnostically interesting parts of the condyle.

In the TMJ programme, the longitudinal pre-positioning displacement of the overhead carriageis inhibited, and the equipment always starts the exposure cycle from the default resetposition at Y = 7 mm.

Operation is otherwise the same as for Standard Panoramic.

Specifications of the Frontal TMJ (Temporo-Mandibular Joint) modality programme:• Total Exposure time: 6 s• Total Cycle time: 27 s• Magnification: 1.64• Default kV factor: 72 kV small patient,


The non exposed parts of the frontal TMJ radiography can be used for the lateral views (left& right - see relative paragraph for detailed instructions). Do not remove the film from the

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Typical radiograph


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cassette from one exposure to the other.

Use of special TMJ cephalostat

The special patented skull cephalostat for TMJ examinations (pt. nr. 9801 401 30004) isdesigned for stable, accurate, and repeatable positioning of the patient’s head during aTMJ x-ray examination with Orthoralix 9200.

With this cephalostat, patient positioning is not done with reference to the dentition butrather to his/her acoustic meati, a landmark very close to the Temporo-Mandibular Jointitself. The chin is completely free to move, so two consecutive radiographs with closedand open mouth (or protruded jaw) can be taken, if necessary, without moving the patient’shead. Radiographs of the same patient taken in this way are geometrically congruent, i.e.shape and measurements of the anatomic objects therein are directly comparable betweendifferent radiographs.The TMJ cephalostat plugs into the clamp for the positioning aids, and determines thepatient position via three adjustable support points: two ear plugs in the acoustic meati, andone nasion support. It accommodates patient heads with inter-temporal width in the range120-200 mm, and a nasion-meatus distance (projected onto the sagittal plane) in the range70-110 mm. In case of a frontal projection, the head must be oriented with the Frankfurtplane slightly tilted downwards in order to reduce the shadow cast by the zigomatic boneonto the condyle head.

Make sure that the Orthoralix 9200 is in reset position. Select the suitable TMJ projectionand the technique factors. Open the motorised headrest completely. Remove the bite blockor the chin rest from the clamp, and insert the TMJ cephalostat instead. Make sure the plugis firmly clamped in. Displace the ear plugs as far apart as possible, by using the lever underthe cephalostat. Release the nasion support by loosening the knob at its side, and move itforward as much as possible. Move the overhead carriage to the proper height so that theear plugs are level with the patient’s ears.

Use hygienic protections (pt. nr. 4519 128 20952, set of 280 pieces) on the ear plugs. Placethe patient between the ear plugs so that he/she looks at the mirror. Ask him/her to graspthe handgrip. Adjust the ear plugs, gently closing them into the patient’s ears. The patientshould stand in a natural, comfortable stance, but with the neck as stretched as possible.Adjust the head inclination by resting onto the nasion support, and lock this last in positionby turning its knob. Make the exposure(s) by following the relevant instructions in thismanual.

References:

Welander U, Tronije G, McDavid WD

Layer thickness in rotational panoramic radiography: some specific aspects.

Dentomaxillofac Radiol 1989; 18:119-127.v

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10. Image quality

40

Head turned to left: left sideis broadened, the right sideis diminished.Incorrect position.

Correct position: theocclusion plane is slightlycurved, ascending raminearly parallel.

Signs of incorrect positioning (panoramic mode)

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10. Image quality

41

Head tilted forward: theocclusion plane is verycurved, ascending ramisloping together.Incorrect position.

Head tilted backward: theocclusion plane iscorrugated, ascending ramidiverging.Incorrect position.

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10. Image quality

42

Vertical laser beam shiftedbackward: the teeth arediminished, and rowstogether.Incorrect position.

Vertical laser beam shiftedforward: the teeth areenlarged, and rowsseparated.Incorrect position.

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10. Image quality

Using the technical test phantom to check the projection geometry parameters

A patented universal technical test phantom (code nr. 4519 124 20471) is available, and supplied as an accessorywith every Orthoralix 9200, for measuring the most important geometrical parameters of images in panoramicmode.

The phantom consists of a moulded object that incorporates a radio-opaque curved line reproducing shape andposition of a line passing through the midpoint of the teeth roots in the average human maxilla. Short radio-opaque segments of fixed length and inclination are equally spaced along this line. The most frontal position ofthe curve is fitted with a set of pseudo-spherical objects, to check the exact position of the focal trough. Structuressimulating position and inclination of the condyles, in occluded jaw condition, are also included.

With Orthoralix 9200, the phantom should be fixed by screws in the two holes of the included transparent chinrest. The phantom and chin rest set can then be inserted into the positioning aids clamp.

Use a cassette without front intensifying screen, the screen can actually be removed or, better, it can be obscuredby interposing a black film (a film exposed to light and developed). Use the minimum possible technique factors,i.e. 60 kV 3 mA. The purpose of this is to attain acceptable film density notwithstanding the very low absorptionfrom the technical test phantom. Alternative to this, a normally loaded cassette with both intensifying screenscan be used, but the x-ray intensity must be decreased with the help of suitable filters (in aluminium and/orcopper) in front of the tubehead, by trial and errors, until proper film density is achieved.

