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GENDEX

English
Orthoralix 9200
Contents

1. Read me first 2

2. Standards and Regulations 4

3. Safety procedures 5

4. General description 8

5. Control panel 10

6. Preliminary procedures 11

7. Making an exposure in panoramic mode 13

8. Standard panoramic programme 16

9. Special projection modalities 20

10. Image quality 40

11. Making an exposure in Transversal tomography 46

12. Making an exposure in cephalometric mode 57

13. Geometry of the x-ray projections 64

14. Hygienic procedures and cleaning 68

15. Configuration programme 69

16. Technical data 71

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1. Read me first

The operation of Orthoralix 9200 is supervised via the touch-control panel on the right side
of 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 technique
factors, selection of the projection modality, patient positioning) are located in the lower part
of the control panel. The upper part of the same is reserved for those keys whose use is not
essential 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 accessible
only if foreseen for that particular version.

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

In the case of a cephalometric tele-radiography attachment a similar pictographic quick


reference guide is positioned on the ceph arm, illustrating the step-by-step actions necessary
to 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 Orthoralix
9200 correctly;

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

Warnings, indicated by the icon.

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 this
Operator's Manual are subject to change without prior notice.

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1. Read me first

This manual is intended to assist the user in the safe and efficient operation of the equipment
described. The equipment must be used in accordance with the procedures contained in the
manual and must not be used for purposes other than those which are described herein. The
equipment should only be used by persons having recognised qualifications and, if relevant,
having adequate training on that particular equipment, especially regarding protective measures
such as radiation protection. It is the responsibility of the user to ensure that existing legal
regulations regarding installation of the equipment are observed. Moreover, the legal
regulations regarding operation of the equipment must be observed. Incorrect operation, or
failure 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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2. Standards and Regulations


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. 114
UL 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 from
1998 onwards, meets the provisions of the European Council Directive 92/42 concerning
medical devices.

Classification
The Orthoralix 9200 is Class I and Type B electromedical x-ray equipment according to
IEC 601-1(1998)

Explanation of symbols
The 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 devices
In order to fulfill the obligations foreseen by the CE marking, the user is obliged to report any
accident 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 to
patient and/or operator, to the competent Health Authorities. Such reporting must also be promptly
notified to the manufacturer or his agent, in order to permit the fulfilment of the obligations foreseen
for said manufacturer in the a.m. European Directive.

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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 defects
whatsoever. 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 Technical
Service Manual for the recommended programmed maintenance activities. Modifications and
additions to the equipment must be carried out only by Gendex personnel or third parties that are
expressly authorised by Gendex, and must comply with the applicable legal requirements as well
as with the generally accepted technical regulations.
The tubehead contains mineral insulating oil . Such oils are potentially harmful in case of ingestion
or contact with skin or mucosa. In case of a defect or fault, an oil leak can occur. Avoid direct
contact with the oil and do not inhale its vapors. In case of minor leaks, the oil can be wiped away
with a dry cloth, wearing protective gloves.
• Radiation protection
The 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 the
responsibility of the qualified Radiation Protection Inspector to ensure that the proper measures
are taken to prevent undue radiation exposure to personnel and to the public at large. All personnel
in the examination room must exercise radiation safety procedures. To protect the patient against
unnecessary radiation, other accessories can be used whenever necessary, in addition to those
provided on the x-ray equipment itself (collimators, shields, spacers and filters). Care must be
taken, however, that these accessories do not interfere with the proper radiographic operation of
the 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, or
behind 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 well
below the applicable limits specified by the national and international standards.
• Electrical safety
Only qualified service personnel should be authorised to remove the covers of, or otherwise obtain
access to, parts of the equipment that include line voltage powered circuits. The equipment may
only be used in rooms which comply with the relevant national and/or international legislation and
recommendations concerning electrical safety in rooms used for medical purposes, e.g. IEC, US
National Electrical Code, or VDE standards.
Always disconnect or switch off the equipment before cleaning or disinfecting. No water or any
other liquid should be allowed to enter the equipment, as they could cause short-circuits and
corrosion.
• Mechanical Safety
Due care must be taken when the system is used to ensure that neither patient nor personnel reach
into the equipment or get their clothing caught in it. The equipment contains mechanical components
such as cables, rubber belts and gears, which are subject to operational wear and tear. To prevent
any risk of injury to patient and operator due to components which no longer comply to normal
safely standards (e.g. worn cables subject to movement), the equipment must be subject to regular
technical testing and maintenance.
• Explosion safety
This equipment is not suitable for use in the presence of flammable gases or vapours. Certain
disinfectants vaporise and form explosive mixtures. If such disinfectants are used, the vapours
must be left to disperse before the equipment is powered-up again.

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• Positioning safety
During 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 pay
attention 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” which
has to be placed in the direction of the tubehead when loading the cassette. Inside the cassette, the
provided intensifying screens are reporting the letters L (left) and R (right) for the identification of
the image sides.
Once the exposure has been performed, positioning references (L and R) will be displayed on the
acquired 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 in
correspondence of the centre of the mouth.
It’s strongly recommended to pay attention to the L and R letters to identify the anatomical side and
to 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’s
strongly recommended to pay the maximum attention to its correct introduction way and to refer
carefully 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 with
intensifying screens, so no reference letters are inserted in it.
It’s strongly recommended to refer carefully to the instructions of the cassette, the Phosphor
plates and the scanning system for a correct image interpretation. Usually the Phosphor plates are
including reference letters to identify the image sides and the user has to follow the manufacturer’s
instructions to use it properly.
During Cephalometric symmetrical projections, taken with either film or Phospor plates, neither L
nor R is displayed on the image, due to the impossibility for the system to detect if the patient is
placed in Antero-Posterior or Postero-Anterior position. It’s user responsibility to pay attention to
the anatomical side.
• Laser safety
This equipment is designed in accordance with IEC 60825-1: 2001 the position of laser souces
are 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 his
eyes and patient's eyes directily to the laser beam
• Location of lasers aperture
Two lasers for the lighting of the mid-sagittal plane (vertical laser beam) and the lighting of the
Frankfurt 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 (vertical
lateral laser beam) is positioned on the rotating arm, on the left of the sensor (see picture next
page).
Caution - use of controls or adjustments or performance of procedures other than those specified
in manual may result in hazardous radiation exposure.

