Planmeca ProMax User Manual

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Planmeca ProMax

Cephalostat

user's manual

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Table of Contents

1 INTRODUCTION .................................................................................................................1

2 SWITCHING X-RAY UNIT ON ............................................................................................. 1

3 MAIN PARTS ...................................................................................................................... 2

3.1 General view of cephalostat ................................................................................................... 2

3.2 Patient supports ..................................................................................................................... 3

3.3 Patient positioning controls ..................................................................................................... 4

3.4 Emergency stop button .......................................................................................................... 5

4 PREPARATIONS FOR EXPOSURE ..................................................................................... 6

4.1 Preparations on all X-ray units ............................................................................................... 6

4.2 Additional preparations on X-ray units with Dimax sensor ..................................................... 8

4.3 Additional preparations on 3D X-ray units ............................................................................ 11

4.4 Preparing Planmeca Romexis .............................................................................................. 11

4.5 Preparing patient .................................................................................................................. 12

5 CEPHALOMETRIC EXPOSURE ........................................................................................ 13

5.1 Selecting general exposure settings ..................................................................................... 13

5.2 Patient positioning in lateral projection ................................................................................. 15

5.3 Patient positioning in posteroanterior or anteroposterior projection ..................................... 19

5.4 Patient positioning in submental-vertex projection ............................................................... 23

5.5 Patient positioning in Waters’ view ....................................................................................... 24

5.6 Patient positioning in AP Towne projection .......................................................................... 25

5.7 Patient positioning in oblique projection ............................................................................... 26

5.8 Positioning in hand exposure ...............................................................................................28

5.9 Adjusting exposure values for current exposure .................................................................. 29

5.10 Selecting Dynamic Exposure Control (DEC) ........................................................................ 31

5.11 Taking an exposure .............................................................................................................. 32

User’s Manual Planmeca ProMax Cephalostat 1

The manufacturer, assembler and importer are responsible for the safety, reliability and performance of the unit only if:

- installation, calibration, modification and repairs are carried out by qualified authorised personnel

- electrical installations are carried out according to the appropriate requirements such as IEC 60364

- equipment is used according to the operating instructions.

Planmeca pursues a policy of continual product development. Although every effort is made to produce up-to-date product documentation this publication should not be regarded as an infallible guide to current specifications. We reserve the right to make changes without prior notice.

2 Planmeca ProMax Cephalostat User’s Manual

1 INTRODUCTION

NOTE

1 INTRODUCTION

This manual describes how to operate the Planmeca ProMax Cephalostat.

The Planmeca ProMax Cephalostat is used to position the patient’s head accurately for taking X-ray images of the skull. The device can also be used for taking hand images for bone age studies.

The cephalostat is attached to a 2D or 3D Planmeca ProMax X-ray unit. The X-ray unit has a separate manual. Refer to the User’s Manual of the X-ray unit for any general information about the X-ray unit.

This manual is valid for software version 3.8.0.0.r or later. This software version is compatible with Planmeca Romexis software version 4.5.0.r or later. To check the software version of your X-ray unit, select Settings > About > 4100 Component Information > ProMax SW version.

Make sure that you are fully acquainted with the appropriate radiation protection measures and these instructions before you use the X-ray unit.

The X-ray unit may be used by health care professionals only.

2 SWITCHING X-RAY UNIT ON

The on / off switch is located on the underside of the stationary column top.

To prolong the lifetime of your X-ray unit, always switch the X-ray unit off when it is not in active use.

User’s Manual Planmeca ProMax Cephalostat 1

3 MAIN PARTS

Ceph&Dimax2.eps

3 MAIN PARTS

3.1 General view of cephalostat

1 Height adjusting button

2 Head support plate

3 Rotation scale

4 Nasal positioner

5 Dimax sensor

6 Ear posts

(see section 3.2 “Patient supports” on page 3)

7 Release lever on ear post holder (patient’s left ear)

8 Collimator

2 Planmeca ProMax Cephalostat User’s Manual

3 MAIN PARTS

3.2 Patient supports

Hand_imaging_support.eps

1 Ear post for patient’s left ear (marked with letter L)

2 Ear post for patient’s right ear (marked with letter R)

3 Positioning cones

4 Nasal positioner

5 Hand imaging support

User’s Manual Planmeca ProMax Cephalostat 3

3 MAIN PARTS

NOTE

Ceph&Dimax2.eps

3.3 Patient positioning controls

The patient positioning controls are located above the touch screen.