Make an exposure with the projection modality that you want to verify. Properly process the film.

The following information can be elicited from the film so exposed:- Symmetry of the x-ray projection.- The exact position of the focal trough in the most frontal part of the image layer corresponds

to the one blot that is perfectly round in the series of oval blots at the center of the image.The blots that are closer to the projection center (respect to the focal trough) are shownelongated horizontally, those more external (farther away from the projection center towardsthe film) are shown elongated vertically. If the whole series of blots is shown almost round,it means that the image layer is broad and well centred respect to the average jaw shape.Please note that the lateral vertical light, indicating the most frontal position of the focaltrough, should coincide with the most frontal position of the curve, and the center of theseries of blots.

- The deviation of the image layer provided by the equipment, respect to the average standardcurve for the dentition, can be assessed by observing the radiographic shape of the verticalsegments. In case of perfect coincidence (both in shape and position), the segments willbe shown focused at their center, corresponding with the intersection with the averagestandard curve, and gradually defocused at their extremes.

- The horizontal and vertical magnification in different parts of the image can be measured onthe image from the horizontal spacing between each pair of adjacent segments (it is 5 mmis reality), and from the projection to the vertical of the segments length ( would correspondto magnification one), respectively.

- The angle, in different parts of the image, between the x-ray beam and the average standardcurve of dentition can be measured as the angle to the vertical of the segments image.

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10. Image quality

Standard average jaw shape for dentition

Y

X

1:1

References:

Nummikoski P, Prihoda T, Langlais RP, McDavid WD, Welander UDental and mandibular arch width in three ethnic groups in Texas: a radiographic study.Oral Surg Oral Med Oral Pathol 1988; 64:609-617.

Welander U, Nummikoski P, Tronije G, McDavid WD, Legrell PE, Langlais RPStandard forms of dentition and mandible for application in rotational panoramic radiography.Dentomaxillofac Radiol 1989;18:60-67.

Molteni RA universal test phantom for dental panoramic radiographyMedicaMundi 1991; 36/3:212-217.

1.

2.

3.

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10. Image quality

45

Typical radiograph obtained with a test phantom

Density Test

When enabled via the User's Configuration Programme (default is disable), a special projection modality for testingthe consistency of film blackening (in Panoramic mode) is available.

This programme exposes the panoramic film with a sequence of seven (vertical) bands of gradually changing density,each obtained with an exposure dose rate differing by 20% in respect to the adjacent band. In order for the film densityso achieved to lie within the useful range, the intensifying screen in the cassette front must be obscured by coveringwith a black (exposed) film. The image thus obtained can be compared with a reference image previously taken in thesame way and with flawless exposure and processing conditions.

In the case that the two films are not equal, i.e. the density of the test film differs from the reference film by at least onegrade (generally in the test film the density might be lower than in the reference film, i.e. it will be lighter) then one of thefollowing problems is likely to have occured:- Exhausted processing chemicals (by far the most probable circumstance);- Improper operation of the film processor, e.g. temperature too low or too high, wrong processing time, wrong chemicals;- Wrong film type;- Malfunctioning or loss of adjustment of the collimator;- Wrong or deteriorated intensifying screens in the film cassette;- Deterioration of the x-ray tube e.g. because of ageing;- Malfunctioning of the electronic circuitry.

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11.11.11.11.11. Making an exposure in transversal Tomography modeMaking an exposure in transversal Tomography modeMaking an exposure in transversal Tomography modeMaking an exposure in transversal Tomography modeMaking an exposure in transversal Tomography mode(TRANSCAN option)(TRANSCAN option)(TRANSCAN option)(TRANSCAN option)(TRANSCAN option)

11.111.111.111.111.1 Product descriptionProduct descriptionProduct descriptionProduct descriptionProduct description

The TRANSCAN option is a radiographic projection mode that employs linear tomographytechnology to acquire layered images of varying thickness - selectable by the operator -perpendicular to the dental arch (transversal plane). This option is specifically intended foruse in Implantology.

The use of the TRANSCAN positioning device is a prerequisite to assure reliable andreproducible patient positioning. The device, combined with the patient’s dentition impressionor a dedicated bite block, is employed during preliminary alignment procedures on theworkbench, and subsequently during exposure in transversal tomography mode.

Positioning device with patientimpression alignment templates(positioning guides) and workbenchsupport.

The patient impression must be taken using the supplied components (tray and moldingcompound).

Four programs can be selected on the control panel, offering a complete examination ofthe dental arches and corresponding alveolar bone sections:

• RR posterior molars, premolars, right cuspids• RR incisors right incisors• LL posterior molars, premolars, left cuspids• LL incisors left incisors.

Each program permits a selection between a 3 mm or 6 mm focal trough width,symmetrically disposed relative to the image’s center plane in mesial and distal direction.

Three scans are executed per program and are depicted on the same film plate, with a7 mm displacement between each image. The magnification factor is 1.40 relative tothe central plane of the tomographic scan.

The mathematic model for the dental arch & dentition according to Welander and Nummikosky has beenapplied.


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TRANSCAN MODE

PATIENTTYPE kV mA Sec.

