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(120V version)
User's Manual
Release 28 April 2003 (Rev. 0)
USER'S MANUAL
Contents
Contents
1. INTRODUCTION 1
1.1 Icons appearing in the manual ...............................................................3
2. SAFETY INFORMATION 4
2.1 Warnings ...............................................................................................5
2.2 Environmental risks and displacement...................................................7
2.3 Symbols used ........................................................................................8
5. TECHNICAL SPECIFICATIONS 19
Environmental features ...................................................................... 23
5.1 Dimensions.......................................................................................... 24
5.2 Loading curve of the tube and cooling curve of the anode ..................... 26
5.3 Applied safety regulations .................................................................... 28
5.4 Note on the “Constant magnification” for Panoramic and TMJ
(close/open mouth) exposures.............................................................. 29
5.5 Measurement method of technical factors
(Paragraph for the authorized personnel).............................................. 30
5.6 Verify method of exposure parameters
(Paragraph for the authorized personnel).............................................. 31
7. MAINTENANCE 159
1. INTRODUCTION
NOTE:
The present manual is updated for the product it is sold with in order to
grant an adequate reference to use properly and safely the product.
The manual may not reflect changes to the product not impacting
operating modes or safety.
STRATO 2000 is equipped for the use of advanced functions, than can be
accessed by connection the device to a common PC (not supplied by Villa
Sistemi Medicali).
Specifically by the connection to a common PC it is possible to make use
of the following functions:
U.C.A. (User Customizable Applications) platform
i.e. applications customized by the user. By this function you can
expand by yourself the performance of your STRATO 2000.
You can ask to the local sale organization new specific examinations
for different applications:
• IMPLANT: Linear tomography for implantation procedure
• TMJ: Specific examinations for temporo-mandibular joint
• SINUS: Examination of nasal sinus
• A.D.A.: Advanced Dental Applications including the improved
orthogonal projection, frontal dentition and the
reduced dose panoramic examination.
The new examinations software packages will be delivered on CD and
you will be able to install them in a few minutes.
DMS Software
The DMS (Data Management System) allows the complete
management of the patient archive and of performed examinations,
storing an historical archive of the radiological parameters for each
examination.
The DMS software operates through a serial connection (RS232)
between STRATO 2000 and a PC.
The DMS makes possible the following functions:
• Archive personal data of patients (with the possibility to manage
different archives, for example one for each doctor operating in
the same facility)
• Archive of all examination with the relevant radiological
parameters
• Remake of an examination with the same parameters used time
before
• "Virtual keypad" allowing to select the radiological parameters
from the PC
• Print out of the archive
• Print out of labels with patient data and examination type for film
identification
• Import / Export of archived data
• Update of UCA examination software
• Consulting of on line documentation.
The DMS software is included in each UCA software package.
NOTE:
The DMS software is not an "image acquisition" software.
NOTE:
A detailed description of the function of the DMS software is given in the
specific User's Manual for DMS / U.C.A. software.
The aim of this publication is to instruct the user on the safe and
effective use of the device.
The device must be used complying with the procedures described and
never be used for purposes different from those herewith indicated.
Please read this manual thoroughly before starting using the machine; it
is advisable to keep the manual near the device to refer to it while
operating.
STRATO 2000 is an electro-medical device and it can be used only under
the supervision of a physician or of highly qualified personnel, with the
necessary knowledge on X-ray protection.
The user is liable as concerns legal fulfilment related to the installation
and the operation of the device.
This icon indicates a WARNING: the items marked by this icon refer to
the safety aspects of the patient and/or of the operator.
2. SAFETY INFORMATION
WARNING:
Please read this chapter thoroughly.
VILLA SISTEMI MEDICALI designs and builds its devices complying with
the related safety requirements; furthermore it supplies all information
necessary for a correct use and the warnings related to danger associated
with X-rays generating units.
Only the authorised personnel can remove the covers and/or have
access to the components under tension.
2.1 Warnings
This device has not been designed to be used in environments where
vapours, anaestethic mixes flammable with air, or oxygen and nitrous
oxide can be detected.
Avoid pouring water, even accidentally, or other liquids into the device,
as this could cause short-circuits.
Before cleaning the device, please disconnect it from the line voltage.
Wherever necessary, use the fit accessories, such as the leaded aprons,
to protect the patient from radiations.
While performing the radiography, no one, apart from the operator and
the patient, must remain in the room.
Though this unit has been designed with a quite acceptable protection
level from electromagnetic interferences, it is advisable to install it at a
certain distance from electrical energy transformation chambers, from
Uninterruptible Power Supply (UPS) units, from portable receiving-
transmitting units for amatoeurial use. Cellular telephones are only
admitted at a distance of more than 1,5 mt from any component of the
device.
Other medical instruments and devices that must be used in the same
installation area of the unit must comply the Electromagnetic
Compatibility rules in force. Non-complying instruments, of which the
poor immunity from electromagnetic fields is well known, must be
installed at least 3 mt far from the STRATO 2000 and supplied by a
different electrical line.
STRATO 2000 must be off while using devices such as electrical lancets
or the like.
Please clean and disinfect, when necessary, all parts that can be in
contact with the patient.
Never try to rotate the moving arm manually when the unit is
switched on , to avoid permanent damage to the unit.
After use, please replace the bite and the ear-centring devices.
Though the X-ray quantity supplied by dental X-ray units is quite low
and distributed on a small surface, the operator must adopt the
precautions and/or fit protections for the patient and himself, during the
execution of radiography. It is advisable to control the X-ray emission
from a protected area, by means of a remote control. If it is necessary to
operate near the patient, stay as far as the cable of the remote control
allows it, or at least 1,5 mt far both from the X-ray source and from the
patient, as shown in the Figure 1 and Figure 2.
NOTE:
When the unit is on, do not move manually the rotating arm or the
tube-head (part 2a of Figure 3).
NOTE:
VILLA SISTEMI MEDICALI is not responsible for the displacement of the
device performed by the user and for the related costs.
Symbol Description
∼ A.C.
Protection grounding
Operation grounding
Laser
Dangerous voltage
WARNING:
Disconnect the unit from the net
before performing any cleaning.
Do not let water or liquids enter the unit, these could cause corrosion or
short-circuits.
To clean the rare earths scintillating screens in the cassette, please follow
the indication given by the manufacturer, do not use detergents, solvent
(alcohol, benzine), corrosive or abrasive stuffs.
The bite-holding rod, the centring bite and the ear centring units of
the cephalostatus must be replaced after each examination.
Clean thoroughly the chin rest, the handles, the nose-rest and the
temple-support any time these are used.
4. DESCRIPTION
7
4, 5, 6
1, 2, 3
10, 11
1b
ETL certification label
1a
STRATO 2000
identification label
2
Tube-head 3
identification label IMPLANT device
identification label
4
TMJ device
identification label
5 6
SINUS device A.D.A. device
identification label identification label
7
CEPHALOMETRIC
device
identification label
10
8 (N° 2) Spot laser
Warning label identification label
9
Laser warning
11
label
(N° 2) Laser symbol
label
NOTE:
This STRATO 2000 model is designed to be upgraded with the
implementation of new functions and new examination now under
development in VILLA SISTEMI MEDICALI laboratories.
The device has been designed to follow technological and clinical
evolution of RX examination of the maxillo-facial complex.
NOTE:
The U.C.A. function allows customer to enable the option using special
codes that must be inserted into the software using a Personal Computer
(not supplied by Villa Sistemi Medicali).
Procedure on how enabled this options is described into the STRATO
2000 DMS Manual; please refer to this Manual for information on how to
proceed.
• Cephalometric device
This option is not a U.C.A. because to be enabled it needs the
installation of the CEPH arm.
KONIKA MG Verde KR II
KONIKA MGH Verde KR II
KODAK T-MAT G/RA Verde Lanex Regular
AGFA HTA Verde Medium
FUJI HR-G Verde G8
IMATION XDA Verde T 16
KODAK T-MAT G/RA Verde Lanex Medium
STERLING ULTRAVISION Blu Ultravision Rapid
Table 1
NOTE:
It is advisable to use always films and screens of the same brand.
Combinations of films and screen of different manufacturer are possible
so long as the same sensitivity is maintained. Never combine films and
screens with different sensibility (green and blue).
The factory set values of the exposure factors listed in paragraph 6.13.4
as default, are indicative and optimised for the combination film/screen
supplied with the device (film T-MAT G/RA and screens Lanex Regular or
film KONIKA MG and KONIKA screens). For the other combinations listed
in the table or for further combinations, the exposure factors have to be
modified accordingly by acting as described in paragraph 6.13.
The real adjustment of these values depends on different conditions such
as the preference of the user for much or less exposed images.
The quality of the image, therefore, does not exclusively depend on
STRATO 2000 but it is also extremely important to pay attention to the
processing procedure of the films and the materials related
NOTE:
Perform the maintenance of the film processor as described in the related
instruction manual.
Regularly check the levels of the used chemical substances; replace them
regularly as indicated by the manufacturer (or according to the number
of processed films).
NOTE:
All these examination can be added directly by the user, by the U.C.A.
(User Customizable Application) function. The additional function can be
added on STRATO 2000 units in field or on upgradable models of
STRATO X units.
NOTE:
The code inserted into STRATO 2000 to enable the optional examinations
is protected by an Unique Identification Code (UIC); in case the UIC is not
present or is faulty, an error E601 will be shown.
The Enter key "23" pressure will reset this condition, but at the
The UIC can be visualized on the system console by pressing at the same
The UIC is simple an identifier of the single STRATO 2000 unit; in order
to enable optional functions it is necessary to ask at Villa Sistemi
Medicali the enabling codes which are derived from the UIC.
30
2a
1
1a
Figure 3
1- Column with base equipped with electrical power part and cursor
with motorised vertical movement. The column must be fixed at the
wall by 4 dowels, two fixing the upper part and two fixing the lower.
The front part of the column is equipped with an housing closed by
two covers, within which it is possible to set 4 trays (1a) containing
the consumables (bites, rods, etc.) and options (supports, etc.).
3- Cassettes holder for all functions (apart from cephalometry) with flat
standard cassette 15x30 cm.
30 - X-ray push button equipped with extendible cable, which allows the
user to operate the unit from proper distance as required by the
safety rules.
5. TECHNICAL SPECIFICATIONS
General features
Type STRATO 2000
Manufacturer VILLA SISTEMI MEDICALI
Buccinasco (MI) Italia
Class Class II according to 21CFR-
subchapter J.
Class II B for European Directive
for Medical Devices 93/42.
Class I with type B applied parts
according to IEC 601-1
Protection degree IP20
Rated line voltage 120 V∼ ±10%
Line frequency 60 Hz
Maximum line current 15 A (at 108V, 80kV, 12mA – see Note 1)
Power consumption 2 kVA
Protection fuse (F2) 15 A F
Transformer protection fuse T1 (F1) 0.8 A T
Controls supply protection fuse (F5) 0.5 A T
Column motor protection fuse (F3, F4) 7AT
Line voltage regulation < 3% at 108 V∼ (see Note 1)
Rated output voltage (kVp) 50 ÷ 80 kVp in 2 kVp steps
Anodic current 4 ÷ 10 mA in 1 mA steps for PAN/TMJ
4 ÷ 12 mA in 1 mA steps for Ceph
NOTE 1:
Due to the technology used to compensate line voltage fluctuations, the
max line current drawn from the line is at lowest voltage (108 V).