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4. General description
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 trajectory
around 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 scattered
radiation originating from the patient.

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

Patient positioning is simple, accurate and consistent thanks to the motorised headrest, the
motorised 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 different
projection geometries can be executed.

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

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

The different versions and options available are:


- Orthoralix 9200 - equipment with limited projection programmes functionality (without
AEC program)
- Orthoralix 9200 Plus - equipment with full projection programmes functionality (with
AEC program);
- Orthoralix 9200AEC - equipment with limited projection programs functionality
and 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) option
and the Transcan option, you obtain an Orthoralix 9200 with full capability.

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4. General description

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 Ceph
mode provides facilities for cephalography in Latero-Lateral, and for Antero-Posterior or
Postero-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 is
possible to activate the Automatic Exposure Control (AEC) mode.
AEC is a real-time control of the dosage necessary to obtain the correct exposure of the
radiography, varying the preimposed technical factors for the selected patient type (kV for
Panoramic projections, and exposure time in Cephalometric mode). For further information
refer to the subsequent paragraphs.

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5. Control panel
Each keystroke is associated with one, and only one function or operation: the operator therefore, does not
use more than one key to initiate a given function. Where applicable, each keystroke is confirmed by an
associated LED light and/or a buzz. Each key is labelled with a pictogram graphically related to the performed
function.
-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 carriage
posteriorly to patient;
Move the overhead x-ray carriage
anteriorly to patient;
AEC Select/deactivate Automatic exposure
Control;
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-ray
carriage into start position:
Dummy run, execute a simulation of the
selected programme by performing the
movements without x-ray emission;
The equipment is ready for an x-ray
emission;
X-rays are being emitted.
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6. Preliminary procedures

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

The Orthoralix 9200 is supplied with a radiographic cassette(s) pre-loaded with high-quality
rare-earth intensifying screens. For panoramic and for Transcan exposure modes, the 15x30
cm cassette is provided with a Kodak Lanex Medium screen (speed = 250 approx.). For
Ceph exposure mode, when available, the supplied 18x24 cm cassette is provided with a
Kodak Lanex Regular screen (speed = 400 approx.).

The preset exposure technique factors that Orthoralix 9200 proposes by default, for the various patient sizes
and projection modalities, have been established for these screens in combination with the recommended
Kodak EKTAVISION FILMS supplied as samples in the packaging (to be used only for demostration and
not 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 film
density, or blackening, achieved by different Orthoralix 9200 units on the same subject, due to differences
in the yield of the x-ray tube, the speed of the specific intensifying screen or the efficiency of the film
processor. In addition, each user may have individual preferences for more or less dense images. With
Orthoralix 9200, it is possible to customize the default mA technique factor in order to accommodate for a
different overall system exposure speed, separately for the Pan and Transcan modes and for the Ceph
mode. 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 average
film density for dental diagnosis is usually deemed to be around OD = 1.2, but this may vary broadly
depending on the observer habits and performances, and the type of diagnostic task to be performed.

KODAK, LANEX, EKTAVISION are registred trademarks of EASTMAN KODAK COMPANY


of ROCHESTER, N.Y., USA.

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

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

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

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

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6. Preliminary procedures

In general, mixing film and screens from different brands is not advisable. In particular, blue
films 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 for
film processor.
Pull the lever on the side to open the cassette. Grip the film by a corner, remove from and close the
cassette; 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 prevent
mixing of loaded and unloaded cassettes).

The integrated AEC (Automatic Exposure Control) System for Orthoralix 9200 PLUS & Orthoralix 9200
PLUS CEPH/9200AEC has been calibrated using the cassette(s) consigned with each unit. Error free
AEC 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 new
calibration 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 improper
film processing or handling in the darkroom. To ensure optimal image quality, the directions for use
provided 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 accidental
pressure 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 when
loading and unloading cassettes. X-ray films and intensifying screens should never be handeled with
greasy 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 light
field, in subdued ambient illumination. Objective studies indicate that improper viewing conditions may
adversely affect a correct diagnosis.

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7. Making an exposure in panoramic mode

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 cassette


carriage. If not, manually turn it into the correct position.

Make sure that the lever of the collimator (primary slit) in the
tubehead 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 them
with the symbols. The symbol on the control panel will lights
up.

If the position of the collimator and tubehead are not correctly


aligned, the message COLLIMATOR or TUBEHEAD is
displayed in the control panel. Turn the tubehead or move the
collimator lever to the proper position to correct this.

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

If the above mentioned operations have been carried out


correctly, the current projection modality and default exposure
data are displayed, and the ready symbol lights up.

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7. Making an exposure in panoramic mode

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 up
intermittently and the message "CHOOSE PATIENT SIZE" will be displayed. The AEC
mode can be activated by simply pressing the key marked AEC.