Small Incisor Left-Right 60(*) 4 4.6Posterior Left-Right 64 4 4.6

Medium Incisor Left-Right 64(*) 4 4.6Posterior Left-Right 68 4 4.6

Large Incisor Left-Right 68(*) 4 4.6Posterior Left-Right 72 4 4.6

(*) The film cassette must be loaded in a dark room, following the procedure and sequenceindicated below:

1. Film previously exposed to light anddeveloped (totally black)

2. Non exposed film.

The TRANSCAN mode functions correctly only when applied together with a combinationof intensifying screen & film that is the same as, or equivalent to, the screens & filmsupplied with the panoramic unit (i.e. Kodak Lanex Medium & Kodak EKTAVISION).

TRANSCAN MODE (customizing the technical factors)

The relevant default settings of the exposure parameters (kV, mA) can be modified by following theinstructions in the Orthoralix 9200 Operator manual in section 15. “Configuration programme”.

The following table can be used by the operator to register the new technical factors.

PATIENTTYPE kV mA Sec.

Small Incisor Left-Right ... ... 4.6Posterior Left-Right ... ... 4.6

Medium Incisor Left-Right ... ... 4.6Posterior Left-Right ... ... 4.6

Large Incisor Left-Right ... ... 4.6Posterior Left-Right ... ... 4.6

21

11. Making an exposure in transversal Tomography mode


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11.2 Description of Components.11.2 Description of Components.11.2 Description of Components.11.2 Description of Components.11.2 Description of Components.

Dentition impression Positioning DeviceDentition impression Positioning DeviceDentition impression Positioning DeviceDentition impression Positioning DeviceDentition impression Positioning Device

The function of the positioning device is to set the diagnostic target zone, aligning thepatient’s dentition impression (previously obtained with the supplied impressionmaterial), relative to reference points on the supplied alignment templates.

The possible movements of the positioning device are shown below:

Y AXISY ROTATIONY

ANGLE X AXISY



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upper jaw alignmenttemplate

lower jaw alignment template

molars, premolars,cuspids (left-blue icon)

molars, premolars, cuspids(right-green icon)

incisors

incisors

Alignment TemplatesAlignment TemplatesAlignment TemplatesAlignment TemplatesAlignment Templates

The two transparent plastic templates are required to align the patient’s dentitionimpression for the examination of a target zone in the upper or lower jaw. Four guidepins are used to couple each template to the positioning device.

The reference icons on the template represent the effective position of TRANSCANlayers relative to the corresponding target zone on the dental arch. Each icon isassociated to a programme which can be selected from the control panel. Appropriatelycolor coded reference lines mark Right (blue) or Left (green) jaw.

lower jaw alignment templateupper jaw alignment template

c

b

a

dd

2

1

3

2

1

3

32

1

32

1

c b a

dd

2

1

3

2

1

3

32

1

32

1

1 = distal slice2 = central slice3 = mesial slice

a = molarsb = premolarsc = cuspidsd = incisors

longitudinal reference axes



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Molding compoundMolding compoundMolding compoundMolding compoundMolding compound

The set contains 2 jars containing base andcatalyst paste plus appropriate spoons.

Workbench support for the positioning deviceWorkbench support for the positioning deviceWorkbench support for the positioning deviceWorkbench support for the positioning deviceWorkbench support for the positioning device

The workbench support is equipped with a suited coupling and a fastening screw to securethe positioning device in the pre-examination phase for impressions of both the upper orlower jaw.

Trays for dentition impressionTrays for dentition impressionTrays for dentition impressionTrays for dentition impressionTrays for dentition impression

The set of 24 trays supplied with the positioningdevice contains 12 trays for the upper and 12trays for the lower jaw (3 different sizes).


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11.3 Taking dentition impression.11.3 Taking dentition impression.11.3 Taking dentition impression.11.3 Taking dentition impression.11.3 Taking dentition impression.

Pick the appropriate tray for themandibular or maxillary arch choosingfrom the three different sizes accordingto patient size (small, medium or large).

To prepare the impression material,mix equal amounts (half a spoonful) ofbase and catalyst, place the resultingcompound in the tray and make thedentition impression according to themanufacturer’s instructions.

The quantity of compound used shouldbe just enough to ensure that the patientcan again accurately place the dentitionimpression during X-ray exposure asdescribed in the following pages.

Remove any excess compound using anappropriate cutter or other sharp edgedtool.

If possible place and fix a marker (small steel ball-bearing, or suitable gutta-percha cone) in thediagnostic target zone of the dentition impression. As an alternative mark up the target zone witha non-toxic pen (water soluble ink) to facilitate preliminary alignment on the workbench.

The steel ball-bearing or gutta-percha cone are extremely useful markers for diagnosis of theradiographic results.


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11.4 Preliminary alignment on workbench.11.4 Preliminary alignment on workbench.11.4 Preliminary alignment on workbench.11.4 Preliminary alignment on workbench.11.4 Preliminary alignment on workbench.

• Insert the positioning device into theworkbench support, locking it into placewith the appropriate fastening screw.For mandibular examinations turn thepositioning device upside-downbefore locking into place.