Exposure time
Panoramic (PAN) 15 s PAN Adult / 13.5 s PAN Child
Emi Panoramic 8 s Adult / 8 s Child
TMJ open/closed mouth 5.3 s per image for left and right joint in
open and closed condition (11 s total
time)
TMJ biaxial 10.8 s (total time)
Implant 3.4 s (minimum) - 11.4 s (maximum) for
4 images
Sinus P/A projection 10.5 s
Sinus lateral projection 5.2 s each side
Cephalometry (Ceph) 0.2 ÷ 3 s
Exposure time accuracy ± 10 %
Examination programs
Examination selection • Automatic selection for Adult and
Child, 3 sizes, 3 arches (in Panoramic
and TMJ)
• Automatic selection for Adult and
Child, 3 sizes (in biaxial TMJ)
• Automatic selection for Adult, 3 sizes,
3 arches (in Implant)
• Manual selection
• Collimator with automatic positioning
Panoramic • Standard Panoramic
• Emi Panoramic
TMJ (Temporal Mandibular Joint) • TMJ open and closed mouth
• TMJ biaxial
Implant • 2 slices (one longitudinal and one
transversal)
• 4 slices (one longitudinal and three
transversal)
Cephalometry • Cassette 8" x 10"
• Cassette 18 x 24 cm
• Cassette 30 x 24 cm (24 x 30 cm
optional; in this case the size 24 x 18
symmetric is not available).
• Soft Tissues filter adjustable by
motorized movement.
Image magnification
PAN and TMJ open/closed mouth, 1 : 1.23 (constant)
Sinus P/A or L/L
TMJ biaxial 1.20 (overage)
Implant 1 . 1.37 (constant)
Ceph 1 : 1.1 (overage)
No. of images in TMJ (open/closed 4
mouth and biaxial)
Tubehead characteristics
Model MS 05
Manufacturer Villa Sistemi Medicali S.p.A.
20090 Buccinasco (MI) Italia
Maximum tube voltage 80 kVp
kVp accuracy ±8%
Max. anodic current 12 mA
Anodic current accuracy ± 10 %
Duty cycle 1 : 16
Nominal power 0.96 kW (80 kVp - 12 mA)
Total filtration 2.5 mm Al eq. @ 70 kVp
HVL (Half value layer) >2.5 mm Al eq. @ 80 kVp
Transformer insulation Oil bath
Cooling By convection
Leakage radiation at 1 m < 0.5 mGy/h @ 80 kVp - 12 mA - 3 s duty
cycle 1/16
Reference time product current 1.2 mAs (6mA for 200msec)
Mechanical characteristics
Focus-film distance (PAN, TMJ and 51 cm (20")
Implant)
Film size (PAN, TMJ and Implant) 15 x 30 cm flat cassette
Focus film distance (CEPH) 165 cm (65")
Film size (CEPH) 8" x 10", 18 x 24 cm and 24 x 30 cm
Telescopic motorized column run 67 cm (26.4")
Total height max. 232 cm (91.3")
Width x Length • 100 x 125 cm (39.4" x 49.2") without
CEPH
• 177 x 125 cm (69.7" x 49.2") with
CEPH
Weight • 135 kg without CEPH
• 150 kg with CEPH
Column weight 72 kg
Weight of arm support, rotating arm and 48 kg
tube head
Cassette holder weight 7 kg
Weight of the chin rest arm 8 kg
Environmental features
Working area (please refer to paragraph • 130x130 cm (51.2"x51.2") without
5.3 of the Service Manual) CEPH
• 130x190 cm (74.8"x51.2") with CEPH
Minimum height ceiling (please refer to 250 cm (98.5”)
paragraph 5.3 of the Service Manual)
Temperature in working condition + 10° ÷ + 40°
RH (related humidity) in working 30% ÷ 75%
condition
Temperature for transport and storing - 20° ÷ + 70°
Humidity for transport and storing < 95% without condense
Min. atmospheric pressure for transport 630 hPa
and storing
5.1 Dimensions
≈
≈
≈
≈
░
Load
E(KJ)
350
300
250
200
150
100
50
0
0 100 200 300 400 500
min
• 21 CFR subchapter J
• General safety:
IEC 601-1
IEC 601-1-1
IEC 601-2-7
IEC 601-2-28
• Electromagnetic compliance:
IEC 601-1-2
Classifications
STRATO 2000 is an electro-medical X-ray device belonging to Class I type
B as per classifications IEC 601-1, foreseen for a continuous working at
intermittent load.
According to CE 93/42 Directives for medical devices, the equipment
belongs to class II B.
According to FDA 21CFR, the equipment belongs to class II.
NOTE:
STRATO 2000 is based on a dentition and ascending rami shape as
defined by U. Welander et al., Dentomaxillofacial Radiology, 1989, Vol.
18, May.
This paper, based on statistic study, enstabilishes a form for the
dentomaxillofacial complex that it is assumed as “standard”. A projection
geometry that maintains a constant magnification stated in the technical
characteristics of each examination throughout the exposure of this
shape has been applied to the STRATO 2000. Patient’s anatomy can
differ in a significant way from the statistical model, so the magnification
factor is not maintained and can be different from that value. Based on
his experience and competence, the user has to judge this variation.
WARNING:
These measurements require the removal of the HF group covers; this
means to gain access to internal parts where high voltage are normally
present.
WARNING:
During the panoramic examination, the set value of kV and tube current
varies according to a pre-determined curve in order to compensate the
different absorption of X-ray beam due to different anatomical structures.
In this way, it is possible to obtain a good uniformity of the image’s
contrast. Particularly, the chosen value is lowered on the initial phase of
the panoramic and increased on the scissors/canine zone, in order to
compensate the effect of the cervical spine.
The value displayed during the panoramic examination corresponds to
the to chosen one, while the instantaneous value can be different; these
effects must be considered in case of measure of the exposure factors
using standard diagnostic mode (please refer to the Note at page 52).
Accuracy declared on the section “Technical data” is referred to the
actual value of kV and/or mA. In any case, manufacturer guarantees
that the accuracy of loading factors is always compliance with the
international standard for safety of medical devices IEC 601-1.
Particularly, in accordance with IEC 601-2-7, the maximum deviation
(including the correction and instrument’s accuracy) is less than or equal
to ±10 for kV, while for tube current is less than or equal to ±15%.
NOTE:
The instruments normally used for the measurement of the exposure
parameters (kVp) with the non-invasive method, have an intrinsic
measurement non-linearity when used to measure low dose radiations.
This non-linearity can lead to measuring errors clearly not due to the
STRATO 2000.
As example, please see the next diagram where the sensitivity curve of a
normal measuring instrument is shown. Working outside the dark area,
the instrument is not linear.
1. With the unit on, select the Panoramic examination mode by pressing
key "17" .
off and the display shows the following two messages alternatively:
R E M O V E
C H I N R E S T
and
C L O S E
T E M P L E S U P P O R T
NOTE:
The following operations is a confirmation that the above points have
been performed.
the unit will carry out a movement to reach the "zero" position.
P L E A S E W A I T . . .
Once the "zero" position is reached, the display will show the
following message:
O P E N
C A S S E T T E U N I T
P L E A S E W A I T . . .
In the mean time, the unit sets the primary collimator to position
18x24 symmetric (Slot #5) and the Soft Tissue Filter in position “not
in field”; at the end of the positioning phase, the display shows:
R X P A R A M E T E R S
7 0 k V 0 8 m A 1 . 0 0 S
checks.
The variation range of the parameters is shown in the following table
(see also NOTE at page 31):
Table 2
NOTE:
Acting on key "5" and then on keys "3" or "6" the
PROBE
Figure 6
WARNING:
X-ray will be emitted during the performance of the following operations.
Authorised technicians are therefore recommended to use the greatest
caution and to comply with the safety regulations and laws of the of their
country.
NOTE:
The performances are guaranteed if the measurement of kV and it is
done with the invasive method.
To quit this routine, press key "9" ; the display will show:
C L O S E C A S S E T T E
T O P A N O R A M I C
P R E S S E N T E R
Press key "23" ; the unit will carry out the zeroing and will set
itself in the patient entry position; the display will first show:
P L E A S E W A I T . . .
then
x x k V x x m A 1 5 . 0 s
Luminous
centering
devices
Command
confirm.
LED
Carriage
movement
(canine
plane)
Exam.
setting
key
Exposure parameters
manual selection
Figure 7
Implant Sinus
Cephalometric
TMJ open/closed
mouth
Biaxial TMJ Panoramic
LEGEND:
Messages Examination mode
Display: indicates operative messages, warnings and 14 - Implant (Optional)
exposure parameters. 15 - Cephalometry (Optional)
16 - Sinus examination (Optional)
Signal lights 17 - Panoramic
1 - Led indicating the machine is ready for X-ray 18 - TMJ closed mouth – open mouth
emission (green LED) 19 - TMJ biaxial / TMJ P/A (Optional)
2 - Yellow LED indicating X-rays emission
Centring devices
Manual setting of exposure parameters 20 - Saggital, Frankfurt and Canine Plane centring unit
3 - kV, s or mA increasing 21 - Button not active
4 - Seconds
5 - milliAmpere Patient centring
6 - Reduction of kV, s or mA 22 - Moving canine plane / choise tooth (Implant)
7 - KVolt 23 - Enter key
24 - Button choice: cassette (Ceph), arch (Implant)
Preparation functions 25 - Moving canine plane / choice tooth (Implant)
8 - Key to set Test function 26 - Button choice: cassette (Ceph), arch (Implant)
9 - Reset, axes alignment and enabling to modify
exam modes
10 - Positioning of the rotation unit to start the Height adjustment
selected examination or return of the unit for a 27 + 28 - Column up
new setting 29 + 28 - Column down
Anatomic selection
11 - Adult or Child (green LED)
12 - Small, medium or large size (green LED)
13 - Wide, normal or narrow arch (for Panoramic,
TMJ and Implant exposure) (green LED)
S T R A T O X
R E L E A S E * . * *
> T E S T <
NOTE:
During this phase, STRATO 2000 does not perform any movement, it just
performs a series of checks which, in case of negative result, could
require the intervention of the technician.
The only problem that can be solved by the user is related to the position
of the cassette holder PAN; in this case, the following message will be
displayed:
C L O S E C A S S E T T E
T O P A N O R A M I C
button will light; press "23" key to start the alignment phase of
motors; while waiting the display will show the following message:
M A C H I N E S E T T I N G
Once ENTER has been pressed, the related LED goes OFF and the
display shows the following message during the alignment of axes:
W A I T F O R
M A C H I N E S E T T I N G
WARNING:
During this phase, the machine checks for possible obstacles that may
create collisions simulating the movements performed during the
examination.
During this phase the machine also carries out the following actions:
• counts the motor steps of the cassette path and then position the
cassette in such a way to be accessible to the operator
• moves the carriage in the proper position for the centering of the
canine laser on standard plane.
Once the alignment is done, the software indicates the position of the
cassette holder and the presence of the cassette into its holder.
If the cassette is found in place, the following message is displayed:
R E P L A C E
C A S S E T T E
NOTE:
No operations are available if cassette is not removed.
WARNING:
The position of the identification characters "R" (right side) and "L" (left
side) are correct if the cassette is fit into the unit with the hinges
positioned upward.
S T D . P A N O R A M I C
7 4 k V 1 0 m A 1 5 . 0 s
MACHINE IS READY
NOTE:
The above mentioned condition is chosen also in case for any reason the
device repeats the initialisation phase.
NOTE:
When the chin support is in raised position, perform a TEST examination
to make sure that, during arm rotation, there is no collision between the
tubehead and the shoulder of the patient.
Figure 9
NOTE:
Always remove the chin support when performing Ceph examinations.
"17" .
S T D . P A N O R A M I C
7 4 k V 1 0 m A 1 5 . 0 s
Once the settings have been completed, the chin support must be placed
in position (see the operative notes in paragraph 6.3).
Pressing once again the button "17" will change the selected
NOTE:
If Advanced Dental Applications (A.D.A.) option is enabled, multiple
Panoramic" function.
NOTE:
STRATO 2000 is based on a dention and ascending rami shape as
defined by U. Welander et al., Dentomaxillofacial Radiology, 1989, Vol.
18, May.