The up and down buttons are used to adjust the cephalostat to suit the height of the patient.

The cephalostat moves slowly at first, then faster.

If for some reason either of the buttons gets stuck during operation, you can stop the up / down movement by pressing any of the other control buttons or the positioning joystick. This is a safety measure that guarantees that the up / down movement can be stopped in an emergency.

There is an additional height adjusting button on the underside of the cephalostat. The cephalostat moves up or down depending on which side the button is pressed.

Be careful that the X-ray unit does not hit the ceiling when you press the up button. The maximum height can be adjusted to suit offices with a low ceiling, contact your service technician for help.

Make sure that there is no object under the X-ray unit when you press the down button. If something is in danger of becoming trapped, release the button immediately to stop the movement. Clear any obstruction before pressing the button again.

4 Planmeca ProMax Cephalostat User’s Manual

3 MAIN PARTS

NOTE

emergency_stop.eps

The column movement stops automatically if the emergency stop plate at the bottom is pressed upwards. Clear any obstruction before moving the column again.

When positioning seated patients (e.g. in a wheelchair) always first move the cephalostat down before you position the patient.

3.4 Emergency stop button

The emergency stop button is located on the top of the stationary column. Press the button to stop the X-ray unit operating in an emergency. When the emergency stop button is pressed down, all movements of the X-ray unit are blocked and the unit will not generate radiation. The up / down movement will stop within a distance of 10 mm (0.4 in.).

A help message will appear on the touch screen. Guide the patient away from the X-ray unit. Then release the emergency stop button. The X-ray unit will automatically restart.

User’s Manual Planmeca ProMax Cephalostat 5

4 PREPARATIONS FOR EXPOSURE

NOTE

4 PREPARATIONS FOR EXPOSURE

4.1 Preparations on all X-ray units

4.1.1 Attaching cephalometric patient supports

The ear posts are marked with the letter L for the patient’s left ear and letter R for the patient’s right ear.

The positioning cones contain small metal objects that are visible in the image. They help you to identify the patient’s left and right side.

• The left ear post contains a ball.

• The right ear post contains a ring.

Ensure that you position the ear posts the right way round.

The nasal positioner has to point inward as shown.

1. Lift the locking clip up and slide the ear post / nasal positioner as far up as it will go.

2. Press the locking clip down to lock the ear post / nasal positioner in place.

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4 PREPARATIONS FOR EXPOSURE

enter_to_ceph_scr2.eps

Head_support_attach.eps

ProMax_5_2.eps

4.1.2 Removing 2D or 3D patient supports

If the temple supports are in place, turn them down and remove all patient supports from the patient support table.

If the support bars are in place, remove all patient supports from the patient support table, including support bars, chin cup and adapter.

• To remove the support bars, first loosen the locking knobs and then pull the support bars out.

User’s Manual Planmeca ProMax Cephalostat 7

4 PREPARATIONS FOR EXPOSURE

NOTE

Attach Dimax sensor to cephalostat (refer to section 4.2.2)

Remove Dimax sensor from C-arm (refer to section 4.2.1)

X-ray unit with Dimax sensor

Sensor1.eps

4.2 Additional preparations on X-ray units with Dimax sensor

If a Dimax sensor is attached to the C-arm, the sensor must be moved to the cephalostat before you can take cephalometric exposures.

4.2.1 Removing sensor from C-arm

8 Planmeca ProMax Cephalostat User’s Manual

Do not remove the sensor during imaging process.