• Insert the tray into the forked tray holderon the positioning device.

The necessary angle of rotation for examinations of the mandibular depends on the positionof the occlusal plane relative to the lower mandibular base; deviation from the horizontalplane normally lies in a range between -5° to -10°.

To obtain the best result for the upper jaw, the forked tray holder should be adjusted to thehorizontal plane (0°). For mandibular examinations the forked tray holder should be inclinedbelow the horizontal plane.

In order to ensure an accurate alignment of the dentition impression relative to the icons on thealignment templates, the angle of observation must be perpendicular to the template itself.


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Alignment for the dentition impression of the upper jawAlignment for the dentition impression of the upper jawAlignment for the dentition impression of the upper jawAlignment for the dentition impression of the upper jawAlignment for the dentition impression of the upper jaw

• Loosen all fastening screws and ensure that allcomponents of the positioning device are free to moveas needed.

• Insert the dentition impression into the forked tray holderon the positioning device.

• Fit the alignment template for the upper jaw to the holder,inserting the guide pins into the appropriate holes onthe positioning device.

Molars, premolars & cuspids• While observing the dentition impression through the

transparent template, and using the vernier slides androtating carriage (X- & Y-axis, rotation) of the positioningdevice, maneuver it into a position so that the diagnostictarget zone is aligned with the corresponding centraltooth icon on the template (see figure).

Incisors• Proceed as above until the diagnostic target zone

coincides with the respective icon of the incisors onthe template.

• Fix the position of the tray by tightening the appropriatefastening screws on the vernier slides and rotatingcarriage.

• Remove the alignment templateAlignment for the dentition impression of the lower jawAlignment for the dentition impression of the lower jawAlignment for the dentition impression of the lower jawAlignment for the dentition impression of the lower jawAlignment for the dentition impression of the lower jaw

• Fit the alignment template for the lower jaw to the holder,inserting the guide pins into the appropriate holes onthe positioning device (positioning device is upside-down).

Molars, premolars & cuspids• While observing the dentition impression through the

transparent template, and using the vernier slides androtating carriage (X- & Y-axis, rotation) of the positioningdevice, maneuver it into a position so that the diagnostictarget zone is centered on the cross-hairs created bythe intersection of the depicted central slice line andthe longitudinal axes of the tooth icon under examinationon the template (see figure).

Incisors Refer to procedure as described for incisors of the upper

jaw (see above).

• Fix the position of the tray by tightening the appropriate fastening screws on the vernier slides androtating carriage.

• Remove the alignment template

The position of the tooth icons on the template, which lie outside the sagittal axis, reflect the effectiveposition of single elements relative to jaw morphology. In all cases it is of fundamental importance toverify that the impression tray and above all the section comprising the diagnostic target is aligned withthe inscribed longitudinal axis passing through each tooth icon on the templates.

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11.5 Preliminary procedures for X-ray exposure11.5 Preliminary procedures for X-ray exposure11.5 Preliminary procedures for X-ray exposure11.5 Preliminary procedures for X-ray exposure11.5 Preliminary procedures for X-ray exposure

Move the overhead to the start position bypressing the reset key.

Slide a film-loaded cassette into the Pancassette carriage, making sure that the cassetteis locked into position and verifying that the“ready for exposure” led is on.

Remember to load the film cassettes as described in thepreceding pages when shooting exposures for incisors.

Select secondary collimator opening forTRANSCAN projections.

Shift the lever of the collimator on the tubeheadassembly to the TRANSCAN mode position.

Select the TRANSCAN program on the controlpanel using the selection key: the display willshow the sector and depth of the tomographiclayer (3mm o 6mm).

Pick the patient size (small, medium, large) andpreset technical factors.

After having completed the procedure asdescribed above, insert the TRANSCANpositioning device into the bite block holder andproceed with patient positioning.


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Use of the impression trayWith the aim making the patient ascomfortable as possible during the X-rayexamination, the tray can be croppedlaterally with an appropriate tool (see theproduct instructions).

• Reposition the impression on the patient’sdental arch, making certain that all the teethare in their correct position.

• Move the patient into a position so that theimpression tray in the patient's mouth can becoupled to the tray-holder-fork in the positioningdevice.

11.6 11.6 11.6 11.6 11.6 Patient positioning.Patient positioning.Patient positioning.Patient positioning.Patient positioning.

Depending on the difficulties and conditions which may be encountered during eachexamination (patient’s emotive state, patient morphology, problematic examination,available time etc…) choose one of the two following application methods:

Use of the special TRANSCAN bite block

• Conclude alignment procedure and remove theimpression tray from the positioning device

• Substitute the metal tray-holder-fork with thesupplied special TRANSCAN bite block,making sure that the bite block is in the sameposition as was the tray-holder-fork.

• Have the patient bite on the special bite block,making sure that incisors fit into the appropriatesplines on the bite block.

• Make sure that the patient’s “diastema” isaligned with the central reference on the biteblock, verifying that the mid-sagittal plane iscentered on the reference line (patient’s headshould not be inclined from vertical).

• Verify that the head is neither turned away orinclined, using the positioning light beams ifnecessary.