This paper, based on statistic study, enstabilishes a form for the the
dentomaxillofacial complex that it is assumed as “standard”. A projection
geometry that maintains a constant magnification stated on the technical
characteristics of each examination throughout the exposure of this
shape has been applied to the STRATO 2000. Patient’s anatomy can
differ in a significant way from the statistical model, so the magnification
factor is not maintained and can be different from that value. Based on
his experience and competence, the user has to judge this variation.
NOTE:
If the previous examination had been made manually, press key
Once the unit has been correctly set, the following two operating modes
may be selected:
• ANATOMIC: with the kV and mA values programmed according to
the type of patient and size.
• MANUAL: with the possibility of varying the default kV and mA
values.
NOTE:
In manual condition, the LED on the PANORAMIC function key
"17" , and the Adult / Child led "11" flash so that it is possible to
Child.
Table 3
key .
NOTE:
The type of Arch does not influence the kV and mA values but does
influence the position of the focused layer.
The LED on the Patient Size key switches off and the Adult / Child and
Panoramic keys will flash. One of the two following messages will be
displayed:
> 7 4 k V 1 0 m A 1 5 . 0 s
or
7 4 k V > 1 0 m A 1 5 . 0 s
The selected parameter can be changed using the increase key "3"
NOTE:
To change the values rapidly, keep the increase key "3" or
Select the mouth structure using the Arch wide - medium - narrow
key .
Panoramic positioning
Figure 10
45 Mid-sagittal line
46 Frankfurt plane line
47 Canine centering line
45 46
47
Figure 11
1. Ask the patient to remove all metallic objects located in the area to be
X-rayed (necklaces, earrings, glasses, hairpins, movable dental
prosthesis, etc.). Ensure that there no thick garments in the area to
be X-rayed such as coats, jackets, ties, etc.
2. Provide the patient with a protective apron or similar protection.
Ensure that the protection device does not interfere with the path of
the X-rays beam.
3. Place the patient in a standing position at the chin support. Using
raise/lower the column until the chin support rest is aligned with the
patient's chin.
4. Position the patient at temple support "4" (Figure 10), resting the
chin on the support base "1". The hands should rest on the front
handles. Ask the patient to bite the reference notch of bite "3" on rod
"2" (Figure 10) with his incisors. In case of edentulous patients,
he/her must rest the chin against the reference shoulder of the
edentulous chin support.
5. Instruct the patient to close the eyes.
Three laser beams will light up the mid-sagittal plane line "45", the
horizontal line for the Frankfurt plane reference "46" (the plane that
identifies a line that ideally links the ear hole - the auditory meatus -
with the lower part of the orbital fossa in Figure 11) and the canine
plane line "47" (Figure 11). Position the patient's head in such a way
as to ensure that the luminous beams fall in correspondence of the
respective anatomical references; if it is necessary to adjust the
position of the canine laser beam, the rotating arm can be positioned
alignment of the canine centering device "47" (Figure 11) with the
canine tooth is obtained. If the keys are kept pressed the speed of the
canine laser beam movement is increased.
The luminous beam of the Frankfurt plane can be adjusted according
to the height of the patient. This adjustment is made using knob
"5" (Figure 10) located on the side of the tubehead.
7. At this point, the patient must move his feet towards the keyboard
making sure to maintain the head within the above mentioned
pre-aligned anatomical references. In this way, a greater
straightening of the spine in the cervical area is obtained and
collision between the cassette holder and the patient's shoulder is
prevented. Check that the Frankfurt plane is still horizontal.
8. Also, close the temple support acting on the two knobs "6" (Figure
10). The temple support will help the patient to stay in a correct
position. Check that, during this phase, patient has not changed the
position.
switches off. The luminous centering devices switch off and the
rotating arm goes to its examination start position. Once alignment
has been completed, the following message will be displayed:
S T A R T E X A M
x x k V x x m A 1 5 . 0 s
x = value defined by the settings
NOTE:
The laser centering device remains lit until the button "20" is
NOTE:
this condition, it will be possible to make the unit perform all the
movements made during the examination without emitting X-rays.
Once the cycle has been completed, deactivate the "Test" by pressing key
"8" again
WARNING:
During the emission of X-rays, the protection procedures for the operator
and personnel in the area must be in compliance with the local
regulations.
In all cases, it is recommended that during the emission of X-rays, only
the patient and operator be present in the room. If the operator is not
protected by suitable screens, he must stand at least 1.5 meters away
from the emission of the X-rays (see Figure 1 and Figure 2).
1. Verify once again that the exposure data are correct, if not, correct
them as described in paragraph 6.4.2.2. Check that light unit ready
for X-ray "1" is ON, then press X-ray button "30" for the entire
duration of the exposure, ensuring that the X-ray light "2" is also lit
(if the unit is in view) and that the X-ray acoustic signal sounds. The
following message will be displayed first:
E X A M
P R E - H E A T I N G
> X - R A Y <
x x k V x x m A 1 5 . 0 s
x = the value defined by the settings
NOTE:
If there is no cassette, the following message will be displayed:
> S T A R T E X A M <
I N S E R T C A S S E T T E
The examination will not be continued until the cassette has been
inserted.
WARNING:
The position of the identification characters "R" (right side) and "L" (left
side) are correct if the cassette is fit into the unit with the hinges
positioned upward.
NOTE:
The rotation of the arm and the emission of the rays will start with a
delay of 2 seconds from pressing the X-ray button "30". Since the X-ray
button is a "dead man" control, it must be kept pressed until the end
of the exposure.
P A T I E N T E X I T
P R E S S → 0 ←
At this point, the patient can be freed from the positioning device.
NOTE:
If the examination is made in "Test" mode with the patient already in
position, he must not be removed from the temple support group to avoid
having to reposition him.
Press button "10" to return the unit to its initial position. This
3. Press button "10" . The unit will return to its initial position
P L E A S E W A I T . . .
WARNING:
During this phase the system stores into the internal memory some data.
Switching off the unit during this phase can lead to the loss of some
set-up data normally stored in the memory, which in turn may cause
irreversible damages to the system itself.
Do not switch off the unit in this phase.
If required, switch off the unit only when the green LED "23"
is lit.
R E P L A C E
C A S S E T T E
Once the cassette has been removed, LED "23" will light up
and the following message will be displayed:
x x k V x x m A 1 5 . 0 s
x = the value defined by the settings
that shows the values set for that last exposure. A new exposure can
now be made.
NOTE:
If you try to perform a new exam before the cooling period has elapse
(4 minutes) the following message will be displayed indicating the time to
wait before performing a new examination:
T U B E C O O L I N G
P L E A S E W A I T x x x s
4. Once the cassette has been removed, it can be opened in a dark room
and the film developed.
WARNING:
After every examination, clean the chin support, the handles and
the temple support thoroughly and change the rod and disposable
bite.
NOTE:
If, during the exposure the patient moves or the unit collides with the
patient or with another structure, or the operator realizes that the
parameters set are incorrect, the X-ray button "30" must be released
immediately, thus suspending emission of the X-rays and the movement
of the arm.
If this occurs, the following message will be displayed:
E 5 6 1
P R E S S R E S E T
All the motors will be switched off and it will be possible, if necessary, to
manually rotate the arm allowing the patient to move away from the unit.
It is recommended that this movement be made with great care in
order to prevent damage to the machine.
M A C H I N E S E T T I N G
W A I T F O R
M A C H I N E S E T T I N G
and then:
R E P L A C E
C A S S E T T E
The system now returns to its initial position and the unit must be reset
(cassette and parameters) and the patient repositioned.
NOTE:
Remove the cassette and change the film to prevent a double exposure of
the film that would then provide non-diagnostic results.
NOTE:
During the panoramic examination, the set values of kV and tube current
vary according to a pre-determined curve in order to compensate the
different absorption of X-ray beam due to different anatomical structures.
In this way, it is possible to obtain a good uniformity of the image’s
contrast. Particularly, the chosen value is lowered in the initial and end
sections of the panoramic and increased on the scissors/canine zone.
Tube current vary according to the kV, also if the set value is slightly
increased on the initial/end sections. These variations have the effect to
compensate the higher absorption of X-ray on the zone of the spinal
column. As an example, the variation follows the curve hereafter:
Actual value kV
NOTE:
TMJ functions selection is possible only if the relevant function has been
enabled using the UCA (User Customizable Application) functionality.
R L
Figure 12
NOTE:
During TMJ the X-rays emission is not continuous since it is interrupted
during the transition phases between the different exposures, but is
necessary to keep pressed the X-ray button “30” for the whole rotation
time.
Do not release the X-ray button during the emission interruption if not
necessary.
The cooling phase of the tubehead occurs at the end of all 4 exposures.
In the CHILD position, exposure start is delayed by a few degrees with
respect to the ADULT position.
NOTE:
TMJ function selection is possible only if the relevant function has been
enabled using the UCA (User Customizable Application) functionality.
If the option is not enabled the following message is displayed:
T M J O / C
E X A M N O T E N A B L E D
7 4 k V 1 0 m A 1 0 . 5 s
NOTE:
STRATO 2000 is based on a dentition and ascending rami shape as
defined by U. Welander et al., Dentomaxillofacial Radiology, 1989, Vol.
18, May.
This paper, based on statistic study, enstabilishes a form for the
dentomaxillo-facial complex that it is assumed as "standard". A
projection geometry that maintains a constant magnification stated in
Technical Characteristics of each examination throughout the exposure
of this shape has been applied to the STRATO 2000. Patient’s anatomy
can differ in a significant way from the statistical model, so the
magnification factor is not maintained and can be different from that
value. Based on his experience and competence, the user has to judge
this variation.
NOTE:
If the previous examination had been performed in manual mode, press
After the machine has been set, one of the following modes can be
selected:
• ANATOMIC: with the kV and mA values programmed according to
the type and size of patient.
• MANUAL: with the possibility of changing the set kV and mA values.
NOTE:
The manual condition is indicated by the flashing TMJ function led
"18" , and by the flashing Adult/Child led "11" that enables the
The display will then show the kV and mA settings according to the
selections as per Table 4.
Table 4
These values have been pre-set on the basis of the recommended film-
screen combination.
The time (10.5 sec.) refers to the sum of the four exposures (2 closed
mouth exposures and 2 open mouth exposures).
Select the mouth structure with the Arch key wide – medium -
narrow.
NOTE:
The type of Arch does not affect the kV and mA values but does affect the
position of the focal layer.
The Patient Size LED will switch off, the Adult/Child and TMJ keys will
flash. One of the following two messages will be displayed:
> 7 4 k V 1 0 m A 1 0 . 5 s
or
7 4 k V > 1 0 m A 1 0 . 5 s
NOTE:
Keep key "3" or "6" pressed to change the values rapidly as
required.
NOTE:
TMJ function selection is possible only if the relevant function has been
enabled using the UCA (User Customizable Application) functionality.
If the option is not enabled the following message is displayed:
T M J O / C
E X A M N O T E N A B L E D
1. Ask the patient to remove all metallic objects located in the area to be
X-rayed (necklaces, earrings, glasses, hair-pins, movable dental
prosthesis, etc.). Ensure that there no thick garments in the area to
be X-rayed such as coats, jackets, ties, etc.
2. Provide the patient with a protective apron or similar. Ensure that
the protection device does not interfere with the path of the X-rays
beam.
3. Place the patient in a standing position at the edentulous chin
Reference lines
45 46
5. Position the patient at temple support "4" (Figure 13). Rest the hands
on the front handles.
6. Instruct the patient to close the eyes.
7. Press the laser centering device ON key "20" . Three laser
beams will light the sagittal median plane "45", the horizontal line for
the Frankfurt plane reference "46" (the plane that identifies a line
that ideally links the ear hole - the auditory meatus - with the lower
part of the orbital fossa in Figure 13) and the canine plane line.
Position the patient's head in such a way that the first two light
beams correspond with the relative anatomical parts.
The luminous beam of the Frankfurt plane can be adjusted according
to the height of the patient. This adjustment is made using knob 5
(Figure 13) located on the side of the tubehead.