1. Push in the C-arm electrical connector. This will disconnect the electrical connection between the sensor and C-arm.

4 PREPARATIONS FOR EXPOSURE

CAUTION

Sensor2.eps

Sensor3 .eps

2. Turn the locking knob 180 degrees. This will release the locking mechanism.

3. Carefully pull the sensor out.

Do not drop the sensor. Planmeca limited warranty does not cover damage which is due to misuse, e.g. dropping the sensor, neglect, or any cause other than ordinary use. Do not use the sensor if the shock indicator (1) is red

- contact your service technician for help.

If you have any reason to believe that the sensor might be faulty, take a test exposure before taking a patient exposure.

shockwarningD3.eps

User’s Manual Planmeca ProMax Cephalostat 9

4 PREPARATIONS FOR EXPOSURE

Sensor4.eps

Sensor5.eps

Sensor6.eps

4.2.2 Attaching Dimax sensor to cephalostat

1. Push the sensor onto the adapter on the cephalostat.

2. Turn the locking knob 180 degrees in order to complete the mechanical connection.

3. Push in the cephalostat electrical connector button on the other side. This will make the electrical connection between the sensor and cephalostat.

10 Planmeca ProMax Cephalostat User’s Manual

4 PREPARATIONS FOR EXPOSURE

Tube_head_non_rotating.eps

No joint

Joint (tube head rotates

(tube head does not rotate)

Non-rotating tube head

-> remove 3D sensor from C-arm

Rotating tube head

-> no need to remove 3D sensor

to ceph position)

(refer to section 4.2.1)

3D unit C-arm

4.3 Additional preparations on 3D X-ray units

If your X-ray unit has a non-rotating tube head, you must remove the 3D sensor from the C-arm before you can take cephalometric exposures.

Tube_head_rotating.eps

4.4 Preparing Planmeca Romexis

First select the patient.

Then select the cephalometric exposure.

Refer to the Planmeca Romexis User’s Manual for details on Romexis functions.

User’s Manual Planmeca ProMax Cephalostat 11

4 PREPARATIONS FOR EXPOSURE

NOTE

4.5 Preparing patient

Ask the patient to remove any spectacles, hearing aids, dentures, hairpins, and personal jewellery such as earrings, necklaces and piercings as these can produce shadows or reflections in the image. The patient should also remove any loose items of clothing (e.g. scarf, tie) that might get caught in the arm structures of the X-ray unit.

Place a protective lead apron over the patient’s back if required.

We recommend that you image patients with poor health in a sitting position.

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5 CEPHALOMETRIC EXPOSURE

5.1 Selecting general exposure settings

Refer to section “Touch screen” in the User’s Manual of the X-ray unit for general information on how to make or cancel selections on the touch screen.

5.1.1 Selecting program

Select the cephalometric program (2D Dental > Cephalostat).

5.1.2 Selecting program type

Select the program type from the drop-down menu at the top of the screen.

User’s Manual Planmeca ProMax Cephalostat 13

5 CEPHALOMETRIC EXPOSURE

NOTE

5.1.3 Selecting patient size

Use this button to select the patient size:

• XS = Child

• S = Small adult

• M = Medium-sized adult

• L = Large adult

• XL = Extra large adult

The exposure values will automatically change according to the selected patient size and program type.

The patient size can also be selected on the next screen.

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5 CEPHALOMETRIC EXPOSURE

X2_Di_Ceph2.eps

2 a) 0°

2 b) 180°

5.2 Patient positioning in lateral projection

1. Select the lateral program from the drop-down menu at the top of the screen.

2. Rotate the head support plate

a. to the 0° position if you want the patient to face

away from the wall

b. to the 180° position if you want the patient to

face towards the wall.

X2_Di_Ceph2.eps

3. Select the patient size as described in section 5.1.3 “Selecting patient size” on page 14.

User’s Manual Planmeca ProMax Cephalostat 15

5 CEPHALOMETRIC EXPOSURE

NOTE

4. Select the area that you wish to expose:

• Gray prohibition sign = area to be exposed

• Red prohibition sign = area NOT to be exposed

The size of the exposure area is indicated on the screen. The exposure area is automatically reduced for child patients (XS).

The illustration on the screen is only an example.

5. To go to the next screen, select

• this symbol

• the forward button.