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

With the deactivated AEC mode kV and mA can be individually adjusted (in the whole
range), should the operator deem it necessary to do so, via keys +kV, -kV, +mA, -mA in
the upper part of the control panel. Should the selected technique factors differ from the
default values, then the relevant key lights up. The exposure time (s technique factor) is
solely determined by the exposure modality chosen. You can always reset back to the
default 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 the
type of x-ray film and film processing. Increasing mA manually from the preset value will result in an increment
of film density, or blackening, with constant contrast. The opposite result is obtained by decreasing mA, the
image contrast remaining constant. Increasing kV manually from the pre-programmed value will result in an
increase in film blackening with a decrease in the contrast. Therefore, in order to obtain a low-contrast image
with constant film blackening, kV must be increased and mA must be decreased accordingly. A percent change
in 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 panoramic
exposure is the maximum value during exposure. This is the kV value necessary to compensate for spine
absorption at the centre of the image, whereas the actual momentary kV in other parts of the exposure may be
different 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 programme


or 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, movement
during this return operation can be stopped by pressing key .

Before the patient is positioned, all metal articles such as spectacles, removable dentures and
earrings 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 at
the center of the image layer (the focal trough) is constant throughout the entire image. The focal trough is fashioned so
as to adapt to the theoretical average jaw shape, as reported and published in the scientific literature by independent
studies.

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 key
marked "AEC" is present on the control panel, the Orthoralix "9200" version is not enabled to execute this function. It is
possible to enable, or if required, to disenable the "AEC" mode when powering-up the Orthoralix 9200 PLUS system
using the user configuration programme (see Configuration Programme).

The AEC function uses a sofisticated sensor to measure the energy dosage emerging from the
patient in real time and correcting when necessary, either by increasing or reducing, the preimposed
kV 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, the
operator can verify the maximum value reached by pressing either the kV+ (LED on) key in
case of an increment or the kV- (LED on) key in case of a reduction. The value will be
indicated on the control panel.

The correction limit of the "AEC" mode is set at +/- 6kV: should values outside these limits
have 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 the
preimposed 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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8. Standard panoramic programme

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 this
not 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 the
exposure 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 block


holder mounted on the handgrip.
Tighten firmly the rotating knob to block the positioning
aid. (clockwise = tighten ; anticlockwise = loose).

For hygienc reasons, the bite block must be covered


with a new disposable hygienic bags before use with
any new patient.

Open the motorised headrest to full aperture, if not already


so, by using key .

Move the overhead carriage to the proper height, by


releasing 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’s
chin.

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 carriage
using the keys on the control panel so that either the bite block is level with the occlusal
plane 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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8. Standard panoramic programme

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

The patient should firmly grasp the handgrip with both hands
as 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 should
slightly hang from the handgrip (compatible with his/her
physical possibility to maintain this slightly uncomfortable
position throughout the examination).
The purpose of this position is to stretch the spine as much
as possible in order to decrease the artefact shadow that
would be cast onto the image.
In any case, patients may also stand in a natural and more
comfortable position if they cannot hold the above-described
position (e.g. elderly people). Patients in wheelchairs can also
be positioned.

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

Although compliant to the safety rules, it is a good practice


for the operator to avoid to expose his eyes and patient's eyes directly to the laserbeam; the
position 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 sideways


until the front vertical laser beam coincides with the
mid-sagittal plane, i.e. the midline of the face.
Remember that the center of the dentition should
correspond to the midline of the positioning aid (bite
block or chin rest).

The horizontal laser beam should coincide with the


lower margin of the orbit by using the lever at the
right side of the mirror. Tilt the patient’s head
backwards or forwards by gently raising or lowering
the motorised overhead carriage, so as to
horizontally align the Frankfurt plane (i.e. the line from the lower margin of the orbits to the
tragus at the external auditory meatus).

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8. Standard panoramic programme

Beware not to hurt the patient by raising or lowering the


carriage too fast ( keystroke for more than 2 sec on the up
or down keys).

The vertical lateral laser beam indicates the foremost


position that the focal trough will reach during the
exposure. This should be made to correspond to the
roots of the lateral incisors, which is normally equivalent
to aligning the light beam onto the center of the cuspid.
If it is not already so, attain this by displacing the entire
overhead carriage, and the lateral vertical light beam
with 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 beam
should be shifted a few millimetres backwards (Y > 7 mm) for the case of protruding
incisors, 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 laser
beam is 7 mm, i.e. the most frontal point of the focal trough during an exposure is 7 mm behind the groove
in 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 the
display 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 flippers
until 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 the
exposure by pressing the exposure handswitch. Do not forget to observe the applicable radiation safety
procedures.

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

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” exposure
mode). Should this happen, the unit must be reset, the cassette reloaded in the case that x-ray
had 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 the
time being used for re-positioning of the machine) the yellow signal lights up, and an
audible 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 automatically
open to full width and the patient can be moved away; the machine should be reset, the
cassette removed and the film processed.

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8. Standard panoramic programme

The X-ray tube-head needs to cool down before performing another exposure; the waiting time depends
on the technical factors used. During the cooling-down phase, the message "cooling-down" with the
waiting time (decreasing) is shown on the display; when the message disappears, it's possible to start a
new 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)
X-ray projection geometry
• Default kV factor: 70 kV small patient,
74 kV medium size patient,
78 kV large size patient.

Typical radiograph

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9. Special projection modalities

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

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

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9. Special projection modalities

Child panoramic

Child Panoramic is a common panoramic projection adapted to the specific infantile morphology. Taking
advantage of the shorter shape of a child’s jaw, it is possible to achieve good orthogonality of the x-ray
beam to the dentition in the premolar area, and as a consequence un-deformed images of those teeth with
little 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,
66 kV medium size patient,
70 kV large size patient.

