standard patient positioning for optimal image acquisition_v1.0.0_091130(e)

7/25/2019 Standard Patient Positioning for Optimal Image Acquisition_V1.0.0_091130(E)

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Table of Contents

1 Introduction ........................................................................................... 2

2 Panoramic Patient Positioning Methods ............................................ 4

2.1 Panoramic Imaging Position .......................................................................... 4

2.2 Sinus Imaging Position .................................................................................. 9

2.3 TMJ (Temporomandibular Joint) Imaging Position .................................... 14

3 Patient Positioning Methods for CT imaging ................................... 20

4 Cephalometric Patient Positioning Methods.................................... 24

4.1 PA projection (Posterior to Anterior) ........................................................... 24

4.2 Lateral Projection Mode ...............................................................................27

4.3 SMV Projection (Submento Vertical) Mode ................................................. 30

5 Image Quality Checkpoints and Solutions ....................................... 33


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1 Introduction

This manual provides a guide to achieve correct patient positioning on the panoramic and

cephalometric imaging systems.

This manual is only intended for PaX-500, PaX-Uni3D, PaX-Reve3D, PaX-Primo (Basic model)

and Picasso-Trio which all have the same type of chinrest.

However, the positioning can sometimes vary depending on the patients unique anatomical

structure.

The canine beam adjustment is not required, depending on the equipment model involved.

In that case, please skip the step of adjusting the canine beam.

So, please use thins manual as a base reference only.


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Accessories for positioning

VATECH provides 4 different kinds of bite blocks/chin supports for proper patient positioning thatwill be used for the various imaging modes your unit provides.

Bite block & Chin support (Nomal) Chin support (Toothless)

Chin support (TMJ) Chin support (Sinus)


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2 Panoramic Patient Positioning Methods

2.1 Panoramic Imaging Position

Maxillary Sinus

Head of mandible

Articular eminence

Articular fossa

Styloid process

Zygomatic arch

Coronoid process of mandible

Orbit

Nasal septum

Hard plate

Mandibular canal

Mandible angle

Hyoid bone

Incisive foramen

Mental foramen


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Panoramic Imaging Process

1. Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,

spectacles, dentures, and orthodontic appliances. These items can cause shadow

images that may obscure diagnosis.

2. Insert the normal chin support and bite

block in the units chinrest receptacle.

Place a hygienic cover over the bite

block.

3. It is recommended that the patient wear a lead apron for protection against any possible

scatter radiation.

4. Have the patient stand upright at the

center of the machine with their chin in

line with the chinrest. Ask the patient to

grip both handles on either side of the

unit firmly.


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5. Adjust the height of the system using

the column up/down switch until the

patients chin is resting on the chinrest.

Position the patients chin on the

normal chin support.

6. Ensure that the patients shoulders remain level and their neck is relaxed. The cervical

spine should be straight and upright. To prevent magnifications on the left and right

sides of the final image, make sure that the vertical laser beam is positioned at the

center of the occipital bone.

7. Have the patient bite the bite block along the grooves using their upper incisor. Ensure

that the chin is in good contact with the chin support.


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8. Have the patient smile to properly position the canine laser beam at the center of the

patients canine tooth. Rotate the thumb wheel, located under the patient support rest,

forward and backward to properly align the beam.

9. Position the head of the patient to

properly align their Frankfort plane with

the horizontal laser beam. For proper

positioning, adjust in which way the

patients head is tilted by adjust the unit

slightly upward or downward using the

column up/down switch. The Frankfort

plane is the line from the infra-orbital

point to the superior edge of the External Auditory Meatus (E.A.M).

10. The horizontal laser beam, located at

the side of the column, can be adjusted

up or down to accommodate different

head sizes. This is done by manually

moving the horizontal laser beam lever

up or down.


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11. Using the temple support wheel button,

adjust the temple supports to fit snugly

on either side of the patients head.

The patients head should be

immobilized. The temple support wheel

button is located at the front of the

patient support rest.

12. Have the patient close their lips and keep their tongue positioned towards the palate

throughout the exposure cycle.

13. For a patient with no teeth, the vertical laser beam should be positioned on the patients

mid-sagittal line. The horizontal laser beam should be aligned along the Frankfort plane.

Align the canine beam on the fold on the side of the nose.

14. Ensure that the patients eyes are

closed. Press and hold the exposure

switch button until image acquisition iscomplete.


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2.2 Sinus Imaging Position

Nasal septum

Sphenoid sinus

Orbit

Maxillary sinus

Coronoid process


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Sinus Imaging Process




2. Insert the Chin support (Sinus).


scatter radiation.





unit firmly.