• For both of the above described methods (use of the impression tray or bite block) positionthe mandibular profile horizontally for examinations of the lower jaw. For upper jawexaminations verify that the ala-trago plane is in a horizontal position. Set the necessaryhead inclination by cautiously raising or lowering the overhead of the panoramic unit. Beforeproceeding make sure to loosen the appropriate screws on the positioning deviceto permit this movement. RADIOGRAFIA DELLA MANDIBOLA RADIOGRAFIA DELLA MASCELLARADIOGRAPHIE RADIOGRAPHIE


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• Close the head rest flippers using the appropriate key on the control panel until one ofthese touches the head of the patient, offering a reference point when holding theposition during exposure.

The use of the headrest is possible only for certain modes and depends on the patient’smorphology.

• Press the exposure handswitch to make the exposure.

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Preparation

This mode is only accessible if the optional cephalometric attachment (arm with cephalostatand cassette holder) is installed.

Make sure that the equipment is powered-up, or switch it on by pressing the power-onbutton.

Slide a film-loaded cassette into the Ceph cassette carriage. Thecassette must be inserted until its left side correspond with theapplicable mark on the upper rail of the holder, i.e. 24x18 LL (forLatero-Lateral), 24x18 AP (for Antero-Posterior or PA), 18x24 LL (forLatero-Lateral) & 30x24 (all cases).

Make sure that the tubehead is parallel to the Ceph cassette carriage(and perpendicular to the wall). If not, manually turn it into the correctorientation.

Make sure that the lever of the collimator in the tubehead assemblycorresponds to the one of the two Ceph mode positions indicated by

(Latero Lateral projection) and (Antero Posterior projection).If not, press the lever and slide it there. The symbol on the controlpanel will light up and the message LATERO-LATERAL will bedisplayed.

If the position of the collimator and that of the tubehead are notcongruent, then the message COLLIMATOR is displayed. Turn thetubehead or move the collimator lever to the proper position to correctthis.

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Press the reset key. Please note that the equipment must always be in the reset conditionas a pre-requisite to making any exposure.

If the above mentioned operations have been carried out correctly, the message LATERO-LATERAL plus the technical factors for the exposure to be made are displayed, and theready symbol lights up. It is possible to set the ANTERIOR-POSTERIOR mode using the

and keys.

Should the AEC option be enabled when powering up the unit, the three LED's indicatingthe various patient sizes will light up and the message "SELECT PATIENT SIZE" will bedisplayed. The AEC mode can also be enabled using the relevant key on the control panel.Set the patient type using the key, choosing between small , medium and large

. A medium size patient is normally preset as default. The relevant exposure techniquefactors (kV, mA, s) will be set and displayed. If the operator deems it to be necessary, thesecan be individually set, via the +kV, -kV, +mA, -mA, +s and -s keys in the upper part of thecontrol panel. If the selected technique factors differs from the default settings, the relevantkey lights up. You can always reset back to the default technique factors by pressing therelevant patient size key.

The possibility to manually set the various technical factors is enabled also in the case of the AECoption being activated, but is only limited to the technical factors kV & mA.

As a rule of the thumb, for a child decrease one step of kV and one step of s respect to thetechnique for a small patient.

Note that, from a radiographic point of view, changing the exposure time(s) has basically the same effectas changing the tube current (mA), with the same proportionality. Please refer to section MAKING ANEXPOSURE IN PANORAMIC MODE if you need more information about the choice of technical factors.

Before positioning the patient, all metal articles such as spectacles, removable dentures andearrings must be removed. If he/she is to be fitted with a lead-lined apron for radiation protection,make sure that this will not cause unexposed areas in the radiogram.


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AEC Modality in Cephalometric mode: General Informations

The exposure control modality "AEC" is available only in the Orthoralix 9200 PLUS version. Although the keymarked "AEC" is present on the control panel, the Orthoralix "9200" version is not enabled to execute thisfunction. Its possible to enable, or if required, to disenable the "AEC" mode when powering-up the Orthoralix9200 PLUS system using the user configuration programme (see Configuration Programme).

The AEC function uses a sofisticated sensor to measure the energy dosage emerging fromthe patient in real time and correcting when necessary - either by increasing or interrupting-the exposure time (s) in respect to the estimated ideal dosage for a correct exposure of theradiograph.

At the end of the exposure, and in case of any correction during the exposure time, theoperator can verify the maximum value reached by pressing either the s+ (LED on) key incase of an increment or the s- (LED on) key in case of an interruption of the preselectedexposure time. The value will be indicated on the control panel.

The correction limit of the "AEC" mode is set at ±50% of the exposure time correspondingto the selected patient size. Should the system detect values outside those admissible the"AEC" mode will automatically be disabled (display of the "AEC DISACTIVATED" messagein the control panel). In this case the system will use the preimposed exposure times selectedfor patient size. The operator can verify the maximum value reached by pressing either thes+ (LED on) key. The value will be indicated on the control panel.

The AEC mode can be selected for all panoramic and special projections, excluding thehemi-ortogonal, frontal and Transcan projections.