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9. Special projection modalities

X-ray projection geometry

Typical radiograph

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9. Special projection modalities

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 the
dentition is better than in a conventional Standard Panoramic of the whole jaw, and as a
consequence 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 positioning
mistakes), because the image layer is about twice as thin as in Standard Panoramic. An improper patient
positioning would also cause artefacts in the shape of vertical dark bands, more evident than with Standard
Panoramic. This programme might not be adequate for patients having very protruded incisors, and should not
be used whenever there are amalgam fillings, bridges, implants, or other radio-opaque (metallic) objects in the
most 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,
72 kV medium size patient,
76 kV large size patient.

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9. Special projection modalities

X-ray projection geometry

Typical radiograph

May 2005 - Operator manual 24 Orthoralix 9200


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9. Special projection modalities

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 on
the same film, an advantage in the clinical and chirugical phases of these two diagnoses, its necessary
to use the orthogonal projection of the hemi-arch.

These programmes (right half-dentition & left half-dentition) have been designed to occupy the
space 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't
change the film from one exposure to the next), as the patient positioning and related procedures are
the same for each as described in the Orthogonal-Dentition Programme.

As the hemi-orthogonal is derived from the Orthogonal Dentition projection it guarantees excellent
results (orthogonality of the projection beam) but requires the same attention in patient positioning
recommended 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,
72 kV medium size patient,
76 kV large size patient.

The AEC mode is not applicable to this programme

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9. Special projection modalities

X-ray projection geometry

Typical radiograph

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9. Special projection modalities

Frontal Dentition - (DMF option)

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

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

The larger focal trough makes sure that the position of not perfectly aligned incisors, as required by
the 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,
72 kV medium size patient,
76 kV large size patient.

The AEC mode is not applicable to this programme

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9. Special projection modalities

X-ray projection geometry

Typical radiograph

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9. Special projection modalities

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

The Half Jaw projection modality programmes, Right Jaw and Half Jaw, are dedicated
x-ray projections of the respective sides of the mouth. They are not just a Standard
Panoramic split in two exposures, the movement and consequent projection geometry
is different to that in Standard Panoramic and provide better x-ray beam orthogonality
to dentition (with less apparent crown overlap in the premolar area), and the
radiographic 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,
74 kV medium size patient,
78 kV large size patient.

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9. Special projection modalities

X-ray projection geometry

Typical radiograph

May 2005 - Operator manual 30 Orthoralix 9200


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9. Special projection modalities

Lateral TMJ - Central & External

The Lateral TMJ programme is a projection modality of the Temporo-Mandibular Joint, both
right and left side, where the TMJ is viewed with projections along the major axis of the
condyles (sagittal view of the condyle). This is not exactly a lateral projection, as the condyle
is 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 part
of 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 each
other.

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 the
regular one with ridge (glossy) or (preferably) with the chin rest without ridge (white) and
the TMJ ruler.

Switch on the centering lasers by using


key .
The ear plug of the ruler must be put into
the right auditory meatus, and the head
must be displaced back and forth until the
vertical lateral laser line coincides with the
vertical line in the TMJ ruler.
An average head will thus be positioned
approximately at the same position as for
standard panoramic, i.e. the lateral vertical
laser beam should be at the first premolar
or the corner of the mouth. The center of
the fossa should be about 75 mm behind
this laser beam.

The assumption for this standard patient positioning is that the angle between the major condylar axis and
the perpendicular to the median/sagittal plane is about 10°. If the exact angle is known (this can be
determinated using the submento vertex exam), patient positioning should be done by moving the vertical
lateral laser beam to coincide with the reference values indicated on the TMJ ruler - for both open and
closed mouth projections. This procedure optimizes the orthogonal incidence of the x-ray beam relative to
the 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 the
film in the cassette, thus obtaining the radiography in both conditions of both sides on the same film (if
necessary for the purpose of evaluating thecondyle displacement during jaw protrusion). For optimal
image congruence, the use of the special skull cephalostat for TMJ examination is recommended.

In the TMJ programmes, the longitudinal pre-positioning displacement of the overhead


carriage is inhibit, and the machines always starts the exposure cycle from the default
reset position at Y = 7 mm. Operation is otherwise the same as for Standard Panoramic.

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9. Special projection modalities

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,
74 kV medium size patient,
78 kV large size patient.
X-ray projection geometry

Typical radiograph

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9. Special projection modalities

Frontal sinus (Dento-Maxillo-Facial Option)

The Frontal Sinus programme provides a broad- layer linear scannography of the skull in
postero-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 position
of the image layer frontward or backward, by using keys and , depending on the area
of 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,
76 kV medium size patient,
80 kV large size patient.

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

May 2005 - Operator manual 33 Orthoralix 9200


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9. Special projection modalities

X-ray projection geometry

Typical radiograph

May 2005 - Operator manual 34 Orthoralix 9200


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9. Special projection modalities

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 overhead


carriage is inhibited, and the equipment always starts the exposure cycle from the default
reset 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,
74 kV medium size patient,
78 kV large size patient.

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

May 2005 - Operator manual 35 Orthoralix 9200


GENDEX

9. Special projection modalities

X-ray projection geometry

Typical radiograph

May 2005 - Operator manual 36 Orthoralix 9200


GENDEX

9. Special projection modalities

Frontal TMJ (Dento-Maxillo-Facial Option)

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

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

The patient should keep the mandible as protruded as possible, or open, so as to displace
the condylar head forward, under the eminence. The head must be tilted forward so as to
have the Frankfort plane slightly (approximately 5°) beyond horizontality (cervical spine
slightly 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 the
diagnostically interesting parts of the condyle.

