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Place and Time:

Presentation #13, Informatics Short Talks {Tuesday, March 2, 10:15 – 11:45 a.m., Potomac 3}

Update: Room has been changed to National Harbor 10

“The rapidly evolving technologies in dentistry are changing how dentistry is practiced. From diagnosing pathology, delivering care, even how restorations are made, to defining new standards of care, 3D Mobile imaging is the driving force in this new direction and we are excited to be in the middle of it.”

3D Mobile Imaging aims to be “Your Diagnostic Partner”, by providing the practice with a complete package of diagnostic tools including superior images made possible by the NewTom VGi, to the diagnostic equipment needed for sleep apnea or digital impression scanners, 3D Mobile Imaging incorporates the latest technology for dental practices.

Follow source for more information

[Source Businesswire]

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.

iCBCT Anatomy will let you learn different anatomical structures depicted on Cone Beam CT slices in different orthogonal views (Axial, Coronal, and Sagittal). The slices are labeled on one half and colors were applied to differentiate different anatomical structures on the other half resembling an anatomy atlas. It is also a nice tool for patient education and communication.

New Feature: Zoom! You can now use two finger pinch to zoom-in/zoom-out in all of the slices. This will make it easier to view the anatomical structures and read the labels. Click Fit button to restore the view to its original zoom level.

The iCBCT Anatomy app is available for purchase on iTunes store. The update is available for free to all current iCBCT Anatomy users. Get it here.
You can also search for cbct in your iPhone or iPod Touch and you’ll find it. Please if you like the app don’t forget to leave us a positive feedback!

Invivo 5 is 2D/3D DICOM viewer geared towards dental practitioners. Whether you’re a resident, practitioner, specialist, or a researcher working in a private practice, dental school, imaging center, hospital or at a research institute who deals with Cone Beam CT (CBCT) or medical CT data sets, you’ll find something for yourself in Invivo.

We will start with features that require Anatomage service followed by features in the software.

Features that require Anatomage Service

Cosmetic CBCT

With cosmetic CBCT, it is possible to take intraoral pictures for patient mouth then fuse that with CBCT scan and models scan. This will provide a better and fancier way to look at the scan or models data.

Surgical guides (beta)
The new technology from Anatomage will let the practitioner to integrate CBCT scans with 3D models of their mouth through virtual wax-up technology. The 3D models could be either casts or direct intraoral optical digital impression! The registration according to Anatomage is accurate although we didn’t have the chance to test it yet. Doing digital impression will eliminate the hassle of taking impression then pouring it into a cast then scanning it. This could potentially save the practitioner time, efforts, and costs.

Upload/share case
This will let you connect cases from the software to Anatomodel website (look under File / upload)

New Features:

Surface render

The Bone View under Volumetric Rendering has been completely reworked. Before the bone view was the same orange rendering with basically just slightly more opacity than the teeth rendering, but now the Bone is totally new, it should be a whitish type color looking like real bone. It’s basically a ray casting type of surface rendering, with some other elements in it such as the histogram colorizations, and a few secret algorithms that make it look better than pure ray casting. You’ll notice it looks a little “softer” and more volumetric and responds to the brightness, contrast and opacity settings too. Also when you slice it, especially in the Soft Tissue 2 setting, it’s different than most pure surface renderings. Also the Soft Tissue + Bone 2 is new and interesting, it has the new Bone with the old translucent soft tissue settings, which makes it a very unique hybrid.

Bone surface rendering of Kodak 9500 CBCT

TMJ view
The new TMJ View is geared towards looking at the temporomandibular joint. On top, you see the right and left condylar heads with cross-sections in antero-posterior direction and medial to lateral direction. In addition, the view can be customized. There are different options to control the width and thickness of slices. Colors can be applied using presets.

TMJ view of Kodak 9500 CBCT

TMJ view custom

Video sequencing
Generating better video rendering has been improved thanks to the addition of new different camera and video controls.

For more information please visit Anatomage website. In upcoming posts we will provide tutorials to cover some of those features more in details.

After setting up the dcm4chee PACS server from previous tutorials, you will learn how to access it from a different workstation on the network.

First you need to make sure that Windows firewall or any other firewall software installed on the PACS server is not blocking the server IP address and PACS server port to the outside world. For testing purposes and to make things easier you can disable the firewall.

Since the server will always be online you need to use a fixed IP address for the server as you don’t want to have the IP address changing every now and then or you will be unable to access the server anymore. There are several tutorials on the internet to teach you how to fix an IP address; just search in Google.