8. Also, close the temple support acting on the two knobs "6" (Figure
13). The temple support will help the patient to stay in a correct
position. Check that, during this phase, patient has not changed the
position.
9. Press key "23" to confirm. The confirmation request LED
switches off. The luminous centering devices switch off and the
rotating arm goes to its examination start position. Once alignment
has been completed, the following message will be displayed:
S T A R T E X A M
x x k V x x m A 1 5 . 0 s
x = value defined by the settings
NOTE:
The laser centering device remains lit until the laser centering device ON
WARNING:
During the emission of X-rays, the protection procedures for the operator
and personnel in the area must be in compliance with the local
regulations.
In all cases, it is recommended that during the emission of X-rays, only
the patient and operator be present in the room. If the operator is not
protected by suitable screens, he must stand at least 1.5 meters away
from the emission of the rays (see the Figure 1 and Figure 2).
NOTE:
If deemed necessary it is possible to check the interference of the rotation
movement with the shoulder of the patient by activating the Test
In this condition, it will be possible to make the unit perform all the
movements made during the examination without emitting X-rays. The
test function of the TMJ open/closed mouth is the same as for panoramic
mode and so there will not be a second rotation corresponding to the
open mouth exam.
Once the cycle has been completed, deactivate the "Test" function and
press key "8" again.
1. Check once again that the exposure data are correct, if not, correct
them as described in paragraph 6.5.2.2. Check that the unit ready
for X-ray light "1" is on, then press X-ray button "30" for the entire
duration of the exposure, ensuring that the X-ray light "2" is also lit
(if the unit is in view) and that the X-ray signal sounds. The following
message will be displayed first:
E X A M
P R E - H E A T I N G
and then (after 2 seconds), the following message will be displayed:
> X - R A Y <
x x k V x x m A x . x x s
x = the value defined by the settings
NOTE:
If there is no cassette, the following message will be displayed:
> S T A R T E X A M <
I N S E R T C A S S E T T E
The examination will not be continued until the cassette has been
inserted.
WARNING:
The position of the identification characters "R" (right side) and "L" (left
side) are correct if the cassette is fit into the unit with the hinges
positioned upward.
NOTE:
The rotation of the arm and the emission of the X-rays will start with a
delay of 2 seconds from pressing the X-ray button "30". Since the X-ray
button is a "dead man" control, it must be kept pressed until the end
of the exposure.
The X-rays emission to the central part of the dental arch is suspended
during the examination phase, the relative signals (sound and visual) are
therefore also suspended.
2. Once the exposure is completed, the system will carry out a short
return rotation and the following message is displayed:
P A T I E N T E X I T
P R E S S → 0 ←
it will then be possible to set-up the system for the open mouth
examination, keeping the patient in position or letting him free.
P L E A S E W A I T . . .
When the machine stops, the key "23" LED will light up and the
following message will be displayed:
I N S T R U C T P A T I E N T
T O O P E N M O U T H !
NOTE:
TMJ function selection is possible only if the relevant function has been
enabled using the UCA (User Customizable Application) functionality.
If the option is not enabled the following message is displayed:
T M J O / C
E X A M N O T E N A B L E D
NOTE:
It is possible to carry out this examination with a new exposure on the
same film used for closed mouth TMJ.
I N S T R U C T P A T I E N T
T O O P E N M O U T H
T M J P / C P H A S E 2
x x k V x x m A 1 1 . 0 s
x = value defined by the settings
3. Position the patient if he had been removed from the centering
device. Tell him to open his mouth (helping him to keep in position
using appropriate mechanical devices if necessary) and keep his chin
touching the edentulous chin support rest.
4. Put in a new panoramic byte: instruct the patient to place the inferior
scissors teeth against the lower part of the bite; this procedure will
help the patient to stay in a correct position during the exposure.
Reference lines
1 Edentulous support
4 Temple support rod
5 Frankfurt plane laser
adjustment knob
6 Adjustment knobs for temple
support
beams will light the sagittal median plane "45", the horizontal line for
the Frankfurt plane reference "46" (Figure 14) and the canine plane
line. Position the patient's head in such a way that the sagittal
median plane is lit by the corresponding laser beam as per Figure 14.
7. After having positioned the head, close the temple support acting on
the two knobs "6" (Figure 14). The temple support will help the
patient to stay in a correct position. Check that, during this phase,
patient has not changed the position.
NOTE:
The laser centering device remains lit until the laser centering device ON
WARNING:
During the emission of X-rays, the protection procedures for the operator
and personnel in the area must be in compliance with the local
regulations.
In all cases, it is recommended that during the emission of X-rays, only
the patient and operator be present in the room. If the operator is not
protected by suitable screens, he must stand at least 1.5 meters away
from the emission of the X-rays (see the Figure 1 and Figure 2).
WARNING:
Using the laser centering devices check that the system is still aligned
with the patient's sagittal median plane.
S T A R T E X A M
x x k V x x m A 1 0 . 5 s
Check again that the exposure data are correct (see paragraph 6.5.2).
NOTE:
The Adult/Child and Size small - medium - large selection keys are
deactivated. The exposure parameters can be changed as described in
paragraph 6.5.2.
Press the X-ray key "30" for the entire time of exposure, at the same
time checking that the X-ray light “2” is lit (if the unit is in view) and
that the X-ray signal sounds. The following message will be displayed
first:
E X A M
P R E - H E A T I N G
> X - R A Y <
x x k V x x m A x x . x s
x = the value defined by the settings
NOTE:
The rotation of the arm and the emission of the X-rays will start with a
delay of 2 seconds from pressing the X-ray button "30". Since the X-ray
button is a "dead man" control, it must be kept pressed until the end
of the exposure.
The X-rays emission to the central part of the dental arch is suspended
during the examination phase, the relative signals (sound and visual) are
therefore also suspended.
2. Once the exposure is completed the system will rotate back. When it
stops, the following message will be displayed:
P A T I E N T E X I T
P R E S S → 0 ←
P L E A S E W A I T . . .
WARNING:
During this phase the system stores into the internal memory some data.
Switching off the unit during this phase can lead to the loss of some
set-up data normally stored in the memory, which in turn may cause
irreversible damages to the system itself.
Do not switch off the unit in this phase.
If required, switch off the unit only when the green LED "23"
is lit.
R E P L A C E
C A S S E T T E
When the cassette has been removed, LED "23" will light up
and the following message will be displayed:
x x k V x x m A 1 0 . 5 s
x = value defined by the settings
That shows the values set for the exposure just made. A new
exposure can now be made.
WARNING:
Clean the edentulous chin support, the handles and the temple support
thoroughly after each examination.
NOTE:
If, during the exposure the patient moves or the unit collides with the
patient or with another structure, or the operator realises that the
parameters set are incorrect, the X-ray button "30" must be released
immediately, thus suspending emission of the X-rays and the movement
of the arm.
If this occurs, the following message will be displayed:
E 5 6 1
P R E S S R E S E T
All the motors will be switched off and it will be possible, if necessary, to
manually rotate the arm and allow the patient to move away from the
unit. It is recommended that this movement be made with great care
in order to prevent damage to the machine.
M A C H I N E S E T T I N G
W A I T F O R
M A C H I N E S E T T I N G
and then:
R E P L A C E
C A S S E T T E
The system now returns to its initial position and the unit must be reset
(cassette and parameters) and the patient can be repositioned.
NOTE:
If the open mouth exposure is not completed, the closed mouth exposure
must be repeated or the four complete pictures will not appear on the
same plate.
No warning message will be given if the cassette is removed but the film
is not replaced, and another exposure is made. However, the film would
provide non-diagnostic results due to the double exposure.
NOTE:
TMJ function selection is possible only if the relevant function has been
enabled using the UCA (User Customizable Application) functionality.
If the option is not enabled the following message is displayed:
T M J B I A X I A L
E X A M N O T E N A B L E D
pressing key "19" ; multiple selection of the same key will toggle
The TMJ examination in biaxial mode will give an X-ray similar to the one
obtained with the TMJ open/closed mouth, i.e. four radiographed images
placed side by side, although the type of projection is essentially
different.
R L
Figure 15
NOTE:
During the biaxial TMJ examination, the X-rays emission is not
continuous since it is interrupted during the transition from one
exposure to another. Furthermore, the arm both rotates and translates
between the various exposures. Consequently the relative signals
(acoustic and visual) are also interrupted.
NOTE:
The arch selection is not available for this examination.
7 4 k V 1 0 m A 1 0 . 5 s
Once the machine has been set, place the standard chin support in
position if it had been previously removed (see notes in paragraph 6.3).
NOTE:
STRATO 2000 is based on a dentition and ascending rami shape as
defined by U. Welander et al., Dentomaxillofacial Radiology, 1989, Vol.
18, May.
This paper, based on statistic study, enstabilishes a form for the the
dentomaxillofacial complex that it is assumed as "standard". A projection
geometry that maintains a constant magnification stated in Technical
Characteristics of each examination throughout the exposure of this
shape has been applied to the STRATO 2000. Patient’s anatomy can
differ in a significant way from the statistical model, so the magnification
factor is not maintained and can be different from that value. Based on
his experience and competence, the user has to judge this variation.
NOTE:
If the previous examination had been made in manual mode, press key
Once the machine has been set, the following two modes may be selected:
• ANATOMIC: the kV and mA values have been programmed according
to the type of patient and size.
• MANUAL: with the possibility of changing the default kV and mA
values.
NOTE:
In manual condition, the LED on the Biaxial TMJ function key
"19" , and the Adult / Child led "11" flash so that the type of
Select the type of build using the Size small - medium - large key.
Table 5
"5" . The LED on the Patient Size key switches off and the
Adult / Child and Biaxial TMJ keys will flash. One of the two following
messages will be displayed:
> 7 4 k V 1 0 m A 1 0 . 5 s
or
7 4 k V > 1 0 m A 1 0 . 5 s
The selected parameter can be changed using the increase key "3"
NOTE:
To change the values rapidly, keep the increase key "3" or
1. Ask the patient to remove all metallic objects located in the area to be
X-rayed (necklaces, earrings, glasses, hairpins, movable dental
prosthesis, etc.). Ensure that there no thick garments in the area to
be X-rayed such as coats, jackets, ties, etc.
45 Mid-sagittal line
46 Frankfurt plane line
47 Canine centering line
1 Edentulous support
2 Bite rod
3 Centering bite
4 Temple support rod
5 Adjustment knob for
Frankfurt plane laser
6 Adjustment knobs for temple
support
4. Position the patient at temple support "4" (Figure 16), resting the
chin on the support base "1". The hands should rest on the front
handles. Ask the patient to bite the reference notch of bite "3" on rod
"2" (Figure 16) with his incisors. In case of edentulous patients,
he/her must rest the chin against the reference shoulder of the
edentulous chin support.
5. Instruct the patient to close the eyes.
laser beams will light up the mid-sagittal plane line "45", the
horizontal line for the Frankfurt plane reference "46" (the plane that
identifies a line that ideally links the ear hole - the auditory meatus -
with the lower part of the orbital fossa - Figure 16) and the canine
plane line "47" (Figure 16). Position the patient's head in such a way
as to ensure that the first two luminous beams fall in correspondence
of the respective anatomical references.
The luminous beam of the Frankfurt plane can be adjusted according
to the height of the patient. This adjustment is made using knob "5"
(Figure 16) located on the side of the tubehead.
7. Also, close the temple support acting on the two knobs "6" (Figure
16). The temple support will help the patient to stay in a correct
position. Check that, during this phase, patient has not changed the
position.
switches off. The luminous centering devices switch off and the
rotating arm goes to its examination start position. Once alignment
has been completed, the following message will be displayed:
S T A R T E X A M
x x k V x x m A 1 0 . 5 s
x = value defined by the settings
NOTE:
The laser centering device remains lit until the laser centering device ON
WARNING:
During the emission of X-rays, the protection procedures for the operator
and personnel in the area must be in compliance with the local
regulations.