In the TMJ programme, the longitudinal pre-positioning displacement of the overhead carriage
is inhibited, and the equipment always starts the exposure cycle from the default reset
position 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,
76 kV medium size patient,
80 kV large size 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

May 2005 - Operator manual 37 Orthoralix 9200


GENDEX

9. Special projection modalities

X-ray projection geometry

Typical radiograph

May 2005 - Operator manual 38 Orthoralix 9200


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9. Special projection modalities

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) is
designed for stable, accurate, and repeatable positioning of the patient’s head during a
TMJ x-ray examination with Orthoralix 9200.

With this cephalostat, patient positioning is not done with reference to the dentition but
rather to his/her acoustic meati, a landmark very close to the Temporo-Mandibular Joint
itself. The chin is completely free to move, so two consecutive radiographs with closed
and open mouth (or protruded jaw) can be taken, if necessary, without moving the patient’s
head. 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 between
different radiographs.
The TMJ cephalostat plugs into the clamp for the positioning aids, and determines the
patient position via three adjustable support points: two ear plugs in the acoustic meati, and
one nasion support. It accommodates patient heads with inter-temporal width in the range
120-200 mm, and a nasion-meatus distance (projected onto the sagittal plane) in the range
70-110 mm. In case of a frontal projection, the head must be oriented with the Frankfurt
plane slightly tilted downwards in order to reduce the shadow cast by the zigomatic bone
onto the condyle head.

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

Use hygienic protections (pt. nr. 4519 128 20952, set of 280 pieces) on the ear plugs. Place
the patient between the ear plugs so that he/she looks at the mirror. Ask him/her to grasp
the handgrip. Adjust the ear plugs, gently closing them into the patient’s ears. The patient
should 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 position
by turning its knob. Make the exposure(s) by following the relevant instructions in this
manual.

References:

Welander U, Tronije G, McDavid WD


Layer thickness in rotational panoramic radiography: some specific aspects.
Dentomaxillofac Radiol 1989; 18:119-127.v

May 2005 - Operator manual 39 Orthoralix 9200


GENDEX

10. Image quality


Signs of incorrect positioning (panoramic mode)

Correct position: the


occlusion plane is slightly
curved, ascending rami
nearly parallel.

Head turned to left: left side


is broadened, the right side
is diminished.
Incorrect position.

May 2005 - Operator manual 40 Orthoralix 9200


GENDEX

10. Image quality

Head tilted forward: the


occlusion plane is very
curved, ascending rami
sloping together.
Incorrect position.

Head tilted backward: the


occlusion plane is
corrugated, ascending rami
diverging.
Incorrect position.

May 2005 - Operator manual 41 Orthoralix 9200


GENDEX

10. Image quality

Vertical laser beam shifted


backward: the teeth are
diminished, and rows
together.
Incorrect position.

Vertical laser beam shifted


forward: the teeth are
enlarged, and rows
separated.
Incorrect position.

May 2005 - Operator manual 42 Orthoralix 9200


GENDEX

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 accessory
with every Orthoralix 9200, for measuring the most important geometrical parameters of images in panoramic
mode.

The phantom consists of a moulded object that incorporates a radio-opaque curved line reproducing shape and
position 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 of
the curve is fitted with a set of pseudo-spherical objects, to check the exact position of the focal trough. Structures
simulating 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 chin
rest. 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 obscured
by 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 absorption
from the technical test phantom. Alternative to this, a normally loaded cassette with both intensifying screens
can be used, but the x-ray intensity must be decreased with the help of suitable filters (in aluminium and/or
copper) 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 shown
elongated horizontally, those more external (farther away from the projection center towards
the 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 focal
trough, should coincide with the most frontal position of the curve, and the center of the
series of blots.
- The deviation of the image layer provided by the equipment, respect to the average standard
curve for the dentition, can be assessed by observing the radiographic shape of the vertical
segments. In case of perfect coincidence (both in shape and position), the segments will
be shown focused at their center, corresponding with the intersection with the average
standard curve, and gradually defocused at their extremes.
- The horizontal and vertical magnification in different parts of the image can be measured on
the image from the horizontal spacing between each pair of adjacent segments (it is 5 mm
is reality), and from the projection to the vertical of the segments length ( would correspond
to magnification one), respectively.
- The angle, in different parts of the image, between the x-ray beam and the average standard
curve of dentition can be measured as the angle to the vertical of the segments image.

May 2005 - Operator manual 43 Orthoralix 9200


GENDEX

10. Image quality

References:

1. Nummikoski P, Prihoda T, Langlais RP, McDavid WD, Welander U


Dental and mandibular arch width in three ethnic groups in Texas: a radiographic study.
Oral Surg Oral Med Oral Pathol 1988; 64:609-617.

2. Welander U, Nummikoski P, Tronije G, McDavid WD, Legrell PE, Langlais RP


Standard forms of dentition and mandible for application in rotational panoramic radiography.
Dentomaxillofac Radiol 1989;18:60-67.

3. Molteni R
A universal test phantom for dental panoramic radiography
MedicaMundi 1991; 36/3:212-217.

Standard average jaw shape for dentition

Y 1:1

May 2005 - Operator manual 44 Orthoralix 9200


GENDEX

10. Image quality

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 testing
the 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 density
so achieved to lie within the useful range, the intensifying screen in the cassette front must be obscured by covering
with a black (exposed) film. The image thus obtained can be compared with a reference image previously taken in the
same 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 one
grade (generally in the test film the density might be lower than in the reference film, i.e. it will be lighter) then one of the
following 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.