The IP address of our server is 192.168.1.106 to find the IP address for your server you can go to command prompt and type:

ipconfig /all

dcm4chee pacs ip address

Scroll all the way up and under IPv4 Address is your IP address. dcm4chee default port is 11112. Now we got all what we need to establish a connection. Open OsiriX on your Mac and go to Preferences and select Locations. Click on Add new node. Put the IP address, port, AETitle, and description. It should like this:

dcm4chee osirix pacs

Make sure you check the boxes next to Q& R (Query and Retrieve) and Send. Q& R allows Osirix to query the PACS server for patients and retrieve the data set the user asks for. Send allows OsiriX to send data sets stored locally on the machine running OsiriX to be stored in the PACS server. Close the preferences window.

Now we need to store some patient data on the server. We do that by loading a data set in OsiriX then send it to be stored on the server. Open a DICOM data set in Osirix. In this example, we will be using a CBCT DICOM data set from the Hitachi MercuRay CBCT scanner. You can load a DICOM set under File menu. After the data set loading is completed, select it and click the Send button from the toolbar on top.

Sending cbct dicom data set from osirix to dcm4chee

You can follow the status in Osirix by installing Growl app.

DICOM send Done!

Now it’s time to test Q & R function. Click on Query button from the OsiriX top bar. You should be able to search for the data set you just uploaded using different search criteria. OsiriX comes loaded with many powerful tools that let you query the server for data either by patient name, date, modality…etc. It also allows you to specify to which workstation you want to retrieve your data to.

DICOM Q & R Osirix and dcm4chee

Set Retrieve to your Mac OsiriX workstation if it not set already from the drop down menu. Click Retrieve.

Incoming DICOM data set from dcm4chee to OsiriX PACS workstation

Depending on your server/workstation hard drive speed, network speed, and data set size; it can take from less than a minute to several minutes to download the data set to your local machine.

Double click on the data set to open it.

Opening DICOM CBCT data set in OsiriX

Congratulations!! You’ve just managed to link an Open Source PACS server (dcm4chee) to an Open Source PACS workstation OsiriX!

It is possible to send different types of data sets to the PACS server and not only CT data sets but since many oral and maxillofacial radiologists as well as dental schools use Cone Beam CT (CBCT) in their practice we decided to use a CBCT data set as an example.

As you can see, we setup the dcm4chee PACS server under Windows 7 Pro running  Parallels Dekstop 5. While this is not the best setup and you’ll need a dedicated PACS server for your work; it helps to show how powerful a Mac computer can be and  it make things easier for us for writing this tutorial!

While a CBCT scanner costs a fraction of a medical CT scanner, a CBCT scanner can cost between $100,000 – $200,000, so it is still a heavy investment for general practitioners. Enough shielding to the walls should be provided when installing a new CBCT scanner in the dental office in order to protect the staff and patients from getting radiation exposure. For practitioners who do implant placement from time to time, it might worth it to refer the patient to an imaging center rather than investing in purchasing a CBCT machine.

Dental labs personnel who purchase CBCT to scan referral and non-referral patients know that a radiologist reading their scan is important; as an oral and maxillofacial radiologist (OMR) have the necessary training to detect early and current pathological conditions -if present- like carotid artery calcifications, sinus problems, or benign and malignant tumors. If you’re a patient insist on getting your CBCT scan read by a trained OMR. Some of those labs offer the scan data in DICOM format so the referring dentist can use their favorite software to work with the data.

[Source LMT]

If you were living on the west coast (starting to sound familiar we know) and if you happen to need a CBCT scan for your patients on the go , today might be your lucky day. The Mobile CT Imaging team will be happy to answer your call. Mobile CT Imaging uses the NewTom VG CBCT scanner to provide your patients with an easy and fast Cone Beam CT scan and they  have partnered with different software companies to facilitate implant planning and image volume visualization. Here is an interesting video to show you the process from start to finish (don’t check your speakers for audio as the audio is off for some reasons beyond our level of comprehension)

[Source Mobile CT Imaging]

Invivo 5

Invivo 5 is the new flagship product of Anatomage Inc. previously known as InVivoDental. Invivo is a DICOM viewer that can be used to view Cone Beam CT (CBCT) and medical CT DICOM data sets. It has different built-in dedicated modules to display and manipulate images. The new version packs many cool features. We’ve been playing with the software for quite sometime and we can say we’re impressed! We reported our experience to Anatomage and provided them with our input and feedback regarding the new version and we’re glad to say the company is listening. Many fixed has been added since the early beta. Expect the new version to be out very soon.

For those of you with faint hearts, here are some screen shots for Invivo 5.

Invivo5 TMJ

New feature in Invivo 5

New feature in Invivo 5

about invivo