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Patient positioning and exposure for latero-lateral radiography

The most common use of the cephalometric extension is to take latero-lateral radiographs of the skull, mostlyused to trace a cephalogram for the purpose of orthodontic treatment. There are different methods to acheivethis, however it is generally accepted that the following three points must be visible in the radiogram: the pogonion,the nasion, and the porion. In addition, the frontal profile of the soft tissues, including the chin and the nose tip, aswell as the Bolton point and the last vertebrae of the spine should preferably also be visible.

Make sure that the collimator lever on the tubehead is in the position for Latero-Lateral,indicated by the symbol .

Manually turn the cephalostat, if not already in position, by firmly grasping its circular cover,so that the patient’s head will look away from the wall (sagittal plane parallel to the casset-te). Fully open the ear rods of the cephalostat, using the lever to the right of the cephalostat.Extract the nasion support fully, using the lever to the left of the cephalostat, and turnupwards the support itself.

Move the cephalostat arm to the proper height, using the appropriate "up" and "down" keyson the control panel or those on the rear side of the cephalostat, so that the ear plugs areapproximately level with the patient’s acoustic meati (ears). Make sure that the hygieniccovers have been inserted into the ear plugs.

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Place the patient’s head in the cephalostat, carefully adjusting theheight of the cephalometric arm, making sure that the patient isstanding in a for him/her natural posture, eyes to front having theFrankfort plane on the horizontal. Make sure that the ear plugs arecovered with the hygienic protections. Gently close the ear rods, bymeans of the lever, so the ear plugs enter into the acoustic meati.

Stabilisation of the head can be aided using the nasion support(useful for the positioning of the soft tissue filter) which can be rotatedvertically, adjusted longitudinally (using the lever at the side of thecephalostat) and raised by releasing the knob at its front.

For Latero Lateral exposure, an adjustable soft-tissue filter is provided,to gradually decrease the intensity of the radiation in the front part ofthe x-ray field, so that the profile of soft tissues of the face can beseen on the radiography, which would otherwise be radiographicallyburned out by the more intense dose necessary for the hard anddenser parts of the skull. The curved shape of the filter adapts betterto the profile of the face.

A lever on the left side of the tubehead adjusts the position of thesoft tissue filter in relation to head position and x-ray field. Fivenumbered and graduated segments of increasing size are markedon the tubehead in correspondence to the above lever, on the upperrail of the cassette holder and also next to the adjustment lever ofthe nasion support.

Having completed the patient positioning, the value indicated on thecraniostat corresponds to the value for the lever on the tubehead(approximate position where the soft tissue filter has no effect).

Ask the patient to close the mouth, i.e. teeth and lips.

Make an exposure, by pressing the exposure handswitch. Do not forget to observe theapplicable radiation safety procedures.

Correct installation and calibration of the filter (see appropriate section in the ServiceManual) are essential to assure to the precise and reliable postioning of the soft tissuefilter.

The exposure handswitch must be kept firmly pressed during the whole exposure proce-dure, otherwise x-ray emission will be stopped prematurely (“dead man” exposure mode),resulting in an under-exposed film.

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The actual x-ray emission starts 0.8 s after pressing the handswitch. During the emission ofx-rays (which takes place only during part of the entire cycle) the yellow signal lights up,and an audible buzz is emitted, both at the unit itself and at the remote attachment, ifinstalled.

When exposure has been concluded, free the patient from the craniostat, remove the cas-sette and proceed with film processing.

Specifications of the Cephalography mode:• Magnification: 1.1• Default kV factor: 70 kV 0.8 s small patient,

74 kV 0.8 s medium patient,78 kV 0.8 s large patient.

Typical radiograph

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Patient positioning and exposure for antero posterior radiography

Rotate the craniostat, by turning the round cover, so that the patient is facing towards thetubehead and away from the cassette holder.

Make sure that the collimator lever on the tubehead is in the position for Antero- Posterior,indicated by the symbol , and that the ANTERO-POSTERIOR modality is enabled onthe control panel (corresponding technical factors are shown and the message "ANTERO-POSTERIOR" is displayed).

All further procedures for an ANTERO-POSTERIOR radiography are as described for theLatero-Lateral mode.

No soft tissue filter is used for the ANTERO-POSTERIOR projection

A Postero Anterior projection can be obtaining following the procedure described above, by simply turningthe patient by 180°, so that he/she looks towards the cassette and away from the tubehead.The nasion support must be removed from its normal position (for L.L.), by releasing the screw knob, andfixed on the opposite side ( patient’s face side).

Specifications of the AP / PA mode:• Magnification: 1.1• Default kV factor: 74 kV 1 s small patient,

80 kV 1 s medium patient,84 kV 1 s large patient.

In this position Submento-vertex projections can also be obtained, positioning the patient'shead appropriately inclined away from the cassette holder. For patient comfort we recommenda seated position in an appropriate chair.With patients of medium size good results have been obtained with 80 kV-8mA-1.25s andusing a screen/film combination Kodak, Lanex Medium-EKTAVISION, automatic processing.

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Side view

24 X 18 L.L.Frontal view

Top view

EAR PLUGS

NASIONSUPPORT

EAR PLUGSLATERAL PROJECTION

CENTER OF THECEPHALOSTAT

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18 X 24 L.L.