May 2005 - Operator manual 45 Orthoralix 9200


GENDEX

11. Making an exposure in transversal Tomography mode


(TRANSCAN option)

11.1 Product description


The TRANSCAN option is a radiographic projection mode that employs linear tomography
technology to acquire layered images of varying thickness - selectable by the operator -
perpendicular to the dental arch (transversal plane). This option is specifically intended for
use in Implantology.
The use of the TRANSCAN positioning device is a prerequisite to assure reliable and
reproducible patient positioning. The device, combined with the patient’s dentition impression
or a dedicated bite block, is employed during preliminary alignment procedures on the
workbench, and subsequently during exposure in transversal tomography mode.

Positioning device with patient


impression alignment templates
(positioning guides) and workbench
support.

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

Four programs can be selected on the control panel, offering a complete examination of
the 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 a
7 mm displacement between each image. The magnification factor is 1.40 relative to
the central plane of the tomographic scan.

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

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11. Making an exposure in transversal Tomography mode

TRANSCAN MODE

PATIENT
TYPE kV mA Sec.

Small Incisor Left-Right 60(*) 4 4.6


Posterior Left-Right 64 4 4.6
Medium Incisor Left-Right 64(*) 4 4.6
Posterior Left-Right 68 4 4.6
Large Incisor Left-Right 68(*) 4 4.6
Posterior Left-Right 72 4 4.6

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

1. Film previously exposed to light and


2 developed (totally black)

1 2. Non exposed film.

The TRANSCAN mode functions correctly only when applied together with a combination
of intensifying screen & film that is the same as, or equivalent to, the screens & film
supplied 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 the
instructions 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.

PATIENT
TYPE kV mA Sec.

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


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

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11. Making an exposure in transversal Tomography mode

11.2 Description of Components.

Dentition impression Positioning Device

The function of the positioning device is to set the diagnostic target zone, aligning the
patient’s dentition impression (previously obtained with the supplied impression
material), 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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11. Making an exposure in transversal Tomography mode

Alignment Templates

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

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

incisors

upper jaw alignment molars, premolars, cuspids


molars, premolars, template
cuspids (left-blue icon) (right-green icon)
incisors

lower jaw alignment template

1 = distal slice a = molars


2 = central slice b = premolars
longitudinal reference axes
3 = mesial slice c = cuspids
d = incisors
1 1 1 1
2 2 2 2
3 d 3 3 d 3
d d

c
3 3 3 3
b
2 2 2 2
a
1 1 1 1
c b a

upper jaw alignment template lower jaw alignment template


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11. Making an exposure in transversal Tomography mode

Workbench support for the positioning device

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

Trays for dentition impression Molding compound

The set of 24 trays supplied with the positioning The set contains 2 jars containing base and
device contains 12 trays for the upper and 12 catalyst paste plus appropriate spoons.
trays for the lower jaw (3 different sizes).

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11. Making an exposure in transversal Tomography mode

11.3 Taking dentition impression.

Pick the appropriate tray for the


mandibular or maxillary arch choosing
from the three different sizes according
to patient size (small, medium or large).
To prepare the impression material,
mix equal amounts (half a spoonful) of
base and catalyst, place the resulting
compound in the tray and make the
dentition impression according to the
manufacturer’s instructions.

The quantity of compound used should


be just enough to ensure that the patient
can again accurately place the dentition
impression during X-ray exposure as
described in the following pages.

Remove any excess compound using an


appropriate cutter or other sharp edged
tool.

If possible place and fix a marker (small steel ball-bearing, or suitable gutta-percha cone) in the
diagnostic target zone of the dentition impression. As an alternative mark up the target zone with
a 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 the
radiographic results.

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11. Making an exposure in transversal Tomography mode

11.4 Preliminary alignment on workbench.

• Insert the positioning device into the


workbench support, locking it into place
with the appropriate fastening screw.
For mandibular examinations turn the
positioning device upside-down
before locking into place.

• Insert the tray into the forked tray holder


on the positioning device.

The necessary angle of rotation for examinations of the mandibular depends on the position
of the occlusal plane relative to the lower mandibular base; deviation from the horizontal
plane 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 the
horizontal plane (0°). For mandibular examinations the forked tray holder should be inclined
below the horizontal plane.

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

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11. Making an exposure in transversal Tomography mode

Alignment for the dentition impression of the upper jaw


• Loosen all fastening screws and ensure that all
components of the positioning device are free to move
as needed.
• Insert the dentition impression into the forked tray holder
on the positioning device.
• Fit the alignment template for the upper jaw to the holder,
inserting the guide pins into the appropriate holes on
the positioning device.
Molars, premolars & cuspids
• While observing the dentition impression through the
transparent template, and using the vernier slides and
rotating carriage (X- & Y-axis, rotation) of the positioning
device, maneuver it into a position so that the diagnostic
target zone is aligned with the corresponding central
tooth icon on the template (see figure).

Incisors

• Proceed as above until the diagnostic target zone



coincides with the respective icon of the incisors on


the template.
• Fix the position of the tray by tightening the appropriate
fastening screws on the vernier slides and rotating
carriage.
• Remove the alignment template
Alignment 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 on
the positioning device (positioning device is upside-
down).
Molars, premolars & cuspids
• While observing the dentition impression through the
○ ○ ○ ○

transparent template, and using the vernier slides and


rotating carriage (X- & Y-axis, rotation) of the positioning
○ ○ ○

device, maneuver it into a position so that the diagnostic


target zone is centered on the cross-hairs created by
○ ○ ○

the intersection of the depicted central slice line and


the longitudinal axes of the tooth icon under examination
on 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 and
rotating carriage.
• Remove the alignment template

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

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11. Making an exposure in transversal Tomography mode

11.5 Preliminary procedures for X-ray exposure

Move the overhead to the start position by


pressing the reset key.