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5 CEPHALOMETRIC EXPOSURE

X2_Di_Ceph2.eps

Ceph&Dimax2.eps

6. Press the release lever on the left ear post holder and slide the ear posts and nasal positioner out as far as they will go.

7. Adjust the height of the cephalostat by pressing a height adjusting button until the positioning cones at the ends of the ear posts are level with the patient’s ears.

User’s Manual Planmeca ProMax Cephalostat 17

5 CEPHALOMETRIC EXPOSURE

8 a)

8 b)

X2_Di_Ceph.eps

8. Position the patient between the ear posts so that

a. they face away from the wall

b. they face towards the wall.

9. Press the release lever on the left ear post holder and very carefully slide the positioning cones into the patient’s ears.

10. Slide the nasal positioner until it touches the patient’s nasion.

11. Adjust the angle of the patient’s head by sliding the nasal positioner up or down until the Frankfort plane is horizontal.

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5 CEPHALOMETRIC EXPOSURE

Ceph_side.eps

90°

5.3 Patient positioning in posteroanterior or anteroposterior projection

1. Select the posteroanterior program from the dropdown menu at the top of the screen.

2. Rotate the head support plate to either of the 90° positions.

a. To take an anteroposterior exposure, place the

nasal positioner next to the collimator as shown below.

b. To take a posteroanterior exposure, place the

nasal positioner next to the sensor.

3. Select the patient size as described in section 5.1.3 “Selecting patient size” on page 14.

User’s Manual Planmeca ProMax Cephalostat 19

5 CEPHALOMETRIC EXPOSURE

NOTE

4. Select the area that you wish to expose:

• Gray prohibition sign = area to be exposed

• Red prohibition sign = area NOT to be exposed

The size of the exposure area is indicated on the screen. The exposure area is automatically reduced for child patients (XS).

The illustration on the screen is only an example.

5. To go to the next screen, select

• this symbol

• the forward button.

20 Planmeca ProMax Cephalostat User’s Manual

5 CEPHALOMETRIC EXPOSURE

Ceph_side.eps

Ceph&Dimax2.eps

6. Press the release lever on the left ear post holder and slide the ear posts and nasal positioner out as far as they will go.

7. Adjust the height of the cephalostat by pressing a height adjusting button until the positioning cones at the ends of the ear posts are level with the patient’s ears.

User’s Manual Planmeca ProMax Cephalostat 21

5 CEPHALOMETRIC EXPOSURE

8 a)

8 b)

Ceph_app.eps

8. Position the patient between the ear posts.

a. To take a posteroanterior exposure, position the

patient so that they look at the sensor.

b. To take an anteroposterior exposure, position

the patient so that they look at the collimator.

9. Press the release lever on the left ear post holder and very carefully slide the positioning cones into the patient’s ears.

10. Slide the nasal positioner until it touches the patient’s nasion.

11. Adjust the tilt of the patient’s head so that the Frankfort plane is horizontal.

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5 CEPHALOMETRIC EXPOSURE

Ceph_pos_up.eps

5.4 Patient positioning in submental-vertex projection

1. Perform steps one to seven as described in section

5.3 “Patient positioning in posteroanterior or anteroposterior projection” on page 19. Rotate the head support plate to the 90° position so that the nasal positioner is placed next to the collimator.

2. Turn the nasal positioner up.

3. Position the patient between the ear posts and adjust the tilt of the patient’s head until the alar-tragal line is perpendicular to the floor.

4. Press the release lever on the left ear post holder and very carefully slide the positioning cones into the patient’s ears.

User’s Manual Planmeca ProMax Cephalostat 23

5 CEPHALOMETRIC EXPOSURE

Ceph_atline.eps

35-40°

5.5 Patient positioning in Waters’ view

1. Perform steps one to seven as described in section

2. Turn the nasal positioner up.

3. Position the patient between the ear posts so that they face the sensor.

4. Position the patient’s head so that the alar-tragal line is tilted up about 35 to 40 degrees.

5. Press the release lever on the left ear post holder and very carefully slide the positioning cones into the patient’s ears.

