Q/ Hi and thank you for accepting our interview request. Before we start, can you tell the readers more about yourself Dr. Chenin?

First I want to thank you for this interview opportunity, and for the possibility to contribute to your website. I’m a big fan of MARCILAN and also an owner (one of the first) of your iCBCT iPhone application, so its my pleasure. As for myself, I am very involved in 3D imaging as the Director of Clinical Affairs with Anatomage Inc., and I teach as adjunct faculty at the University of the Pacific Orthodontics Department, and at UNLV School of Dental Medicine in the Clinical Sciences department. I really enjoy being a part of the development of new 3D imaging applications and also helping private clinicians, students and faculty learn and teach these new applications. 3D imaging is really changing the potential and practice of dentistry and I’m very grateful to be a part of it.

Q/ Some users have heard about the company Anatomage but others may have not. Can you tell us more about Anatomage?

Sure, Anatomage is a 3D imaging software, service and technology company based in San Jose California, focused on developing and advancing the potential of 3D imaging for dental and medical applications. The company is five years old, growing fast, and we have a great relationship with our customers, Universities, and the 3D industry, whose support has made many things possible in the five years Anatomage has been around.

Q/ What do you think about the current status of Cone Beam CT?

Well in short; its revolutionary! It has and continues to change many aspects of diagnostic and clinical dentistry. A similar trend was seen in medicine with the advent of medical CT machines, it was not long before almost all fields of medicine were benefited and, without being an overstatement, totally revolutionized with the ability to see patients’ anatomy in 3D. And now with the advent of Cone Beam CT, a dental specific CT machine with a fraction of the radiation and a fraction of the cost, it has and continues to revolutionize so much of dentistry.

Q/ Invivo 5 just came out. Are you excited about the new features? Can you briefly tell the readers what’s new?

Yes, we are very excited for the new release of Invivo5, there are a handful of great new features that will make it much more powerful. One of biggest is a whole new generation of CBCT imaging, what we call Cosmetic CBCT. With Cosmetic CBCT, we can fuse the CBCT scan to stone model scans and intra-oral photography, making a big leap forward towards the concept of the virtual patient. Invivo5 also includes a whole new type of volume rendering that looks amazingly realistic, just like real bone. We have a new TMJ layout feature, new video sequencing features, file sharing features, and a general face-lift of the interface design, it looks much more slick now. In fact, you did a great job at going through these features in your Invivo5 review posting on January 12^th , I’d recommend readers to read that posting as well.

Q/ Are there any specific requirements for Invivo 5?

The critical requirement is pretty much the same; a good graphic card. We recommend the NVIDIA graphic cards, with at least 512mb of memory. Before we recommended at least 256mb of memory in the card, so that requirement has gone up. It also helps to have more RAM, but the standard 2GB is fine.

Q/ We noticed that it is now called Invivo instead of InvivoDental. Did you just shorten the name or were there other reasons?

Yes, the name is now Invivo5. This helps isolate exactly which version you have just by the name of it, as we are currently on version 5.0 or Invivo5. Also, Invivo is more general as we do have a fair amount of customers who use Invivo for things other than dental applications, most still focused on cranio-facial applications, but the main focus of Invivo is still dental by far.

Q/ We know Invivo 5 just came out. Any plans for Invivo 6 that you can share with us?

Invivo6 is in the works, but its really top secret at this point. But what I can say is that just like all the other upgrades of Invivo over the years, the new features are very significant new applications, not just minor bug fixes and the like, which are done in between big releases. This really keeps our customers excited and our competition far behind. However, one thing to mention is that we are also making plug-in modules for Invivo and one of the next to come out is a 3D cephalometrics module that will be very important in the overall path of orthodontics towards a 3D cephalometric reality. Up until this point, 3D cephalometrics has been mostly employed in the realm of research, but with this efficient and powerful module, it will open up a new era of 3D cephalometrics in clinical practice, not to mention its facilitation of 3D cephalometric in research as well.

Q/ I use Mac and Windows at my work environment and there might be other users who do that. Does Anatomage have something for Mac users?

Currently our software is totally Windows OS based, however with programs like Boot Camp, its very easy to install and use on a Mac computer. Many of our customers use Invivo on their Mac computers.

Q/ We -at Marcilan- try to support users who speak different languages. In terms of language localization or multilingual support, does Anatoamge intend to support languages other than English?

Yes, we think this is very important too, we just launched a Japanese version and many other languages are soon to come.

Q/ Speaking about support, where would users go if they need help from Anatomage?