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patients chin is resting on the sinus

chin support.










slightly upward or downward using thecolumn up/down switch. The Frankfort


point to the superior edge of the External Auditory Meatus(E.A.M)


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8. The horizontal light should fall on the tip of patients nose. Therefore, you have to tilt the

patients head 10~15 degrees upward.


patients premolars tooth. Rotate the thumb wheel, located under the patient support

rest, forward and backward to properly align the beam.

.

10. Adjust the horizontal laser beam along

the patients Inferior Orbital Fissure.

The horizontal laser beam, located at

the side of the column, can be adjustedup or down to accommodate different



up or down.


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switch button until image acquisition is

complete.


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2.3 TMJ (Temporomandibular Joint) Imaging Position

EAM(External Auditory Meatus)

Head of mandible

Articular fossa

Articular eminence

Mandible angle


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TMJ Imaging Process




2. Insert the chin support (TMJ).


scatter radiation.





unit firmly.


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5. Adjust the height of the system using the column up/down switch until the patients chin

is resting on the chin rest. The top of the TMJ support should be in contact with the

patients acanthion point.





7. Position the head of the patient to properly align their Frankfort plane with the horizontal

laser beam. For proper positioning, adjust in which way the patients head is tilted by

adjust the unit slightly upward or downward using the column up/down switch. TheFrankfort plane is the line from the infra-orbital point to the superior edge of the External

Auditory Meatus (E.A.M)


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8. The horizontal laser beam, located at

the side of the column, can be adjusted

up or down to accommodate different



up or down.




10. For TMJ Open imaging, the patients mouth should be opened as wide as possible.

The top of the TMJ support and the patients acanthion point must remain in contact.

11. Have the patient close their eyes and rest their tongue at the bottom of their mouth



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13. Ensure that the patient does not move

during image acquisition. To expose,

press and hold the exposure switch

until TMJ Open image acquisition is

completed.

14. To subsequently take the TMJ Closed

image, the patients mouth will now

remain closed. The upper lip must

make contact with the TMJ support.


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16. Have the patients close their lips and rest their tongue at the bottom of their mouth







slightly upward or downward using the

column up/down switch. The Frankfort


point to the superior edge of the External Auditory Meatus (E.A.M)

18. Ensure that the patients eyes are closed. Press and hold the exposure switch button

until image acquisition is complete.


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3 Patient Positioning Methods for CT imaging




2. Insert the normal chin support and bite

block in the units chinrest receptacle.

Place a hygienic cover over the bite

block.


scatter radiation.


center of the machine with their chin

in line with the chinrest. Ask the

patient to grip both handles on either

side of the unit firmly.


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patients chin is resting on the chinrest.





7. Have the patient bite the bite block along the grooves using their upper incisor. Ensure

that the chin is in good contact with the chin support.


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9. For CT imaging, the horizontal light should be aligned the patients occlusion. But the

beam cannot be adjusted.

So, to properly align the patients occlusion along the horizontal beam, adjust the height

of the column and chin rest using the up/down control switch and up/down control

buttons of the touch pad screen panel.

< Tip 1 > < Tip 2 > < Sample touch screen image >

Tip: Automatically the horizontal beam located on the center of CT image. If you want

to take a clear image of a particular area, adjust the chin rest using up/down buttons

of the touch pad screen panel, so that the horizontal beam focuses on the area.

1. To focus on the maxillary area, the horizontal light should be aligned at 1.5cm alone the

patients occlusion.

2. To focus on the mandible area, the horizontal light should be aligned at 1.5cm below the

patients occlusion.


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In order to get quality images, the patient is not allowed to swallow saliva or make

tongue movements during x-ray exposure of the imaging process.



switch button until image acquisition is

complete.


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4 Cephalometric Patient Positioning Methods

4.1 PA projection (Posterior to Anterior)

Sagittal suture

Occipital bone

Frontal sinus

Orbit

Crista pyramidis

Mastoid air cells

Sphenoid sinus

Nasal septum

Innominate line

Atlanto-occipital joint

Maxillary sinus

Mandible angle

Incisive foramen


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Cephalometric PA Imaging Process

1. The nasal positioner should be flipped upward to prevent image obstruction.

2. Adjust the distance between the ear

rods, as shown in the illustration.





scatter radiation.

5. Guide the patient to the Cephalometric Unit.

6. Ask the patient to stand upright. Ensure

that the patients shoulders are level

and the neck is relaxed.


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7. Use the column up/down switch to

adjust the height of the machine until

the ear rods are adjacent to the

patients ears.

8. As a positioning checkpoint, ensure

that the patients Frankfort plane is

parallel to the floor.

9. Ensure that the patients eyes are closed.Have the patient remain still. Press and hold

the exposure switch button until image acquisition is complete.