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5 CEPHALOMETRIC EXPOSURE

Ceph_pos_ap.eps

30°

5.6 Patient positioning in AP Towne projection

1. Perform steps one to seven as described in section

2. Turn the nasal positioner up.

3. Position the patient between the ear posts so that they face the collimator.

4. Position the patient’s head so that the Frankfort plane is tilted down about 30 degrees.

5. Ask the patient to open their mouth as wide as possible.

6. Press the release lever on the left ear post holder and very carefully slide the positioning cones into the patient’s ears.

User’s Manual Planmeca ProMax Cephalostat 25

5 CEPHALOMETRIC EXPOSURE

e.g. 30°

5.7 Patient positioning in oblique projection

1. Select the oblique program from the drop-down menu at the top of the screen.

2. Rotate the head support plate to an oblique position (other than 0, 90 or 180 degrees).

X2_Di_Ceph2.eps

3. Select the patient size as described in section 5.1.3 “Selecting patient size” on page 14.

4. To go to the next screen, select

• this symbol

• the forward button.

26 Planmeca ProMax Cephalostat User’s Manual

5 CEPHALOMETRIC EXPOSURE

Ceph&Dimax2.eps

5. Press the release lever on the left ear post holder and slide the ear posts and nasal positioner out as far as they will go.

6. Adjust the height of the cephalostat by pressing a height adjusting button until the positioning cones at the ends of the ear posts are level with the patient’s ears.

7. Position the patient between the ear posts so that the patient faces the nasal positioner.

8. Press the release lever on the left ear post holder and very carefully slide the positioning cones into the patient’s ears.

9. Slide the nasal positioner until it touches the patient’s nasion.

10. Adjust the angle of the patient’s head by sliding the nasal positioner up or down until the Frankfort plane is horizontal.

User’s Manual Planmeca ProMax Cephalostat 27

5 CEPHALOMETRIC EXPOSURE

5.8 Positioning in hand exposure

1. Select the hand program from the drop-down menu at the top of the screen.

2. Rotate the head support plate to either of the 90° positions as described in section 5.3 “Patient positioning in posteroanterior or anteroposterior projection” on page 19.

3. Remove the ear posts from the ear post holders.

4. Attach the hand imaging support to the ear post holders. Ensure that you slide the hand imaging support as far up as it will go.

5. Turn the nasal positioner up.

6. To go to the next screen, select

• this symbol

• the forward button.

7. Ask the patient to place their hand against the hand imaging support.

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5 CEPHALOMETRIC EXPOSURE

NOTE

5.9 Adjusting exposure values for current exposure

The exposure values have been preset at the factory for each patient size and program type. The preset exposure values are average values and they are only meant to guide the user.

Always try to minimize the radiation dose to the patient.

The preset exposure values are shown in the following tables.

Factory presets for program types Lateral and Oblique

PATIENT SIZE kV VALUE mA VALUE

Child (XS) 62 10

Small adult (S) 64 10

Medium-sized adult (M) 66 10

Large adult (L) 68 10

Extra large adult (XL) 70 10

Factory presets for program type Posteroanterior

PATIENT SIZE kV VALUE mA VALUE

Child (XS) 76 11

Small adult (S) 78 11

Medium-sized adult (M) 80 11

Large adult (L) 82 11

Extra large adult (XL) 84 11

Factory presets for program type Hand

PATIENT SIZE kV VALUE mA VALUE

All patient sizes (XS, S, M, L & XL) 60 4

User’s Manual Planmeca ProMax Cephalostat 29

5 CEPHALOMETRIC EXPOSURE

NOTE

If you need to adjust the preset exposure values for the current exposure:

1. Select the kV / mA field.

2. Use the minus or plus buttons to set the exposure values you wish to use. To improve the image contrast, reduce the kV value. To reduce the radiation dose, reduce the mA value.

3. Select the green check mark button.

To adjust the preset exposure values permanently, select Settings > Program > 2100 Programs > 2140 2D Cephalostat. Refer to section “Program settings” in the User’s Manual of the X-ray unit for details.

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5 CEPHALOMETRIC EXPOSURE

NOTE

5.10 Selecting Dynamic Exposure Control (DEC)

Dynamic Exposure Control (DEC) is an optional feature.