Side view

Top view

Frontal view

EAR PLUGSNASION

SUPPORT

EAR PLUGS

CENTER OFCEPHALOSTAT

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24 X 18 A.P./P.A.

Side view

Top view

Frontal view

EAR PLUGS

EAR PLUGS, PROJECTION A.P./P.A.

CENTER OFCEPHALOSTAT

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30 X 24

Side view

Top view

Frontal view

EAR PLUGS

MEAN DISTANCE BETWEEN EAR PLUGSLATERAL PROJECTION

MEAN DISTANCE BETWEEN EAR PLUGSA.P. OR P.A. PROJECTIONS

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14. Hygienic procedures and cleaning

Always substitute the disposable hygieniec covers of the bite block and ear plugsbefore positioning a new patient. These covers should be stored in a clen, dryenvironment and not exposed to direct sunlight or UV radiation.

Bite block and chin rest can be disinfected by immersion in a cold sterilizer, andcan be steam sterilized in autoclave up to 125°C.

The other parts that may come into direct contact with the patient, such as thehandgrip, the transcan positioning aids or the front rest flaps, must be kept cleanand disinfected. These can be cleaned with a 2% ammonia solution, or otherappropriate solutions. The ear plugs should also be kept clean and disinfected.

Always disconnect the unit from the mains supply before cleaning or disinfection. No water or anyother liquids should be allowed to enter the equipment, as this can cause short-circuits andcorrosion.The unit, including accessories and connecting cables, should be cleaned or disinfectedonly using a damp cloth, followed by rubbing down with a dry cloth. Do not use solvents (toluene,benzine, etc.), corrosive cleaning agents or abrasive polishing materials. Spray disinfectants arenot recommended, as the disinfectants may permeate into the unit and cause short circuits orcorrosion. If sprays are unavoidable, the following precautions must be taken:should the room inwhich the equipment is installed have to be disinfected by means of an atomizer, the unit should becarefully covered with a plastic sheet before proceeding.The equipment should be switched off and allowed to cool down well in advance in order to preventconvection currents drawing the disinfectant vapours into the equipment. After dispersal of thevapours, the plastic sheeting can be removed and the unit powered-up for use. The equipment mustnot be used in the presence of disinfectants which vaporize to form explosive mixtures, these vapoursmust be allowed to disperse before the equipment is returned to use. The method of disinfectionused should comply with current regulations and recommendations, including those concerning theprevention of explosive hazards.

The Orthoralix contains substances which may be harmful to the environment. In particular, thetubehead contains approximately 2.5 kg of insulating mineral oil. Therefore, disposal of discardedparts must be done through a company specialized in industrial wastes.

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mA

3

5

8

13

Speed160 15

250 10

400 6

630 4800

500

320

200

Users can pre-configure certain parameters via a special operation mode - the User’s ConfigurationProgramme. Another special operation mode is the Service Programme, for the benefit of the ServiceEngineer during installation, maintenance and repairs. Refer to the Technical Service Manual forinformation regarding the Service Programme. To start the User’s Configuration Programme, keepkey pressed for a few seconds when powering-up the unit, until the message “WAIT” disappearsfrom the display. The five available functions can be selected by using keys or and are shown inthe display; each selection must be confirmed using the key . The functions are:

Set languageEnglish, Français, Italiano, Deutch, Espanol.

Pan sensitivityWith this function the sensitivity, or speed, of the screens/film combination used in Pan and Transcanmode (15 x 30 cm cassette) can be preset. As a consequence the mA factor proposed by the equipmentfor every projection modality will correspondingly change in linear inverse relationship. During the executionof this function, two values are displayed, labelled NEW and OLD. The NEW value is the one that isbeing re-selected, the OLD value is the former (and current) one. The NEW value is changed by keys

or , and the selection is confirmed by key .The speed values, in the R19 scale, and the corresponding mA values are:

The default value (corresponding to Kodak Lanex Medium screen) is 250 (10mA).

Ceph sensitivitySame function and operation as above, but for the screen/film combination used in Ceph mode (normally,18 x 24 cm cassette). The default value corresponds to the Kodak Lanex Regular screen.

Set exposure factorsWith this function, it is possible to individually alter each one of the preset technical factors in any of theprojection modalities and patient sizes (except the exposure time in the Pan and Transcan modes, whereit is determined by the projection kinematics itself). To change the preset technique factors, while thisfunction is active and shown the on the display, simply navigate through the various projection modalitiesand patient sizes in the normal way via keys , , , , , then change the technique factor as desired,in the normal way via keys +kV, -kV, +mA, -mA, +s, -s, and confirm via key . If the general SENSITIVITYis changed, this will also affect in a linear way the altered mA values.

Example:- Default sensitivity (Pan) 250 -->10 mA;- Change sensitivity to e.g. 500 --> the preset current changes to 5 mA;- Alter preset current (in any specific programme) to e.g. 7 mA;- Change (again) sensitivity to e.g. 320 --> the preset current (for the programme above) changes to 11 mA (= 7 x 500/320 approx.).