In all cases, it is recommended that during the emission of X-rays, only
the patient and operator be present in the room. If the operator is not
protected by suitable screens, he must stand at least 1.5 meters away
from the emission of the rays (see the Figure 1 and Figure 2).
NOTE:
If deemed necessary it is possible to check the interference of the rotation
movement with the shoulder of the patient by activating the Test
In this condition, it will be possible to make the unit perform all the
movements made during the examination without emitting X-rays. The
test function of the Biaxial TMJ is the same as for panoramic mode.
Once the cycle has been completed, deactivate the "Test" function and
press key "8" again.
1. Verify once again that the exposure data are correct, if not, correct
them as described in paragraph 6.4.2.2. Check that the unit ready
for X-ray light "1" is on, then press X-ray button "30" for the entire
duration of the exposure, ensuring that the X-ray light "2" is also lit
(if the unit is in view) and that the X-ray signal sounds. The following
message will be displayed first:
E X A M
P R E - H E A T I N G
> X - R A Y <
x x k V x x m A x . x x s
x = the value defined by the settings
NOTE:
If there is no cassette, the following message will be displayed:
> S T A R T E X A M <
I N S E R T C A S S E T T E
The examination will not be continued until the cassette has been
inserted.
WARNING:
The position of the identification characters "R" (right side) and "L" (left
side) are correct if the cassette is fit into the unit with the hinges
positioned upward.
NOTE:
The rotation of the arm and the emission of the X-rays will start with a
delay of 2 seconds from pressing the X-ray button "30". Since the X-ray
button is a "dead man" control, it must be kept pressed until the end
of the exposure.
The X-rays emission to the central part of the dental arch is suspended
during the examination phase, the relative signals (sound and visual) are
therefore also suspended.
P A T I E N T E X I T
P R E S S → 0 ←
At this point, the patient can be freed from the positioning device.
3. Press button "10" . The unit will return to its initial position
P L E A S E W A I T . . .
WARNING:
During this phase the system stores into the internal memory some data.
Switching off the unit during this phase can lead to the loss of some
set-up data normally stored in the memory, which in turn may cause
irreversible damages to the system itself.
Do not switch off the unit in this phase.
If required, switch off the unit only when the green LED "23"
is lit.
R E P L A C E
C A S S E T T E
x x k V x x m A x x . x s
x = the value defined by the settings
that shows the values set for that last exposure. A new exposure can
now be made.
NOTE:
If you try to perform a new exam before the cooling period has elapsed (4
minutes), the following message will be displayed indicating the time to
wait before performing a new examination:
T U B E C O O L I N G
P L E A S E W A I T x x x s
4. Once the cassette has been removed, it can be opened in a dark room
and the film developed.
WARNING:
After every examination, clean the chin support, the handles and
the temple support thoroughly and change the rod and disposable
bite.
NOTE:
If, during the exposure the patient moves or the unit collides with the
patient or with another structure, or the operator realises that the
parameters set are incorrect, the X-ray button "30" must be released
immediately, thus suspending emission of the X-rays and the movement
of the arm.
If this occurs, the following message will be displayed:
E 5 6 1
P R E S S R E S E T
All the motors will be switched off and it will be possible, if necessary, to
manually rotate the arm and allow the patient to move away from the
unit. It is recommended that this movement be made with great care
in order to prevent damage to the machine.
M A C H I N E S E T T I N G
W A I T F O R
M A C H I N E S E T T I N G
and then:
R E P L A C E
C A S S E T T E
The system now returns to its initial position and the unit must be reset
(cassette and parameters) and the patient can be repositioned.
NOTE:
Remove the cassette and change the film to prevent a double exposure of
the film that would then provide non-diagnostic results.
NOTE:
As opposed to Panoramic exposure, the Biaxial TMJ examination is a
non-continuous exposure. There is a pause between each exposure
during which the machine positions itself for the next X-ray.
NOTE:
SINUS functions selection is possible only if the relevant function has
been enabled using the UCA (User Customizable Application)
functionality.
If the option is not enabled, the following message is displayed:
S I N U S
E X A M N O T E N A B L E D
M A X I L . S I N U S X
x x k V x x m A 1 0 . 4 s
x = the value defined by the settings
M A X I L . S I N U S X
7 4 k V 1 0 m A 1 0 . 4 s
L A T . S I N U S R X
7 4 k V 1 0 m A 5 . 2 s
L A T . S I N U S L X
7 4 k V 1 0 m A 5 . 2 s
NOTE:
Images of Right lateral SINUS and Left lateral SINUS can be on the same
film; the two examinations can be carried out in sequence without
changing the film, but only sliding out an in the cassette.
1. Ask the patient to remove all metallic objects located in the area to be
X-rayed (necklaces, earrings, glasses, hair-pins, movable dental
prosthesis, etc.). Ensure that there no thick garments in the area to
be X-rayed such as coats, jackets, ties, etc.
2. Provide the patient with a protective apron or similar. Ensure that
the protection device does not interfere with the path of the X-rays
beam.
3. Place the patient in a standing position at the edentulous chin
Reference lines
45 Mid-sagittal line
46 Frankfurt plane line
47 Canine centering line
4 Edentulous support
5 Bite rod
6 Centering bite
4 Temple support rod
5 Adjustment knob for
Frankfurt plane laser
6 Adjustment knobs for temple
support
beams will light the sagittal median plane "45", the horizontal line for
the Frankfurt plane reference "46" (the plane that identifies a line
that ideally links the ear hole - the auditory meatus - with the lower
part of the orbital fossa in Figure 17) and the canine plane line.
Position the patient's head in such a way that the first two light
beams correspond with the relative anatomical parts.
The luminous beam of the Frankfurt plane can be adjusted according
to the height of the patient. This adjustment is made using knob 5
(Figure 17) located on the side of the tubehead.
7. Also, close the temple support acting on the two knobs "6" (Figure
17). The temple support will help the patient to stay in a correct
position. Check that, during this phase, patient has not changed the
position.
8. Press key "23" to confirm. The confirmation request LED
switches off. The luminous centering devices switch off and the
rotating arm goes to its examination start position. Once alignment
has been completed, the following message will be displayed:
S T A R T E X A M
x x k V x x m A 5 . 2 s
x = value defined by the settings
NOTE:
The laser centering device remains lit until the laser centering device ON
WARNING:
During the emission of X-rays, the protection procedures for the operator
and personnel in the area must be in compliance with the local
regulations.
In all cases, it is recommended that during the emission of X-rays, only
the patient and operator be present in the room. If the operator is not
protected by suitable screens, he must stand at least 1.5 meters away
from the emission of the rays (see the Figure 1 and Figure 2).
NOTE:
If deemed necessary it is possible to check the interference of the rotation
movement with the shoulder of the patient by activating the Test
In this condition, it will be possible to make the unit perform all the
movements made during the examination without emitting X-rays.
Once the cycle has been completed, deactivate the "Test" function and
press key "8" again.
5. Verify once again that the exposure data are correct, if not, correct
them as described in paragraph 6.4.2.2. Check that the unit ready
for X-ray light "1" is on, then press X-ray button "30" for the entire
duration of the exposure, ensuring that the X-ray light "2" is also lit
(if the unit is in view) and that the X-ray signal sounds. The following
message will be displayed first:
E X A M
P R E - H E A T I N G
> X - R A Y <
x x k V x x m A x . x x s
x = the value defined by the settings
NOTE:
If there is no cassette, the following message will be displayed:
> S T A R T E X A M <
I N S E R T C A S S E T T E
The examination will not be continued until the cassette has been
inserted.
WARNING:
The position of the identification characters "R" (right side) and "L" (left
side) are correct if the cassette is fit into the unit with the hinges
positioned upward.
NOTE:
The rotation of the arm and the emission of the X-rays will start with a
delay of 2 seconds from pressing the X-ray button "30". Since the X-ray
button is a "dead man" control, it must be kept pressed until the end
of the exposure.
The X-rays emission to the central part of the dental arch is suspended
during the examination phase, the relative signals (sound and visual) are
therefore also suspended.
P A T I E N T E X I T
P R E S S → 0 ←
At this point, the patient can be freed from the positioning device.
7. Press button "10" . The unit will return to its initial position
P L E A S E W A I T . . .
WARNING:
During this phase the system stores into the internal memory some data.
Switching off the unit during this phase can lead to the loss of some
set-up data normally stored in the memory, which in turn may cause
irreversible damages to the system itself.
Do not switch off the unit in this phase.
If required, switch off the unit only when the green LED "23"
is lit.
R E P L A C E
C A S S E T T E
x x k V x x m A x x . x s
x = the value defined by the settings
that shows the values set for that last exposure. A new exposure can
now be made.
NOTE:
If you try to perform a new exam before the cooling period has elapsed (4
minutes), the following message will be displayed indicating the time to
wait before performing a new examination:
T U B E C O O L I N G
P L E A S E W A I T x x x s
8. Once the cassette has been removed, it can be opened in a dark room
and the film developed.
WARNING:
After every examination, clean the chin support, the handles and
the temple support thoroughly and change the rod and disposable
bite.
NOTE:
If, during the exposure the patient moves or the unit collides with the
patient or with another structure, or the operator realises that the
parameters set are incorrect, the X-ray button "30" must be released
immediately, thus suspending emission of the X-rays and the movement
of the arm.
If this occurs, the following message will be displayed:
E 5 6 1
P R E S S R E S E T
All the motors will be switched off and it will be possible, if necessary, to
manually rotate the arm and allow the patient to move away from the
unit. It is recommended that this movement be made with great care
in order to prevent damage to the machine.
M A C H I N E S E T T I N G
W A I T F O R
M A C H I N E S E T T I N G
and then:
R E P L A C E
C A S S E T T E
The system now returns to its initial position and the unit must be reset
(cassette and parameters) and the patient can be repositioned.
NOTE:
Remove the cassette and change the film to prevent a double exposure of
the film that would then provide non-diagnostic results.
NOTE:
The presence of radio-opaque material close to the area under
examination may generate artifacts which make difficult a good
diagnosis.
Figure 18
STRATO 2000 allows performing the linear tomography in two ways that
are very similar on the conduction of the examination but gives a
different result on film. The first mode, called “complete examination”,
results on a 4 radiographs: one longitudinal image and three cross ones;
of these last, the second one is centred on the point of interest. Referring
to Figure 19, the numbered slices are:
1: longitudinal image, centered on point of interest
3: transversal image, centered on point of interest
2 - 4: other transversal images
1 4
3
2
Figure 19
The second modality, called “reduced implant” gives two images, one
longitudinal and one cross, both centred on the point of interest.
Referring to Figure 20, numbered slices are, respectively:
1: longitudinal image, centered on point of interest
2: transversal image, centered on point of interest.
1
2
Figure 20
Please refer to paragraph 6.8.3 for detailed mode of selecting between two
modalities and also to paragraph 6.8.1.4 to have suggestions on how to
view images and their correct interpretation (please refer to Figure 26 and
following).
The point of interest, i.e. the point where to perform the tomography, is
based on the statistical model of the dental arch. It is selected using the
standard European mode to number teeth, using two digits. The first
digit defines the quadrant (from 1 to 4) while the second digit identifies
the tooth itself, from 1 to 8. It means that selection of the point of
interest must be done by entering into the unit a two-digit number as
above described.
In case of use of the American standard, which is based on a different
method, see next Figure 21 where both European and American standard
numberings are provided, to find out the number (based on European
standard) to input into the unit.
American
Standard 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
European 18 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28
Standard (*)
European
Standard (*) 48 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38
American 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17
Standard
(*) number to input into the unit
Figure 21
These offset values, that can be input on the system when it ask for
them, are measured with the following steps using longitudinal and
transversal images of the point of interest.
2. Place the special ruler (refer to Figure 24) on the film; care has to be
done on such a way to have the four lines (two upper and two on
lower) defining the limit of the image exactly on the borders of the
image (please refer to Figure 22). In this way, the central line of the
ruler, that now is exactly placed in the middle of the image, defines
the point of interest defined by STRATO 2000. Now measurements of
the offset can be made, having this line as a reference; the ruler has
also the positive and negative indication of the measures.