We have a great support team that our users have access to, both by phone, email and webinars. Each customer has access to online training and can ask us questions any time. We have made a full video tutorial series, so if anybody is in need of it, they can call Anatomage support at 408-885-1474 ext 3 to get more info on it. Anybody who is not a current user can just call in or email us at info@anatomage.com for more information. We do regular demonstrations webinars in groups or one-on-one, so if anybody is interested in a demo, they can contact us directly.

Q/ Were there any challenges during the development process of the new version of Invivo?

Well, I am more on the Clinical / Educational side of things, but our engineers work very hard making new applications. I would say the biggest challenge for everyone here is that we are making things that have never been done before, we are not interested in coping other software or technology, we make developments that are new and ground breaking. At the heart of all this progress is Anatomage’s CEO, Jack Choi PhD, who is very innovative and ambitious, so stay tuned as much more is sure to come.

Q/ Are there any news about new coming products from Anatomage?

The next release is the 3D Cephalometrics module and another one called Medical Design Studio. The 3D cepholometrics module I have already mentioned, and the 3D Medical Design Studio is a full segmentation, modeling, and surgical simulation software. It also allows STL files to be imported, exported and manipulated for physical model manufacturing with stereolithography. Thus completing the circle from virtual CBCT images to physical models. Both new products are to be released very soon and will be optional modules that can be added to Invivo5.

Q/ Where do you see CBCT going in the upcoming years? What do you think the future will be so to speak?

Well, there are three broad areas to consider; the machines, the software, and associated services. In terms of machines, we will see the machine progressing in terms of faster scan times, with less radiation, more settings such as different resolutions and FOV sizes, finer resolutions, more hybrid options, and possibly even connections to other types of diagnostic machines, either through software interfaces or directly with the hardware. We will continue to see growth in the purchase and adoption of CBCT machines as well. In terms of software, this is where many of the applications will be developed, as it is in the manipulation of the data that most new potential is achieved. Software is becoming more advanced with new kinds of treatment options, and will continue to expand with more treatment types, and advancements on current ones. Sharing the data with other practitioners is also very important and thus collaboration with other specialists will be facilitated, as is the case with new features in Invivo5 that allow for files to be uploaded to our secure server right from the software and shared with other specialists involved in the case.

Another function that is growing is the convergence of CBCT data with many other digital data sets of the patient, this is also the case with our generation of Cosmetic CBCT where we can fuse stone models or intra-oral scans with CBCT scans and intra-oral photography. I predict that almost any type of digital patient data will somehow eventually be combined or included along with CBCT data, and it will essentially be the matrix of it all. We shall see trends in the convergence of more restorative and CAD/CAM options, and occlusion and jaw tracking as well. In short, what is happening is the creation of a more and more complete virtual patient with each new development. This segues right into the next category, which is the associated services that are currently a part of this, and will continue to grow in importance and number. Currently implant surgical guides and stereolithographic modeling and manufacturing are possible, but we will also see more services being developed as well, making an era of many high-tech 3D laboratory and/or in-office options. The virtual treatment plans will result in physical therapeutic devices and full treatment solutions, thus completing the circle from diagnostics, treatment planning, to imaging guided treatment. Several image guided treatment devices and services are currently possible, the biggest being the surgical guide for implants, but I expect a lot of growth in this area.

In summary, we will see the convergence of many types of patient data, more treatment planning options, and more clinical solutions; with CBCT scans as the matrix of it all.

Q/ Thank you for your time with us Dr. Chenin. We appreciate it, any last words you’d like to give to our readers?

I’d like to thank you again and anyone reading this for their time and interest, and I would also say “stay tuned”, as the rate of progress in 3D technology is stunning. CBCT technology is not some distant future, as very exciting things are happening right now, are possible right now, but even more exciting is that its still growing very fast and amazing things are still to come.

Google Knol CBCT Directory

A major illustrated directory of dental cone beam X-ray services has been published as a service  for patients, dentists and radiologists. Titled CBCT Dental X-ray Services Directory, the guide includes hundreds of free listings for three classes of providers:

• Implantologists / dentists who support CBCT. If they have an in-office CBCT scanner, it is indicated

• Universities / Dental Schools offering CBCT laboratory services

• Private CBCT Laboratories/Clinics

The guide begins with an introduction based on a YouTube video about one of the first CBCT installations in the United States. The dentist being interviewed, Dr. Robert Langlais in this 2001 news piece gets it right:

“Without this imaging, there’s more guesswork involved.”