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Density testEnable/disable the density test (in addition to the normal projection modalities.)

AEC ModeEnable/disable the AEC function when powering-up the Othoralix 9200 PLUS unit for the applicable modalities(if disabled it is always possible to enable by pressing the AEC key on the control panel).

All changes done via the User’s Configuration Mode can be reset to the default values by selecting the functionDEFAULT VALUES and confirming with key .To conclude and exit the User’s Configuration Programme, the equipment must be switched off.

Messages and alarms

A number of warning messages may be displayed in case of certain anomalous conditions:

COLLIMATORThe collimator is not properly set in a position corresponding to any of the possible projection modes. To correctmove the collimator lever to the proper position, as indicated by the symbols on the tubehead cover above thecollimator.

TUBEHEADThe position of the tubehead is not congruent with the selected mode, which is determined by the position of thecollimator. To correct turn the tubehead, or re-select the mode via the collimator.

OPERATOR RELEASEThe operator has released the x-ray handswitch too soon before the conclusion of an x-ray exposure. Pressany key to cancel the message.

MOVEMENT HALTEDThe operator has halted the movement during a reset or a dummy run cycle, before its conclusion. Press anykey to cancel the message. Do reset again.

CASSETTEAt conclusion of a reset cycle or while trying to execute an exposure, no cassette is found in the cassette holder.Press any key to cancel the message, and insert a cassette.

COOLING DOWNThe tubehead has reached its estimated thermal load limits, because of heavy radiographic workload, and justcool down before another x-ray emission. The number of seconds to go for the thermal recovery is shown andcontinuously updated on the display. Wait until this number reaches zero and the message disappears.Other alarm messages might be displayed because of technical faults of the equipment. For these refer to theTechnical Service Manual.

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Refer to the Technical Service Manual for electrical block diagrams and for other more detailedtechnical information.

Power supply voltage: 115 - 250 Vac, ± 10%

Frequency: 50 / 60 Hz ± 2 Hz

Max. line voltage regulation at 115V: 4%

Max. line power rating: 10A at 250V, 15A at 115V

Line current absorption in stand-by: < 0.5A (250V)< 1A (115V)

High voltage waveform: true DC, via square-wave power electronic converter(50 kHz) and voltage multiplier/rectifier

from 60kV to 84kV, in 2 kV steps: max. tolerance from nominal value ±3 kV

from 3mA to 15mA, in 1 mA steps: max. tolerance from nominal value ± 7%

Backup timer: + 20% of the exposure time

Tube type number: GX 100-20DC

Anode angle: 5°

Anode material: Tungsten

Rated peak tube potential: 100kV

Duty factor: 1:20 at full power operation

Inherent filtration: 2.5 mm Al equivalent (84 kV)

Focal spot: 0.5 according with IEC 336 (1993)

Output dose rate: approximate average 0.325 mGy/s at 70 kV, 10 mA, 1000 mm

Leakage radiation from tubehead: less than 250 µGy/hour (84kV) at 1 m inany direction

Leakage technique factors: 84 kV, 15 mA, duty factor 1:20.

Primary X-ray beam shielding : 1.5mm Pb (Pan) 1mm Pb (Ceph)(behind the cassette holder)

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16. Technical data

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16. Technical data

Accessories:

Skull cephalostat - pt. nr. 9801 401 30004Technical test phantom - pt. nr. 4519 124 20471Disposable hygienic covers for bite block (set of 100 pcs) - pt. nr. 4519 129 03601Disp. hygienic protections for ear plugs (set of 280 pcs) - pt. nr. 4519 128 20952

Please refer to the Technical Service Manual for identification of the spare parts.

Source to Detector Distance (SID): 505mm (Pan) – 1500 mm (Ceph)

Detector format, PAN : 15 x 30 cm, 5 x 12 “3.7 x 131 mm (X-ray field size, at detector plane)

Detector format, Transcan : 15 x 30 cm, 5 x 12 “52 x 131 mm (X-ray field size, at detector plane)

Detector format, Ceph : 24 x 18 cm (or 10 x 8") vertical for LL (recommended)18 x 24 cm (or 8 x 10") horizontal for LL24 x 18 cm (or 10 x 8") vertical for AP (recommended)30 x 24 cm vertical (LL or AP)

Lasers:- Class 2, conform to IEC 60825-1:2001- Wavelength 650nm- beam divergence for collimated beam < 1 mrd- pulse duration 30 seconds- maximum output < 1 mW

Net weight: 191kg (Pan) – 211kg (Ceph)

Environmental conditions:

Storage and transport :Min Max

- temperature: 40°C +70°C.- pressure: 500 hPa 1060 hPa- relative humidity: 10% 95% (condensating)

Operation :Min Max

- temperature: 10°C +40°C.- pressure: 700 hPa 1060 hPa- relative humidity: 30% 90% (not condensating)

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Orthoralix 9200 Orthoralix 9200 Ceph

manual ortopam gendex 9200_en.pdf

Documents

firstthis manual

operation of orthoralix

thisoperators manual

normal operation

efficient operation

particular equipment

laterolateral exposure

touchcontrol panel