Select the DEC button.

Dynamic Exposure Control (DEC) automatically provides optimal exposure values for each patient during exposure. The function adjusts the exposure values individually for each patient based on their anatomic structure and bone density. Switching DEC on improves the image quality as the function produces images of more consistent brightness and contrast.

When DEC is switched on the exposure values are automatically adjusted during exposure. The kV value is adjusted by max ±4 kV and the mA value is adjusted by max +4 / -3 mA within the available scale.

5.10.1 Adjusting DEC density

If the images appear to be too bright or too dark, DEC density can be adjusted. Select Settings > Program > 2200 Program Features > 2230 Cephalostat > Ceph DEC Density Lat or Ceph DEC Density PA / AP. Then use the minus or plus sign to adjust the setting.

The setting can be adjusted between 20% (lower exposure values -> brighter image) and 200% (higher exposure values -> darker image). The recommended setting is 100% (default setting).

User’s Manual Planmeca ProMax Cephalostat 31

5 CEPHALOMETRIC EXPOSURE

NOTE

5.11 Taking an exposure

Make sure that you have selected the correct patient and exposure mode in the Planmeca Romexis program.

1. Select the radiation symbol or the forward button.

Green lights flash on the touch screen and exposure button when the X-ray system is getting ready for an exposure. The green lights stop flashing and stay on continuously when the X-ray system is ready for an exposure.

2. Ask the patient to stay as still as possible.

3. Move to a protected area.

4. Press and hold down the exposure button for the duration of the exposure.

During exposure yellow radiation warning lights illuminate on the exposure switch and on the touch screen, and you hear a radiation warning tone. Additionally, a radiation warning symbol is shown on the touch screen.

If the optional DEC (Dynamic Exposure Control) function is switched on, the exposure is taken in two stages. The exposure values are adjusted during the first (short) exposure and the second exposure produces the actual image. Press and hold down the exposure button for the duration of both exposures.

Maintain audio and visual contact with the patient and X-ray unit during exposure. If the sensor and / or collimator stop moving during exposure, release the exposure button immediately.

5. The image is shown on the computer screen.

• Note that you must accept the image in the

Planmeca Romexis program.

32 Planmeca ProMax Cephalostat User’s Manual

6. Press the release lever on the left ear post holder and very carefully slide the positioning cones out of the patient’s ears.

7. Guide the patient away from the cephalostat.

Planmeca Oy | Asentajankatu 6 | 00880 Helsinki | Finland

tel. +358 20 7795 500 | fax +358 20 7795 555 | sales@planmeca.com | www.planmeca.com

Planmeca ProMax User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual

1 INTRODUCTION

2 SWITCHING X-RAY UNIT ON

3 MAIN PARTS

3.1 General view of cephalostat

3.2 Patient supports

3.3 Patient positioning controls

3.4 Emergency stop button

4 PREPARATIONS FOR EXPOSURE

4.1 Preparations on all X-ray units

4.1.1 Attaching cephalometric patient supports

4.1.2 Removing 2D or 3D patient supports

4.2 Additional preparations on X-ray units with Dimax sensor

4.2.1 Removing sensor from C-arm

4.2.2 Attaching Dimax sensor to cephalostat

4.3 Additional preparations on 3D X-ray units

4.4 Preparing Planmeca Romexis

4.5 Preparing patient

5 CEPHALOMETRIC EXPOSURE

5.1 Selecting general exposure settings

5.1.1 Selecting program

5.1.2 Selecting program type

5.1.3 Selecting patient size

5.2 Patient positioning in lateral projection

5.3 Patient positioning in posteroanterior or anteroposterior projection

5.4 Patient positioning in submental-vertex projection

5.5 Patient positioning in Waters’ view

5.6 Patient positioning in AP Towne projection

5.7 Patient positioning in oblique projection

5.8 Positioning in hand exposure

5.9 Adjusting exposure values for current exposure

5.10 Selecting Dynamic Exposure Control (DEC)

5.10.1 Adjusting DEC density

5.11 Taking an exposure