Second
Third
transversal
transversal
image (point of
image
interest)
Figure 22
3. Measure first, using the ruler, the distance from the real point of
interest to the reference line, considering also the sign: + if the
point of interest is on the right side of the reference line, - if it is on
the left one. This value is the longitudinal displacement; it has to be
input (if needed) on STRATO 2000 when display showa the following
message:
LONGIT OFFS:>+00
On the same way, it is possible to measure the transversal
displacement (offset).
4. Place now the special ruler (refer to Figure 23) on the film; care has
to be done on such a way to have the four lines (two upper and two
on lower) defining the limit of the image exactly on the borders of the
transversal (or cross) image of the point of interest. That image is the
third from the left (second transversal) in case of a complete exam or
the latest image in case of reduced exam. In this way, the central line
of the ruler, that now is exactly placed in the middle of the image,
defines the point of interest defined by STRATO 2000. Now
measurements of the offset can be made, having this line as a
reference; the ruler has also the positive and negative indication of
the measures.
Second
transversal
image (point of
interest)
Longitudinal
image
Figure 23
5. Measure, using the ruler, the distance from the real point of interest
to the reference line, considering also the sign: + if the point of
interest is on the right side of the reference line, - if it is on the left
one. This value is the langitudinal displacement (or longitudinal); it
has to be input (if needed) on STRATO 2000 when display shows the
following message:
TRANSV OFFS:>+00
Figure 24
Thickness (→g←) of
longitudinal slice: 4, 6 or 8 mm
Thickness (→g←) of
tranversal slice: 2, 3 or 4 mm
Point of interest
Figure 25
Second
Longitudinal First transversal Third transversal
transversal image
image image image
(point of interest)
Figure 26
Transversal
Longitudinal
image
image
(point of interest)
Figure 27
With the film placed as above indicated, anatomical point are as per the
following paragraphs.
Vestibolar
Vestibolar
Palatal /
Palatal /
Palatal /
Lingual
Lingual
Lingual
Mesial
Distal
Figure 28
Palatal /
Lingual
Mesial
Distal
Coronal image
Longitudinal
image Point of
interest
Figure 29
Vestibolar
Vestibolar
Vestibolar
Palatal /
Palatal /
Palatal /
Lingual
Lingual
Lingual
Mesial
Distal
Figure 30
Distal
Transversal
image
Longitudinal
image
Point of
interest
Figure 31
WARNING:
All images obtained with the Implant program have a magnification
factor of 1.37.
To conduct the implant mode, STRATO 2000 is delivered with two special
“Implant bite block”, used to hold the patient on the point of interest: the
first bite block is used for the maxilla while the second one is used for
mandible (for simplicity, they will be referred to as: maxilla implant bite
block and mandible implant bite block).
Two parts make up both devices: a base support and a bite. Particularly,
the mandible implant bite block has been studied to hold the mandibular
border horizontal during the exam. To do this, the bite can be inclined
having two different angles.
1. Remove the standards bite block and insert the special implant bite
block for maxilla (main characteristics: cannot be inclined).
2. Insert the plastic bite, after its cold disinfecting, in the bite block
base (please refer to item 3 in Figure 32.
3. Take care that the plastic bite is on the lower position, in order to
assure that the area of interest will be irradiated (please refer to
Figure 32) To do this, unscrew the stopping mechanism using the
knob 1, place the bite 2 in the lowest position and fix the position
using the knob 1, in order to hold the bite in the correct position
during the examination.
Legend:
1 - Knob
2 - Bite
3 - Base
Figure 32
1. Remove the standards bite block and insert the special implant bite
block for mandible (main characteristics: can be inclined).
2. Insert the plastic bite, after its cold disaffection, in the bite block
base (please refer to item 5 in Figure 33).
3. Select the correct angle; according to the patient’s morphology: it
must be evaluated case by case. As suggestion, for all teeth it advised
to use the lower angle (refer to Figure 33A). It is possible, however for
some patient, depending on his morphology that the higher angle has
to be used. (please refer to Figure 33C) for posterior teeth. To do this,
referring to Figure 33B:
• unscrew the stopping mechanism using the knob 3
• place the bite block support 4 on the chosen angle
• hold the bite support on the position using the knob 3, in order
to hold the correct position during the examination.
NOTE:
We suggest to use, as a reference to check the horizontality of the
mandibular border, the laser beam normally used for the Frankfurt
plane. Then choose the correct angle.
4. Take care that the plastic bite is on the higher position, in order to
assure that the area of interest will be irradiated (please refer to the
Figure 33A). To do this, unscrew the stopping mechanism using the
knob 1, place the bite 2 in the highest position and fix the position
using the knob 1, in order to hold the bite in the correct position
during the examination.
Legend:
1 - Knob used to
fix the bite
2 - Bite
3 - Knob to fix the
angulation
4 - Bite block
5 - Base
Figure 33
T O O T H : 1 4
■ ■ ( 2 )
T O O T H : 1 4
■ ■ ■ ■ ( 4 )
NOTE:
Before use, it is mandatory to perform a cold disinfecting of the plastic
bite using a, for instance, a 2% water solution of Glutaraldehydes
according to the instruction for use specified by its manufacturer.
NOTE:
CHILD selection cannot be performed.
NOTE:
If previous exam was conducted on manual mode, to select the
NOTE:
Manual mode is easily recognised by the blinking of the LEDS IMPLANT
Based on the selected size, display will show the pre-set values for kV
and mA.
The pre-set value has been chosen based on the suggested combination
of film/screen.
In case the pre-set values are judged not sufficient for exam/patient, it is
always possible to set values using the manual exposure mode.
NOTE:
In manual mode, take care that exposure parameters has to be set
considering the type of images they are referring to; in fact, for
longitudinal (or lateral) images kV value is increased passing from
posterior to anterior teeth, and must be higher for scissors/canine to
compensate the high X-ray absorption due to spine column. Vice versa,
for cross images the value has to be lower for scissors/canine and higher
for molar teeth.
be pressed, respectively; in this way, the LED of button Patient size will
be switched off, while LEDs of buttons Adult/Child and Implant will
blink; display will show, per example, one of the following messages:
→ g ← L O N G I T : 6 m m
> 5 8 k V 0 7 m A 0 3 . 5 s
or
→ g ← T R A N S V : 4 m m
5 8 k V > 0 7 m A 0 3 . 5 s
NOTE:
For a quick change, it is possible to speed up the process holding down
Select the Dental arch using the button Arch select large – medium (or
standard) – narrow .
NOTE:
In case that values of kV or mA are considered not adequate, both for
longitudinal and/or cross image, it is possible to select a new exposure
parameter’ value using the method of manual exposure as described on
paragraph 6.8.4.
NOTE:
In case that values of kV or mA are considered not adequate, both for
longitudinal and/or cross image, it is possible to select a new exposure
parameter’ value using the method of manual exposure as described on
paragraph 6.8.4.
L O N G I T O F F S : > + 0 0
T R A N S V O F F S : > + 0 0
Input data of the offset for longitudinal and cross slices using
the correct value with its sign; using buttons "22" or "25"
D I S T A N C E : 2 m m
5 8 k V 0 7 m A 0 3 . 5 s
P A T I E N T E N T R Y
5 8 k V 0 7 m A 0 3 . 5 s
NOTE:
Indicated exposure time is strictly dependent on the selection of
tomographic images parameters.
1. Ask the patient to remove all metallic objects located in the area to be
X-rayed (necklaces, earrings, glasses, hairpins, movable dental
prosthesis, etc.). Ensure that there no thick garments in the area to
be X-rayed such as coats, jackets, ties, etc.
2. Provide the patient with a protective apron or similar protection.
Ensure that the protection device does not interfere with the path of
the X-ray beam.
3. Place the patient in a stranding position at the implant support.
laser beams will light up the mid-longitudinal plane line 45, the
horizontal line for the Frankfurt plane reference 46 (the plane that
identifies a line that ideally links the ear hole - the auditory meatus -
with the lower part of the orbital fossa in Figure 34 and Figure 35).
The laser beam of the Frankfurt plane must be adjusted, according to
the selected arch using knob 5 (Figure 34 and Figure 35) located on
the side of the tubehead and according to maxilla or mandible
examinations as follows:
• Maxilla: position the patient's head in such a way as to
ensure that the luminous beams fall in
correspondence of the respective anatomical
references (refer to Figure 34).
• Mandible: position the head of the patient in such a way as to
ensure that luminous longitudinal beam fall in
correspondence of the anatomical reference. Check,
using the Frankfurt laser beam, that mandibular
border at the point of interest is more horizontal than
possible (look at Figure 35).
Note:
For mandible examination, the
Frankfurt plane is not used; the
corresponding laser beam is used as a
reference to have the mandibular
border horizontal.
Figure 35: Mandible position
7. At this point, the patient must move his feet towards the keyboard. In
this way, a better straightening of the spine in the cervical area is
obtained thus improving the darkening of the radiography.
8. Also, close the temple support acting on the two knobs "6" (Figure 34
and Figure 35). The temple support will help the patient to stay in a
correct position. Check that, during this phase, patient has not
changed the position.
NOTE:
The laser centring device remains lit until the button "20" is
S T A R T E X A M
x x k V x x m A 1 5 . 0 s
x = value defined by the settings
NOTE:
When key "8" is pressed, the Test function will be activated. In
this condition, it will be possible to make the unit perform all the
movements made during the examination without emitting X-rays.
Once the cycle has been completed, deactivate the "Test" by pressing key
"8" again.
WARNING:
During the emission of X-rays, the protection procedures for the operator
and personnel in the area must be in compliance with the regulations in
force in the country where the machine is used.
In all cases, it is recommended that during the emission of X-rays, only
the patient and operator be present in the room. If the operator is not
protected by suitable screens, he must stand at least 1.5 meters away
from the focal spot of the tubehead.
S T A R T E X A M
x x k V x x m A 1 5 . 0 s
Verify once again that the exposure data are correct, if not, correct
them as described in paragraph 6.8.4. Check that light unit ready for
X-ray is ON, then press X-ray button "30" for the entire duration of
the exposure, ensuring that the X-ray light 2 is also lit (if the unit is
in view) and that the X-ray acoustic signal sounds. The following
message will be displayed first:
> S T A R T E X A M
P R E - H E A T I N G
> X - R A Y <
x x k V x x m A Y . Y Y s
x = the value defined by the settings
> X - R A Y <
x x k V x x m A Y . Y Y s
x = the value defined by the settings
will be displayed.
NOTE:
Exposure values displayed are changing according to the selected mode
(longitudinal or cross).
NOTE:
If there is no cassette, the following message will be displayed:
> S T A R T E X A M <
I N S E R T C A S S E T T E
The examination will not be continued until the cassette has been
inserted.
NOTE:
The rotation of the arm and the emission of the rays will start with a
delay of 2 seconds from pressing the X-ray button "30". Since the X-ray
button is a "dead man control, it must be kept pressed until the end
of the exposure.
2. Once the exposure is completed, the system will rotate to its initial
position. At the end of this movement, the following message will be
displayed:
P A T I E N T E X I T
P R E S S → 0 ←
At this point, the patient can be freed from the positioning device.
NOTE:
If the examination is made in "Test" mode with the patient already in
position, he must not be removed from the temple support group to avoid
having to reposition him.
Press button "10" to return the unit to its initial position. This
3. Press button "10" . The unit will return to its initial position
P L E A S E W A I T . . .
WARNING:
During this phase the system stores into the internal memory some data.
Switching off the unit during this phase can lead to the loss of some
set-up data normally stored in the memory, which in turn may cause
irreversible damages to the system itself.
Do not switch off the unit in this phase.
If required, switch off the unit only when the green LED "23"
is lit.
