Kodak demonstrated their new CBCT software during the AAOMR meeting in Louisville, Kentucky this year. The software is feature packed and has an intuitive interface. We just got our hands on the latest beta of their 3D viewer called: Kodak Dental Imaging Software  3D v2.2 (KDIS).

The software is still in beta stage and under development. From what we heard from Kodak, they intend to release the software as a shareware or freeware. Yes, you heard it right! You might wonder: but it would open just Kodak CBCT volumes, right? Not really, the software is able to open not only Kodak CBCT volume but all other 3rd party CBCT volumes as well . In this article we will review KDIS and see what it has to offer. We will explore the interface, see a list of features, and limitations in the current version.

Computer Setup:
-Workstation 1-

AMD Phenom X4 @ 3.2Ghz
8GB DDR3 memory
NVIDIA Quadro FX 5800
MSI 790FX motherboard
1TB WD 7200RPM HDD in RAID 1 + 0
Dual 22″ monitors
Windows 7 Professional 64bit

-Workstation 2-

Intel Quad Core Q6600 @ 2.2Ghz
4GB DDR2 memory
NVIDIA GeForce 8800GT
500GB Seagate 7200RPM HDD
22″ monitor

Windows 7 Professional 64bit

-15″ MacBook Pro-

2.8Ghz Intel Core 2 Duo
4GB DDR 3 memory
NVIDIA 9400/9600 graphics card
500GB 7200RPM HDD
Snow Leopard 10.6.2
Windows 7 Professional 32bit
Parallels Desktop 5

Before we start the review, Kodak informed us that they didn’t have the time to test their software against Windows 7; however, support for Windows 7 should be coming in Q1 2010.

Installation

The installation went smoothly on all systems. It took less than a minute to install the software.

Exploring the interface

When you launch the software, it will start with a window asking you to select a CBCT data set. It can recognize .dcm (DICOM) extension; however, if your CBCT data set has no file extension like: Sirona Galilleos DICOM export. The software will not be able to find it. You will need to add a file extension for all the files. There is no way to select show all files. There are many free utilities on the web that can rename files very quickly. We decided to start with  the data set Kodak sent to us to make sure everything works right. Kodak supplied us with two data sets from their Kodak 9500 CBCT scanner.

The software applies special filtering to improve the quality of the image and reduce noise. Once the software finishes loading the DICOM data set, you will be presented with a Reformatting Tool window which has several options.  Here you can generate a new volume from the original DICOM data set you loaded. You can crop, adjust voxel size, and reorient the volume. To save the new volume ,you must specify a new volume name and click OK.

If you hit the Skip button, the software will proceed to the main interface.

The interface is neatly organized. There is a sidebar that contains the tools. The default view comes divided into 4 different views: axial, coronal, sagittal, and volume render. All views can be further customized using the view toolbox located in the top left corner of each view. There are three tabs that switch the interface to three different workspaces: Orthogonal Slicing, Curved Slicing (Also known as panoramic), and Oblique Slicing.

The tools in the sidebar are grouped into: Adjustments, Tools, and Export. There are brightness/contrast adjustment controls. Volume opacity and segmentation can be adjust as well. It is possible to apply different shade profiles or palettes to the volume to change the color of different densities.

One of the cool features is the ability to show the slices on the volume itself. This allows correlation of the slices to the volume. For users who don’t have much experience with viewing CBCT volume, it is not always easy to orient oneself in 3D space. This feature will certainly be handy for those users.

Navigation

Although navigating the volume was good; however, navigating through the orthogonal slices was a pain! there is no easy way to zoom-in or pan in the orthogonal views. There is a way to switch the function of the mouse scroll button from slice scroll to zoom but it is inconvenient and counter productive. Kodak promised us they will look into this and add proper controls.

At the top left cornet of each view, you have view controls. In orthogonal slices, starting from the left, you can maximize the current view. You can send the view to a secondary display in full screen mode (Dual display) which was really cool. You can also change the display matrix and slice thickness which allows the user to generate thick slices.

In volume render, you have similar tools with the addition of volume orientation buttons: axial (top), coronal (front), sagittal (side) and perspective. Having the the view controls inside the view window itself eliminates the need to look at the main interface  which can be distracting.  Although the volume has letter “A” for anterior, “P” for posterior, “L”  for left and “R” for right, Kodak referred to top as ‘H’ and bottom as ‘F”. It might be better to use “S” for superior and “I” for inferior instead.

Curved Slicing View

Just like what you’d expect from a curved slicing view. It is the place where you can generate panoramic image, cross-sections, trace the mandibular canal, and do implant planning. KDIS supports all of these features.

You start by drawing the panoramic curve on the axial slice and the software will generate a panoramic radiograph in the adjacent view. The processing to generate a panoramic image was very fast.  You can also change the thickness of the pan from the slice thickness drop down menu in the panoramic view.

The controls for the cross sections are available on the panoramic view as well. There are linear distance and angular measurements tools. The panoramic radiograph was used for tracing the inferior alveolar canal.

Implant planning

There are different implant libraries you can select from. You can also create custom implants and add them to your favorite implants library.

Placing an implant was easy and straightforward. It is possible to do oblique slicing along the axis of the implant. The volume render will show you the dental canal tracing in 3D with the implant. It would be helpful to have the ability to do cross-sections around the implant for better antero-posterior alignment

Loading non Kodak CBCT volumes

The software was tested against two data sets: NewTom 3G and MercuRay from Hitachi.

In both scenarios, the software managed to load the volumes. There was a problem displaying the slices correctly with the NewTom data set but the MercuRay data set was displayed correctly.

Performance

The application loading time was very good. It took less than a minute to load 256MB CBCT data set. Scrolling through the axial slices wasn’t very fast. However, maximizing the viewing window improved speed which make us wonder if this has to do with the way the render views are updated. The volume render window performance was fast when its view window was small. Once the view is maximized, there is a great penalty hit in performance (5-10 fps). Volume rendering uses the CPU (processor) instead of the GPU  (graphics card) which is several times faster and it leaves the CPU to perform other tasks. GPU rendering also consumes less power and can be helpful while you are on the go and you need battery life.

The viewer can utilize 2 CPU cores at once which is considered a plus. Many applications are still unable to utilize more than 1 CPU core. If you have more cores: 4 or 8, the viewer will use up to 2 while the remaining cores will be sitting idle. It is worth to mention that till today programming for multiple cores is still difficult.

Using the default configuration in Parallels on Mac OS 10.6, the performance was fairly slow; however, changing the configuration in Parallels to let the virtual machine have 2 CPU cores and 2GB of memory instead of 1GB improved the performance greatly. The application never crashed while switching between display modes: Coherence, Crystal, or Full Screen. All functions worked including the volume render.

Reports

It is possible to capture or print screenshots either for the entire viewing window or full size image.

Other issues

On both workstations, the drop down menu had tearing artifacts display issues. Kodak explained that this could be due to an issue with Windows 7 and they will work to fix it. On the MacBook Pro, there was no tearing problem, possibly because of the virtualization of the graphics card. There is no Save button to save your work.

In Conclusion

The new CBCT viewer from Kodak looks very promising and can be a real alternative for other pricier software on the market. The overall value was very good albeit the issues we faced. It is also worth to mention that the software is still in beta and hopefully when the final version comes out, all of those issues will be ironed out.