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4.2 Lateral Projection Mode

Lambdoid suture

Occipital bone

Mastoid air cells

Coronal suture

Frontal sinus

Dorsume sella

Nasal bone

Orbit

Sphenoid sinus

Maxillary sinus

Head of mandible

EAM(External Auditory Meatus)

Mandible angle

Hyoid bone

Nation point

16 Acanthion point


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Cephalometric Lateral Imaging Process




2. Flip the nasal positioner down and rotate the ear rods to position the patient laterally.

Adjust the distance between the ear rods.


scatter radiation.



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5. Use the column up/down switch to adjust the height of the machine until the ear rods

are adjacent to the patients ears. Ensure that the ear rods have a comfortable yet firm

fit in the patients ears.

6. For proper positioning, the patients

Orbitomeatal Line(OML) should be

parallel to the floor. Adjust the nasal

positioner on the patients soft tissue

nasion point.

7. Ask the patient to stand upright. Make sure that the patients shoulders are level and the

neck is relaxed.

8. Have the patient remain still. Press and hold the exposure switch button until image

acquisition is complete.


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4.3 SMV Projection (Submento Vertical) Mode

Zygomatic bone

Teeth

Nasal septume

Mandible angle

Mastoid air cells

Sphenoid sinus

Great formamen

Odontoid process


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Cephalometric SMV Imaging Process

1. The nasal positioner should be flipped

upward to prevent image obstruction.

2. Adjust the distance between the ear rods for head positioning.





scatter radiation.


6. Ask the patient to stand upright, facing

the machines rotating unit.


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7. Use the column up/down switch to

adjust the height of the machine until

the ear rods are adjacent to the

patients ears. Ensure that the ear rods

have a comfortable yet firm fit in the

patients ears.

8. For proper SMV positioning, the patients Frankfurt plane must be perpendicular to the

floor, as shown below.

9. Have the patient remain still. Press and hold the exposure switch button until image

acquisition is complete.


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5 Image Quality Checkpoints and Solutions

Case 1. Patient Stepped too far into the Imaging Device

Anterior teeth area looks hazy

Premolar teeth look overlapped

The patient bit the bite stick beyond its grooves.

Canine laser beam was not correctly aligned.

The patient stood too far into the machine.

Ensure that the patients incisors are properly aligned on the grooves of the bite block.

Have the patient smile to properly align the canine laser beam with the center of the

patients canine tooth.

Anterior Enlargement


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Case 2. Patients Head is Angled in a Downward Position

Roots of the anterior teeth area are hazy, while the premolars look overlapped.

The patients head was tilted in a downward position.

Properly align the horizontal laser beam along the patients Frankfurt plane by adjusting

the column slightly upwards using the up/down switch.

If situation persists despite adjustments, the dentition of the patient is not normal.


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Case 3. Patients Head is Angled in an Upward Position

Roots of the anterior teeth area are hazy.

The patients head was tilted in a downward position.

Properly align the horizontal laser beam along the patients Frankfort plane by adjusting

the column slightly downwards using the up/down switch.


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Case 4.Patients Head is Tilted

Hazy image in which the patients head appears to lean to the right or left.

Differing magnification on the right and left sides of the image.

The patients head was tilted to the left or right during image acquisition.

Align the sagittal beam properly along the patients Mid-Sagittal plane.

The vertical beam should be positioned at the center of the occipital bone.


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Case 5. Patients Head is Turned

Differing magnifications on the right and left sides of the image.

A part of chin looks much wider than normal.

The patient turned their head.

Align the sagittal beam properly along the Mid-Sagittal plane of the patient.


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Case 6. Upper Jaw is Dark

Upper jaw looks dark.

The patients tongue was not positioned towards the palatal area.

Ensure that the patient keeps their tongue against their palate while taking the image.


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Case 7. Patient Movement

Whole image is hazy with undefined lines

Blurry image

Patient moved during image capture.

If the patient is nervous, try to calm them.

Ask the patient not to move during image acquisition.


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Case 8. Inappropriate Patient Posture

A pyramid shaped ghost (white) image appears in the middle of the image.

Patients posture is bent.

When positioning the patient, ensure that their spine is straight.

Keep the shoulders down so that the tip of the chin does not reach the nape.

Adjust the vertical carriage slightly upwards to properly position the patients head and

to straighten the spine.


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Case 9.Metal Objects

Ghost images (reflections) of the metal objects appear in the image.

Patient did not remove all metal objects.

Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,

spectacles, dentures, and orthodontic appliances.


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Case 10.Image is too Bright

Image is too bright.

The x-ray dose is too low.

Increase the kVp and mA exposure values.


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Case 11. Image is too Dark

Image is too dark.

The x-ray dose is too high.

Decrease the kVp and mA of exposure values.


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standard patient positioning for optimal image acquisition_v1.0.0_091130(e)

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