Slide a film-loaded cassette into the Pan


cassette carriage, making sure that the cassette
is locked into position and verifying that the
“ready for exposure” led is on.

Remember to load the film cassettes as described in the


preceding pages when shooting exposures for incisors.

Select secondary collimator opening for


TRANSCAN projections.

Shift the lever of the collimator on the tubehead


assembly to the TRANSCAN mode position.

Select the TRANSCAN program on the control


panel using the selection key: the display will
show the sector and depth of the tomographic
layer (3mm o 6mm).

Pick the patient size (small, medium, large) and


preset technical factors.

After having completed the procedure as


described above, insert the TRANSCAN
positioning device into the bite block holder and
proceed with patient positioning.

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11. Making an exposure in transversal Tomography mode

11.6 Patient positioning.


Depending on the difficulties and conditions which may be encountered during each
examination (patient’s emotive state, patient morphology, problematic examination,
available time etc…) choose one of the two following application methods:
Use of the impression tray Use of the special TRANSCAN bite block
With the aim making the patient as • Conclude alignment procedure and remove the
comfortable as possible during the X-ray impression tray from the positioning device
examination, the tray can be cropped
laterally with an appropriate tool (see the • Substitute the metal tray-holder-fork with the
product instructions). supplied special TRANSCAN bite block,
making sure that the bite block is in the same
position as was the tray-holder-fork.

• Reposition the impression on the patient’s


dental arch, making certain that all the teeth • Have the patient bite on the special bite block,
are in their correct position. making sure that incisors fit into the appropriate
splines on the bite block.
• Move the patient into a position so that the
impression tray in the patient's mouth can be • Make sure that the patient’s “diastema” is
coupled to the tray-holder-fork in the positioning aligned with the central reference on the bite
device. block, verifying that the mid-sagittal plane is
centered on the reference line (patient’s head
should not be inclined from vertical).
• Verify that the head is neither turned away or
inclined, using the positioning light beams if
necessary.

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

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GENDEX

11. Making an exposure in transversal Tomography mode

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

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

• Press the exposure handswitch to make the exposure.

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12. Making an exposure in cephalometric mode


Preparation

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

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 Ceph cassette carriage. The


cassette must be inserted until its left side correspond with the
applicable mark on the upper rail of the holder, i.e. 24x18 LL (for
Latero-Lateral), 24x18 AP (for Antero-Posterior or PA), 18x24 LL (for
Latero-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 correct
orientation.

Make sure that the lever of the collimator in the tubehead assembly
corresponds 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 control
panel will light up and the message LATERO-LATERAL will be
displayed.

If the position of the collimator and that of the tubehead are not
congruent, then the message COLLIMATOR is displayed. Turn the
tubehead or move the collimator lever to the proper position to correct
this.

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12. Making an exposure in cephalometric mode

Press the reset key. Please note that the equipment must always be in the reset condition
as 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 the
ready 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 indicating
the various patient sizes will light up and the message "SELECT PATIENT SIZE" will be
displayed. 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 technique
factors (kV, mA, s) will be set and displayed. If the operator deems it to be necessary, these
can be individually set, via the +kV, -kV, +mA, -mA, +s and -s keys in the upper part of the
control panel. If the selected technique factors differs from the default settings, the relevant
key lights up. You can always reset back to the default technique factors by pressing the
relevant patient size key.

The possibility to manually set the various technical factors is enabled also in the case of the AEC
option 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 the
technique for a small patient.

Note that, from a radiographic point of view, changing the exposure time(s) has basically the same effect
as changing the tube current (mA), with the same proportionality. Please refer to section MAKING AN
EXPOSURE 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 and
earrings 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 key
marked "AEC" is present on the control panel, the Orthoralix "9200" version is not enabled to execute this
function. Its possible to enable, or if required, to disenable the "AEC" mode when powering-up the Orthoralix
9200 PLUS system using the user configuration programme (see Configuration Programme).

The AEC function uses a sofisticated sensor to measure the energy dosage emerging from
the 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 the
radiograph.

At the end of the exposure, and in case of any correction during the exposure time, the
operator can verify the maximum value reached by pressing either the s+ (LED on) key in
case of an increment or the s- (LED on) key in case of an interruption of the preselected
exposure 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 corresponding
to the selected patient size. Should the system detect values outside those admissible the
"AEC" mode will automatically be disabled (display of the "AEC DISACTIVATED" message
in the control panel). In this case the system will use the preimposed exposure times selected
for patient size. The operator can verify the maximum value reached by pressing either the
s+ (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 the
hemi-ortogonal, frontal and Transcan projections.

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12. Making an exposure in cephalometric mode

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, mostly
used to trace a cephalogram for the purpose of orthodontic treatment. There are different methods to acheive
this, 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, as
well 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 turn
upwards the support itself.

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

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12. Making an exposure in cephalometric mode

Place the patient’s head in the cephalostat, carefully adjusting the


height of the cephalometric arm, making sure that the patient is
standing in a for him/her natural posture, eyes to front having the
Frankfort plane on the horizontal. Make sure that the ear plugs are
covered with the hygienic protections. Gently close the ear rods, by
means 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 rotated
vertically, adjusted longitudinally (using the lever at the side of the
cephalostat) 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 of
the x-ray field, so that the profile of soft tissues of the face can be
seen on the radiography, which would otherwise be radiographically
burned out by the more intense dose necessary for the hard and
denser parts of the skull. The curved shape of the filter adapts better
to the profile of the face.