R E P L A C E
C A S S E T T E
Once the cassette has been removed, LED "23" will light up
T O O T H : 1 4
■ ■ ( 2 )
or
T O O T H : 1 4
■ ■ ■ ■ ( 4 )
NOTE:
If, once a cassette has been inserted or exposure values for another
patient have been set and a new exposure needs to be made, and less
than 4 minutes has expired from the end of the previous exposure, the
following message will be displayed indicating the time to wait before
performing a new examination:
T U B E C O O L I N G
P L E A S E W A I T x x x s
4. Once the cassette has been removed, it can be opened in a dark room
and the film developed.
WARNING:
After every examination, clean the chin support, the handles and
the temple support thoroughly and change the rod and the bite.
WARNING:
After each use, the bite MUST be removed from the unit and disinfected
using commonly utilized solution like as Glutaraldehydes.
To perform this operation, the bite has to be removed from its base
loosening the knob “1” (Figure 32 and Figure 33). It is not necessary to
remove the knob completely, but loosing it as to allow the bite to freely
rotate; at this point the bite can be taken off sliding it up to the
maximum and eventually rotating it.
NOTE:
If, during the exposure the patient moves or the unit collides with the
patient or with another structure, or the operator realises that the
parameters set are incorrect, the X-ray button "30" must be released
immediately, thus suspending emission of the X-rays and the movement
of the arm.
If this occurs, the following message will be displayed:
E 5 6 1
P R E S S R E S E T
All the motors will be switched off and it will be possible, if necessary, to
manually rotate the arm allowing the patient to move away from the unit.
It is recommended that this movement be made with great care in
order to prevent damage to the machine.
M A C H I N E S E T T I N G
W A I T F O R
M A C H I N E S E T T I N G
and then
R E P L A C E
C A S S E T T E
The system now returns to its initial position and the unit must be reset
(cassette and parameters) and the patient repositioned.
NOTE:
Remove the cassette and change the film to prevent a double exposure of
the film that would then provide non-diagnostic results.
• INCHES
8"x10"
8"x10" Symmetrical for 10"x8" 12"x10"
Asymmetrical Antero-Posterior Asymmetrical Symmetrical
for Latero-Lateral and Postero- for Latero-Lateral for Latero-Lateral
Anterior
• 18 x 24 cm
18x24
18x24 Symmetrical for 24x18 30x24
Asymmetrical Antero-Posterior Asymmetrical Symmetrical
for Latero-Lateral and Postero- for Latero-Lateral for Latero-Lateral
Anterior
• 24 x 30 cm
24x30
18x24 Symmetrical for 24x30 30x24
Asymmetrical Antero-Posterior Asymmetrical Symmetrical
for Latero-Lateral and Postero- for Latero-Lateral for Latero-Lateral
Anterior
NOTE:
The size of the cassette is not automatically recognized by the unit but
must be input by the operator.
NOTE:
The cephalometric examination may
also be used for radiographies made to
determine the current state of bone
calcification. For example, the
hand/wrist group can be X-rayed as
shown in Figure 36. To perform this
kind of exposure, the ear rods and
nose rest must be positioned as for the
postero-anterior cephalometric
examination.
To perform this kind of examination,
the exposure parameters allowed by
current regulations can give an
overexposed film. It is recommended
to use a cassette having a medium
type intensifying screen or a cassette Figure 36
with only one screen.
An alternative can be to set technique
factors at 60kV, 8mA, 0.5sec.
WARNING:
In order to make a radiographic examination that can be diagnosed, it is
important to position the cephalostat group for cephalometric
examination all the way down using knob "6" located on the ceph arm
close to the cassette holder (Figure 37). Otherwise, the ear rods will not
be aligned.
The cephalostat group can be positioned in a different position for
making examinations that require a larger view of the cervical vertebrae
areas.
C E P H - R E M O V E
C H I N R E S T
and
C E P H - C L O S E
T E M P L E S U P P O R T
The first message tells the operator to remove the chin support, while the
second message tells him to close the temple support. These operations
are necessary to prevent interference with the rays beam and with the
panoramic cassette holder when the arm is being positioned.
WARNING:
Neither of the two messages are controlled by the system and therefore
they can appear even if the unit has been set correctly.
These messages can be reset even if the unit has not been set
accordingly.
WARNING:
There is no need to position any type of chin support for the
cephalometric examination. The chin support used for panoramic
examinations must be removed as indicated on the display. If the chin
support is not removed, it will collide with the cassette holder during
alignment and can obscure some anatomical parts of the patient during
the examination.
At the same time, the temple support must be closed in order to avoid
collision with the rotating arm.
1. Having completed the above, press key "23" . The two previous
C E P H
P L E A S E W A I T . . .
C E P H - O P E N
C A S S E T T E U N I T
NOTE:
The position of the cassette holder for panoramic examination is
controlled by two microswitches, it must therefore be completely opened.
8 x 1 0 A S T F = 0 8 . 3
7 0 k V 1 0 m A 0 . 8 0 s
NOTE:
The system sets to the following configuration:
• ADULT: the upper LED of button "11" lights up
• MEDIUM BUILD: the central LED of button "12" lights up
• CEPHALOMETRY: the LED of button "15" lights up
LED "23" lights up.
NOTE:
The size and the orientation of the cassette is not automatically
recognized by the unit but must be input by the operator.
size of the cassette and the type of projection (see the Table 6 at the
beginning of the chapter).
NOTE:
Exposure cannot be made if a cassette has not been inserted.
NOTE:
If the presence of a cassette is detected the system will ask for its
replacement before the exposure.
It is possible to erase this request, if the cassette had been replaced
NOTE:
The system does not detect if the film has already been exposed; if the
cassette has been removed, but the film has not been replaced the
exposure will be allowed, but the result will not be significant from the
diagnostic point of view.
NOTE:
If the preceding examination had been made manually, press key
After having set the machine accordingly, the following two operating
modes may be selected:
• ANATOMIC: with the kV, mA and s values programmed according to
the type of patient and size
• MANUAL: with the possibility of changing the kV, mA and s values
set.
NOTE:
In manual condition, the LED on the CEPHALOMETRY function
key "15" , and the Adult / Child led "11" flash so that the type of
Select the type of build using the Size small - medium - large key.
Adult Child
kV mA s kV mA s
Small 74 12 0,8 72 11 0,9
Medium 76 12 0,8 74 11 0,9
Large 78 12 0,8 76 12 0,7
Table 6
These values have been set for latero-lateral projection, according to the
recommended film-screen combination. Different selections are used for
antero-posterior.
NOTE:
The Arch selection key is not activated.
If the kV, mA and s combinations of the above table are not considered
suitable for a specific examination, it will be possible to set new
parameters using the manual mode.
To change the kV or mA values, press key "7" , or key "5" .
The LED on the Patient Size key switches off and the Adult / Child and
Cephalometry keys will flash. One of the following messages will be
displayed:
8 x 1 0 A S T F = 0 8 . 3
> 7 0 k V 1 0 m A 0 . 8 0 s
8 x 1 0 A S T F = 0 8 . 3
7 0 k V > 1 0 m A 0 . 8 0 s
8 x 1 0 A S T F = 0 8 . 3
7 0 k V 1 0 m A > 0 . 8 0 s
The selected parameter can be changed using the increase key "3"
The "kV" value can vary between 60 and 80 kV, with 2 kV steps.
The "mA" value can vary between 4 and 12 mA, with 1 mA steps.
The "s" value can vary between 0.20 s and 3.00 s as per the following
table:
NOTE:
To change the values rapidly, keep the increase key "3" or
1. Ask the patient to remove all metallic objects located in the area to be
X-rayed (necklaces, earrings, glasses, hair-pins, movable dental
prosthesis, etc.). Ensure that there no thick garments in the area to
be X-rayed such as coats, jackets, ties, etc.
3. Open the ear centering device "4" (Figure 37) as wide as possible by
pressing open the upper part of the rods of the device. Push the nose
rest "2" (Figure 37) outwards as far as it will go. Manually rotate the
cephalostat group according the cephalometric projection to be made,
moving the upper part of the ear centering device "4" (Figure 37).
(Figure 37) are close to the ear hole and then with the upper part of
the rods fix the head of the patient so that the pins enter the ear hole
(Figure 37).
beam will light up the FRANKFURT "1" plane reference (Figure 37).
The luminous beam of the Frankfurt plane (the plane that identifies a
line that ideally links the ear hole - the auditory meatus - with the
lower part of the orbital fossa) must be adjusted according to the
height of the patient. This adjustment is made using knob "5" (Figure
10) located on the side of the tubehead.
NOTE:
The laser centering device remains lit until the button "20" is
key "24" , the STF position can be changed to match the value
NOTE:
The value relative to the soft tissues filter (STF) corresponds to the value
given on the graded scale located on the patient centering device in
cephalometry (see paragraph 6.9.3).
NOTE:
The graded scale of the nose rest serves only for making a latero-lateral
projection. For postero-anterior or antero-posterior projections, its use is
not necessary and so it must be placed in a parked position by rotating it
until it lies horizontal. Furthermore, for latter projections, the software
automatically moves the Soft Tissue Filter out-of-field to enable
exposures to be correctly made.
Legend
Figure 37
WARNING:
During the emission of X-rays, the protection procedures for the operator
and personnel in the area must be in compliance with the regulations in
force in the country where the machine is used.
In all cases, it is recommended that during the emission of X-rays, only
the patient and operator be present in the room. If the operator is not
protected by suitable screens, he must stand at least 1.5 meters away
from the emission of the rays (see Figure 1 and Figure 2).
1. Verify once again that the exposure data are correct (see paragraph
6.9.2). Advise the patient to remain still and to keep his mouth closed
with the teeth touching throughout the duration of the exposure.
NOTE:
To cancel this operation, press button "10" .
2. Press the X-ray button "30" for the entire duration of the exposure,
ensuring that the X-ray light 2 is also lit (if the unit is in view) and
that the X-ray signal acoustic sounds. The following message will be
displayed first:
S T A R T E X A M
P R E - H E A T I N G
> X - R A Y <
x x k V x x m A x . x x s
x = the value defined by the settings
NOTE:
If there is no cassette, the following message will be displayed:
C E P H
I N S E R T F I L M
NOTE:
If, during the preparation of the first cephalometric examination the
system detects a cassette which has not been replaced, the following
message will be displayed:
C E P H
R E M O V E F I L M
The examination will not be continued until a new cassette has been
inserted.
NOTE:
X-rays are emitted with a delay of two seconds from pressing the X-ray
button to allow the heating of the filament and the control of all set
parameters. Since the X-ray button is a "dead man" control, it must
be kept pressed until the end of the exposure.
C E P H
R E M O V E F I L M
4. Remove the cassette. LED "23" lights up and the set cassette,
STF, kV, mA and seconds values relative to the exposure made will
be displayed.
NOTE:
If you try to perform a new exam before the cooling period has elapse (4
minutes), the following message will be displayed indicating the time to
wait before performing a new examination:
T U B E C O O L I N G
P L E A S E W A I T x x x s
5. The cassette can now be opened in a dark room and the film
developed.
NOTE:
After every examination, clean the ear centering device and temple
support thoroughly.
NOTE:
If, during the exposure the patient moves or the operator realizes that the
parameters set are incorrect, the X-ray button "30" must be released
immediately, thus suspending emission of the X-rays.
The following message will be displayed:
E 5 6 1
P R E S S R E S E T
C E P H
R E M O V E F I L M
The system now returns to the position for Ceph exam and the unit
starts the procedure for the new examination.
NOTE:
We recommend verifying that the system is still aligned correctly with the
patient (Frankfurt plane) via the laser centering devices.