A quotation from Dr. Steven Guttenberg (pictured) of the Washington Institute for Mouth, Face and Jaw Surgery, drives home the point:

My original impetus for purchasing a CBCT was to assist in the complete evaluation of a site to accept a dental implant. It allowed me not only to appreciate the true location of the inferior alveolar nerve canal and the mental foramen, but also the maxillary sinus and the true proximity to the incisive canal, adjacent teeth, and nasal floor. Plain films allow only the ability to judge the height of the alveolus, but with CBCT I was able to get complete information to a hundredth of a millimeter of not only the alveolar ridge height but also of its width. The CBCT also allows us to appreciate the morphology of that ridge. These are all extremely important factors to have in one’s command prior to implant placement.

Next, a PowerPoint style presentation — actually a Google “Doc” that lives “in the cloud” of cyberspace — provides a review of CBCT Scanners. Some 18 different systems are shown pictorially in a format that automatically advances every four seconds. The guide is kept up to date by the author as new scanners enter the market. Good photos of each system entice treaters to learn more, like sports car buffs at the Auto Show. Each photo includes a hotlink to the manufacturer’s website. The links will prove useful to practitioners who want to do some comparison shopping.

Listings come next, beginning with the United States. They are organized alphabetically. Each listing is accompanied by a thumbnail image of the system offered by the practice, lab or dental school.  Some of the listings include quotations, like this one from Dr. Joseph Kravitz, whose practice includes in Imtec Iluma:

...with the Iluma, we can take 360º X-rays that give us incredibly accurate 3-D views of your teeth, gums and mouth. …This state-of-the-art technology — available nowhere else in the area — gives us the opportunity to discover and treat problems much earlier, almost as if we’re seeing into the future…. Our advanced computer-guided implant techniques allow us to map out the entire process beforehand. The preplanning on the computer lets us to accurately find the perfect placement for dental implants while steering clear of problems, such as nerves, arteries, veins and other teeth.

Typical listing of a CBCT installation

The listings (see the photo for a typical listing) include full contact information for each treater, clinic or school. When available, e-mail addresses are included. One of the directory’s requirements for listing is that each entry must include a website link that takes readers to CBCT information. This rule was written to encourage practitioners to promote the use of CBCT  for advance treatment planning, as a safety measure.  Bringing CBCT to patients as the standard of care is one of the directory’s motives.

Following the listing  of systems in about half of the 50 states, other nations are listed alphabetically beginning with Australia. So far, practices in seven nations have submitted information to the directory. This is likely to change as the global recession gives way to prosperity.

CBCT Dental X-ray Services Directory awaits your perusal. The author suggests that practices that are serious about CBCT add the directory to their website patient communication offerings. Any practice, clinic or dental school that offers CBCT services to the public are welcome to list in the directory at no charge at the present time.

The author has also written a richly detailed companion article on Dental Implants focused on patient safety. It contains CBCT images and detailed artist concepts that drive home the key messages for patients and dentists alike. It will be reported here at Marcilan in the near future.

NVIDIA Professor Partnership program offers new possibilities for researchers around the world to work and collaborate with NVIDIA. It aims to provide  access to cutting-edge technology to drive innovation in research at the universities. Professor Partnerships may include:

• Financial support for research projects, typically in the form of unrestricted cash grants
• Equipment donations and/or discounts for labs, teaching facilities, and research projects
• Sponsoring and/or support of curricular initiatives in GPU computing, parallel computing, and computer graphics

We applied for the program and our research proposal has been accepted. NVIDIA generously provided us with their flagship Quadro FX 5800 which has the fastest graphics chips  on the face of the planet which we intend to use it for scientific visualization and CBCT volume rendering research. The Quadro FX 5800 comes with 4GB DD3 memory on board and very powerful quad buffered API. NVIDIA also sent us their NVISION 3D bundle.

NVIDIA also provides graduates fellowships for graduate students to support their research.

For more information about NVIDIA Professor Partnership Program and the online application form, follow the source link after the break.

[Source: NVIDIA]

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! (Update: the software will burned to the disc if you own a Kodak machine as a viewer but it is free). The software will be 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. (Update: there are issues with mis-orientation of the volume from 3rd party Cone Beam CT data sets). 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.

UPDATE : Kodak has provided us with the form to get their software.

In an article published recently “Does your Cone Beam CT see too much?“, Dental Products Report (DPR)  senior editor: Noah Levine; discussed the introduction of Cone Beam CT  to dentists as a new modality that provides 3D information depth and allows new possibilities for diagnosis and treatment planning. But what about the image volume  readout? What about liability and what are the possible ways for practitioners to handle their CBCT scan of their patients?

The full article can be found by following the link here