A lever on the left side of the tubehead adjusts the position of the
soft tissue filter in relation to head position and x-ray field. Five
numbered and graduated segments of increasing size are marked
on the tubehead in correspondence to the above lever, on the upper
rail of the cassette holder and also next to the adjustment lever of
the nasion support.

Having completed the patient positioning, the value indicated on the


craniostat 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 the
applicable radiation safety procedures.

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

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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12. Making an exposure in cephalometric mode

The actual x-ray emission starts 0.8 s after pressing the handswitch. During the emission of
x-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, if
installed.

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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12. Making an exposure in cephalometric mode

Patient positioning and exposure for antero posterior radiography

Rotate the craniostat, by turning the round cover, so that the patient is facing towards the
tubehead 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 on
the 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 the
Latero-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 turning
the 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, and
fixed 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's
head appropriately inclined away from the cassette holder. For patient comfort we recommend
a seated position in an appropriate chair.
With patients of medium size good results have been obtained with 80 kV-8mA-1.25s and
using a screen/film combination Kodak, Lanex Medium-EKTAVISION, automatic processing.

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13. Geometry of the x-ray projections

Side view EAR PLUGS


LATERAL PROJECTION

Top view CENTER OF THE


CEPHALOSTAT

24 X 18 L.L.
Frontal view
NASION
SUPPORT

EAR PLUGS

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GENDEX

13. Geometry of the x-ray projections

Side view
EAR PLUGS

CENTER OF
Top view CEPHALOSTAT

18 X 24 L.L.

Frontal view

NASION
EAR PLUGS SUPPORT

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GENDEX

13. Geometry of the x-ray projections

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

Top view CENTER OF


CEPHALOSTAT

24 X 18 A.P./P.A.
Frontal view

EAR PLUGS

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GENDEX

13. Geometry of the x-ray projections

Side view

Top view MEAN DISTANCE BETWEEN EAR PLUGS


LATERAL PROJECTION

MEAN DISTANCE BETWEEN EAR PLUGS


A.P. OR P.A. PROJECTIONS

30 X 24
Frontal view

EAR PLUGS

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14. Hygienic procedures and cleaning

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

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

The other parts that may come into direct contact with the patient, such as the
handgrip, the transcan positioning aids or the front rest flaps, must be kept clean
and disinfected. These can be cleaned with a 2% ammonia solution, or other
appropriate 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 any
other liquids should be allowed to enter the equipment, as this can cause short-circuits and
corrosion.The unit, including accessories and connecting cables, should be cleaned or disinfected
only 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 are
not recommended, as the disinfectants may permeate into the unit and cause short circuits or
corrosion. If sprays are unavoidable, the following precautions must be taken:should the room in
which the equipment is installed have to be disinfected by means of an atomizer, the unit should be
carefully covered with a plastic sheet before proceeding.
The equipment should be switched off and allowed to cool down well in advance in order to prevent
convection currents drawing the disinfectant vapours into the equipment. After dispersal of the
vapours, the plastic sheeting can be removed and the unit powered-up for use. The equipment must
not be used in the presence of disinfectants which vaporize to form explosive mixtures, these vapours
must be allowed to disperse before the equipment is returned to use. The method of disinfection
used should comply with current regulations and recommendations, including those concerning the
prevention of explosive hazards.

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

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15. Configuration programme


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

Set language
English, Français, Italiano, Deutch, Espanol.

Pan sensitivity
With this function the sensitivity, or speed, of the screens/film combination used in Pan and Transcan
mode (15 x 30 cm cassette) can be preset. As a consequence the mA factor proposed by the equipment
for every projection modality will correspondingly change in linear inverse relationship. During the execution
of this function, two values are displayed, labelled NEW and OLD. The NEW value is the one that is
being 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:

Speed mA
160 15
200 13
250 10
320 8
400 6
500 5
630 4
800 3

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

Ceph sensitivity
Same 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 factors


With this function, it is possible to individually alter each one of the preset technical factors in any of the
projection modalities and patient sizes (except the exposure time in the Pan and Transcan modes, where
it is determined by the projection kinematics itself). To change the preset technique factors, while this
function is active and shown the on the display, simply navigate through the various projection modalities
and 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 SENSITIVITY
is 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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15. Configuration programme

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

AEC Mode
Enable/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 function
DEFAULT 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:

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

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

OPERATOR RELEASE
The operator has released the x-ray handswitch too soon before the conclusion of an x-ray exposure. Press
any key to cancel the message.

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

CASSETTE
At 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 DOWN
The tubehead has reached its estimated thermal load limits, because of heavy radiographic workload, and just
cool down before another x-ray emission. The number of seconds to go for the thermal recovery is shown and
continuously 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 the
Technical Service Manual.

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16. Technical data

Refer to the Technical Service Manual for electrical block diagrams and for other more detailed
technical 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 in


any 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

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 LL
24 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)

Accessories:

Skull cephalostat - pt. nr. 9801 401 30004


Technical test phantom - pt. nr. 4519 124 20471
Disposable hygienic covers for bite block (set of 100 pcs) - pt. nr. 4519 129 03601
Disp. 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.

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Orthoralix 9200 Orthoralix 9200 Ceph

May 2005 - Operator manual 73 Orthoralix 9200