NOTE:
No warning message will be given if the cassette is removed but the film
is not replaced, and another exposure is made. However, the film would
provide non-diagnostic results due to the double exposure.
will be as follows
E x x x
P R E S S R E S E T
xxx = error message code number
E x x x
C A L L T E C H A S S .
xxx = error message code number
E x x x
S W I T C H P O W E R O F F
xxx = error message code number
Motors movement
Collimator 1
Collimator 2
Cassette Holder
Buttons
Memory Checksum
If error E560 is detected, the display will show which key has been
pressed in start-up phase, and the following message is shown:
E 5 6 0 ( x x x x x x x x )
C A L L T E C H A S S .
xxxxxxxx code number for error message 560
6.11.2 Defects due to wrong data setting and to the dark room
2. In case the soft tissue of the patient are not highlighted while
performing a cephalometry, in a latero-lateral, let the technician
verify the adjustment of the soft tissue filter.
Figure 38
1. The patient should not dress clothes that may interfere with the
X-ray beam, also to leave more space between the patient’s shoulders
and the rotating arm of the machine. Care must be taken in order to
avoid interference between the X-ray beam and the protective apron
worn by the patient.
2. Metal objects (neck chain, ear-ring) must be avoided; this objects not
only create radio-opaque images in their own position but also false
images projected in other parts of the radiography, so disturbing the
correct view of the anatomy.
3. The patient’s head must be lightly tilted downward in order to have
the Frankfurt plane horizontal. In this way, the hard palatal ceiling
will be projected slightly over the superior apex of anterior teeth. If
the patient has a low palatal ceiling, slightly increase the tilting
downward.
4. Align the middle sagittal plane with centre of the chin support,
normally indicated by the relevant light beam.
5. Check that the vertical light beam falls on the canine and lays
between the third and fourth teeth. This will insure that the apex of
the anterior teeth are positioned within the focussed area and
therefore will be properly reproduced on the radiography. Normally,
the panoramic equipment has a narrower focussed layer in the front
area, and therefore a proper positioning of the anterior teeth is of the
utmost importance.
Figure 39
STRATO 2000 (120V) 140 (Rev. 0)
USER'S MANUAL
General instructions for use
The result of all the above listed actions will be radiography where all the
parts are properly exposed are well identifiable as in the schema of
Figure 40.
Figure 40
Figure 41
Possible cause:
The patient is positioned too forward, e.g. the centring light beam
falls at the back as shown in the drawing, the anterior teeth will
result unfocussed and reduced.
Remedy:
Check the patient positioning by using the light beams and the
adjustment knob of the canine light beam.
If, after the correct patient’s positioning, the problem still remain,
check the alignment of the centering laser lights, simply lighting on
the beams and verifying its positioning. The mid sagittal line must lay
on the center of chin rest while the canine one has to lay on the
terminal part of the bite block.
Figure 42
Possible cause:
In the case the patient is positioned too backward, e.g. the centring
light beam falls at the beginning of the anterior teeth, as shown in
the drawing.
Remedy:
Check the patient positioning by using the light beams and the
adjustment knob of the canine light beam as above described.
Figure 43
Possible cause:
This effect can be due to two different causes.
In the first one, the median-sagittal plane is not
aligned with the relevant centring light beam, which
falls at the centre of the chin support.
In the second case instead, the centre of the median-
sagittal plane matched the centre of the chin support,
but the patient’s head is rotated.
In both cases, one side is closer to the film plane than the other, thus
resulting in a different magnification of the two sides; the part more
distant from the film will be more magnified while the part closer to
the film plane will result smaller. This error in positioning the patient
will result in a radiography as shown in the next drawing: the right-
most area of the image shows a bigger magnification that can be
noticed either on the teeth and on the ascending rami of the TMJ.
Remedy:
Check the positioning of the median-sagittal plane by using the
relevant centring light beam.
Check also the position of the middle sagittal beam; lighted, it must
fall down on the center of the chin rest and also on the center of the
byte.
intersection of the laser beam with the reference line of the flat
template. The intersection point must not drift more than 2 mm,
measure this drift.
If this does not happens, means that the sigittal laser is not aligned
with the rotation center, so it must be adjusted; to perform it, remove
the upper cover of the STRATO 2000.
the X axis half of the above measure and on the opposite direction of
the drift; save the new position of the X-axis. At this point, the mid
sagittal laser will not be in the correct position and it must be aligned
using the four screws of the laser support; this operation must be
performed in such a way that all the laser beam falls on the reference
line.
Figure 44
Possible cause:
The mid sagittal plane is not vertical. This can be a patient’s
problem, but if the defect is always present, check the laser beam.
Remedy:
Verify that the laser beam is vertical; this check can be performed
very quicly using the laser beam and verifying that falls on the center
of the chin support; remove the chin support itself and check that
the beam falls on the center of the holes used to fix the chin itself.
If not, a possible cause can be due to a non perfect horizontally of the
chin arm, that must be adjusted using the relevant screws.
As can be seen on Figure 45, the upper teeth are magnified and
unfocussed, with the shadow of the hard palate positioned over the
superior apex. The temporo-mandibular joints are exposed outward,
with lines divergent upward. In some cases, the condile vertex might
not appear on the image.
Figure 45
Possible cause:
Patient’s head tilted upward.
A Frankfurt plane too tilted upward produces different anomalies
that may also appear contemporaneously. A chin support plane too
high during the patient positioning or when extending the spine may
generate this mistake. In this condition, the rear side of the patient’s
head may also interfere with rotating arm of the panoramic
equipment.
Figure 46
Possible cause:
Patient’s head tilted downward, as on the aside schema.
Remedy:
Check the positioning of the patient by aligning it with the help of the
corresponding light beam.
NOTE:
In some cases the positioning of the Frankfurt plane too tilted downward
produces a correct image of the lower incisors, but the projection of the
palate falls on the lower teeth apex, as shown on Figure 47.
Figure 47
In this case, a light tilting downward of the Frankfurt plane causes the
palate to be projected over and too far from the root of the teeth of the
maxilla arch, without distortion of the incisor teeth, as on Figure 48.
Figure 48
Figure 49
The part identified with "6" in Figure 49 represents the image of the
controlateral mandible (the other side of the mandible). That
therefore results as a clearer area overlapped to the real image. Very
often the resulting darker area in the bottom corner is noticed and is
considered as an artefact of the radiological image.
With reference to the previous Figure 49, let’s analyse the cause and
remedy.
In the case the image shows a too clear and unfocussed area in the
central portion (see point "4" - Figure 49), this is probably caused by
the wrong position of the spine that has not been properly extended
by the patient. In this case, the spine absorbs a too big quantity of
radiation that therefore causes the image to be too clear. This
lightness can be noticed especially in the lower part of the film, while
it’s normally less visible on the upper part of the film.
Remedy:
Ask the patient to step forward thus extending the spine, in order to
reduce X-ray absorption.
The most common cause for the presence of these artefacts is the
presence of metal objects worn by the patient (ear-rings, necklace).
The necklace worn on the neck of the patient can normally result in a
radio-opaque arch positioned in the chin area. This arch normally
overlaps the chin itself and the shadow of the spine, disturbing the
diagnosis of possible problems in the chin area and in the area of the
superior apex.
The ear-rings instead creates real images in the proper position and
shadow images projected in the contro-lateral area, thus hiding
possible problems or generating bright areas within the paranasal
sinuses.
In some cases, that may depend either on the trajectory of the
panoramic machine or on the position of the metal objects, they can
generate up to three images (one real ad two shadows), thus further
disturbing the correct diagnosis.
This situation may occur especially if the patient has large prothesis
or metal cures and if it is associated to a positioning error, that
projects the shadow of the metal part on wide area of the image.
Remedy:
Properly position the leaded apron (it must be worn well tight to the
shoulder and neck of the patient) then carry out a new examination.
Remedy:
Ask the patient to position the tongue against the palate during the
exposure.
If these artefacts are always in the same position on the film, they are
probably generated by dirty or damaged intensifying screen.
Remedy:
Check and clean/replace the screen.
The cassette has been fit into the machine on the wrong side. As
general rule, the film is underexposed due to the presence of the
secondary lead shielding.
Remedy:
Repeat the examination by properly fitting the cassette into the
machine.
• Damaged films
Possible cause:
The problems are probably due to the developer (ruler worn out
or dirty).
Remedy:
Check the developing machine, looking to scratches on ruler;
replace the developing liquids.
Possible cause:
In this case a cassette with patient identification window has
been used.
Remedy:
Use a cassette without the identification label.
Possible cause:
They might be caused by electrostatic charges produced by the
intensifying screens or the scratching of the intensifying screens
against the film.
Remedy:
Check the humidity of the dark room and place the film into the
cassette without scratching it against the intensifying screen.
Normally this indicates that the exposure parameters are too low
with respect to the patient size. Another possible cause is a wrong
film development process, especially if a manual developer is used.
Another possibility is the misalignment of the X-ray beam with
respect to the alignement of the two collimators.
Remedy:
– Increase the exposure parameters
– Check the development process (liquids, temperatures, duration,
etc.)
– Check that the panoramic cassette holder is fully closed in
panoramic position (check that it is really fully pushed against
the mechanical stop)
Possible cause:
Exposure parameters too high with respect to the patient size.
Remedy:
– Decrease the exposure parameters
– Check that the development process (liquids, temperatures,
duration, etc.).
In the case the film has a poor contrast (flat image), there can be
different causes.
• Blurred film
Possible cause:
This problem is normally coupled to the presence of poor brightness
in the areas with metal parts.
This may indicate a problem of the dark room (the film has been
exposed to the light during the handling), or to the wrong storage of
the film package or, the films themselves are expired.
Also the film package has been unintentionally exposed to X-ray.
Remedy:
Avoid the above conditions.
The film was already exposed Check the film package, if exposed
by mistake or casually, replace it
with a new one; take care of not
expose it to X-ray or light
Light filters through the dark room Check for the presence of light in the
or in the cassette dark room and eliminate it. Use
special lamps in the dark room
The cassette has not been properly Close correctly the cassette before
closed exiting from the dark room with a
new film
1. Select the exam, the type of patient and the size to be modified.
NOTE:
The pressure of one of the three parameters setting keys will cause the
de-activation of the patient size LED and the blinking of the patient type
and function/examination LED's. This LED's will be reactivated only
when storing parameters (paragraph 6.13.3).
It is possible to set the default value of the Soft Tissue Filter in function
of patient type (Adult/Child) and the patient size (small, medium, large).
NOTE:
The value of Soft Tissue Filter is stored for all Asymmetric projections.
For the symmetrical projections instead, the default position of the STF is
out (the display shows OUT).
To store the set value, press the key "28" e "23" , at the
U P D A T E C H A N G E S ?
E N T E R = Y R E S E T = N
press key "23" to confirm, the LED's will lit again, or the key
"9" to cancel the setting; in this case the LED's blink and the
70 kV 66 kV 70 kV 60 kV
Thin Thin
10 mA 8 mA 10 mA 10 mA
74 kV 68 kV 74 kV 66 kV
Normal Normal
10 mA 8 mA 10 mA 10 mA
76 kV 70 kV 78 kV 70 kV
Robust Robust
10 mA 9 mA 10 mA 10 mA
70 kV 60 kV 74 kV 72 kV
12 mA 11 mA
Thin Thin
10 mA 10 mA 0.8 s 0.9 s
83 FPM 83 FPM
74 kV 66 kV 76 KV 74 kV
12 mA 11 mA
Normal Normal
10 mA 10 mA 0.8 s 0.9 s
83 FPM 83 FPM
78 kV 72 kV 78 KV 76 kV
12 mA 12 mA
Robust Robust
10 mA 10 mA 0.8 s 0.7 s
83 FPM 83 FPM
7. MAINTENANCE
This unit, exactly as all other electrical appliances, requires to be
correctly employed and also serviced and controlled at regular intervals.
This precaution ensures a safe and efficient performance.
WARNING:
In case the operator would detect faults or abnormalities, he must
immediately call the Technical Service.
MAINTENANCE LOG-BOOK
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Dent-X
250 Clearbrook Rd.
Elmsford, NY 10523 - USA
Tel. (914) 592-6100
Fax (914) 592-6148
www.Dent-X.com